Rates Effective as of: 1/1/2022,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CPT,Billing Code,Billing Code Type ,Billing Code Description,Service Area,Rate Methodology,Rev Code, Gross Charge ,Harvard Pilgrim ,Aetna Commercial,Aetna Medicare Advantage,Allways Health Partners HMO/PPO,Allways Health Partners Connector,BCBS - Indemnity,BCBS - PPA,BCBS - HMO Blue,BCBS Medicare Advantage,Commonwealth Care Alliance PHO,FCHP Select Care (HMO) and Fallon Preferred Care (PPO),FCHP Direct Care (HMO),"Fallon Medicare Plus (HMO), Medicare Advantage NaviCare, Medicare Plus Central (HMO)","Humana Medicare PPO, POS, Network PFFS, or HMO",Tufts HMO,Tufts POS,Tufts PPO,Tufts Select,Tufts - Medicare (TMC),Cigna,United,De-Identified Min,De-Identified Max,Discounted Cash Price (self pay uninsured)
,4540000001,Hospital Chargemaster,Private Room - ICU,Inpatient,Per Diem,110," $1,300.00 ", See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $858.00 , $852.54 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $852.54 ," $3,664.00 ", $910.00
,R&B - PRIVATE,Hospital Chargemaster,R&B - PRIVATE,Inpatient,Per Diem,111, $730.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $481.80 , $478.73 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $478.73 ," $3,664.00 ", $511.00
,PEDI M/S PRIVATE,Hospital Chargemaster,PEDI M/S PRIVATE,Inpatient,Per Diem,111, $900.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $594.00 , $590.22 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $590.22 ," $3,664.00 ", $630.00
,R&B - PRIVATE,Hospital Chargemaster,R&B - PRIVATE,Inpatient,Per Diem,111, $780.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $514.80 , $511.52 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $511.52 ," $3,664.00 ", $546.00
,ICU M/S - PRIVATE,Hospital Chargemaster,ICU M/S - PRIVATE,Inpatient,Per Diem,111, $730.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $481.80 , $478.73 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $478.73 ," $3,664.00 ", $511.00
,4501010001,Hospital Chargemaster,W2 MedSurg Private,Inpatient,Per Diem,111, $730.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $481.80 , $478.73 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $478.73 ," $3,664.00 ", $511.00
,4501410001,Hospital Chargemaster,W1 MedSurg Private,Inpatient,Per Diem,111, $780.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $514.80 , $511.52 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $511.52 ," $3,664.00 ", $546.00
,OBS M/S PVT,Hospital Chargemaster,OBS M/S PVT,Inpatient,Per Diem,112, $730.00 , See APR-DRG Rate ," $4,021.12 ", See MS-DRG Rate , $481.80 , $478.73 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $7,093.00 "," $6,884.00 ", See MS-DRG Rates , See MS-DRG Rates ," $7,514.75 "," $7,514.75 "," $7,514.75 "," $7,514.75 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $478.73 ," $7,514.75 ", $511.00
,OBSTETRICS R&B PRIVATE,Hospital Chargemaster,OBSTETRICS R&B PRIVATE,Inpatient,Per Diem,112, $730.00 , See APR-DRG Rate ," $4,021.12 ", See MS-DRG Rate , $481.80 , $478.73 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $7,093.00 "," $6,884.00 ", See MS-DRG Rates , See MS-DRG Rates ," $7,514.75 "," $7,514.75 "," $7,514.75 "," $7,514.75 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $478.73 ," $7,514.75 ", $511.00
,4550010003,Hospital Chargemaster,Obstetrics Private,Inpatient,Per Diem,112, $730.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $481.80 , $478.73 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $7,093.00 "," $6,884.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $478.73 ," $7,093.00 ", $511.00
,4501010002,Hospital Chargemaster,PEDI MedSurg Private,Inpatient,Per Diem,113, $730.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $481.80 , $478.73 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $7,093.00 "," $6,884.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $478.73 ," $7,093.00 ", $511.00
,ROOM & BOARD - SEMI PRIV 2 BED,Hospital Chargemaster,ROOM & BOARD - SEMI PRIV 2 BED,Inpatient,Per Diem,121, $730.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $481.80 , $478.73 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $478.73 ," $3,664.00 ", $511.00
,4501010003,Hospital Chargemaster,W2 MedSurg Semi Private,Inpatient,Per Diem,121, $730.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $481.80 , $478.73 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $478.73 ," $3,664.00 ", $511.00
,4501010005,Hospital Chargemaster,W2 AND,Inpatient,Per Diem,121, $204.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $134.64 , $133.78 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $133.78 ," $3,664.00 ", $142.80
,4501410003,Hospital Chargemaster,W1 MedSurg Semi Private,Inpatient,Per Diem,121, $780.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $514.80 , $511.52 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $511.52 ," $3,664.00 ", $546.00
,4501410005,Hospital Chargemaster,W1 AND,Inpatient,Per Diem,121, $250.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $165.00 , $163.95 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $163.95 ," $3,664.00 ", $175.00
,OBSTETRICS R&B SEMI-PRIV 2 BED,Hospital Chargemaster,OBSTETRICS R&B SEMI-PRIV 2 BED,Inpatient,Per Diem,122, $730.00 , See APR-DRG Rate ," $4,021.12 ", See MS-DRG Rate , $481.80 , $478.73 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $7,514.75 "," $7,514.75 "," $7,514.75 "," $7,514.75 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $478.73 ," $7,514.75 ", $511.00
,4550010004,Hospital Chargemaster,Obstetrics Semi Private,Inpatient,Per Diem,122, $730.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $481.80 , $478.73 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $7,514.75 "," $7,514.75 "," $7,514.75 "," $7,514.75 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $478.73 ," $7,514.75 ", $511.00
,4550010005,Hospital Chargemaster,Obstetrics AND,Inpatient,Per Diem,122, $218.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $143.88 , $142.96 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $7,514.75 "," $7,514.75 "," $7,514.75 "," $7,514.75 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $142.96 ," $7,514.75 ", $152.60
,4501010004,Hospital Chargemaster,PEDI MedSurg Semi Private,Inpatient,Per Diem,123, $730.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $481.80 , $478.73 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $478.73 ," $3,664.00 ", $511.00
,4501010006,Hospital Chargemaster,PEDI AND,Inpatient,Per Diem,123, $250.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $165.00 , $163.95 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $163.95 ," $3,664.00 ", $175.00
,ROOM & BOARD,Hospital Chargemaster,ROOM & BOARD,Inpatient,Per Diem,124," $1,150.00 ", See APR-DRG Rate ," $1,236.00 ", See MS-DRG Rate , $759.00 , $754.17 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $754.17 ," $3,664.00 ", $805.00
,GPU SEMI PVT SNF S9485,Hospital Chargemaster,GPU SEMI PVT SNF S9485,Inpatient,Per Diem,124," $1,150.00 ", See APR-DRG Rate ," $1,236.00 ", See MS-DRG Rate , $759.00 , $754.17 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $754.17 ," $3,664.00 ", $805.00
,MHU R&B SEMI-PRIV 2 BED,Hospital Chargemaster,MHU R&B SEMI-PRIV 2 BED,Inpatient,Per Diem,124, $975.00 , See APR-DRG Rate ," $1,236.00 ", See MS-DRG Rate , $643.50 , $639.41 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $639.41 ," $3,664.00 ", $682.50
,4530010001,Hospital Chargemaster,Semi Private - PSYCH,Inpatient,Per Diem,124, $975.00 , See APR-DRG Rate ," $1,236.00 ", See MS-DRG Rate , $643.50 , $639.41 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $639.41 ," $3,664.00 ", $682.50
,4530010003,Hospital Chargemaster,MHU Semi Private AND,Inpatient,Per Diem,124, $250.00 , See APR-DRG Rate ," $1,236.00 ", See MS-DRG Rate , $165.00 , $163.95 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $163.95 ," $3,664.00 ", $175.00
,4534010001,Hospital Chargemaster,GPU Semi Private,Inpatient,Per Diem,124," $1,150.00 ", See APR-DRG Rate ," $1,236.00 ", See MS-DRG Rate , $759.00 , $754.17 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $754.17 ," $3,664.00 ", $805.00
,4534010002,Hospital Chargemaster,GPU Semi Private SNF S9485,Inpatient,Per Diem,124," $1,150.00 ", See APR-DRG Rate ," $1,236.00 ", See MS-DRG Rate , $759.00 , $754.17 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $754.17 ," $3,664.00 ", $805.00
,4534010003,Hospital Chargemaster,GPU Semi Private AND,Inpatient,Per Diem,124, $250.00 , See APR-DRG Rate ," $1,236.00 ", See MS-DRG Rate , $165.00 , $163.95 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $163.95 ," $3,664.00 ", $175.00
,4530010002,Hospital Chargemaster,AND - Psych,Inpatient,Per Diem,129, $975.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $643.50 , $639.41 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $639.41 ," $3,664.00 ", $682.50
,4540010001,Hospital Chargemaster,Private Room - ICU,Inpatient,Per Diem,129, $730.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $481.80 , $478.73 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $478.73 ," $3,664.00 ", $511.00
,4540010002,Hospital Chargemaster,Semi Private - ICU,Inpatient,Per Diem,129, $780.00 , See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $514.80 , $511.52 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $511.52 ," $3,664.00 ", $546.00
,4540010003,Hospital Chargemaster,Out Patient Bed - ICU,Inpatient,Per Diem,129," $1,300.00 ", See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $858.00 , $852.54 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $3,082.00 "," $2,992.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $852.54 ," $3,664.00 ", $910.00
,NEWBORN NURSERY,Hospital Chargemaster,NEWBORN NURSERY,Inpatient,Per Diem,171, $600.00 , See APR-DRG Rate ," $2,090.90 ", See MS-DRG Rate , $396.00 , $393.48 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates , $822.00 , $796.00 , See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates , $596.50 ," $3,664.00 ", $393.48 ," $3,664.00 ", $420.00
,4553110001,Hospital Chargemaster,Semi Private - NUR,Inpatient,Per Diem,171, $600.00 , See APR-DRG Rate ," $2,090.90 ", See MS-DRG Rate , $396.00 , $393.48 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates , $822.00 , $796.00 , See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates , $596.50 ," $3,664.00 ", $393.48 ," $3,664.00 ", $420.00
,4553110002,Hospital Chargemaster,Boarder Nursery,Inpatient,Per Diem,179, $600.00 , See APR-DRG Rate ," $2,090.90 ", See MS-DRG Rate , $396.00 , $393.48 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates , $822.00 , $796.00 , See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates , $596.50 ," $3,664.00 ", $393.48 ," $3,664.00 ", $420.00
,4540010004,Hospital Chargemaster,Intensive Care Unit,Inpatient,Per Diem,202," $1,300.00 ", See APR-DRG Rate ," $3,117.81 ", See MS-DRG Rate , $858.00 , $852.54 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $4,793.00 "," $4,655.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,979.78 "," $3,664.00 ", $852.54 ," $4,793.00 ", $910.00
,4501410002,Hospital Chargemaster,W1 Telemetry Private,Inpatient,Per Diem,214, $780.00 , See APR-DRG Rate ," $3,117.81 ", See MS-DRG Rate , $514.80 , $511.52 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $4,793.00 "," $4,655.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $4,738.00 ", $511.52 ," $4,793.00 ", $546.00
,4501410004,Hospital Chargemaster,W1 Telemetry Semi Private,Inpatient,Per Diem,214, $780.00 , See APR-DRG Rate ," $3,117.81 ", See MS-DRG Rate , $514.80 , $511.52 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $4,793.00 "," $4,655.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $4,738.00 ", $511.52 ," $4,793.00 ", $546.00
,4540010006,Hospital Chargemaster,Telemetry - ICU,Inpatient,Per Diem,214, $780.00 , See APR-DRG Rate ," $3,117.81 ", See MS-DRG Rate , $514.80 , $511.52 , See APR-DRG Rate , See APR-DRG Rate , See APR-DRG Rate , See MS-DRG Rates , See MS-DRG Rates ," $4,793.00 "," $4,655.00 ", See MS-DRG Rates , See MS-DRG Rates ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $4,738.00 ", $511.52 ," $4,793.00 ", $546.00
,5710010001,Hospital Chargemaster,0.9 % Sod Chl 1000 mL IV Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $25.49 , $14.02 , $20.39 , See APC Packaged Rates , $17.84 , $9.94 , $24.60 , $24.70 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.10 , $17.10 , See APC Packaged Rates , See APC Packaged Rates , $23.71 , $23.71 , $23.71 , $23.71 , See APC Packaged Rates , $8.92 , $15.29 , $8.92 , $24.70 , $17.84
,5710010002,Hospital Chargemaster,0.9 % Sod Chl 100 mL IV Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $5.76 , $3.17 , $4.61 , See APC Packaged Rates , $4.03 , $2.25 , $5.56 , $5.58 , $2.97 , See APC Packaged Rates , See APC Packaged Rates , $3.86 , $3.86 , See APC Packaged Rates , See APC Packaged Rates , $5.36 , $5.36 , $5.36 , $5.36 , See APC Packaged Rates , $2.02 , $3.46 , $2.02 , $5.58 , $4.03
,5710010003,Hospital Chargemaster,0.9 % Sod Chl 150 mL IV Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $13.40 , $7.37 , $10.72 , See APC Packaged Rates , $9.38 , $5.23 , $12.93 , $12.99 , $6.90 , See APC Packaged Rates , See APC Packaged Rates , $8.99 , $8.99 , See APC Packaged Rates , See APC Packaged Rates , $12.46 , $12.46 , $12.46 , $12.46 , See APC Packaged Rates , $4.69 , $8.04 , $4.69 , $12.99 , $9.38
,5710010004,Hospital Chargemaster,0.9 % Sod Chl 250 mL IV Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $6.38 , $3.51 , $5.10 , See APC Packaged Rates , $4.47 , $2.49 , $6.16 , $6.18 , $3.29 , See APC Packaged Rates , See APC Packaged Rates , $4.28 , $4.28 , See APC Packaged Rates , See APC Packaged Rates , $5.93 , $5.93 , $5.93 , $5.93 , See APC Packaged Rates , $2.23 , $3.83 , $2.23 , $6.18 , $4.47
,5710010005,Hospital Chargemaster,0.9 % Sod Chl 250 mL IV Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $12.96 , $7.13 , $10.37 , See APC Packaged Rates , $9.07 , $5.05 , $12.51 , $12.56 , $6.67 , See APC Packaged Rates , See APC Packaged Rates , $8.70 , $8.70 , See APC Packaged Rates , See APC Packaged Rates , $12.05 , $12.05 , $12.05 , $12.05 , See APC Packaged Rates , $4.54 , $7.78 , $4.54 , $12.56 , $9.07
,5710010006,Hospital Chargemaster,0.9 % Sod Chl 500 mL IV Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $12.64 , $6.95 , $10.11 , See APC Packaged Rates , $8.85 , $4.93 , $12.20 , $12.25 , $6.51 , See APC Packaged Rates , See APC Packaged Rates , $8.48 , $8.48 , See APC Packaged Rates , See APC Packaged Rates , $11.76 , $11.76 , $11.76 , $11.76 , See APC Packaged Rates , $4.42 , $7.58 , $4.42 , $12.25 , $8.85
,5710010007,Hospital Chargemaster,0.9 % Sod Chl 500 mL IV Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $12.75 , $7.01 , $10.20 , See APC Packaged Rates , $8.93 , $4.97 , $12.30 , $12.36 , $6.57 , See APC Packaged Rates , See APC Packaged Rates , $8.56 , $8.56 , See APC Packaged Rates , See APC Packaged Rates , $11.86 , $11.86 , $11.86 , $11.86 , See APC Packaged Rates , $4.46 , $7.65 , $4.46 , $12.36 , $8.93
,5710010008,Hospital Chargemaster,0.9 % Sod Chl 50 mL IV Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $5.79 , $3.18 , $4.63 , See APC Packaged Rates , $4.05 , $2.26 , $5.59 , $5.61 , $2.98 , See APC Packaged Rates , See APC Packaged Rates , $3.89 , $3.89 , See APC Packaged Rates , See APC Packaged Rates , $5.38 , $5.38 , $5.38 , $5.38 , See APC Packaged Rates , $2.03 , $3.47 , $2.03 , $5.61 , $4.05
,5710010009,Hospital Chargemaster,0.9 % Sod Chl 100 mL IV Pggybk,Outpatient,Outpatient Default Percent / Case Rate,250, $6.20 , $3.41 , $4.96 , See APC Packaged Rates , $4.34 , $2.42 , $5.98 , $6.01 , $3.19 , See APC Packaged Rates , See APC Packaged Rates , $4.16 , $4.16 , See APC Packaged Rates , See APC Packaged Rates , $5.77 , $5.77 , $5.77 , $5.77 , See APC Packaged Rates , $2.17 , $3.72 , $2.17 , $6.01 , $4.34
,5710010011,Hospital Chargemaster,0.9 % Sod Chl 250 mL IV Pggybk,Outpatient,Outpatient Default Percent / Case Rate,250, $8.22 , $4.52 , $6.58 , See APC Packaged Rates , $5.75 , $3.21 , $7.93 , $7.97 , $4.23 , See APC Packaged Rates , See APC Packaged Rates , $5.52 , $5.52 , See APC Packaged Rates , See APC Packaged Rates , $7.64 , $7.64 , $7.64 , $7.64 , See APC Packaged Rates , $2.88 , $4.93 , $2.88 , $7.97 , $5.75
,5710010014,Hospital Chargemaster,0.9 % Sod Chl 10 mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,250, $1.56 , $0.86 , $1.25 , See APC Packaged Rates , $1.09 , $0.61 , $1.51 , $1.51 , $0.80 , See APC Packaged Rates , See APC Packaged Rates , $1.05 , $1.05 , See APC Packaged Rates , See APC Packaged Rates , $1.45 , $1.45 , $1.45 , $1.45 , See APC Packaged Rates , $0.55 , $0.94 , $0.55 , $1.51 , $1.09
,5710010015,Hospital Chargemaster,0.9 % Sod Chl 10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $2.26 , $1.24 , $1.81 , See APC Packaged Rates , $1.58 , $0.88 , $2.18 , $2.19 , $1.16 , See APC Packaged Rates , See APC Packaged Rates , $1.52 , $1.52 , See APC Packaged Rates , See APC Packaged Rates , $2.10 , $2.10 , $2.10 , $2.10 , See APC Packaged Rates , $0.79 , $1.36 , $0.79 , $2.19 , $1.58
,5710010018,Hospital Chargemaster,AA2.36%/D6.8W/Fat 1920 mL Emul,Outpatient,Outpatient Default Percent / Case Rate,250, $101.97 , $56.08 , $81.58 , See APC Packaged Rates , $71.38 , $39.77 , $98.39 , $98.82 , $52.52 , See APC Packaged Rates , See APC Packaged Rates , $68.42 , $68.42 , See APC Packaged Rates , See APC Packaged Rates , $94.83 , $94.83 , $94.83 , $94.83 , See APC Packaged Rates , $35.69 , $61.18 , $35.69 , $98.82 , $71.38
,5710010019,Hospital Chargemaster,AA3.31%/D9.8W/Fat 1540 mL Emul,Outpatient,Outpatient Default Percent / Case Rate,250, $114.75 , $63.11 , $91.80 , See APC Packaged Rates , $80.33 , $44.75 , $110.72 , $111.20 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $77.00 , $77.00 , See APC Packaged Rates , See APC Packaged Rates , $106.72 , $106.72 , $106.72 , $106.72 , See APC Packaged Rates , $40.16 , $68.85 , $40.16 , $111.20 , $80.33
,5710010020,Hospital Chargemaster,AA3.31%/D9.8W/Fat 2053 mL Emul,Outpatient,Outpatient Default Percent / Case Rate,250, $127.47 , $70.11 , $101.98 , See APC Packaged Rates , $89.23 , $49.71 , $123.00 , $123.53 , $65.65 , See APC Packaged Rates , See APC Packaged Rates , $85.53 , $85.53 , See APC Packaged Rates , See APC Packaged Rates , $118.55 , $118.55 , $118.55 , $118.55 , See APC Packaged Rates , $44.61 , $76.48 , $44.61 , $123.53 , $89.23
,5710010050,Hospital Chargemaster,acetaZOLAMIDE sod 500 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $80.33 , $44.18 , $64.26 , See APC Packaged Rates , $56.23 , $31.33 , $77.51 , $77.85 , $41.37 , See APC Packaged Rates , See APC Packaged Rates , $53.90 , $53.90 , See APC Packaged Rates , See APC Packaged Rates , $74.71 , $74.71 , $74.71 , $74.71 , See APC Packaged Rates , $28.12 , $48.20 , $28.12 , $77.85 , $56.23
,5710010196,Hospital Chargemaster,Ascorbic Acid 25000mg/50mL VIA,Outpatient,Outpatient Default Percent / Case Rate,250, $276.88 , $152.28 , $221.50 , See APC Packaged Rates , $193.82 , $107.98 , $267.16 , $268.32 , $142.60 , See APC Packaged Rates , See APC Packaged Rates , $185.79 , $185.79 , See APC Packaged Rates , See APC Packaged Rates , $257.50 , $257.50 , $257.50 , $257.50 , See APC Packaged Rates , $96.91 , $166.13 , $96.91 , $268.32 , $193.82
,5710010240,Hospital Chargemaster,Aztreonam 1 gm Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $78.56 , $43.21 , $62.85 , See APC Packaged Rates , $54.99 , $30.64 , $75.80 , $76.13 , $40.46 , See APC Packaged Rates , See APC Packaged Rates , $52.71 , $52.71 , See APC Packaged Rates , See APC Packaged Rates , $73.06 , $73.06 , $73.06 , $73.06 , See APC Packaged Rates , $27.50 , $47.14 , $27.50 , $76.13 , $54.99
,5710010241,Hospital Chargemaster,Aztreonam 2 gm Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $147.90 , $81.35 , $118.32 , See APC Packaged Rates , $103.53 , $57.68 , $142.71 , $143.33 , $76.17 , See APC Packaged Rates , See APC Packaged Rates , $99.24 , $99.24 , See APC Packaged Rates , See APC Packaged Rates , $137.55 , $137.55 , $137.55 , $137.55 , See APC Packaged Rates , $51.77 , $88.74 , $51.77 , $143.33 , $103.53
,5710010320,Hospital Chargemaster,Bumetanide 1 mg/4 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $5.38 , $2.96 , $4.30 , See APC Packaged Rates , $3.77 , $2.10 , $5.19 , $5.21 , $2.77 , See APC Packaged Rates , See APC Packaged Rates , $3.61 , $3.61 , See APC Packaged Rates , See APC Packaged Rates , $5.00 , $5.00 , $5.00 , $5.00 , See APC Packaged Rates , $1.88 , $3.23 , $1.88 , $5.21 , $3.77
,5710010323,Hospital Chargemaster,Bupivacaine 0.5 % 50 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $6.53 , $3.59 , $5.22 , See APC Packaged Rates , $4.57 , $2.55 , $6.30 , $6.33 , $3.36 , See APC Packaged Rates , See APC Packaged Rates , $4.38 , $4.38 , See APC Packaged Rates , See APC Packaged Rates , $6.07 , $6.07 , $6.07 , $6.07 , See APC Packaged Rates , $2.29 , $3.92 , $2.29 , $6.33 , $4.57
,5710010325,Hospital Chargemaster,BupivPF 0.25 % w/Epine 50mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $34.32 , $18.88 , $27.46 , See APC Packaged Rates , $24.02 , $13.38 , $33.12 , $33.26 , $17.68 , See APC Packaged Rates , See APC Packaged Rates , $23.03 , $23.03 , See APC Packaged Rates , See APC Packaged Rates , $31.92 , $31.92 , $31.92 , $31.92 , See APC Packaged Rates , $12.01 , $20.59 , $12.01 , $33.26 , $24.02
,5710010328,Hospital Chargemaster,BupivPF 0.25 % w/Epine 10mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $13.54 , $7.45 , $10.83 , See APC Packaged Rates , $9.48 , $5.28 , $13.06 , $13.12 , $6.97 , See APC Packaged Rates , See APC Packaged Rates , $9.09 , $9.09 , See APC Packaged Rates , See APC Packaged Rates , $12.59 , $12.59 , $12.59 , $12.59 , See APC Packaged Rates , $4.74 , $8.12 , $4.74 , $13.12 , $9.48
,5710010330,Hospital Chargemaster,BupivPF 0.25 % w/Epine 30mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $7.94 , $4.37 , $6.35 , See APC Packaged Rates , $5.56 , $3.10 , $7.66 , $7.69 , $4.09 , See APC Packaged Rates , See APC Packaged Rates , $5.33 , $5.33 , See APC Packaged Rates , See APC Packaged Rates , $7.38 , $7.38 , $7.38 , $7.38 , See APC Packaged Rates , $2.78 , $4.76 , $2.78 , $7.69 , $5.56
,5710010331,Hospital Chargemaster,BupivPF 0.5 % w/Epine 10 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $6.07 , $3.34 , $4.86 , See APC Packaged Rates , $4.25 , $2.37 , $5.86 , $5.88 , $3.13 , See APC Packaged Rates , See APC Packaged Rates , $4.07 , $4.07 , See APC Packaged Rates , See APC Packaged Rates , $5.65 , $5.65 , $5.65 , $5.65 , See APC Packaged Rates , $2.12 , $3.64 , $2.12 , $5.88 , $4.25
,5710010332,Hospital Chargemaster,BupivPF 0.5 % w/Epine 30 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $6.19 , $3.40 , $4.95 , See APC Packaged Rates , $4.33 , $2.41 , $5.97 , $6.00 , $3.19 , See APC Packaged Rates , See APC Packaged Rates , $4.15 , $4.15 , See APC Packaged Rates , See APC Packaged Rates , $5.76 , $5.76 , $5.76 , $5.76 , See APC Packaged Rates , $2.17 , $3.71 , $2.17 , $6.00 , $4.33
,5710010334,Hospital Chargemaster,Bupivacaine MPF 0.25 % 10mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $14.69 , $8.08 , $11.75 , See APC Packaged Rates , $10.28 , $5.73 , $14.17 , $14.24 , $7.57 , See APC Packaged Rates , See APC Packaged Rates , $9.86 , $9.86 , See APC Packaged Rates , See APC Packaged Rates , $13.66 , $13.66 , $13.66 , $13.66 , See APC Packaged Rates , $5.14 , $8.81 , $5.14 , $14.24 , $10.28
,5710010335,Hospital Chargemaster,Bupivacaine MPF 0.25 % 30mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $4.23 , $2.33 , $3.38 , See APC Packaged Rates , $2.96 , $1.65 , $4.08 , $4.10 , $2.18 , See APC Packaged Rates , See APC Packaged Rates , $2.84 , $2.84 , See APC Packaged Rates , See APC Packaged Rates , $3.93 , $3.93 , $3.93 , $3.93 , See APC Packaged Rates , $1.48 , $2.54 , $1.48 , $4.10 , $2.96
,5710010336,Hospital Chargemaster,Bupivacaine MPF 0.5 % 10 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $11.56 , $6.36 , $9.25 , See APC Packaged Rates , $8.09 , $4.51 , $11.15 , $11.20 , $5.95 , See APC Packaged Rates , See APC Packaged Rates , $7.76 , $7.76 , See APC Packaged Rates , See APC Packaged Rates , $10.75 , $10.75 , $10.75 , $10.75 , See APC Packaged Rates , $4.05 , $6.94 , $4.05 , $11.20 , $8.09
,5710010337,Hospital Chargemaster,Bupivacaine MPF 0.5 % 30 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $4.69 , $2.58 , $3.75 , See APC Packaged Rates , $3.28 , $1.83 , $4.53 , $4.55 , $2.42 , See APC Packaged Rates , See APC Packaged Rates , $3.15 , $3.15 , See APC Packaged Rates , See APC Packaged Rates , $4.36 , $4.36 , $4.36 , $4.36 , See APC Packaged Rates , $1.64 , $2.81 , $1.64 , $4.55 , $3.28
,5710010382,Hospital Chargemaster,Calcium Chl 1 gm/10mL Syr,Outpatient,Outpatient Default Percent / Case Rate,250, $24.61 , $13.54 , $19.69 , See APC Packaged Rates , $17.23 , $9.60 , $23.75 , $23.85 , $12.67 , See APC Packaged Rates , See APC Packaged Rates , $16.51 , $16.51 , See APC Packaged Rates , See APC Packaged Rates , $22.89 , $22.89 , $22.89 , $22.89 , See APC Packaged Rates , $8.61 , $14.77 , $8.61 , $23.85 , $17.23
,5710010411,Hospital Chargemaster,Carboprost Tromethamin 250mcg,Outpatient,Outpatient Default Percent / Case Rate,250," $1,084.57 ", $596.51 , $867.66 , See APC Packaged Rates , $759.20 , $422.98 ," $1,046.50 "," $1,051.06 ", $558.58 , See APC Packaged Rates , See APC Packaged Rates , $727.75 , $727.75 , See APC Packaged Rates , See APC Packaged Rates ," $1,008.65 "," $1,008.65 "," $1,008.65 "," $1,008.65 ", See APC Packaged Rates , $379.60 , $650.74 , $379.60 ," $1,051.06 ", $759.20
,5710010530,Hospital Chargemaster,Cisatracurium 10 mg/5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $50.96 , $28.03 , $40.77 , See APC Packaged Rates , $35.67 , $19.87 , $49.17 , $49.39 , $26.25 , See APC Packaged Rates , See APC Packaged Rates , $34.19 , $34.19 , See APC Packaged Rates , See APC Packaged Rates , $47.39 , $47.39 , $47.39 , $47.39 , See APC Packaged Rates , $17.84 , $30.58 , $17.84 , $49.39 , $35.67
,5710010548,Hospital Chargemaster,Clindamycin 900 mg/6 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $10.74 , $5.91 , $8.59 , See APC Packaged Rates , $7.52 , $4.19 , $10.36 , $10.41 , $5.53 , See APC Packaged Rates , See APC Packaged Rates , $7.21 , $7.21 , See APC Packaged Rates , See APC Packaged Rates , $9.99 , $9.99 , $9.99 , $9.99 , See APC Packaged Rates , $3.76 , $6.44 , $3.76 , $10.41 , $7.52
,5710010550,Hospital Chargemaster,Clindamycin 600 mg/4 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $7.41 , $4.08 , $5.93 , See APC Packaged Rates , $5.19 , $2.89 , $7.15 , $7.18 , $3.82 , See APC Packaged Rates , See APC Packaged Rates , $4.97 , $4.97 , See APC Packaged Rates , See APC Packaged Rates , $6.89 , $6.89 , $6.89 , $6.89 , See APC Packaged Rates , $2.59 , $4.45 , $2.59 , $7.18 , $5.19
,5710010551,Hospital Chargemaster,Clindamycin/D5W 300 mg Bag,Outpatient,Outpatient Default Percent / Case Rate,250, $25.09 , $13.80 , $20.07 , See APC Packaged Rates , $17.56 , $9.79 , $24.21 , $24.31 , $12.92 , See APC Packaged Rates , See APC Packaged Rates , $16.84 , $16.84 , See APC Packaged Rates , See APC Packaged Rates , $23.33 , $23.33 , $23.33 , $23.33 , See APC Packaged Rates , $8.78 , $15.05 , $8.78 , $24.31 , $17.56
,5710010552,Hospital Chargemaster,Clindamycin/D5W 600 mg Bag,Outpatient,Outpatient Default Percent / Case Rate,250, $37.21 , $20.47 , $29.77 , See APC Packaged Rates , $26.05 , $14.51 , $35.90 , $36.06 , $19.16 , See APC Packaged Rates , See APC Packaged Rates , $24.97 , $24.97 , See APC Packaged Rates , See APC Packaged Rates , $34.61 , $34.61 , $34.61 , $34.61 , See APC Packaged Rates , $13.02 , $22.33 , $13.02 , $36.06 , $26.05
,5710010553,Hospital Chargemaster,Clindamycin/D5W 900 mg Bag,Outpatient,Outpatient Default Percent / Case Rate,250, $46.21 , $25.42 , $36.97 , See APC Packaged Rates , $32.35 , $18.02 , $44.59 , $44.78 , $23.80 , See APC Packaged Rates , See APC Packaged Rates , $31.01 , $31.01 , See APC Packaged Rates , See APC Packaged Rates , $42.98 , $42.98 , $42.98 , $42.98 , See APC Packaged Rates , $16.17 , $27.73 , $16.17 , $44.78 , $32.35
,5710010605,Hospital Chargemaster,Cyanocob (Vit B12) 1000mcg Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $17.50 , $9.63 , $14.00 , See APC Packaged Rates , $12.25 , $6.83 , $16.89 , $16.96 , $9.01 , See APC Packaged Rates , See APC Packaged Rates , $11.74 , $11.74 , See APC Packaged Rates , See APC Packaged Rates , $16.28 , $16.28 , $16.28 , $16.28 , See APC Packaged Rates , $6.13 , $10.50 , $6.13 , $16.96 , $12.25
,5710010670,Hospital Chargemaster,Dexmedetomidine 200 mcg Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $100.98 , $55.54 , $80.78 , See APC Packaged Rates , $70.69 , $39.38 , $97.44 , $97.86 , $52.01 , See APC Packaged Rates , See APC Packaged Rates , $67.76 , $67.76 , See APC Packaged Rates , See APC Packaged Rates , $93.91 , $93.91 , $93.91 , $93.91 , See APC Packaged Rates , $35.34 , $60.59 , $35.34 , $97.86 , $70.69
,5710010672,Hospital Chargemaster,Dexmedetomidine/NS 400mcg Btl,Outpatient,Outpatient Default Percent / Case Rate,250, $212.15 , $116.68 , $169.72 , See APC Packaged Rates , $148.51 , $82.74 , $204.70 , $205.59 , $109.26 , See APC Packaged Rates , See APC Packaged Rates , $142.35 , $142.35 , See APC Packaged Rates , See APC Packaged Rates , $197.30 , $197.30 , $197.30 , $197.30 , See APC Packaged Rates , $74.25 , $127.29 , $74.25 , $205.59 , $148.51
,5710010685,Hospital Chargemaster,Dextrose 10 %-Water 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710010686,Hospital Chargemaster,Dextrose 10 %-Water 250 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $6.38 , $3.51 , $5.10 , See APC Packaged Rates , $4.47 , $2.49 , $6.16 , $6.18 , $3.29 , See APC Packaged Rates , See APC Packaged Rates , $4.28 , $4.28 , See APC Packaged Rates , See APC Packaged Rates , $5.93 , $5.93 , $5.93 , $5.93 , See APC Packaged Rates , $2.23 , $3.83 , $2.23 , $6.18 , $4.47
,5710010687,Hospital Chargemaster,Dextrose 10 %-Water 500 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $13.58 , $7.47 , $10.86 , See APC Packaged Rates , $9.51 , $5.30 , $13.10 , $13.16 , $6.99 , See APC Packaged Rates , See APC Packaged Rates , $9.11 , $9.11 , See APC Packaged Rates , See APC Packaged Rates , $12.63 , $12.63 , $12.63 , $12.63 , See APC Packaged Rates , $4.75 , $8.15 , $4.75 , $13.16 , $9.51
,5710010693,Hospital Chargemaster,Dex 5 %-0.9 % NaCl 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710010695,Hospital Chargemaster,Dextrose 5 % in Water 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.42 , $13.98 , $20.34 , See APC Packaged Rates , $17.79 , $9.91 , $24.53 , $24.63 , $13.09 , See APC Packaged Rates , See APC Packaged Rates , $17.06 , $17.06 , See APC Packaged Rates , See APC Packaged Rates , $23.64 , $23.64 , $23.64 , $23.64 , See APC Packaged Rates , $8.90 , $15.25 , $8.90 , $24.63 , $17.79
,5710010696,Hospital Chargemaster,Dextrose 5 % in Water 100 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $13.06 , $7.18 , $10.45 , See APC Packaged Rates , $9.14 , $5.09 , $12.60 , $12.66 , $6.73 , See APC Packaged Rates , See APC Packaged Rates , $8.76 , $8.76 , See APC Packaged Rates , See APC Packaged Rates , $12.15 , $12.15 , $12.15 , $12.15 , See APC Packaged Rates , $4.57 , $7.84 , $4.57 , $12.66 , $9.14
,5710010698,Hospital Chargemaster,Dextrose 5 % in Water 150 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $13.39 , $7.36 , $10.71 , See APC Packaged Rates , $9.37 , $5.22 , $12.92 , $12.98 , $6.90 , See APC Packaged Rates , See APC Packaged Rates , $8.98 , $8.98 , See APC Packaged Rates , See APC Packaged Rates , $12.45 , $12.45 , $12.45 , $12.45 , See APC Packaged Rates , $4.69 , $8.03 , $4.69 , $12.98 , $9.37
,5710010700,Hospital Chargemaster,Dextrose 5 % in Water 250 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $7.75 , $4.26 , $6.20 , See APC Packaged Rates , $5.43 , $3.02 , $7.48 , $7.51 , $3.99 , See APC Packaged Rates , See APC Packaged Rates , $5.20 , $5.20 , See APC Packaged Rates , See APC Packaged Rates , $7.21 , $7.21 , $7.21 , $7.21 , See APC Packaged Rates , $2.71 , $4.65 , $2.71 , $7.51 , $5.43
,5710010702,Hospital Chargemaster,Dextrose 5 % in Water 500 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $12.75 , $7.01 , $10.20 , See APC Packaged Rates , $8.93 , $4.97 , $12.30 , $12.36 , $6.57 , See APC Packaged Rates , See APC Packaged Rates , $8.56 , $8.56 , See APC Packaged Rates , See APC Packaged Rates , $11.86 , $11.86 , $11.86 , $11.86 , See APC Packaged Rates , $4.46 , $7.65 , $4.46 , $12.36 , $8.93
,5710010703,Hospital Chargemaster,Dextrose 5 % in Water 500 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $12.75 , $7.01 , $10.20 , See APC Packaged Rates , $8.93 , $4.97 , $12.30 , $12.36 , $6.57 , See APC Packaged Rates , See APC Packaged Rates , $8.56 , $8.56 , See APC Packaged Rates , See APC Packaged Rates , $11.86 , $11.86 , $11.86 , $11.86 , See APC Packaged Rates , $4.46 , $7.65 , $4.46 , $12.36 , $8.93
,5710010705,Hospital Chargemaster,Dextrose 5 % in Water 50 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $5.51 , $3.03 , $4.41 , See APC Packaged Rates , $3.86 , $2.15 , $5.32 , $5.34 , $2.84 , See APC Packaged Rates , See APC Packaged Rates , $3.70 , $3.70 , See APC Packaged Rates , See APC Packaged Rates , $5.12 , $5.12 , $5.12 , $5.12 , See APC Packaged Rates , $1.93 , $3.31 , $1.93 , $5.34 , $3.86
,5710010707,Hospital Chargemaster,Dex 5 %-0.2 % NaCl 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710010710,Hospital Chargemaster,Dex 5 %-0.45 % NaCl 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710010713,Hospital Chargemaster,Dex 5%-Lactated Ring 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710010714,Hospital Chargemaster,Dex 5%-Lactated Ring 500 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $13.11 , $7.21 , $10.49 , See APC Packaged Rates , $9.18 , $5.11 , $12.65 , $12.70 , $6.75 , See APC Packaged Rates , See APC Packaged Rates , $8.80 , $8.80 , See APC Packaged Rates , See APC Packaged Rates , $12.19 , $12.19 , $12.19 , $12.19 , See APC Packaged Rates , $4.59 , $7.87 , $4.59 , $12.70 , $9.18
,5710010716,Hospital Chargemaster,Dextrose 25 gm/50 mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,250, $23.69 , $13.03 , $18.95 , See APC Packaged Rates , $16.58 , $9.24 , $22.86 , $22.96 , $12.20 , See APC Packaged Rates , See APC Packaged Rates , $15.90 , $15.90 , See APC Packaged Rates , See APC Packaged Rates , $22.03 , $22.03 , $22.03 , $22.03 , See APC Packaged Rates , $8.29 , $14.21 , $8.29 , $22.96 , $16.58
,5710010717,Hospital Chargemaster,Dextrose 25 gm/50 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $7.84 , $4.31 , $6.27 , See APC Packaged Rates , $5.49 , $3.06 , $7.56 , $7.60 , $4.04 , See APC Packaged Rates , See APC Packaged Rates , $5.26 , $5.26 , See APC Packaged Rates , See APC Packaged Rates , $7.29 , $7.29 , $7.29 , $7.29 , See APC Packaged Rates , $2.74 , $4.70 , $2.74 , $7.60 , $5.49
,5710010749,Hospital Chargemaster,dilTIAZem 25 mg/5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $7.13 , $3.92 , $5.70 , See APC Packaged Rates , $4.99 , $2.78 , $6.88 , $6.91 , $3.67 , See APC Packaged Rates , See APC Packaged Rates , $4.78 , $4.78 , See APC Packaged Rates , See APC Packaged Rates , $6.63 , $6.63 , $6.63 , $6.63 , See APC Packaged Rates , $2.50 , $4.28 , $2.50 , $6.91 , $4.99
,5710010750,Hospital Chargemaster,dilTIAZem 50 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $9.28 , $5.10 , $7.42 , See APC Packaged Rates , $6.50 , $3.62 , $8.95 , $8.99 , $4.78 , See APC Packaged Rates , See APC Packaged Rates , $6.23 , $6.23 , See APC Packaged Rates , See APC Packaged Rates , $8.63 , $8.63 , $8.63 , $8.63 , See APC Packaged Rates , $3.25 , $5.57 , $3.25 , $8.99 , $6.50
,5710010751,Hospital Chargemaster,dilTIAZem 100 mg Vial Port,Outpatient,Outpatient Default Percent / Case Rate,250, $32.95 , $18.12 , $26.36 , See APC Packaged Rates , $23.07 , $12.85 , $31.79 , $31.93 , $16.97 , See APC Packaged Rates , See APC Packaged Rates , $22.11 , $22.11 , See APC Packaged Rates , See APC Packaged Rates , $30.64 , $30.64 , $30.64 , $30.64 , See APC Packaged Rates , $11.53 , $19.77 , $11.53 , $31.93 , $23.07
,5710010826,Hospital Chargemaster,Doxycycline Hyclate 100 mg Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $62.94 , $34.62 , $50.35 , See APC Packaged Rates , $44.06 , $24.55 , $60.73 , $61.00 , $32.42 , See APC Packaged Rates , See APC Packaged Rates , $42.23 , $42.23 , See APC Packaged Rates , See APC Packaged Rates , $58.53 , $58.53 , $58.53 , $58.53 , See APC Packaged Rates , $22.03 , $37.76 , $22.03 , $61.00 , $44.06
,5710010871,Hospital Chargemaster,ePHEDrine 50 mg/1 mL Ampul,Outpatient,Outpatient Default Percent / Case Rate,250, $144.71 , $79.59 , $115.77 , See APC Packaged Rates , $101.30 , $56.44 , $139.63 , $140.24 , $74.53 , See APC Packaged Rates , See APC Packaged Rates , $97.10 , $97.10 , See APC Packaged Rates , See APC Packaged Rates , $134.58 , $134.58 , $134.58 , $134.58 , See APC Packaged Rates , $50.65 , $86.83 , $50.65 , $140.24 , $101.30
,5710010905,Hospital Chargemaster,Esmolol 100000 mcg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $35.68 , $19.62 , $28.54 , See APC Packaged Rates , $24.98 , $13.92 , $34.43 , $34.58 , $18.38 , See APC Packaged Rates , See APC Packaged Rates , $23.94 , $23.94 , See APC Packaged Rates , See APC Packaged Rates , $33.18 , $33.18 , $33.18 , $33.18 , See APC Packaged Rates , $12.49 , $21.41 , $12.49 , $34.58 , $24.98
,5710010906,Hospital Chargemaster,Esmolol/NaCl 2500 mg/250 mL,Outpatient,Outpatient Default Percent / Case Rate,250," $1,192.58 ", $655.92 , $954.06 , See APC Packaged Rates , $834.81 , $465.11 ," $1,150.72 "," $1,155.73 ", $614.20 , See APC Packaged Rates , See APC Packaged Rates , $800.22 , $800.22 , See APC Packaged Rates , See APC Packaged Rates ," $1,109.10 "," $1,109.10 "," $1,109.10 "," $1,109.10 ", See APC Packaged Rates , $417.40 , $715.55 , $417.40 ," $1,155.73 ", $834.81
,5710010928,Hospital Chargemaster,Etomidate 20 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $14.15 , $7.78 , $11.32 , See APC Packaged Rates , $9.91 , $5.52 , $13.65 , $13.71 , $7.29 , See APC Packaged Rates , See APC Packaged Rates , $9.49 , $9.49 , See APC Packaged Rates , See APC Packaged Rates , $13.16 , $13.16 , $13.16 , $13.16 , See APC Packaged Rates , $4.95 , $8.49 , $4.95 , $13.71 , $9.91
,5710010937,Hospital Chargemaster,Famotidine/NaCl 20mg/50mL Bag,Outpatient,Outpatient Default Percent / Case Rate,250, $12.24 , $6.73 , $9.79 , See APC Packaged Rates , $8.57 , $4.77 , $11.81 , $11.86 , $6.30 , See APC Packaged Rates , See APC Packaged Rates , $8.21 , $8.21 , See APC Packaged Rates , See APC Packaged Rates , $11.38 , $11.38 , $11.38 , $11.38 , See APC Packaged Rates , $4.28 , $7.34 , $4.28 , $11.86 , $8.57
,5710010938,Hospital Chargemaster,Famotidine/PF 20 mg/2 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $2.30 , $1.27 , $1.84 , See APC Packaged Rates , $1.61 , $0.90 , $2.22 , $2.23 , $1.18 , See APC Packaged Rates , See APC Packaged Rates , $1.54 , $1.54 , See APC Packaged Rates , See APC Packaged Rates , $2.14 , $2.14 , $2.14 , $2.14 , See APC Packaged Rates , $0.81 , $1.38 , $0.81 , $2.23 , $1.61
,5710010989,Hospital Chargemaster,Flumazenil 0.5 mg/5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $1.66 , $0.91 , $1.33 , See APC Packaged Rates , $1.16 , $0.65 , $1.60 , $1.61 , $0.85 , See APC Packaged Rates , See APC Packaged Rates , $1.11 , $1.11 , See APC Packaged Rates , See APC Packaged Rates , $1.54 , $1.54 , $1.54 , $1.54 , See APC Packaged Rates , $0.58 , $1.00 , $0.58 , $1.61 , $1.16
,5710010996,Hospital Chargemaster,Fluorescein Oph 1 mg STRIP,Outpatient,Outpatient Default Percent / Case Rate,250, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011007,Hospital Chargemaster,fluPHENAZine Dec 25 mg/1 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $39.78 , $21.88 , $31.82 , See APC Packaged Rates , $27.85 , $15.51 , $38.38 , $38.55 , $20.49 , See APC Packaged Rates , See APC Packaged Rates , $26.69 , $26.69 , See APC Packaged Rates , See APC Packaged Rates , $37.00 , $37.00 , $37.00 , $37.00 , See APC Packaged Rates , $13.92 , $23.87 , $13.92 , $38.55 , $27.85
,5710011031,Hospital Chargemaster,Folic Acid 5 mg/1 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $12.14 , $6.68 , $9.71 , See APC Packaged Rates , $8.50 , $4.73 , $11.71 , $11.76 , $6.25 , See APC Packaged Rates , See APC Packaged Rates , $8.15 , $8.15 , See APC Packaged Rates , See APC Packaged Rates , $11.29 , $11.29 , $11.29 , $11.29 , See APC Packaged Rates , $4.25 , $7.28 , $4.25 , $11.76 , $8.50
,5710011107,Hospital Chargemaster,Glycopyrrolate 0.2 mg/1 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $33.15 , $18.23 , $26.52 , See APC Packaged Rates , $23.21 , $12.93 , $31.99 , $32.13 , $17.07 , See APC Packaged Rates , See APC Packaged Rates , $22.24 , $22.24 , See APC Packaged Rates , See APC Packaged Rates , $30.83 , $30.83 , $30.83 , $30.83 , See APC Packaged Rates , $11.60 , $19.89 , $11.60 , $32.13 , $23.21
,5710011129,Hospital Chargemaster,Haloperidol 5 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $3.60 , $1.98 , $2.88 , See APC Packaged Rates , $2.52 , $1.40 , $3.47 , $3.49 , $1.85 , See APC Packaged Rates , See APC Packaged Rates , $2.42 , $2.42 , See APC Packaged Rates , See APC Packaged Rates , $3.35 , $3.35 , $3.35 , $3.35 , See APC Packaged Rates , $1.26 , $2.16 , $1.26 , $3.49 , $2.52
,5710011132,Hospital Chargemaster,Heparin 1000 Unit/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $7.29 , $4.01 , $5.83 , See APC Packaged Rates , $5.10 , $2.84 , $7.03 , $7.06 , $3.75 , See APC Packaged Rates , See APC Packaged Rates , $4.89 , $4.89 , See APC Packaged Rates , See APC Packaged Rates , $6.78 , $6.78 , $6.78 , $6.78 , See APC Packaged Rates , $2.55 , $4.37 , $2.55 , $7.06 , $5.10
,5710011134,Hospital Chargemaster,Heparin 5000 Unit/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $6.70 , $3.69 , $5.36 , See APC Packaged Rates , $4.69 , $2.61 , $6.46 , $6.49 , $3.45 , See APC Packaged Rates , See APC Packaged Rates , $4.50 , $4.50 , See APC Packaged Rates , See APC Packaged Rates , $6.23 , $6.23 , $6.23 , $6.23 , See APC Packaged Rates , $2.35 , $4.02 , $2.35 , $6.49 , $4.69
,5710011135,Hospital Chargemaster,"Hepar/D5W 25,000 Unit/250 mL",Outpatient,Outpatient Default Percent / Case Rate,250, $35.35 , $19.44 , $28.28 , See APC Packaged Rates , $24.75 , $13.79 , $34.11 , $34.26 , $18.21 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , See APC Packaged Rates , See APC Packaged Rates , $32.88 , $32.88 , $32.88 , $32.88 , See APC Packaged Rates , $12.37 , $21.21 , $12.37 , $34.26 , $24.75
,5710011166,Hospital Chargemaster,hydrALAZINE 20 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $33.06 , $18.18 , $26.45 , See APC Packaged Rates , $23.14 , $12.89 , $31.90 , $32.04 , $17.03 , See APC Packaged Rates , See APC Packaged Rates , $22.18 , $22.18 , See APC Packaged Rates , See APC Packaged Rates , $30.75 , $30.75 , $30.75 , $30.75 , See APC Packaged Rates , $11.57 , $19.84 , $11.57 , $32.04 , $23.14
,5710011183,Hospital Chargemaster,Hydrocort Sod Succ/PF 100mg Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $39.19 , $21.55 , $31.35 , See APC Packaged Rates , $27.43 , $15.28 , $37.81 , $37.98 , $20.18 , See APC Packaged Rates , See APC Packaged Rates , $26.30 , $26.30 , See APC Packaged Rates , See APC Packaged Rates , $36.45 , $36.45 , $36.45 , $36.45 , See APC Packaged Rates , $13.72 , $23.51 , $13.72 , $37.98 , $27.43
,5710011318,Hospital Chargemaster,Ketamine HCl 500 mg/5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $20.99 , $11.54 , $16.79 , See APC Packaged Rates , $14.69 , $8.19 , $20.25 , $20.34 , $10.81 , See APC Packaged Rates , See APC Packaged Rates , $14.08 , $14.08 , See APC Packaged Rates , See APC Packaged Rates , $19.52 , $19.52 , $19.52 , $19.52 , See APC Packaged Rates , $7.35 , $12.59 , $7.35 , $20.34 , $14.69
,5710011319,Hospital Chargemaster,Ketamine HCl 200 mg/20 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $61.53 , $33.84 , $49.22 , See APC Packaged Rates , $43.07 , $24.00 , $59.37 , $59.63 , $31.69 , See APC Packaged Rates , See APC Packaged Rates , $41.29 , $41.29 , See APC Packaged Rates , See APC Packaged Rates , $57.22 , $57.22 , $57.22 , $57.22 , See APC Packaged Rates , $21.54 , $36.92 , $21.54 , $59.63 , $43.07
,5710011332,Hospital Chargemaster,Labetalol 20 mg/4 mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,250, $17.95 , $9.87 , $14.36 , See APC Packaged Rates , $12.57 , $7.00 , $17.32 , $17.40 , $9.24 , See APC Packaged Rates , See APC Packaged Rates , $12.04 , $12.04 , See APC Packaged Rates , See APC Packaged Rates , $16.69 , $16.69 , $16.69 , $16.69 , See APC Packaged Rates , $6.28 , $10.77 , $6.28 , $17.40 , $12.57
,5710011335,Hospital Chargemaster,Labetalol 100 mg/20 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $9.03 , $4.97 , $7.22 , See APC Packaged Rates , $6.32 , $3.52 , $8.71 , $8.75 , $4.65 , See APC Packaged Rates , See APC Packaged Rates , $6.06 , $6.06 , See APC Packaged Rates , See APC Packaged Rates , $8.40 , $8.40 , $8.40 , $8.40 , See APC Packaged Rates , $3.16 , $5.42 , $3.16 , $8.75 , $6.32
,5710011404,Hospital Chargemaster,Levothyroxine 100 mcg Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $262.68 , $144.47 , $210.14 , See APC Packaged Rates , $183.88 , $102.45 , $253.46 , $254.56 , $135.29 , See APC Packaged Rates , See APC Packaged Rates , $176.26 , $176.26 , See APC Packaged Rates , See APC Packaged Rates , $244.29 , $244.29 , $244.29 , $244.29 , See APC Packaged Rates , $91.94 , $157.61 , $91.94 , $254.56 , $183.88
,5710011406,Hospital Chargemaster,Lidocaine 1 % 2 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $6.53 , $3.59 , $5.22 , See APC Packaged Rates , $4.57 , $2.55 , $6.30 , $6.33 , $3.36 , See APC Packaged Rates , See APC Packaged Rates , $4.38 , $4.38 , See APC Packaged Rates , See APC Packaged Rates , $6.07 , $6.07 , $6.07 , $6.07 , See APC Packaged Rates , $2.29 , $3.92 , $2.29 , $6.33 , $4.57
,5710011407,Hospital Chargemaster,Lidocaine 1 % 10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $5.41 , $2.98 , $4.33 , See APC Packaged Rates , $3.79 , $2.11 , $5.22 , $5.24 , $2.79 , See APC Packaged Rates , See APC Packaged Rates , $3.63 , $3.63 , See APC Packaged Rates , See APC Packaged Rates , $5.03 , $5.03 , $5.03 , $5.03 , See APC Packaged Rates , $1.89 , $3.25 , $1.89 , $5.24 , $3.79
,5710011408,Hospital Chargemaster,Lidocaine 1 % 20 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $7.48 , $4.11 , $5.98 , See APC Packaged Rates , $5.24 , $2.92 , $7.22 , $7.25 , $3.85 , See APC Packaged Rates , See APC Packaged Rates , $5.02 , $5.02 , See APC Packaged Rates , See APC Packaged Rates , $6.96 , $6.96 , $6.96 , $6.96 , See APC Packaged Rates , $2.62 , $4.49 , $2.62 , $7.25 , $5.24
,5710011411,Hospital Chargemaster,Lidocaine 2 % 20 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $5.36 , $2.95 , $4.29 , See APC Packaged Rates , $3.75 , $2.09 , $5.17 , $5.19 , $2.76 , See APC Packaged Rates , See APC Packaged Rates , $3.60 , $3.60 , See APC Packaged Rates , See APC Packaged Rates , $4.98 , $4.98 , $4.98 , $4.98 , See APC Packaged Rates , $1.88 , $3.22 , $1.88 , $5.19 , $3.75
,5710011412,Hospital Chargemaster,Lidocaine 2 % 50 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $9.38 , $5.16 , $7.50 , See APC Packaged Rates , $6.57 , $3.66 , $9.05 , $9.09 , $4.83 , See APC Packaged Rates , See APC Packaged Rates , $6.29 , $6.29 , See APC Packaged Rates , See APC Packaged Rates , $8.72 , $8.72 , $8.72 , $8.72 , See APC Packaged Rates , $3.28 , $5.63 , $3.28 , $9.09 , $6.57
,5710011413,Hospital Chargemaster,Lidocaine 2 % 10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $7.65 , $4.21 , $6.12 , See APC Packaged Rates , $5.36 , $2.98 , $7.38 , $7.41 , $3.94 , See APC Packaged Rates , See APC Packaged Rates , $5.13 , $5.13 , See APC Packaged Rates , See APC Packaged Rates , $7.11 , $7.11 , $7.11 , $7.11 , See APC Packaged Rates , $2.68 , $4.59 , $2.68 , $7.41 , $5.36
,5710011425,Hospital Chargemaster,Lidoc 1%/Epi 1:100k 10 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $7.89 , $4.34 , $6.31 , See APC Packaged Rates , $5.52 , $3.08 , $7.61 , $7.65 , $4.06 , See APC Packaged Rates , See APC Packaged Rates , $5.29 , $5.29 , See APC Packaged Rates , See APC Packaged Rates , $7.34 , $7.34 , $7.34 , $7.34 , See APC Packaged Rates , $2.76 , $4.73 , $2.76 , $7.65 , $5.52
,5710011426,Hospital Chargemaster,Lidoc 1%/Epi 1:100k 20 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $5.45 , $3.00 , $4.36 , See APC Packaged Rates , $3.82 , $2.13 , $5.26 , $5.28 , $2.81 , See APC Packaged Rates , See APC Packaged Rates , $3.66 , $3.66 , See APC Packaged Rates , See APC Packaged Rates , $5.07 , $5.07 , $5.07 , $5.07 , See APC Packaged Rates , $1.91 , $3.27 , $1.91 , $5.28 , $3.82
,5710011427,Hospital Chargemaster,Lidoc 1%/Epi 1:100k 30 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $13.02 , $7.16 , $10.42 , See APC Packaged Rates , $9.11 , $5.08 , $12.56 , $12.62 , $6.71 , See APC Packaged Rates , See APC Packaged Rates , $8.74 , $8.74 , See APC Packaged Rates , See APC Packaged Rates , $12.11 , $12.11 , $12.11 , $12.11 , See APC Packaged Rates , $4.56 , $7.81 , $4.56 , $12.62 , $9.11
,5710011429,Hospital Chargemaster,Lidoc 2%/Epi 1:100k 20 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $9.69 , $5.33 , $7.75 , See APC Packaged Rates , $6.78 , $3.78 , $9.35 , $9.39 , $4.99 , See APC Packaged Rates , See APC Packaged Rates , $6.50 , $6.50 , See APC Packaged Rates , See APC Packaged Rates , $9.01 , $9.01 , $9.01 , $9.01 , See APC Packaged Rates , $3.39 , $5.81 , $3.39 , $9.39 , $6.78
,5710011430,Hospital Chargemaster,Lidoc 2%/Epi 1:100k 30 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $11.96 , $6.58 , $9.57 , See APC Packaged Rates , $8.37 , $4.66 , $11.54 , $11.59 , $6.16 , See APC Packaged Rates , See APC Packaged Rates , $8.03 , $8.03 , See APC Packaged Rates , See APC Packaged Rates , $11.12 , $11.12 , $11.12 , $11.12 , See APC Packaged Rates , $4.19 , $7.18 , $4.19 , $11.59 , $8.37
,5710011433,Hospital Chargemaster,Lidoc 1% PF/Epi 1:200k 10mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $18.82 , $10.35 , $15.06 , See APC Packaged Rates , $13.17 , $7.34 , $18.16 , $18.24 , $9.69 , See APC Packaged Rates , See APC Packaged Rates , $12.63 , $12.63 , See APC Packaged Rates , See APC Packaged Rates , $17.50 , $17.50 , $17.50 , $17.50 , See APC Packaged Rates , $6.59 , $11.29 , $6.59 , $18.24 , $13.17
,5710011435,Hospital Chargemaster,Lidoc 2% PF/Epi 1:200k 10mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $22.77 , $12.52 , $18.22 , See APC Packaged Rates , $15.94 , $8.88 , $21.97 , $22.07 , $11.73 , See APC Packaged Rates , See APC Packaged Rates , $15.28 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $21.18 , $21.18 , $21.18 , $21.18 , See APC Packaged Rates , $7.97 , $13.66 , $7.97 , $22.07 , $15.94
,5710011436,Hospital Chargemaster,Lidoc 2% PF/Epi 1:200k 20mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $40.09 , $22.05 , $32.07 , See APC Packaged Rates , $28.06 , $15.64 , $38.68 , $38.85 , $20.65 , See APC Packaged Rates , See APC Packaged Rates , $26.90 , $26.90 , See APC Packaged Rates , See APC Packaged Rates , $37.28 , $37.28 , $37.28 , $37.28 , See APC Packaged Rates , $14.03 , $24.05 , $14.03 , $38.85 , $28.06
,5710011437,Hospital Chargemaster,Lidocaine 0.5 % MPF 50 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $32.10 , $17.66 , $25.68 , See APC Packaged Rates , $22.47 , $12.52 , $30.97 , $31.11 , $16.53 , See APC Packaged Rates , See APC Packaged Rates , $21.54 , $21.54 , See APC Packaged Rates , See APC Packaged Rates , $29.85 , $29.85 , $29.85 , $29.85 , See APC Packaged Rates , $11.24 , $19.26 , $11.24 , $31.11 , $22.47
,5710011438,Hospital Chargemaster,Lidocaine 1 % MPF 10 mL Amp,Outpatient,Outpatient Default Percent / Case Rate,250, $13.18 , $7.25 , $10.54 , See APC Packaged Rates , $9.23 , $5.14 , $12.72 , $12.77 , $6.79 , See APC Packaged Rates , See APC Packaged Rates , $8.84 , $8.84 , See APC Packaged Rates , See APC Packaged Rates , $12.26 , $12.26 , $12.26 , $12.26 , See APC Packaged Rates , $4.61 , $7.91 , $4.61 , $12.77 , $9.23
,5710011439,Hospital Chargemaster,Lidocaine 1 % MPF 2 mL Amp,Outpatient,Outpatient Default Percent / Case Rate,250, $2.96 , $1.63 , $2.37 , See APC Packaged Rates , $2.07 , $1.15 , $2.86 , $2.87 , $1.52 , See APC Packaged Rates , See APC Packaged Rates , $1.99 , $1.99 , See APC Packaged Rates , See APC Packaged Rates , $2.75 , $2.75 , $2.75 , $2.75 , See APC Packaged Rates , $1.04 , $1.78 , $1.04 , $2.87 , $2.07
,5710011440,Hospital Chargemaster,Lidocaine 1 % MPF 30 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $7.49 , $4.12 , $5.99 , See APC Packaged Rates , $5.24 , $2.92 , $7.23 , $7.26 , $3.86 , See APC Packaged Rates , See APC Packaged Rates , $5.03 , $5.03 , See APC Packaged Rates , See APC Packaged Rates , $6.97 , $6.97 , $6.97 , $6.97 , See APC Packaged Rates , $2.62 , $4.49 , $2.62 , $7.26 , $5.24
,5710011441,Hospital Chargemaster,Lidocaine 1 % MPF 5 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $19.68 , $10.82 , $15.74 , See APC Packaged Rates , $13.78 , $7.68 , $18.99 , $19.07 , $10.14 , See APC Packaged Rates , See APC Packaged Rates , $13.21 , $13.21 , See APC Packaged Rates , See APC Packaged Rates , $18.30 , $18.30 , $18.30 , $18.30 , See APC Packaged Rates , $6.89 , $11.81 , $6.89 , $19.07 , $13.78
,5710011443,Hospital Chargemaster,Lidocaine 2 % MPF 10 mL Amp,Outpatient,Outpatient Default Percent / Case Rate,250, $9.76 , $5.37 , $7.81 , See APC Packaged Rates , $6.83 , $3.81 , $9.42 , $9.46 , $5.03 , See APC Packaged Rates , See APC Packaged Rates , $6.55 , $6.55 , See APC Packaged Rates , See APC Packaged Rates , $9.08 , $9.08 , $9.08 , $9.08 , See APC Packaged Rates , $3.42 , $5.86 , $3.42 , $9.46 , $6.83
,5710011447,Hospital Chargemaster,Lidocaine/PF 100 mg/5 mL Syr,Outpatient,Outpatient Default Percent / Case Rate,250, $8.99 , $4.94 , $7.19 , See APC Packaged Rates , $6.29 , $3.51 , $8.67 , $8.71 , $4.63 , See APC Packaged Rates , See APC Packaged Rates , $6.03 , $6.03 , See APC Packaged Rates , See APC Packaged Rates , $8.36 , $8.36 , $8.36 , $8.36 , See APC Packaged Rates , $3.15 , $5.39 , $3.15 , $8.71 , $6.29
,5710011542,Hospital Chargemaster,Meperidine/PF 25 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $7.23 , $3.98 , $5.78 , See APC Packaged Rates , $5.06 , $2.82 , $6.98 , $7.01 , $3.72 , See APC Packaged Rates , See APC Packaged Rates , $4.85 , $4.85 , See APC Packaged Rates , See APC Packaged Rates , $6.72 , $6.72 , $6.72 , $6.72 , See APC Packaged Rates , $2.53 , $4.34 , $2.53 , $7.01 , $5.06
,5710011589,Hospital Chargemaster,Methylergonovine Mal 0.2mg Inj,Outpatient,Outpatient Default Percent / Case Rate,250, $22.44 , $12.34 , $17.95 , See APC Packaged Rates , $15.71 , $8.75 , $21.65 , $21.75 , $11.56 , See APC Packaged Rates , See APC Packaged Rates , $15.06 , $15.06 , See APC Packaged Rates , See APC Packaged Rates , $20.87 , $20.87 , $20.87 , $20.87 , See APC Packaged Rates , $7.85 , $13.46 , $7.85 , $21.75 , $15.71
,5710011615,Hospital Chargemaster,Metoprolol 5 mg/5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $4.92 , $2.71 , $3.94 , See APC Packaged Rates , $3.44 , $1.92 , $4.75 , $4.77 , $2.53 , See APC Packaged Rates , See APC Packaged Rates , $3.30 , $3.30 , See APC Packaged Rates , See APC Packaged Rates , $4.58 , $4.58 , $4.58 , $4.58 , See APC Packaged Rates , $1.72 , $2.95 , $1.72 , $4.77 , $3.44
,5710011621,Hospital Chargemaster,metroNIDAZOLE/NS 500 mg/100mL,Outpatient,Outpatient Default Percent / Case Rate,250, $5.75 , $3.16 , $4.60 , See APC Packaged Rates , $4.03 , $2.24 , $5.55 , $5.57 , $2.96 , See APC Packaged Rates , See APC Packaged Rates , $3.86 , $3.86 , See APC Packaged Rates , See APC Packaged Rates , $5.35 , $5.35 , $5.35 , $5.35 , See APC Packaged Rates , $2.01 , $3.45 , $2.01 , $5.57 , $4.03
,5710011700,Hospital Chargemaster,"MVI, Adult 10 mL Vial",Outpatient,Outpatient Default Percent / Case Rate,250, $27.27 , $15.00 , $21.82 , See APC Packaged Rates , $19.09 , $10.64 , $26.31 , $26.43 , $14.04 , See APC Packaged Rates , See APC Packaged Rates , $18.30 , $18.30 , See APC Packaged Rates , See APC Packaged Rates , $25.36 , $25.36 , $25.36 , $25.36 , See APC Packaged Rates , $9.54 , $16.36 , $9.54 , $26.43 , $19.09
,5710011723,Hospital Chargemaster,Naloxone HCl 2 mg/2 mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,250, $84.15 , $46.28 , $67.32 , See APC Packaged Rates , $58.91 , $32.82 , $81.20 , $81.55 , $43.34 , See APC Packaged Rates , See APC Packaged Rates , $56.46 , $56.46 , See APC Packaged Rates , See APC Packaged Rates , $78.26 , $78.26 , $78.26 , $78.26 , See APC Packaged Rates , $29.45 , $50.49 , $29.45 , $81.55 , $58.91
,5710011724,Hospital Chargemaster,Naloxone HCl 0.4 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $40.37 , $22.20 , $32.30 , See APC Packaged Rates , $28.26 , $15.74 , $38.95 , $39.12 , $20.79 , See APC Packaged Rates , See APC Packaged Rates , $27.09 , $27.09 , See APC Packaged Rates , See APC Packaged Rates , $37.54 , $37.54 , $37.54 , $37.54 , See APC Packaged Rates , $14.13 , $24.22 , $14.13 , $39.12 , $28.26
,5710011761,Hospital Chargemaster,niCARdipine 25 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $40.70 , $22.39 , $32.56 , See APC Packaged Rates , $28.49 , $15.87 , $39.27 , $39.44 , $20.96 , See APC Packaged Rates , See APC Packaged Rates , $27.31 , $27.31 , See APC Packaged Rates , See APC Packaged Rates , $37.85 , $37.85 , $37.85 , $37.85 , See APC Packaged Rates , $14.25 , $24.42 , $14.25 , $39.44 , $28.49
,5710011799,Hospital Chargemaster,Norepinephrine 4 mg/4 mL Ampul,Outpatient,Outpatient Default Percent / Case Rate,250, $30.10 , $16.56 , $24.08 , See APC Packaged Rates , $21.07 , $11.74 , $29.04 , $29.17 , $15.50 , See APC Packaged Rates , See APC Packaged Rates , $20.20 , $20.20 , See APC Packaged Rates , See APC Packaged Rates , $27.99 , $27.99 , $27.99 , $27.99 , See APC Packaged Rates , $10.54 , $18.06 , $10.54 , $29.17 , $21.07
,5710011824,Hospital Chargemaster,OLANZapine 10 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $95.09 , $52.30 , $76.07 , See APC Packaged Rates , $66.56 , $37.09 , $91.75 , $92.15 , $48.97 , See APC Packaged Rates , See APC Packaged Rates , $63.81 , $63.81 , See APC Packaged Rates , See APC Packaged Rates , $88.43 , $88.43 , $88.43 , $88.43 , See APC Packaged Rates , $33.28 , $57.05 , $33.28 , $92.15 , $66.56
,5710011845,Hospital Chargemaster,Ondansetron 2 mg/2.5 mL Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $30.57 , $16.81 , $24.46 , See APC Packaged Rates , $21.40 , $11.92 , $29.50 , $29.63 , $15.74 , See APC Packaged Rates , See APC Packaged Rates , $20.51 , $20.51 , See APC Packaged Rates , See APC Packaged Rates , $28.43 , $28.43 , $28.43 , $28.43 , See APC Packaged Rates , $10.70 , $18.34 , $10.70 , $29.63 , $21.40
,5710011903,Hospital Chargemaster,Pantoprazole 40 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $12.80 , $7.04 , $10.24 , See APC Packaged Rates , $8.96 , $4.99 , $12.35 , $12.40 , $6.59 , See APC Packaged Rates , See APC Packaged Rates , $8.59 , $8.59 , See APC Packaged Rates , See APC Packaged Rates , $11.90 , $11.90 , $11.90 , $11.90 , See APC Packaged Rates , $4.48 , $7.68 , $4.48 , $12.40 , $8.96
,5710011927,Hospital Chargemaster,Penicill G Pot 5 MU Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $32.41 , $17.83 , $25.93 , See APC Packaged Rates , $22.69 , $12.64 , $31.27 , $31.41 , $16.69 , See APC Packaged Rates , See APC Packaged Rates , $21.75 , $21.75 , See APC Packaged Rates , See APC Packaged Rates , $30.14 , $30.14 , $30.14 , $30.14 , See APC Packaged Rates , $11.34 , $19.45 , $11.34 , $31.41 , $22.69
,5710011976,Hospital Chargemaster,Phenytoin Sod 250 mg/5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $5.07 , $2.79 , $4.06 , See APC Packaged Rates , $3.55 , $1.98 , $4.89 , $4.91 , $2.61 , See APC Packaged Rates , See APC Packaged Rates , $3.40 , $3.40 , See APC Packaged Rates , See APC Packaged Rates , $4.72 , $4.72 , $4.72 , $4.72 , See APC Packaged Rates , $1.77 , $3.04 , $1.77 , $4.91 , $3.55
,5710012003,Hospital Chargemaster,Polymyx/Trimeth Oph 10 mL Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $3.42 , $1.88 , $2.74 , See APC Packaged Rates , $2.39 , $1.33 , $3.30 , $3.31 , $1.76 , See APC Packaged Rates , See APC Packaged Rates , $2.29 , $2.29 , See APC Packaged Rates , See APC Packaged Rates , $3.18 , $3.18 , $3.18 , $3.18 , See APC Packaged Rates , $1.20 , $2.05 , $1.20 , $3.31 , $2.39
,5710012006,Hospital Chargemaster,Polyvin Alc/Povid/PF Oph Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $1.01 , $0.56 , $0.81 , See APC Packaged Rates , $0.71 , $0.39 , $0.97 , $0.98 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.68 , $0.68 , See APC Packaged Rates , See APC Packaged Rates , $0.94 , $0.94 , $0.94 , $0.94 , See APC Packaged Rates , $0.35 , $0.61 , $0.35 , $0.98 , $0.71
,5710012012,Hospital Chargemaster,Potassium Chl 40 mEq/20 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $11.57 , $6.36 , $9.26 , See APC Packaged Rates , $8.10 , $4.51 , $11.16 , $11.21 , $5.96 , See APC Packaged Rates , See APC Packaged Rates , $7.76 , $7.76 , See APC Packaged Rates , See APC Packaged Rates , $10.76 , $10.76 , $10.76 , $10.76 , See APC Packaged Rates , $4.05 , $6.94 , $4.05 , $11.21 , $8.10
,5710012016,Hospital Chargemaster,KCl 20 mEq/0.9 % NaCl 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.27 , $13.90 , $20.22 , See APC Packaged Rates , $17.69 , $9.86 , $24.38 , $24.49 , $13.01 , See APC Packaged Rates , See APC Packaged Rates , $16.96 , $16.96 , See APC Packaged Rates , See APC Packaged Rates , $23.50 , $23.50 , $23.50 , $23.50 , See APC Packaged Rates , $8.84 , $15.16 , $8.84 , $24.49 , $17.69
,5710012017,Hospital Chargemaster,KCl 40 mEq/0.9 % NaCl 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710012018,Hospital Chargemaster,KCl 20 mEq/5 % Dextr 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710012020,Hospital Chargemaster,KCl 40 mEq/5 % Dextr 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710012021,Hospital Chargemaster,KCl 20 mEq/5% Dex/LR 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $26.05 , $14.33 , $20.84 , See APC Packaged Rates , $18.24 , $10.16 , $25.14 , $25.25 , $13.42 , See APC Packaged Rates , See APC Packaged Rates , $17.48 , $17.48 , See APC Packaged Rates , See APC Packaged Rates , $24.23 , $24.23 , $24.23 , $24.23 , See APC Packaged Rates , $9.12 , $15.63 , $9.12 , $25.25 , $18.24
,5710012022,Hospital Chargemaster,Potassium Chl 10 mEq/100mL Bag,Outpatient,Outpatient Default Percent / Case Rate,250, $8.77 , $4.82 , $7.02 , See APC Packaged Rates , $6.14 , $3.42 , $8.46 , $8.50 , $4.52 , See APC Packaged Rates , See APC Packaged Rates , $5.88 , $5.88 , See APC Packaged Rates , See APC Packaged Rates , $8.16 , $8.16 , $8.16 , $8.16 , See APC Packaged Rates , $3.07 , $5.26 , $3.07 , $8.50 , $6.14
,5710012023,Hospital Chargemaster,Potassium Chl 20 mEq/100mL Bag,Outpatient,Outpatient Default Percent / Case Rate,250, $8.94 , $4.92 , $7.15 , See APC Packaged Rates , $6.26 , $3.49 , $8.63 , $8.66 , $4.60 , See APC Packaged Rates , See APC Packaged Rates , $6.00 , $6.00 , See APC Packaged Rates , See APC Packaged Rates , $8.31 , $8.31 , $8.31 , $8.31 , See APC Packaged Rates , $3.13 , $5.36 , $3.13 , $8.66 , $6.26
,5710012025,Hospital Chargemaster,KCl 20 mEq/0.45% NaCl 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710012026,Hospital Chargemaster,KCl 20 mEq/D5-1/4NS 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710012028,Hospital Chargemaster,KCl 20 mEq/D5-1/2NS 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710012030,Hospital Chargemaster,KCl 40 mEq/D5-1/2NS 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710012031,Hospital Chargemaster,KCl 20 mEq/D5-NS 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710012032,Hospital Chargemaster,KCl 40 mEq/D5-NS 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710012035,Hospital Chargemaster,Potassium Phos 15 MMOL/5 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $37.77 , $20.77 , $30.22 , See APC Packaged Rates , $26.44 , $14.73 , $36.44 , $36.60 , $19.45 , See APC Packaged Rates , See APC Packaged Rates , $25.34 , $25.34 , See APC Packaged Rates , See APC Packaged Rates , $35.13 , $35.13 , $35.13 , $35.13 , See APC Packaged Rates , $13.22 , $22.66 , $13.22 , $36.60 , $26.44
,5710012036,Hospital Chargemaster,Potassium Phos 45 MMOL/15mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $77.21 , $42.47 , $61.77 , See APC Packaged Rates , $54.05 , $30.11 , $74.50 , $74.82 , $39.76 , See APC Packaged Rates , See APC Packaged Rates , $51.81 , $51.81 , See APC Packaged Rates , See APC Packaged Rates , $71.81 , $71.81 , $71.81 , $71.81 , See APC Packaged Rates , $27.02 , $46.33 , $27.02 , $74.82 , $54.05
,5710012081,Hospital Chargemaster,Prochlorperazine 10 mg/2 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $47.18 , $25.95 , $37.74 , See APC Packaged Rates , $33.03 , $18.40 , $45.52 , $45.72 , $24.30 , See APC Packaged Rates , See APC Packaged Rates , $31.66 , $31.66 , See APC Packaged Rates , See APC Packaged Rates , $43.88 , $43.88 , $43.88 , $43.88 , See APC Packaged Rates , $16.51 , $28.31 , $16.51 , $45.72 , $33.03
,5710012095,Hospital Chargemaster,Propofol 500 mg/50 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $47.82 , $26.30 , $38.26 , See APC Packaged Rates , $33.47 , $18.65 , $46.14 , $46.34 , $24.63 , See APC Packaged Rates , See APC Packaged Rates , $32.09 , $32.09 , See APC Packaged Rates , See APC Packaged Rates , $44.47 , $44.47 , $44.47 , $44.47 , See APC Packaged Rates , $16.74 , $28.69 , $16.74 , $46.34 , $33.47
,5710012096,Hospital Chargemaster,Propofol 200 mg/20 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $6.14 , $3.38 , $4.91 , See APC Packaged Rates , $4.30 , $2.39 , $5.92 , $5.95 , $3.16 , See APC Packaged Rates , See APC Packaged Rates , $4.12 , $4.12 , See APC Packaged Rates , See APC Packaged Rates , $5.71 , $5.71 , $5.71 , $5.71 , See APC Packaged Rates , $2.15 , $3.68 , $2.15 , $5.95 , $4.30
,5710012097,Hospital Chargemaster,Propofol 1000 mg/100 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $71.77 , $39.47 , $57.42 , See APC Packaged Rates , $50.24 , $27.99 , $69.25 , $69.55 , $36.96 , See APC Packaged Rates , See APC Packaged Rates , $48.16 , $48.16 , See APC Packaged Rates , See APC Packaged Rates , $66.75 , $66.75 , $66.75 , $66.75 , See APC Packaged Rates , $25.12 , $43.06 , $25.12 , $69.55 , $50.24
,5710012116,Hospital Chargemaster,Pyridoxine (Vit B6) 50 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,250, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012154,Hospital Chargemaster,Remifentanil HCl 1 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $156.29 , $85.96 , $125.03 , See APC Packaged Rates , $109.40 , $60.95 , $150.80 , $151.46 , $80.49 , See APC Packaged Rates , See APC Packaged Rates , $104.87 , $104.87 , See APC Packaged Rates , See APC Packaged Rates , $145.35 , $145.35 , $145.35 , $145.35 , See APC Packaged Rates , $54.70 , $93.77 , $54.70 , $151.46 , $109.40
,5710012168,Hospital Chargemaster,Lactated Ringers 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710012170,Hospital Chargemaster,Lactated Ringers 500 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $12.73 , $7.00 , $10.18 , See APC Packaged Rates , $8.91 , $4.96 , $12.28 , $12.34 , $6.56 , See APC Packaged Rates , See APC Packaged Rates , $8.54 , $8.54 , See APC Packaged Rates , See APC Packaged Rates , $11.84 , $11.84 , $11.84 , $11.84 , See APC Packaged Rates , $4.46 , $7.64 , $4.46 , $12.34 , $8.91
,5710012195,Hospital Chargemaster,Rocuronium 50 mg/5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $9.38 , $5.16 , $7.50 , See APC Packaged Rates , $6.57 , $3.66 , $9.05 , $9.09 , $4.83 , See APC Packaged Rates , See APC Packaged Rates , $6.29 , $6.29 , See APC Packaged Rates , See APC Packaged Rates , $8.72 , $8.72 , $8.72 , $8.72 , See APC Packaged Rates , $3.28 , $5.63 , $3.28 , $9.09 , $6.57
,5710012196,Hospital Chargemaster,Rocuronium 100 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $21.42 , $11.78 , $17.14 , See APC Packaged Rates , $14.99 , $8.35 , $20.67 , $20.76 , $11.03 , See APC Packaged Rates , See APC Packaged Rates , $14.37 , $14.37 , See APC Packaged Rates , See APC Packaged Rates , $19.92 , $19.92 , $19.92 , $19.92 , See APC Packaged Rates , $7.50 , $12.85 , $7.50 , $20.76 , $14.99
,5710012252,Hospital Chargemaster,Sod Phosphate 45 MMOL/15 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $38.45 , $21.15 , $30.76 , See APC Packaged Rates , $26.92 , $15.00 , $37.10 , $37.26 , $19.80 , See APC Packaged Rates , See APC Packaged Rates , $25.80 , $25.80 , See APC Packaged Rates , See APC Packaged Rates , $35.76 , $35.76 , $35.76 , $35.76 , See APC Packaged Rates , $13.46 , $23.07 , $13.46 , $37.26 , $26.92
,5710012253,Hospital Chargemaster,Sodium Acet 40 mEq/20 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $8.08 , $4.44 , $6.46 , See APC Packaged Rates , $5.66 , $3.15 , $7.80 , $7.83 , $4.16 , See APC Packaged Rates , See APC Packaged Rates , $5.42 , $5.42 , See APC Packaged Rates , See APC Packaged Rates , $7.51 , $7.51 , $7.51 , $7.51 , See APC Packaged Rates , $2.83 , $4.85 , $2.83 , $7.83 , $5.66
,5710012255,Hospital Chargemaster,Sod Bicarb 4.2% 10 mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,250, $27.57 , $15.16 , $22.06 , See APC Packaged Rates , $19.30 , $10.75 , $26.60 , $26.72 , $14.20 , See APC Packaged Rates , See APC Packaged Rates , $18.50 , $18.50 , See APC Packaged Rates , See APC Packaged Rates , $25.64 , $25.64 , $25.64 , $25.64 , See APC Packaged Rates , $9.65 , $16.54 , $9.65 , $26.72 , $19.30
,5710012256,Hospital Chargemaster,Sod Bicarb 4.2% 5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $48.07 , $26.44 , $38.46 , See APC Packaged Rates , $33.65 , $18.75 , $46.38 , $46.58 , $24.76 , See APC Packaged Rates , See APC Packaged Rates , $32.25 , $32.25 , See APC Packaged Rates , See APC Packaged Rates , $44.71 , $44.71 , $44.71 , $44.71 , See APC Packaged Rates , $16.82 , $28.84 , $16.82 , $46.58 , $33.65
,5710012258,Hospital Chargemaster,Sod Bicarb 8.4% 50 mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,250, $30.82 , $16.95 , $24.66 , See APC Packaged Rates , $21.57 , $12.02 , $29.74 , $29.87 , $15.87 , See APC Packaged Rates , See APC Packaged Rates , $20.68 , $20.68 , See APC Packaged Rates , See APC Packaged Rates , $28.66 , $28.66 , $28.66 , $28.66 , See APC Packaged Rates , $10.79 , $18.49 , $10.79 , $29.87 , $21.57
,5710012259,Hospital Chargemaster,Sod Bicarb 8.4% 50 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $24.82 , $13.65 , $19.86 , See APC Packaged Rates , $17.37 , $9.68 , $23.95 , $24.05 , $12.78 , See APC Packaged Rates , See APC Packaged Rates , $16.65 , $16.65 , See APC Packaged Rates , See APC Packaged Rates , $23.08 , $23.08 , $23.08 , $23.08 , See APC Packaged Rates , $8.69 , $14.89 , $8.69 , $24.05 , $17.37
,5710012263,Hospital Chargemaster,Sodium Chl 23.4 % 30 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012266,Hospital Chargemaster,Sodium Chloride 0.45 % 1000mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.50 , $14.03 , $20.40 , See APC Packaged Rates , $17.85 , $9.95 , $24.60 , $24.71 , $13.13 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $15.30 , $8.93 , $24.71 , $17.85
,5710012303,Hospital Chargemaster,Sugammadex 200 mg/2 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $226.60 , $124.63 , $181.28 , See APC Packaged Rates , $158.62 , $88.37 , $218.65 , $219.60 , $116.70 , See APC Packaged Rates , See APC Packaged Rates , $152.05 , $152.05 , See APC Packaged Rates , See APC Packaged Rates , $210.74 , $210.74 , $210.74 , $210.74 , See APC Packaged Rates , $79.31 , $135.96 , $79.31 , $219.60 , $158.62
,5710012311,Hospital Chargemaster,Sulfamethox/Trimeth 10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $31.98 , $17.59 , $25.58 , See APC Packaged Rates , $22.39 , $12.47 , $30.86 , $30.99 , $16.47 , See APC Packaged Rates , See APC Packaged Rates , $21.46 , $21.46 , See APC Packaged Rates , See APC Packaged Rates , $29.74 , $29.74 , $29.74 , $29.74 , See APC Packaged Rates , $11.19 , $19.19 , $11.19 , $30.99 , $22.39
,5710012337,Hospital Chargemaster,Terbutaline 1 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $45.87 , $25.23 , $36.70 , See APC Packaged Rates , $32.11 , $17.89 , $44.26 , $44.45 , $23.62 , See APC Packaged Rates , See APC Packaged Rates , $30.78 , $30.78 , See APC Packaged Rates , See APC Packaged Rates , $42.66 , $42.66 , $42.66 , $42.66 , See APC Packaged Rates , $16.05 , $27.52 , $16.05 , $44.45 , $32.11
,5710012405,Hospital Chargemaster,Tranexamic Acid 1000mg/10mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $58.50 , $32.18 , $46.80 , See APC Packaged Rates , $40.95 , $22.82 , $56.45 , $56.69 , $30.13 , See APC Packaged Rates , See APC Packaged Rates , $39.25 , $39.25 , See APC Packaged Rates , See APC Packaged Rates , $54.41 , $54.41 , $54.41 , $54.41 , See APC Packaged Rates , $20.48 , $35.10 , $20.48 , $56.69 , $40.95
,5710012462,Hospital Chargemaster,Valproic Acid 500 mg/5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $17.09 , $9.40 , $13.67 , See APC Packaged Rates , $11.96 , $6.67 , $16.49 , $16.56 , $8.80 , See APC Packaged Rates , See APC Packaged Rates , $11.47 , $11.47 , See APC Packaged Rates , See APC Packaged Rates , $15.89 , $15.89 , $15.89 , $15.89 , See APC Packaged Rates , $5.98 , $10.25 , $5.98 , $16.56 , $11.96
,5710012476,Hospital Chargemaster,Vecuronium Bromide 10 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $15.15 , $8.33 , $12.12 , See APC Packaged Rates , $10.61 , $5.91 , $14.62 , $14.68 , $7.80 , See APC Packaged Rates , See APC Packaged Rates , $10.17 , $10.17 , See APC Packaged Rates , See APC Packaged Rates , $14.09 , $14.09 , $14.09 , $14.09 , See APC Packaged Rates , $5.30 , $9.09 , $5.30 , $14.68 , $10.61
,5710012529,Hospital Chargemaster,"Water for Inj, Ster 10 mL",Outpatient,Outpatient Default Percent / Case Rate,250, $2.30 , $1.27 , $1.84 , See APC Packaged Rates , $1.61 , $0.90 , $2.22 , $2.23 , $1.18 , See APC Packaged Rates , See APC Packaged Rates , $1.54 , $1.54 , See APC Packaged Rates , See APC Packaged Rates , $2.14 , $2.14 , $2.14 , $2.14 , See APC Packaged Rates , $0.81 , $1.38 , $0.81 , $2.23 , $1.61
,5710012546,Hospital Chargemaster,Trace Elements 1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $31.24 , $17.18 , $24.99 , See APC Packaged Rates , $21.87 , $12.18 , $30.14 , $30.27 , $16.09 , See APC Packaged Rates , See APC Packaged Rates , $20.96 , $20.96 , See APC Packaged Rates , See APC Packaged Rates , $29.05 , $29.05 , $29.05 , $29.05 , See APC Packaged Rates , $10.93 , $18.74 , $10.93 , $30.27 , $21.87
,5710012588,Hospital Chargemaster,Cisatracurium Besylate,Outpatient,Outpatient Default Percent / Case Rate,250, $41.39 , $22.76 , $33.11 , See APC Packaged Rates , $28.97 , $16.14 , $39.94 , $40.11 , $21.32 , See APC Packaged Rates , See APC Packaged Rates , $27.77 , $27.77 , See APC Packaged Rates , See APC Packaged Rates , $38.49 , $38.49 , $38.49 , $38.49 , See APC Packaged Rates , $14.49 , $24.83 , $14.49 , $40.11 , $28.97
,5710012589,Hospital Chargemaster,Cisatracurium Besylate,Outpatient,Outpatient Default Percent / Case Rate,250, $70.38 , $38.71 , $56.30 , See APC Packaged Rates , $49.27 , $27.45 , $67.91 , $68.21 , $36.25 , See APC Packaged Rates , See APC Packaged Rates , $47.22 , $47.22 , See APC Packaged Rates , See APC Packaged Rates , $65.45 , $65.45 , $65.45 , $65.45 , See APC Packaged Rates , $24.63 , $42.23 , $24.63 , $68.21 , $49.27
,5710012596,Hospital Chargemaster,Vasopressin 20 unit Inj,Outpatient,Outpatient Default Percent / Case Rate,250, $538.13 , $295.97 , $430.50 , See APC Packaged Rates , $376.69 , $209.87 , $519.24 , $521.50 , $277.15 , See APC Packaged Rates , See APC Packaged Rates , $361.09 , $361.09 , See APC Packaged Rates , See APC Packaged Rates , $500.46 , $500.46 , $500.46 , $500.46 , See APC Packaged Rates , $188.35 , $322.88 , $188.35 , $521.50 , $376.69
,5710012605,Hospital Chargemaster,"Heparin Sodium,Porcine/1/2NS",Outpatient,Outpatient Default Percent / Case Rate,250, $24.63 , $13.55 , $19.70 , See APC Packaged Rates , $17.24 , $9.61 , $23.77 , $23.87 , $12.68 , See APC Packaged Rates , See APC Packaged Rates , $16.53 , $16.53 , See APC Packaged Rates , See APC Packaged Rates , $22.91 , $22.91 , $22.91 , $22.91 , See APC Packaged Rates , $8.62 , $14.78 , $8.62 , $23.87 , $17.24
,5710012606,Hospital Chargemaster,Insulin Regular in 0.9 % NaCl,Outpatient,Outpatient Default Percent / Case Rate,250, $89.25 , $49.09 , $71.40 , See APC Packaged Rates , $62.48 , $34.81 , $86.12 , $86.49 , $45.97 , See APC Packaged Rates , See APC Packaged Rates , $59.89 , $59.89 , See APC Packaged Rates , See APC Packaged Rates , $83.00 , $83.00 , $83.00 , $83.00 , See APC Packaged Rates , $31.24 , $53.55 , $31.24 , $86.49 , $62.48
,5710012625,Hospital Chargemaster,Bupivacaine 0.125%/Fentanyl,Outpatient,Outpatient Default Percent / Case Rate,250, $74.51 , $40.98 , $59.61 , See APC Packaged Rates , $52.16 , $29.06 , $71.89 , $72.21 , $38.37 , See APC Packaged Rates , See APC Packaged Rates , $50.00 , $50.00 , See APC Packaged Rates , See APC Packaged Rates , $69.29 , $69.29 , $69.29 , $69.29 , See APC Packaged Rates , $26.08 , $44.71 , $26.08 , $72.21 , $52.16
,5710012655,Hospital Chargemaster,ePHEDrine sulf in 0.9 % NaCl,Outpatient,Outpatient Default Percent / Case Rate,250, $461.04 , $253.57 , $368.83 , See APC Packaged Rates , $322.73 , $179.81 , $444.86 , $446.79 , $237.44 , See APC Packaged Rates , See APC Packaged Rates , $309.36 , $309.36 , See APC Packaged Rates , See APC Packaged Rates , $428.77 , $428.77 , $428.77 , $428.77 , See APC Packaged Rates , $161.36 , $276.62 , $161.36 , $446.79 , $322.73
,5710012657,Hospital Chargemaster,Glycopyrrolate in Water/PF,Outpatient,Outpatient Default Percent / Case Rate,250, $6.63 , $3.65 , $5.30 , See APC Packaged Rates , $4.64 , $2.59 , $6.40 , $6.43 , $3.41 , See APC Packaged Rates , See APC Packaged Rates , $4.45 , $4.45 , See APC Packaged Rates , See APC Packaged Rates , $6.17 , $6.17 , $6.17 , $6.17 , See APC Packaged Rates , $2.32 , $3.98 , $2.32 , $6.43 , $4.64
,5710012658,Hospital Chargemaster,Rocuronium Bromide,Outpatient,Outpatient Default Percent / Case Rate,250, $3.38 , $1.86 , $2.70 , See APC Packaged Rates , $2.37 , $1.32 , $3.26 , $3.28 , $1.74 , See APC Packaged Rates , See APC Packaged Rates , $2.27 , $2.27 , See APC Packaged Rates , See APC Packaged Rates , $3.14 , $3.14 , $3.14 , $3.14 , See APC Packaged Rates , $1.18 , $2.03 , $1.18 , $3.28 , $2.37
,5710012660,Hospital Chargemaster,Ketamine HCl in 0.9 % NaCl,Outpatient,Outpatient Default Percent / Case Rate,250, $306.00 , $168.30 , $244.80 , See APC Packaged Rates , $214.20 , $119.34 , $295.26 , $296.54 , $157.60 , See APC Packaged Rates , See APC Packaged Rates , $205.33 , $205.33 , See APC Packaged Rates , See APC Packaged Rates , $284.58 , $284.58 , $284.58 , $284.58 , See APC Packaged Rates , $107.10 , $183.60 , $107.10 , $296.54 , $214.20
,5710012673,Hospital Chargemaster,Folic Acid 1mg/0.2mL,Outpatient,Outpatient Default Percent / Case Rate,250, $2.76 , $1.52 , $2.21 , See APC Packaged Rates , $1.93 , $1.08 , $2.66 , $2.67 , $1.42 , See APC Packaged Rates , See APC Packaged Rates , $1.85 , $1.85 , See APC Packaged Rates , See APC Packaged Rates , $2.57 , $2.57 , $2.57 , $2.57 , See APC Packaged Rates , $0.97 , $1.66 , $0.97 , $2.67 , $1.93
,5710012691,Hospital Chargemaster,Potassium Phos 15 mmol/250 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $20.13 , $11.07 , $16.10 , See APC Packaged Rates , $14.09 , $7.85 , $19.42 , $19.51 , $10.37 , See APC Packaged Rates , See APC Packaged Rates , $13.51 , $13.51 , See APC Packaged Rates , See APC Packaged Rates , $18.72 , $18.72 , $18.72 , $18.72 , See APC Packaged Rates , $7.05 , $12.08 , $7.05 , $19.51 , $14.09
,5710012699,Hospital Chargemaster,Nitroglycerin/D5W 50mg/250mL,Outpatient,Outpatient Default Percent / Case Rate,250, $52.39 , $28.81 , $41.91 , See APC Packaged Rates , $36.67 , $20.43 , $50.55 , $50.77 , $26.98 , See APC Packaged Rates , See APC Packaged Rates , $35.15 , $35.15 , See APC Packaged Rates , See APC Packaged Rates , $48.72 , $48.72 , $48.72 , $48.72 , See APC Packaged Rates , $18.34 , $31.43 , $18.34 , $50.77 , $36.67
,5710012700,Hospital Chargemaster,Norepinephrine/D5W 4 mg/250mL,Outpatient,Outpatient Default Percent / Case Rate,250, $26.20 , $14.41 , $20.96 , See APC Packaged Rates , $18.34 , $10.22 , $25.28 , $25.39 , $13.49 , See APC Packaged Rates , See APC Packaged Rates , $17.58 , $17.58 , See APC Packaged Rates , See APC Packaged Rates , $24.37 , $24.37 , $24.37 , $24.37 , See APC Packaged Rates , $9.17 , $15.72 , $9.17 , $25.39 , $18.34
,5710012704,Hospital Chargemaster,Norepinephrine/NS 8 mg/250mL,Outpatient,Outpatient Default Percent / Case Rate,250, $55.18 , $30.35 , $44.14 , See APC Packaged Rates , $38.63 , $21.52 , $53.24 , $53.47 , $28.42 , See APC Packaged Rates , See APC Packaged Rates , $37.03 , $37.03 , See APC Packaged Rates , See APC Packaged Rates , $51.32 , $51.32 , $51.32 , $51.32 , See APC Packaged Rates , $19.31 , $33.11 , $19.31 , $53.47 , $38.63
,5710012709,Hospital Chargemaster,LET Gel 3 ml,Outpatient,Outpatient Default Percent / Case Rate,250, $27.41 , $15.08 , $21.93 , See APC Packaged Rates , $19.19 , $10.69 , $26.45 , $26.56 , $14.12 , See APC Packaged Rates , See APC Packaged Rates , $18.39 , $18.39 , See APC Packaged Rates , See APC Packaged Rates , $25.49 , $25.49 , $25.49 , $25.49 , See APC Packaged Rates , $9.59 , $16.45 , $9.59 , $26.56 , $19.19
,5710012804,Hospital Chargemaster,Ketamine/H20 50mg/mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,250, $12.71 , $6.99 , $10.17 , See APC Packaged Rates , $8.90 , $4.96 , $12.26 , $12.32 , $6.55 , See APC Packaged Rates , See APC Packaged Rates , $8.53 , $8.53 , See APC Packaged Rates , See APC Packaged Rates , $11.82 , $11.82 , $11.82 , $11.82 , See APC Packaged Rates , $4.45 , $7.63 , $4.45 , $12.32 , $8.90
,5710012808,Hospital Chargemaster,Endoscopy Marking Ink,Outpatient,Outpatient Default Percent / Case Rate,250, $57.71 , $31.74 , $46.17 , See APC Packaged Rates , $40.40 , $22.51 , $55.68 , $55.93 , $29.72 , See APC Packaged Rates , See APC Packaged Rates , $38.72 , $38.72 , See APC Packaged Rates , See APC Packaged Rates , $53.67 , $53.67 , $53.67 , $53.67 , See APC Packaged Rates , $20.20 , $34.63 , $20.20 , $55.93 , $40.40
,5710012829,Hospital Chargemaster,AA2.36%/D6.8W/Fat 1440 mL Emul,Outpatient,Outpatient Default Percent / Case Rate,250, $89.22 , $49.07 , $71.38 , See APC Packaged Rates , $62.45 , $34.80 , $86.09 , $86.46 , $45.95 , See APC Packaged Rates , See APC Packaged Rates , $59.87 , $59.87 , See APC Packaged Rates , See APC Packaged Rates , $82.97 , $82.97 , $82.97 , $82.97 , See APC Packaged Rates , $31.23 , $53.53 , $31.23 , $86.46 , $62.45
,5710012842,Hospital Chargemaster,Bupivacaine HCl 0.125%/NaCl PF,Outpatient,Outpatient Default Percent / Case Rate,250, $124.47 , $68.46 , $99.58 , See APC Packaged Rates , $87.13 , $48.54 , $120.10 , $120.62 , $64.10 , See APC Packaged Rates , See APC Packaged Rates , $83.52 , $83.52 , See APC Packaged Rates , See APC Packaged Rates , $115.76 , $115.76 , $115.76 , $115.76 , See APC Packaged Rates , $43.56 , $74.68 , $43.56 , $120.62 , $87.13
,5710012843,Hospital Chargemaster,Dermabond,Outpatient,Outpatient Default Percent / Case Rate,250, $32.51 , $17.88 , $26.01 , See APC Packaged Rates , $22.76 , $12.68 , $31.37 , $31.51 , $16.74 , See APC Packaged Rates , See APC Packaged Rates , $21.81 , $21.81 , See APC Packaged Rates , See APC Packaged Rates , $30.23 , $30.23 , $30.23 , $30.23 , See APC Packaged Rates , $11.38 , $19.51 , $11.38 , $31.51 , $22.76
,5710012844,Hospital Chargemaster,LIdocaine HCL 1 % MPF 2mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $5.13 , $2.82 , $4.10 , See APC Packaged Rates , $3.59 , $2.00 , $4.95 , $4.97 , $2.64 , See APC Packaged Rates , See APC Packaged Rates , $3.44 , $3.44 , See APC Packaged Rates , See APC Packaged Rates , $4.77 , $4.77 , $4.77 , $4.77 , See APC Packaged Rates , $1.80 , $3.08 , $1.80 , $4.97 , $3.59
,5710012853,Hospital Chargemaster,fentaNYL 300 mcg/Bupiv 0.125%,Outpatient,Outpatient Default Percent / Case Rate,250, $74.51 , $40.98 , $59.61 , See APC Packaged Rates , $52.16 , $29.06 , $71.89 , $72.21 , $38.37 , See APC Packaged Rates , See APC Packaged Rates , $50.00 , $50.00 , See APC Packaged Rates , See APC Packaged Rates , $69.29 , $69.29 , $69.29 , $69.29 , See APC Packaged Rates , $26.08 , $44.71 , $26.08 , $72.21 , $52.16
,5710012858,Hospital Chargemaster,PPD 5 TUB Unit/0.1 mL 1ml vial,Outpatient,Outpatient Default Percent / Case Rate,250, $22.65 , $12.46 , $18.12 , See APC Packaged Rates , $15.86 , $8.83 , $21.85 , $21.95 , $11.67 , See APC Packaged Rates , See APC Packaged Rates , $15.20 , $15.20 , See APC Packaged Rates , See APC Packaged Rates , $21.06 , $21.06 , $21.06 , $21.06 , See APC Packaged Rates , $7.93 , $13.59 , $7.93 , $21.95 , $15.86
,5710012873,Hospital Chargemaster,Levothyroxine Sod 100mcg/5mL,Outpatient,Outpatient Default Percent / Case Rate,250, $282.69 , $155.48 , $226.15 , See APC Packaged Rates , $197.88 , $110.25 , $272.77 , $273.95 , $145.59 , See APC Packaged Rates , See APC Packaged Rates , $189.68 , $189.68 , See APC Packaged Rates , See APC Packaged Rates , $262.90 , $262.90 , $262.90 , $262.90 , See APC Packaged Rates , $98.94 , $169.61 , $98.94 , $273.95 , $197.88
,67401771,Hospital Chargemaster,Levemir Pen 300 Unit,Outpatient,Outpatient Default Percent / Case Rate,250, $84.52 , $46.49 , $67.62 , See APC Packaged Rates , $59.16 , $32.96 , $81.55 , $81.91 , $43.53 , See APC Packaged Rates , See APC Packaged Rates , $56.71 , $56.71 , See APC Packaged Rates , See APC Packaged Rates , $78.60 , $78.60 , $78.60 , $78.60 , See APC Packaged Rates , $29.58 , $50.71 , $29.58 , $81.91 , $59.16
,67401999,Hospital Chargemaster,Vancomycin 125 MG CAP,Outpatient,Outpatient Default Percent / Case Rate,250, $4.18 , $2.30 , $3.34 , See APC Packaged Rates , $2.93 , $1.63 , $4.03 , $4.05 , $2.15 , See APC Packaged Rates , See APC Packaged Rates , $2.80 , $2.80 , See APC Packaged Rates , See APC Packaged Rates , $3.89 , $3.89 , $3.89 , $3.89 , See APC Packaged Rates , $1.46 , $2.51 , $1.46 , $4.05 , $2.93
,67402152,Hospital Chargemaster,Dilaudid 1 MG/ML 1 ML Carp,Outpatient,Outpatient Default Percent / Case Rate,250, $3.29 , $1.81 , $2.63 , See APC Packaged Rates , $2.30 , $1.28 , $3.17 , $3.19 , $1.69 , See APC Packaged Rates , See APC Packaged Rates , $2.21 , $2.21 , See APC Packaged Rates , See APC Packaged Rates , $3.06 , $3.06 , $3.06 , $3.06 , See APC Packaged Rates , $1.15 , $1.97 , $1.15 , $3.19 , $2.30
,67404663,Hospital Chargemaster,Imodium A-D Liq 1 MG,Outpatient,Outpatient Default Percent / Case Rate,250, $4.71 , $2.59 , $3.77 , See APC Packaged Rates , $3.30 , $1.84 , $4.54 , $4.56 , $2.43 , See APC Packaged Rates , See APC Packaged Rates , $3.16 , $3.16 , See APC Packaged Rates , See APC Packaged Rates , $4.38 , $4.38 , $4.38 , $4.38 , See APC Packaged Rates , $1.65 , $2.83 , $1.65 , $4.56 , $3.30
,67405624,Hospital Chargemaster,Nimbex 10 MG/5 ML Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $26.93 , $14.81 , $21.54 , See APC Packaged Rates , $18.85 , $10.50 , $25.98 , $26.10 , $13.87 , See APC Packaged Rates , See APC Packaged Rates , $18.07 , $18.07 , See APC Packaged Rates , See APC Packaged Rates , $25.04 , $25.04 , $25.04 , $25.04 , See APC Packaged Rates , $9.43 , $16.16 , $9.43 , $26.10 , $18.85
,67409028,Hospital Chargemaster,Magnesium Sulf 4GM/Water,Outpatient,Outpatient Default Percent / Case Rate,250, $8.23 , $4.53 , $6.58 , See APC Packaged Rates , $5.76 , $3.21 , $7.94 , $7.98 , $4.24 , See APC Packaged Rates , See APC Packaged Rates , $5.52 , $5.52 , See APC Packaged Rates , See APC Packaged Rates , $7.65 , $7.65 , $7.65 , $7.65 , See APC Packaged Rates , $2.88 , $4.94 , $2.88 , $7.98 , $5.76
,67409129,Hospital Chargemaster,"Perikabiven 1,920 ML",Outpatient,Outpatient Default Percent / Case Rate,250, $57.38 , $31.56 , $45.90 , See APC Packaged Rates , $40.17 , $22.38 , $55.37 , $55.61 , $29.55 , See APC Packaged Rates , See APC Packaged Rates , $38.50 , $38.50 , See APC Packaged Rates , See APC Packaged Rates , $53.36 , $53.36 , $53.36 , $53.36 , See APC Packaged Rates , $20.08 , $34.43 , $20.08 , $55.61 , $40.17
,67409130,Hospital Chargemaster,Vitamin C 500 MG/1 ML VL,Outpatient,Outpatient Default Percent / Case Rate,250, $7.68 , $4.22 , $6.14 , See APC Packaged Rates , $5.38 , $3.00 , $7.41 , $7.44 , $3.96 , See APC Packaged Rates , See APC Packaged Rates , $5.15 , $5.15 , See APC Packaged Rates , See APC Packaged Rates , $7.14 , $7.14 , $7.14 , $7.14 , See APC Packaged Rates , $2.69 , $4.61 , $2.69 , $7.44 , $5.38
,67409342,Hospital Chargemaster,Norepinephrine 32 MC,Outpatient,Outpatient Default Percent / Case Rate,250, $31.50 , $17.33 , $25.20 , See APC Packaged Rates , $22.05 , $12.29 , $30.39 , $30.53 , $16.22 , See APC Packaged Rates , See APC Packaged Rates , $21.14 , $21.14 , See APC Packaged Rates , See APC Packaged Rates , $29.30 , $29.30 , $29.30 , $29.30 , See APC Packaged Rates , $11.03 , $18.90 , $11.03 , $30.53 , $22.05
,67409345,Hospital Chargemaster,Perikabiven 1440 ML,Outpatient,Outpatient Default Percent / Case Rate,250, $50.27 , $27.65 , $40.22 , See APC Packaged Rates , $35.19 , $19.61 , $48.51 , $48.72 , $25.89 , See APC Packaged Rates , See APC Packaged Rates , $33.73 , $33.73 , See APC Packaged Rates , See APC Packaged Rates , $46.75 , $46.75 , $46.75 , $46.75 , See APC Packaged Rates , $17.59 , $30.16 , $17.59 , $48.72 , $35.19
Q9967,5710012609,Hospital Chargemaster,Iohexol 300 mg/ml 100 ml,Outpatient,Outpatient Default Percent / Case Rate,255, $285.83 , $- , $235.52 , See APC Packaged Rates , $200.08 , $111.47 , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $191.79 , $191.79 , See APC Packaged Rates , See APC Packaged Rates , $265.82 , $265.82 , $265.82 , $265.82 , See APC Packaged Rates , $100.04 , $- , $- , $265.82 , $200.08
,67408106,Hospital Chargemaster,Trace Elements 1 ML,Outpatient,Outpatient Default Percent / Case Rate,258, $19.53 , $10.74 , $15.62 , See APC Packaged Rates , $13.67 , $7.62 , $18.84 , $18.93 , $10.06 , See APC Packaged Rates , See APC Packaged Rates , $13.10 , $13.10 , See APC Packaged Rates , See APC Packaged Rates , $18.16 , $18.16 , $18.16 , $18.16 , See APC Packaged Rates , $6.84 , $11.72 , $6.84 , $18.93 , $13.67
,67408115,Hospital Chargemaster,Potassium Phos 3 MM/ML 15 ML,Outpatient,Outpatient Default Percent / Case Rate,258, $30.94 , $17.02 , $24.75 , See APC Packaged Rates , $21.66 , $12.07 , $29.85 , $29.98 , $15.93 , See APC Packaged Rates , See APC Packaged Rates , $20.76 , $20.76 , See APC Packaged Rates , See APC Packaged Rates , $28.77 , $28.77 , $28.77 , $28.77 , See APC Packaged Rates , $10.83 , $18.56 , $10.83 , $29.98 , $21.66
J1410,5710010916,Hospital Chargemaster,"Estrogens, Conj 25 mg Inj",Outpatient,Outpatient Default Percent / Case Rate,259, $- , $325.51 , $- , $399.70 , $- , $- , $325.62 , $325.62 , $325.62 , $399.70 , $399.70 , $- , $- , $419.69 , $407.70 , $- , $- , $- , $- , $399.70 , $- , $341.50 , $- , $419.69 , $-
Q0163,5710010771,Hospital Chargemaster,diphenhydrAMINE 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.04 , $0.04 , $0.04 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.04 , $-
,5710010030,Hospital Chargemaster,Abacavir/lamiVUD 600/300 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $109.80 , $60.39 , $87.84 , See APC Packaged Rates , $76.86 , $42.82 , $105.95 , $106.41 , $56.55 , See APC Packaged Rates , See APC Packaged Rates , $73.68 , $73.68 , See APC Packaged Rates , See APC Packaged Rates , $102.11 , $102.11 , $102.11 , $102.11 , See APC Packaged Rates , $38.43 , $65.88 , $38.43 , $106.41 , $76.86
,5710010033,Hospital Chargemaster,Acamprosate 333 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.49 , $2.47 , $3.59 , See APC Packaged Rates , $3.14 , $1.75 , $4.33 , $4.35 , $2.31 , See APC Packaged Rates , See APC Packaged Rates , $3.01 , $3.01 , See APC Packaged Rates , See APC Packaged Rates , $4.18 , $4.18 , $4.18 , $4.18 , See APC Packaged Rates , $1.57 , $2.69 , $1.57 , $4.35 , $3.14
,5710010035,Hospital Chargemaster,Acetaminophen 160 mg/5 mL Oral,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010036,Hospital Chargemaster,Acetaminophen 325mg/10.15mL Or,Outpatient,Outpatient Default Percent / Case Rate,259, $5.32 , $2.93 , $4.26 , See APC Packaged Rates , $3.72 , $2.07 , $5.13 , $5.16 , $2.74 , See APC Packaged Rates , See APC Packaged Rates , $3.57 , $3.57 , See APC Packaged Rates , See APC Packaged Rates , $4.95 , $4.95 , $4.95 , $4.95 , See APC Packaged Rates , $1.86 , $3.19 , $1.86 , $5.16 , $3.72
,5710010038,Hospital Chargemaster,Acetaminophen 120 mg Supp,Outpatient,Outpatient Default Percent / Case Rate,259, $1.89 , $1.04 , $1.51 , See APC Packaged Rates , $1.32 , $0.74 , $1.82 , $1.83 , $0.97 , See APC Packaged Rates , See APC Packaged Rates , $1.27 , $1.27 , See APC Packaged Rates , See APC Packaged Rates , $1.76 , $1.76 , $1.76 , $1.76 , See APC Packaged Rates , $0.66 , $1.13 , $0.66 , $1.83 , $1.32
,5710010039,Hospital Chargemaster,Acetaminophen 325 mg Supp,Outpatient,Outpatient Default Percent / Case Rate,259, $2.04 , $1.12 , $1.63 , See APC Packaged Rates , $1.43 , $0.80 , $1.97 , $1.98 , $1.05 , See APC Packaged Rates , See APC Packaged Rates , $1.37 , $1.37 , See APC Packaged Rates , See APC Packaged Rates , $1.90 , $1.90 , $1.90 , $1.90 , See APC Packaged Rates , $0.71 , $1.22 , $0.71 , $1.98 , $1.43
,5710010040,Hospital Chargemaster,Acetaminophen 650 mg Supp,Outpatient,Outpatient Default Percent / Case Rate,259, $1.69 , $0.93 , $1.35 , See APC Packaged Rates , $1.18 , $0.66 , $1.63 , $1.64 , $0.87 , See APC Packaged Rates , See APC Packaged Rates , $1.13 , $1.13 , See APC Packaged Rates , See APC Packaged Rates , $1.57 , $1.57 , $1.57 , $1.57 , See APC Packaged Rates , $0.59 , $1.01 , $0.59 , $1.64 , $1.18
,5710010041,Hospital Chargemaster,Acetaminophen 80 mg Supp,Outpatient,Outpatient Default Percent / Case Rate,259, $2.04 , $1.12 , $1.63 , See APC Packaged Rates , $1.43 , $0.80 , $1.97 , $1.98 , $1.05 , See APC Packaged Rates , See APC Packaged Rates , $1.37 , $1.37 , See APC Packaged Rates , See APC Packaged Rates , $1.90 , $1.90 , $1.90 , $1.90 , See APC Packaged Rates , $0.71 , $1.22 , $0.71 , $1.98 , $1.43
,5710010042,Hospital Chargemaster,Acetaminophen 80 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010043,Hospital Chargemaster,Acetaminophen 500 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010044,Hospital Chargemaster,Acetaminophen 325 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010047,Hospital Chargemaster,Acetaminophen w/Codeine #3 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010048,Hospital Chargemaster,acetaZOLAMIDE 250 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $8.42 , $4.63 , $6.74 , See APC Packaged Rates , $5.89 , $3.28 , $8.12 , $8.16 , $4.34 , See APC Packaged Rates , See APC Packaged Rates , $5.65 , $5.65 , See APC Packaged Rates , See APC Packaged Rates , $7.83 , $7.83 , $7.83 , $7.83 , See APC Packaged Rates , $2.95 , $5.05 , $2.95 , $8.16 , $5.89
,5710010058,Hospital Chargemaster,Acetylcysteine 6000mg/30mL Vl,Outpatient,Outpatient Default Percent / Case Rate,259, $26.09 , $14.35 , $20.87 , See APC Packaged Rates , $18.26 , $10.18 , $25.17 , $25.28 , $13.44 , See APC Packaged Rates , See APC Packaged Rates , $17.51 , $17.51 , See APC Packaged Rates , See APC Packaged Rates , $24.26 , $24.26 , $24.26 , $24.26 , See APC Packaged Rates , $9.13 , $15.65 , $9.13 , $25.28 , $18.26
,5710010060,Hospital Chargemaster,Activated Charcoal 25gm/120mL,Outpatient,Outpatient Default Percent / Case Rate,259, $42.59 , $23.42 , $34.07 , See APC Packaged Rates , $29.81 , $16.61 , $41.10 , $41.27 , $21.93 , See APC Packaged Rates , See APC Packaged Rates , $28.58 , $28.58 , See APC Packaged Rates , See APC Packaged Rates , $39.61 , $39.61 , $39.61 , $39.61 , See APC Packaged Rates , $14.91 , $25.55 , $14.91 , $41.27 , $29.81
,5710010061,Hospital Chargemaster,ActIvated Charcoal 50gm/240mL,Outpatient,Outpatient Default Percent / Case Rate,259, $60.31 , $33.17 , $48.25 , See APC Packaged Rates , $42.22 , $23.52 , $58.19 , $58.45 , $31.06 , See APC Packaged Rates , See APC Packaged Rates , $40.47 , $40.47 , See APC Packaged Rates , See APC Packaged Rates , $56.09 , $56.09 , $56.09 , $56.09 , See APC Packaged Rates , $21.11 , $36.19 , $21.11 , $58.45 , $42.22
,5710010064,Hospital Chargemaster,Acyclovir 400 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.88 , $2.68 , $3.90 , See APC Packaged Rates , $3.42 , $1.90 , $4.71 , $4.73 , $2.51 , See APC Packaged Rates , See APC Packaged Rates , $3.27 , $3.27 , See APC Packaged Rates , See APC Packaged Rates , $4.54 , $4.54 , $4.54 , $4.54 , See APC Packaged Rates , $1.71 , $2.93 , $1.71 , $4.73 , $3.42
,5710010081,Hospital Chargemaster,Albuterol 8 gm Inhaler,Outpatient,Outpatient Default Percent / Case Rate,259, $65.97 , $36.28 , $52.78 , See APC Packaged Rates , $46.18 , $25.73 , $63.65 , $63.93 , $33.98 , See APC Packaged Rates , See APC Packaged Rates , $44.27 , $44.27 , See APC Packaged Rates , See APC Packaged Rates , $61.35 , $61.35 , $61.35 , $61.35 , See APC Packaged Rates , $23.09 , $39.58 , $23.09 , $63.93 , $46.18
,5710010083,Hospital Chargemaster,Albuterol 0.63 mg/3 mL Neb,Outpatient,Outpatient Default Percent / Case Rate,259, $4.23 , $2.33 , $3.38 , See APC Packaged Rates , $2.96 , $1.65 , $4.08 , $4.10 , $2.18 , See APC Packaged Rates , See APC Packaged Rates , $2.84 , $2.84 , See APC Packaged Rates , See APC Packaged Rates , $3.93 , $3.93 , $3.93 , $3.93 , See APC Packaged Rates , $1.48 , $2.54 , $1.48 , $4.10 , $2.96
,5710010085,Hospital Chargemaster,Albuterol 2.5 mg/3 mL Neb,Outpatient,Outpatient Default Percent / Case Rate,259, $2.03 , $1.12 , $1.62 , See APC Packaged Rates , $1.42 , $0.79 , $1.96 , $1.97 , $1.05 , See APC Packaged Rates , See APC Packaged Rates , $1.36 , $1.36 , See APC Packaged Rates , See APC Packaged Rates , $1.89 , $1.89 , $1.89 , $1.89 , See APC Packaged Rates , $0.71 , $1.22 , $0.71 , $1.97 , $1.42
,5710010090,Hospital Chargemaster,Alendronate 70 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $36.48 , $20.06 , $29.18 , See APC Packaged Rates , $25.54 , $14.23 , $35.20 , $35.35 , $18.79 , See APC Packaged Rates , See APC Packaged Rates , $24.48 , $24.48 , See APC Packaged Rates , See APC Packaged Rates , $33.93 , $33.93 , $33.93 , $33.93 , See APC Packaged Rates , $12.77 , $21.89 , $12.77 , $35.35 , $25.54
,5710010091,Hospital Chargemaster,Allopurinol 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.27 , $0.70 , $1.02 , See APC Packaged Rates , $0.89 , $0.50 , $1.23 , $1.23 , $0.65 , See APC Packaged Rates , See APC Packaged Rates , $0.85 , $0.85 , See APC Packaged Rates , See APC Packaged Rates , $1.18 , $1.18 , $1.18 , $1.18 , See APC Packaged Rates , $0.44 , $0.76 , $0.44 , $1.23 , $0.89
,5710010092,Hospital Chargemaster,Allopurinol 300 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.94 , $1.07 , $1.55 , See APC Packaged Rates , $1.36 , $0.76 , $1.87 , $1.88 , $1.00 , See APC Packaged Rates , See APC Packaged Rates , $1.30 , $1.30 , See APC Packaged Rates , See APC Packaged Rates , $1.80 , $1.80 , $1.80 , $1.80 , See APC Packaged Rates , $0.68 , $1.16 , $0.68 , $1.88 , $1.36
,5710010093,Hospital Chargemaster,ALPRAZolam 0.25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.62 , $0.89 , $1.30 , See APC Packaged Rates , $1.13 , $0.63 , $1.56 , $1.57 , $0.83 , See APC Packaged Rates , See APC Packaged Rates , $1.09 , $1.09 , See APC Packaged Rates , See APC Packaged Rates , $1.51 , $1.51 , $1.51 , $1.51 , See APC Packaged Rates , $0.57 , $0.97 , $0.57 , $1.57 , $1.13
,5710010094,Hospital Chargemaster,ALPRAZolam 0.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.05 , $1.13 , $1.64 , See APC Packaged Rates , $1.44 , $0.80 , $1.98 , $1.99 , $1.06 , See APC Packaged Rates , See APC Packaged Rates , $1.38 , $1.38 , See APC Packaged Rates , See APC Packaged Rates , $1.91 , $1.91 , $1.91 , $1.91 , See APC Packaged Rates , $0.72 , $1.23 , $0.72 , $1.99 , $1.44
,5710010103,Hospital Chargemaster,Amantadine 100 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $5.15 , $2.83 , $4.12 , See APC Packaged Rates , $3.61 , $2.01 , $4.97 , $4.99 , $2.65 , See APC Packaged Rates , See APC Packaged Rates , $3.46 , $3.46 , See APC Packaged Rates , See APC Packaged Rates , $4.79 , $4.79 , $4.79 , $4.79 , See APC Packaged Rates , $1.80 , $3.09 , $1.80 , $4.99 , $3.61
,5710010108,Hospital Chargemaster,aMILoride HCl 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010120,Hospital Chargemaster,Amiodarone 200 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.54 , $0.85 , $1.23 , See APC Packaged Rates , $1.08 , $0.60 , $1.49 , $1.49 , $0.79 , See APC Packaged Rates , See APC Packaged Rates , $1.03 , $1.03 , See APC Packaged Rates , See APC Packaged Rates , $1.43 , $1.43 , $1.43 , $1.43 , See APC Packaged Rates , $0.54 , $0.92 , $0.54 , $1.49 , $1.08
,5710010125,Hospital Chargemaster,Amitriptyline 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010126,Hospital Chargemaster,Amitriptyline 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.10 , $0.61 , $0.88 , See APC Packaged Rates , $0.77 , $0.43 , $1.06 , $1.07 , $0.57 , See APC Packaged Rates , See APC Packaged Rates , $0.74 , $0.74 , See APC Packaged Rates , See APC Packaged Rates , $1.02 , $1.02 , $1.02 , $1.02 , See APC Packaged Rates , $0.39 , $0.66 , $0.39 , $1.07 , $0.77
,5710010127,Hospital Chargemaster,Amitriptyline 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.67 , $1.47 , $2.14 , See APC Packaged Rates , $1.87 , $1.04 , $2.58 , $2.59 , $1.38 , See APC Packaged Rates , See APC Packaged Rates , $1.79 , $1.79 , See APC Packaged Rates , See APC Packaged Rates , $2.48 , $2.48 , $2.48 , $2.48 , See APC Packaged Rates , $0.93 , $1.60 , $0.93 , $2.59 , $1.87
,5710010129,Hospital Chargemaster,amLODIPine 2.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010130,Hospital Chargemaster,amLODIPine 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010133,Hospital Chargemaster,Ammonium Lact 140 gm Cream,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010134,Hospital Chargemaster,Ammonium Lact 226 gm Lotion,Outpatient,Outpatient Default Percent / Case Rate,259, $1.86 , $1.02 , $1.49 , See APC Packaged Rates , $1.30 , $0.73 , $1.79 , $1.80 , $0.96 , See APC Packaged Rates , See APC Packaged Rates , $1.25 , $1.25 , See APC Packaged Rates , See APC Packaged Rates , $1.73 , $1.73 , $1.73 , $1.73 , See APC Packaged Rates , $0.65 , $1.12 , $0.65 , $1.80 , $1.30
,5710010136,Hospital Chargemaster,Amoxapine 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.01 , $1.66 , $2.41 , See APC Packaged Rates , $2.11 , $1.17 , $2.90 , $2.92 , $1.55 , See APC Packaged Rates , See APC Packaged Rates , $2.02 , $2.02 , See APC Packaged Rates , See APC Packaged Rates , $2.80 , $2.80 , $2.80 , $2.80 , See APC Packaged Rates , $1.05 , $1.81 , $1.05 , $2.92 , $2.11
,5710010137,Hospital Chargemaster,Amoxicillin 250 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010138,Hospital Chargemaster,Amoxicillin 500 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.20 , $0.66 , $0.96 , See APC Packaged Rates , $0.84 , $0.47 , $1.16 , $1.16 , $0.62 , See APC Packaged Rates , See APC Packaged Rates , $0.81 , $0.81 , See APC Packaged Rates , See APC Packaged Rates , $1.12 , $1.12 , $1.12 , $1.12 , See APC Packaged Rates , $0.42 , $0.72 , $0.42 , $1.16 , $0.84
,5710010140,Hospital Chargemaster,Amoxicillin 4000 mg/80 mL Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $13.54 , $7.45 , $10.83 , See APC Packaged Rates , $9.48 , $5.28 , $13.06 , $13.12 , $6.97 , See APC Packaged Rates , See APC Packaged Rates , $9.09 , $9.09 , See APC Packaged Rates , See APC Packaged Rates , $12.59 , $12.59 , $12.59 , $12.59 , See APC Packaged Rates , $4.74 , $8.12 , $4.74 , $13.12 , $9.48
,5710010142,Hospital Chargemaster,Amoxicillin 8000 mg/100mL Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $16.68 , $9.17 , $13.34 , See APC Packaged Rates , $11.68 , $6.51 , $16.09 , $16.16 , $8.59 , See APC Packaged Rates , See APC Packaged Rates , $11.19 , $11.19 , See APC Packaged Rates , See APC Packaged Rates , $15.51 , $15.51 , $15.51 , $15.51 , See APC Packaged Rates , $5.84 , $10.01 , $5.84 , $16.16 , $11.68
,5710010143,Hospital Chargemaster,Amoxicillin/K Clav 2000mg/50mL,Outpatient,Outpatient Default Percent / Case Rate,259, $47.05 , $25.88 , $37.64 , See APC Packaged Rates , $32.94 , $18.35 , $45.40 , $45.60 , $24.23 , See APC Packaged Rates , See APC Packaged Rates , $31.57 , $31.57 , See APC Packaged Rates , See APC Packaged Rates , $43.76 , $43.76 , $43.76 , $43.76 , See APC Packaged Rates , $16.47 , $28.23 , $16.47 , $45.60 , $32.94
,5710010148,Hospital Chargemaster,Amoxicillin/K Clav 875 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $12.23 , $6.73 , $9.78 , See APC Packaged Rates , $8.56 , $4.77 , $11.80 , $11.85 , $6.30 , See APC Packaged Rates , See APC Packaged Rates , $8.21 , $8.21 , See APC Packaged Rates , See APC Packaged Rates , $11.37 , $11.37 , $11.37 , $11.37 , See APC Packaged Rates , $4.28 , $7.34 , $4.28 , $11.85 , $8.56
,5710010149,Hospital Chargemaster,Amoxicillin/K Clav 250 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $15.10 , $8.31 , $12.08 , See APC Packaged Rates , $10.57 , $5.89 , $14.57 , $14.63 , $7.78 , See APC Packaged Rates , See APC Packaged Rates , $10.13 , $10.13 , See APC Packaged Rates , See APC Packaged Rates , $14.04 , $14.04 , $14.04 , $14.04 , See APC Packaged Rates , $5.29 , $9.06 , $5.29 , $14.63 , $10.57
,5710010166,Hospital Chargemaster,Anastrozole 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.28 , $2.90 , $4.22 , See APC Packaged Rates , $3.70 , $2.06 , $5.09 , $5.12 , $2.72 , See APC Packaged Rates , See APC Packaged Rates , $3.54 , $3.54 , See APC Packaged Rates , See APC Packaged Rates , $4.91 , $4.91 , $4.91 , $4.91 , See APC Packaged Rates , $1.85 , $3.17 , $1.85 , $5.12 , $3.70
,5710010171,Hospital Chargemaster,Apixaban 2.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $20.35 , $11.19 , $16.28 , See APC Packaged Rates , $14.25 , $7.94 , $19.64 , $19.72 , $10.48 , See APC Packaged Rates , See APC Packaged Rates , $13.65 , $13.65 , See APC Packaged Rates , See APC Packaged Rates , $18.93 , $18.93 , $18.93 , $18.93 , See APC Packaged Rates , $7.12 , $12.21 , $7.12 , $19.72 , $14.25
,5710010172,Hospital Chargemaster,Apixaban 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $20.53 , $11.29 , $16.42 , See APC Packaged Rates , $14.37 , $8.01 , $19.81 , $19.90 , $10.57 , See APC Packaged Rates , See APC Packaged Rates , $13.78 , $13.78 , See APC Packaged Rates , See APC Packaged Rates , $19.09 , $19.09 , $19.09 , $19.09 , See APC Packaged Rates , $7.19 , $12.32 , $7.19 , $19.90 , $14.37
,5710010177,Hospital Chargemaster,Arformoterol 15 mcg/2 mL Neb,Outpatient,Outpatient Default Percent / Case Rate,259, $45.91 , $25.25 , $36.73 , See APC Packaged Rates , $32.14 , $17.90 , $44.30 , $44.49 , $23.64 , See APC Packaged Rates , See APC Packaged Rates , $30.81 , $30.81 , See APC Packaged Rates , See APC Packaged Rates , $42.70 , $42.70 , $42.70 , $42.70 , See APC Packaged Rates , $16.07 , $27.55 , $16.07 , $44.49 , $32.14
,5710010181,Hospital Chargemaster,ARIPiprazole 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $77.88 , $42.83 , $62.30 , See APC Packaged Rates , $54.52 , $30.37 , $75.15 , $75.47 , $40.11 , See APC Packaged Rates , See APC Packaged Rates , $52.26 , $52.26 , See APC Packaged Rates , See APC Packaged Rates , $72.43 , $72.43 , $72.43 , $72.43 , See APC Packaged Rates , $27.26 , $46.73 , $27.26 , $75.47 , $54.52
,5710010182,Hospital Chargemaster,ARIPiprazole 15 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.72 , $2.60 , $3.78 , See APC Packaged Rates , $3.30 , $1.84 , $4.55 , $4.57 , $2.43 , See APC Packaged Rates , See APC Packaged Rates , $3.17 , $3.17 , See APC Packaged Rates , See APC Packaged Rates , $4.39 , $4.39 , $4.39 , $4.39 , See APC Packaged Rates , $1.65 , $2.83 , $1.65 , $4.57 , $3.30
,5710010184,Hospital Chargemaster,ARIPiprazole 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $75.81 , $41.70 , $60.65 , See APC Packaged Rates , $53.07 , $29.57 , $73.15 , $73.47 , $39.04 , See APC Packaged Rates , See APC Packaged Rates , $50.87 , $50.87 , See APC Packaged Rates , See APC Packaged Rates , $70.50 , $70.50 , $70.50 , $70.50 , See APC Packaged Rates , $26.53 , $45.49 , $26.53 , $73.47 , $53.07
,5710010186,Hospital Chargemaster,ARIPiprazole 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $74.67 , $41.07 , $59.74 , See APC Packaged Rates , $52.27 , $29.12 , $72.05 , $72.36 , $38.46 , See APC Packaged Rates , See APC Packaged Rates , $50.10 , $50.10 , See APC Packaged Rates , See APC Packaged Rates , $69.44 , $69.44 , $69.44 , $69.44 , See APC Packaged Rates , $26.13 , $44.80 , $26.13 , $72.36 , $52.27
,5710010194,Hospital Chargemaster,Ascorbic Acid 250 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010195,Hospital Chargemaster,Ascorbic Acid 500 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $0.99 , $0.54 , $0.79 , See APC Packaged Rates , $0.69 , $0.39 , $0.96 , $0.96 , $0.51 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.92 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , $0.35 , $0.59 , $0.35 , $0.96 , $0.69
,5710010200,Hospital Chargemaster,Aspirin 300 mg Supp,Outpatient,Outpatient Default Percent / Case Rate,259, $3.72 , $2.05 , $2.98 , See APC Packaged Rates , $2.60 , $1.45 , $3.59 , $3.61 , $1.92 , See APC Packaged Rates , See APC Packaged Rates , $2.50 , $2.50 , See APC Packaged Rates , See APC Packaged Rates , $3.46 , $3.46 , $3.46 , $3.46 , See APC Packaged Rates , $1.30 , $2.23 , $1.30 , $3.61 , $2.60
,5710010201,Hospital Chargemaster,Aspirin 81 mg Tab Chew,Outpatient,Outpatient Default Percent / Case Rate,259, $0.99 , $0.54 , $0.79 , See APC Packaged Rates , $0.69 , $0.39 , $0.96 , $0.96 , $0.51 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.92 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , $0.35 , $0.59 , $0.35 , $0.96 , $0.69
,5710010202,Hospital Chargemaster,Aspirin 325 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010203,Hospital Chargemaster,Aspirin EC 325 mg Tablet DR,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010204,Hospital Chargemaster,Aspirin EC 81 mg Tablet DR,Outpatient,Outpatient Default Percent / Case Rate,259, $0.99 , $0.54 , $0.79 , See APC Packaged Rates , $0.69 , $0.39 , $0.96 , $0.96 , $0.51 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.92 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , $0.35 , $0.59 , $0.35 , $0.96 , $0.69
,5710010205,Hospital Chargemaster,Aspirin/Dipyridamole ER 25/200,Outpatient,Outpatient Default Percent / Case Rate,259, $21.32 , $11.73 , $17.06 , See APC Packaged Rates , $14.92 , $8.31 , $20.57 , $20.66 , $10.98 , See APC Packaged Rates , See APC Packaged Rates , $14.31 , $14.31 , See APC Packaged Rates , See APC Packaged Rates , $19.83 , $19.83 , $19.83 , $19.83 , See APC Packaged Rates , $7.46 , $12.79 , $7.46 , $20.66 , $14.92
,5710010210,Hospital Chargemaster,Atenolol 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.04 , $1.12 , $1.63 , See APC Packaged Rates , $1.43 , $0.80 , $1.97 , $1.98 , $1.05 , See APC Packaged Rates , See APC Packaged Rates , $1.37 , $1.37 , See APC Packaged Rates , See APC Packaged Rates , $1.90 , $1.90 , $1.90 , $1.90 , See APC Packaged Rates , $0.71 , $1.22 , $0.71 , $1.98 , $1.43
,5710010211,Hospital Chargemaster,Atenolol 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.08 , $1.14 , $1.66 , See APC Packaged Rates , $1.46 , $0.81 , $2.01 , $2.02 , $1.07 , See APC Packaged Rates , See APC Packaged Rates , $1.40 , $1.40 , See APC Packaged Rates , See APC Packaged Rates , $1.93 , $1.93 , $1.93 , $1.93 , See APC Packaged Rates , $0.73 , $1.25 , $0.73 , $2.02 , $1.46
,5710010214,Hospital Chargemaster,Atorvastatin 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.59 , $0.87 , $1.27 , See APC Packaged Rates , $1.11 , $0.62 , $1.53 , $1.54 , $0.82 , See APC Packaged Rates , See APC Packaged Rates , $1.07 , $1.07 , See APC Packaged Rates , See APC Packaged Rates , $1.48 , $1.48 , $1.48 , $1.48 , See APC Packaged Rates , $0.56 , $0.95 , $0.56 , $1.54 , $1.11
,5710010215,Hospital Chargemaster,Atorvastatin 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010216,Hospital Chargemaster,Atorvastatin 40 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010218,Hospital Chargemaster,Atovaquone 750 mg/5 mL Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $84.56 , $46.51 , $67.65 , See APC Packaged Rates , $59.19 , $32.98 , $81.59 , $81.95 , $43.55 , See APC Packaged Rates , See APC Packaged Rates , $56.74 , $56.74 , See APC Packaged Rates , See APC Packaged Rates , $78.64 , $78.64 , $78.64 , $78.64 , See APC Packaged Rates , $29.60 , $50.74 , $29.60 , $81.95 , $59.19
,5710010228,Hospital Chargemaster,Atropine 1 % 5 mL Drops,Outpatient,Outpatient Default Percent / Case Rate,259, $29.78 , $16.38 , $23.82 , See APC Packaged Rates , $20.85 , $11.61 , $28.73 , $28.86 , $15.34 , See APC Packaged Rates , See APC Packaged Rates , $19.98 , $19.98 , See APC Packaged Rates , See APC Packaged Rates , $27.70 , $27.70 , $27.70 , $27.70 , See APC Packaged Rates , $10.42 , $17.87 , $10.42 , $28.86 , $20.85
,5710010231,Hospital Chargemaster,azaTHIOprine 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.38 , $2.96 , $4.30 , See APC Packaged Rates , $3.77 , $2.10 , $5.19 , $5.21 , $2.77 , See APC Packaged Rates , See APC Packaged Rates , $3.61 , $3.61 , See APC Packaged Rates , See APC Packaged Rates , $5.00 , $5.00 , $5.00 , $5.00 , See APC Packaged Rates , $1.88 , $3.23 , $1.88 , $5.21 , $3.77
,5710010234,Hospital Chargemaster,Azithromycin 600 mg/15mL Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $128.14 , $70.48 , $102.51 , See APC Packaged Rates , $89.70 , $49.97 , $123.64 , $124.18 , $65.99 , See APC Packaged Rates , See APC Packaged Rates , $85.98 , $85.98 , See APC Packaged Rates , See APC Packaged Rates , $119.17 , $119.17 , $119.17 , $119.17 , See APC Packaged Rates , $44.85 , $76.88 , $44.85 , $124.18 , $89.70
,5710010235,Hospital Chargemaster,Azithromycin 250 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $19.50 , $10.73 , $15.60 , See APC Packaged Rates , $13.65 , $7.61 , $18.82 , $18.90 , $10.04 , See APC Packaged Rates , See APC Packaged Rates , $13.08 , $13.08 , See APC Packaged Rates , See APC Packaged Rates , $18.14 , $18.14 , $18.14 , $18.14 , See APC Packaged Rates , $6.83 , $11.70 , $6.83 , $18.90 , $13.65
,5710010245,Hospital Chargemaster,Bacitracin 14 gm Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010248,Hospital Chargemaster,Bacitracin 0.9 gm Packet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010249,Hospital Chargemaster,Bacit/Poly B 3.5 gm Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $15.45 , $8.50 , $12.36 , See APC Packaged Rates , $10.82 , $6.03 , $14.91 , $14.97 , $7.96 , See APC Packaged Rates , See APC Packaged Rates , $10.37 , $10.37 , See APC Packaged Rates , See APC Packaged Rates , $14.37 , $14.37 , $14.37 , $14.37 , See APC Packaged Rates , $5.41 , $9.27 , $5.41 , $14.97 , $10.82
,5710010250,Hospital Chargemaster,Baclofen 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.17 , $3.39 , $4.94 , See APC Packaged Rates , $4.32 , $2.41 , $5.95 , $5.98 , $3.18 , See APC Packaged Rates , See APC Packaged Rates , $4.14 , $4.14 , See APC Packaged Rates , See APC Packaged Rates , $5.74 , $5.74 , $5.74 , $5.74 , See APC Packaged Rates , $2.16 , $3.70 , $2.16 , $5.98 , $4.32
,5710010252,Hospital Chargemaster,Baclofen 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.94 , $1.62 , $2.35 , See APC Packaged Rates , $2.06 , $1.15 , $2.84 , $2.85 , $1.51 , See APC Packaged Rates , See APC Packaged Rates , $1.97 , $1.97 , See APC Packaged Rates , See APC Packaged Rates , $2.73 , $2.73 , $2.73 , $2.73 , See APC Packaged Rates , $1.03 , $1.76 , $1.03 , $2.85 , $2.06
,5710010255,Hospital Chargemaster,Eye Irrigation Soln 30 mL,Outpatient,Outpatient Default Percent / Case Rate,259, $46.67 , $25.67 , $37.34 , See APC Packaged Rates , $32.67 , $18.20 , $45.03 , $45.23 , $24.04 , See APC Packaged Rates , See APC Packaged Rates , $31.32 , $31.32 , See APC Packaged Rates , See APC Packaged Rates , $43.40 , $43.40 , $43.40 , $43.40 , See APC Packaged Rates , $16.33 , $28.00 , $16.33 , $45.23 , $32.67
,5710010256,Hospital Chargemaster,Balsalazide 750 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $4.08 , $2.24 , $3.26 , See APC Packaged Rates , $2.86 , $1.59 , $3.94 , $3.95 , $2.10 , See APC Packaged Rates , See APC Packaged Rates , $2.74 , $2.74 , See APC Packaged Rates , See APC Packaged Rates , $3.79 , $3.79 , $3.79 , $3.79 , See APC Packaged Rates , $1.43 , $2.45 , $1.43 , $3.95 , $2.86
,5710010257,Hospital Chargemaster,Barium Sulfate 450mL Oral Prep,Outpatient,Outpatient Default Percent / Case Rate,259, $11.48 , $6.31 , $9.18 , See APC Packaged Rates , $8.04 , $4.48 , $11.08 , $11.13 , $5.91 , See APC Packaged Rates , See APC Packaged Rates , $7.70 , $7.70 , See APC Packaged Rates , See APC Packaged Rates , $10.68 , $10.68 , $10.68 , $10.68 , See APC Packaged Rates , $4.02 , $6.89 , $4.02 , $11.13 , $8.04
,5710010259,Hospital Chargemaster,Beclomethasone Dip 40 mcg Inh,Outpatient,Outpatient Default Percent / Case Rate,259, $589.90 , $324.45 , $471.92 , See APC Packaged Rates , $412.93 , $230.06 , $569.19 , $571.67 , $303.81 , See APC Packaged Rates , See APC Packaged Rates , $395.82 , $395.82 , See APC Packaged Rates , See APC Packaged Rates , $548.61 , $548.61 , $548.61 , $548.61 , See APC Packaged Rates , $206.47 , $353.94 , $206.47 , $571.67 , $412.93
,5710010260,Hospital Chargemaster,Beclomethasone Dip 80 mcg Inh,Outpatient,Outpatient Default Percent / Case Rate,259, $794.20 , $436.81 , $635.36 , See APC Packaged Rates , $555.94 , $309.74 , $766.32 , $769.66 , $409.03 , See APC Packaged Rates , See APC Packaged Rates , $532.91 , $532.91 , See APC Packaged Rates , See APC Packaged Rates , $738.61 , $738.61 , $738.61 , $738.61 , See APC Packaged Rates , $277.97 , $476.52 , $277.97 , $769.66 , $555.94
,5710010267,Hospital Chargemaster,Benzocaine 20% 0.5 mL Spray,Outpatient,Outpatient Default Percent / Case Rate,259, $32.61 , $17.94 , $26.09 , See APC Packaged Rates , $22.83 , $12.72 , $31.47 , $31.60 , $16.79 , See APC Packaged Rates , See APC Packaged Rates , $21.88 , $21.88 , See APC Packaged Rates , See APC Packaged Rates , $30.33 , $30.33 , $30.33 , $30.33 , See APC Packaged Rates , $11.41 , $19.57 , $11.41 , $31.60 , $22.83
,5710010269,Hospital Chargemaster,Benzocaine 20% 9 gm Gel,Outpatient,Outpatient Default Percent / Case Rate,259, $2.01 , $1.11 , $1.61 , See APC Packaged Rates , $1.41 , $0.78 , $1.94 , $1.95 , $1.04 , See APC Packaged Rates , See APC Packaged Rates , $1.35 , $1.35 , See APC Packaged Rates , See APC Packaged Rates , $1.87 , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , $0.70 , $1.21 , $0.70 , $1.95 , $1.41
,5710010272,Hospital Chargemaster,Benzocaine/Menthol S/F LOZENGE,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010273,Hospital Chargemaster,Benzocaine/Menthol 56 gm AERO,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010275,Hospital Chargemaster,Benzonatate 100 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $6.38 , $3.51 , $5.10 , See APC Packaged Rates , $4.47 , $2.49 , $6.16 , $6.18 , $3.29 , See APC Packaged Rates , See APC Packaged Rates , $4.28 , $4.28 , See APC Packaged Rates , See APC Packaged Rates , $5.93 , $5.93 , $5.93 , $5.93 , See APC Packaged Rates , $2.23 , $3.83 , $2.23 , $6.18 , $4.47
,5710010277,Hospital Chargemaster,Benztropine 0.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010278,Hospital Chargemaster,Benztropine 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.05 , $0.58 , $0.84 , See APC Packaged Rates , $0.74 , $0.41 , $1.01 , $1.02 , $0.54 , See APC Packaged Rates , See APC Packaged Rates , $0.70 , $0.70 , See APC Packaged Rates , See APC Packaged Rates , $0.98 , $0.98 , $0.98 , $0.98 , See APC Packaged Rates , $0.37 , $0.63 , $0.37 , $1.02 , $0.74
,5710010285,Hospital Chargemaster,Bethanechol 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.81 , $3.75 , $5.45 , See APC Packaged Rates , $4.77 , $2.66 , $6.57 , $6.60 , $3.51 , See APC Packaged Rates , See APC Packaged Rates , $4.57 , $4.57 , See APC Packaged Rates , See APC Packaged Rates , $6.33 , $6.33 , $6.33 , $6.33 , See APC Packaged Rates , $2.38 , $4.09 , $2.38 , $6.60 , $4.77
,5710010288,Hospital Chargemaster,Bicalutamide 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $47.25 , $25.99 , $37.80 , See APC Packaged Rates , $33.08 , $18.43 , $45.59 , $45.79 , $24.33 , See APC Packaged Rates , See APC Packaged Rates , $31.70 , $31.70 , See APC Packaged Rates , See APC Packaged Rates , $43.94 , $43.94 , $43.94 , $43.94 , See APC Packaged Rates , $16.54 , $28.35 , $16.54 , $45.79 , $33.08
,5710010290,Hospital Chargemaster,Bimatoprost 0.01% 2.5 mL Drop,Outpatient,Outpatient Default Percent / Case Rate,259, $220.61 , $121.34 , $176.49 , See APC Packaged Rates , $154.43 , $86.04 , $212.87 , $213.79 , $113.62 , See APC Packaged Rates , See APC Packaged Rates , $148.03 , $148.03 , See APC Packaged Rates , See APC Packaged Rates , $205.17 , $205.17 , $205.17 , $205.17 , See APC Packaged Rates , $77.21 , $132.37 , $77.21 , $213.79 , $154.43
,5710010292,Hospital Chargemaster,Bisacodyl 10 mg Supp,Outpatient,Outpatient Default Percent / Case Rate,259, $3.73 , $2.05 , $2.98 , See APC Packaged Rates , $2.61 , $1.45 , $3.60 , $3.61 , $1.92 , See APC Packaged Rates , See APC Packaged Rates , $2.50 , $2.50 , See APC Packaged Rates , See APC Packaged Rates , $3.47 , $3.47 , $3.47 , $3.47 , See APC Packaged Rates , $1.31 , $2.24 , $1.31 , $3.61 , $2.61
,5710010293,Hospital Chargemaster,Bisacodyl 5 mg Tablet DR,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010294,Hospital Chargemaster,Bismuth Sub 262 mg/15 mL Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $2.01 , $1.11 , $1.61 , See APC Packaged Rates , $1.41 , $0.78 , $1.94 , $1.95 , $1.04 , See APC Packaged Rates , See APC Packaged Rates , $1.35 , $1.35 , See APC Packaged Rates , See APC Packaged Rates , $1.87 , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , $0.70 , $1.21 , $0.70 , $1.95 , $1.41
,5710010296,Hospital Chargemaster,Bismuth Sub 262 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010307,Hospital Chargemaster,Brimonidine 0.2 % 5 mL Drops,Outpatient,Outpatient Default Percent / Case Rate,259, $9.26 , $5.09 , $7.41 , See APC Packaged Rates , $6.48 , $3.61 , $8.93 , $8.97 , $4.77 , See APC Packaged Rates , See APC Packaged Rates , $6.21 , $6.21 , See APC Packaged Rates , See APC Packaged Rates , $8.61 , $8.61 , $8.61 , $8.61 , See APC Packaged Rates , $3.24 , $5.56 , $3.24 , $8.97 , $6.48
,5710010308,Hospital Chargemaster,Brinzolamide 1% 10 mL Drops,Outpatient,Outpatient Default Percent / Case Rate,259, $86.38 , $47.51 , $69.10 , See APC Packaged Rates , $60.47 , $33.69 , $83.35 , $83.71 , $44.49 , See APC Packaged Rates , See APC Packaged Rates , $57.96 , $57.96 , See APC Packaged Rates , See APC Packaged Rates , $80.33 , $80.33 , $80.33 , $80.33 , See APC Packaged Rates , $30.23 , $51.83 , $30.23 , $83.71 , $60.47
,5710010312,Hospital Chargemaster,Budesonide 0.25 mg/2 mL Neb,Outpatient,Outpatient Default Percent / Case Rate,259, $22.24 , $12.23 , $17.79 , See APC Packaged Rates , $15.57 , $8.67 , $21.46 , $21.55 , $11.45 , See APC Packaged Rates , See APC Packaged Rates , $14.92 , $14.92 , See APC Packaged Rates , See APC Packaged Rates , $20.68 , $20.68 , $20.68 , $20.68 , See APC Packaged Rates , $7.78 , $13.34 , $7.78 , $21.55 , $15.57
,5710010313,Hospital Chargemaster,Budesonide 0.5 mg/2 mL Neb,Outpatient,Outpatient Default Percent / Case Rate,259, $25.44 , $13.99 , $20.35 , See APC Packaged Rates , $17.81 , $9.92 , $24.55 , $24.65 , $13.10 , See APC Packaged Rates , See APC Packaged Rates , $17.07 , $17.07 , See APC Packaged Rates , See APC Packaged Rates , $23.66 , $23.66 , $23.66 , $23.66 , See APC Packaged Rates , $8.90 , $15.26 , $8.90 , $24.65 , $17.81
,5710010315,Hospital Chargemaster,Budesonide/Formote 80/4.5 Inh,Outpatient,Outpatient Default Percent / Case Rate,259, $77.78 , $42.78 , $62.22 , See APC Packaged Rates , $54.45 , $30.33 , $75.05 , $75.38 , $40.06 , See APC Packaged Rates , See APC Packaged Rates , $52.19 , $52.19 , See APC Packaged Rates , See APC Packaged Rates , $72.34 , $72.34 , $72.34 , $72.34 , See APC Packaged Rates , $27.22 , $46.67 , $27.22 , $75.38 , $54.45
,5710010316,Hospital Chargemaster,Budesonide/Formote 160/4.5 Inh,Outpatient,Outpatient Default Percent / Case Rate,259, $105.54 , $58.05 , $84.43 , See APC Packaged Rates , $73.88 , $41.16 , $101.84 , $102.28 , $54.36 , See APC Packaged Rates , See APC Packaged Rates , $70.82 , $70.82 , See APC Packaged Rates , See APC Packaged Rates , $98.15 , $98.15 , $98.15 , $98.15 , See APC Packaged Rates , $36.94 , $63.32 , $36.94 , $102.28 , $73.88
,5710010317,Hospital Chargemaster,Bumetanide 0.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.75 , $1.51 , $2.20 , See APC Packaged Rates , $1.93 , $1.07 , $2.65 , $2.67 , $1.42 , See APC Packaged Rates , See APC Packaged Rates , $1.85 , $1.85 , See APC Packaged Rates , See APC Packaged Rates , $2.56 , $2.56 , $2.56 , $2.56 , See APC Packaged Rates , $0.96 , $1.65 , $0.96 , $2.67 , $1.93
,5710010318,Hospital Chargemaster,Bumetanide 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.78 , $1.53 , $2.22 , See APC Packaged Rates , $1.95 , $1.08 , $2.68 , $2.69 , $1.43 , See APC Packaged Rates , See APC Packaged Rates , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $2.59 , $2.59 , $2.59 , $2.59 , See APC Packaged Rates , $0.97 , $1.67 , $0.97 , $2.69 , $1.95
J0571,5710010344,Hospital Chargemaster,Buprenorphine 2 mg Tab SL,Outpatient,Outpatient Default Percent / Case Rate,259, $11.55 , $0.38 , $4.62 , See APC Packaged Rates , $8.09 , $4.50 , $0.43 , $0.43 , $0.43 , See APC Packaged Rates , See APC Packaged Rates , $7.75 , $7.75 , See APC Packaged Rates , See APC Packaged Rates , $10.74 , $10.74 , $10.74 , $10.74 , See APC Packaged Rates , $4.04 , $1.59 , $0.38 , $10.74 , $8.09
J0571,5710010345,Hospital Chargemaster,Buprenorphine 8 mg Tab SL,Outpatient,Outpatient Default Percent / Case Rate,259, $21.62 , $0.38 , $8.65 , See APC Packaged Rates , $15.13 , $8.43 , $0.43 , $0.43 , $0.43 , See APC Packaged Rates , See APC Packaged Rates , $14.51 , $14.51 , See APC Packaged Rates , See APC Packaged Rates , $20.11 , $20.11 , $20.11 , $20.11 , See APC Packaged Rates , $7.57 , $1.59 , $0.38 , $20.11 , $15.13
J0573,5710010349,Hospital Chargemaster,Buprenorp/Nalox 4/1 mg Film,Outpatient,Outpatient Default Percent / Case Rate,259, $22.90 , $7.91 , $9.16 , See APC Packaged Rates , $16.03 , $8.93 , $8.84 , $8.84 , $8.84 , See APC Packaged Rates , See APC Packaged Rates , $15.37 , $15.37 , See APC Packaged Rates , See APC Packaged Rates , $21.30 , $21.30 , $21.30 , $21.30 , See APC Packaged Rates , $8.02 , $11.29 , $7.91 , $21.30 , $16.03
,5710010352,Hospital Chargemaster,buPROPion 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.69 , $1.48 , $2.15 , See APC Packaged Rates , $1.88 , $1.05 , $2.60 , $2.61 , $1.39 , See APC Packaged Rates , See APC Packaged Rates , $1.80 , $1.80 , See APC Packaged Rates , See APC Packaged Rates , $2.50 , $2.50 , $2.50 , $2.50 , See APC Packaged Rates , $0.94 , $1.61 , $0.94 , $2.61 , $1.88
,5710010353,Hospital Chargemaster,buPROPion 75 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.82 , $2.10 , $3.06 , See APC Packaged Rates , $2.67 , $1.49 , $3.69 , $3.70 , $1.97 , See APC Packaged Rates , See APC Packaged Rates , $2.56 , $2.56 , See APC Packaged Rates , See APC Packaged Rates , $3.55 , $3.55 , $3.55 , $3.55 , See APC Packaged Rates , $1.34 , $2.29 , $1.34 , $3.70 , $2.67
,5710010354,Hospital Chargemaster,buPROPion SR 100 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $4.21 , $2.32 , $3.37 , See APC Packaged Rates , $2.95 , $1.64 , $4.06 , $4.08 , $2.17 , See APC Packaged Rates , See APC Packaged Rates , $2.82 , $2.82 , See APC Packaged Rates , See APC Packaged Rates , $3.92 , $3.92 , $3.92 , $3.92 , See APC Packaged Rates , $1.47 , $2.53 , $1.47 , $4.08 , $2.95
,5710010355,Hospital Chargemaster,buPROPion SR 150 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $4.81 , $2.65 , $3.85 , See APC Packaged Rates , $3.37 , $1.88 , $4.64 , $4.66 , $2.48 , See APC Packaged Rates , See APC Packaged Rates , $3.23 , $3.23 , See APC Packaged Rates , See APC Packaged Rates , $4.47 , $4.47 , $4.47 , $4.47 , See APC Packaged Rates , $1.68 , $2.89 , $1.68 , $4.66 , $3.37
,5710010356,Hospital Chargemaster,buPROPion XL 150 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $11.83 , $6.51 , $9.46 , See APC Packaged Rates , $8.28 , $4.61 , $11.41 , $11.46 , $6.09 , See APC Packaged Rates , See APC Packaged Rates , $7.94 , $7.94 , See APC Packaged Rates , See APC Packaged Rates , $11.00 , $11.00 , $11.00 , $11.00 , See APC Packaged Rates , $4.14 , $7.10 , $4.14 , $11.46 , $8.28
,5710010358,Hospital Chargemaster,busPIRone 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.44 , $1.89 , $2.75 , See APC Packaged Rates , $2.41 , $1.34 , $3.32 , $3.33 , $1.77 , See APC Packaged Rates , See APC Packaged Rates , $2.31 , $2.31 , See APC Packaged Rates , See APC Packaged Rates , $3.20 , $3.20 , $3.20 , $3.20 , See APC Packaged Rates , $1.20 , $2.06 , $1.20 , $3.33 , $2.41
,5710010359,Hospital Chargemaster,busPIRone 15 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.82 , $2.65 , $3.86 , See APC Packaged Rates , $3.37 , $1.88 , $4.65 , $4.67 , $2.48 , See APC Packaged Rates , See APC Packaged Rates , $3.23 , $3.23 , See APC Packaged Rates , See APC Packaged Rates , $4.48 , $4.48 , $4.48 , $4.48 , See APC Packaged Rates , $1.69 , $2.89 , $1.69 , $4.67 , $3.37
,5710010360,Hospital Chargemaster,busPIRone 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.81 , $1.00 , $1.45 , See APC Packaged Rates , $1.27 , $0.71 , $1.75 , $1.75 , $0.93 , See APC Packaged Rates , See APC Packaged Rates , $1.21 , $1.21 , See APC Packaged Rates , See APC Packaged Rates , $1.68 , $1.68 , $1.68 , $1.68 , See APC Packaged Rates , $0.63 , $1.09 , $0.63 , $1.75 , $1.27
,5710010362,Hospital Chargemaster,Butal/Apap/Caff 50/325/40 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $3.43 , $1.89 , $2.74 , See APC Packaged Rates , $2.40 , $1.34 , $3.31 , $3.32 , $1.77 , See APC Packaged Rates , See APC Packaged Rates , $2.30 , $2.30 , See APC Packaged Rates , See APC Packaged Rates , $3.19 , $3.19 , $3.19 , $3.19 , See APC Packaged Rates , $1.20 , $2.06 , $1.20 , $3.32 , $2.40
,5710010371,Hospital Chargemaster,Calamine/Zinc Ox 177 mL Lotion,Outpatient,Outpatient Default Percent / Case Rate,259, $1.40 , $0.77 , $1.12 , See APC Packaged Rates , $0.98 , $0.55 , $1.35 , $1.36 , $0.72 , See APC Packaged Rates , See APC Packaged Rates , $0.94 , $0.94 , See APC Packaged Rates , See APC Packaged Rates , $1.30 , $1.30 , $1.30 , $1.30 , See APC Packaged Rates , $0.49 , $0.84 , $0.49 , $1.36 , $0.98
,5710010373,Hospital Chargemaster,Calcitonin Nasal 3.7 mL Spray,Outpatient,Outpatient Default Percent / Case Rate,259," $4,473.23 "," $2,460.28 "," $3,578.58 ", See APC Packaged Rates ," $3,131.26 "," $1,744.56 "," $4,316.22 "," $4,335.01 "," $2,303.80 ", See APC Packaged Rates , See APC Packaged Rates ," $3,001.54 "," $3,001.54 ", See APC Packaged Rates , See APC Packaged Rates ," $4,160.10 "," $4,160.10 "," $4,160.10 "," $4,160.10 ", See APC Packaged Rates ," $1,565.63 "," $2,683.94 "," $1,565.63 "," $4,335.01 "," $3,131.26 "
,5710010376,Hospital Chargemaster,Calcitriol 0.25 mcg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $2.89 , $1.59 , $2.31 , See APC Packaged Rates , $2.02 , $1.13 , $2.79 , $2.80 , $1.49 , See APC Packaged Rates , See APC Packaged Rates , $1.94 , $1.94 , See APC Packaged Rates , See APC Packaged Rates , $2.69 , $2.69 , $2.69 , $2.69 , See APC Packaged Rates , $1.01 , $1.73 , $1.01 , $2.80 , $2.02
,5710010378,Hospital Chargemaster,Calcium Acetate 667 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $2.63 , $1.45 , $2.10 , See APC Packaged Rates , $1.84 , $1.03 , $2.54 , $2.55 , $1.35 , See APC Packaged Rates , See APC Packaged Rates , $1.76 , $1.76 , See APC Packaged Rates , See APC Packaged Rates , $2.45 , $2.45 , $2.45 , $2.45 , See APC Packaged Rates , $0.92 , $1.58 , $0.92 , $2.55 , $1.84
,5710010379,Hospital Chargemaster,Calcium Carb 500 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $0.98 , $0.54 , $0.78 , See APC Packaged Rates , $0.69 , $0.38 , $0.95 , $0.95 , $0.50 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.91 , $0.91 , $0.91 , $0.91 , See APC Packaged Rates , $0.34 , $0.59 , $0.34 , $0.95 , $0.69
,5710010381,Hospital Chargemaster,Calcium/Vit D 600/400 Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $0.98 , $0.54 , $0.78 , See APC Packaged Rates , $0.69 , $0.38 , $0.95 , $0.95 , $0.50 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.91 , $0.91 , $0.91 , $0.91 , See APC Packaged Rates , $0.34 , $0.59 , $0.34 , $0.95 , $0.69
,5710010392,Hospital Chargemaster,Captopril 12.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.39 , $2.41 , $3.51 , See APC Packaged Rates , $3.07 , $1.71 , $4.24 , $4.25 , $2.26 , See APC Packaged Rates , See APC Packaged Rates , $2.95 , $2.95 , See APC Packaged Rates , See APC Packaged Rates , $4.08 , $4.08 , $4.08 , $4.08 , See APC Packaged Rates , $1.54 , $2.63 , $1.54 , $4.25 , $3.07
,5710010393,Hospital Chargemaster,Captopril 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.75 , $2.61 , $3.80 , See APC Packaged Rates , $3.33 , $1.85 , $4.58 , $4.60 , $2.45 , See APC Packaged Rates , See APC Packaged Rates , $3.19 , $3.19 , See APC Packaged Rates , See APC Packaged Rates , $4.42 , $4.42 , $4.42 , $4.42 , See APC Packaged Rates , $1.66 , $2.85 , $1.66 , $4.60 , $3.33
,5710010395,Hospital Chargemaster,carBAMazepine 100 mg Tab Chew,Outpatient,Outpatient Default Percent / Case Rate,259, $1.30 , $0.72 , $1.04 , See APC Packaged Rates , $0.91 , $0.51 , $1.25 , $1.26 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.87 , $0.87 , See APC Packaged Rates , See APC Packaged Rates , $1.21 , $1.21 , $1.21 , $1.21 , See APC Packaged Rates , $0.46 , $0.78 , $0.46 , $1.26 , $0.91
,5710010396,Hospital Chargemaster,carBAMazepine 200 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.30 , $1.27 , $1.84 , See APC Packaged Rates , $1.61 , $0.90 , $2.22 , $2.23 , $1.18 , See APC Packaged Rates , See APC Packaged Rates , $1.54 , $1.54 , See APC Packaged Rates , See APC Packaged Rates , $2.14 , $2.14 , $2.14 , $2.14 , See APC Packaged Rates , $0.81 , $1.38 , $0.81 , $2.23 , $1.61
,5710010400,Hospital Chargemaster,carBAMazepine ER 200mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $10.30 , $5.67 , $8.24 , See APC Packaged Rates , $7.21 , $4.02 , $9.94 , $9.98 , $5.30 , See APC Packaged Rates , See APC Packaged Rates , $6.91 , $6.91 , See APC Packaged Rates , See APC Packaged Rates , $9.58 , $9.58 , $9.58 , $9.58 , See APC Packaged Rates , $3.61 , $6.18 , $3.61 , $9.98 , $7.21
,5710010402,Hospital Chargemaster,Carbamide Perox 6.5% Ear 15mL,Outpatient,Outpatient Default Percent / Case Rate,259, $1.35 , $0.74 , $1.08 , See APC Packaged Rates , $0.95 , $0.53 , $1.30 , $1.31 , $0.70 , See APC Packaged Rates , See APC Packaged Rates , $0.91 , $0.91 , See APC Packaged Rates , See APC Packaged Rates , $1.26 , $1.26 , $1.26 , $1.26 , See APC Packaged Rates , $0.47 , $0.81 , $0.47 , $1.31 , $0.95
,5710010404,Hospital Chargemaster,Carbidopa/Levodopa 25/100 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $2.09 , $1.15 , $1.67 , See APC Packaged Rates , $1.46 , $0.82 , $2.02 , $2.03 , $1.08 , See APC Packaged Rates , See APC Packaged Rates , $1.40 , $1.40 , See APC Packaged Rates , See APC Packaged Rates , $1.94 , $1.94 , $1.94 , $1.94 , See APC Packaged Rates , $0.73 , $1.25 , $0.73 , $2.03 , $1.46
,5710010405,Hospital Chargemaster,Carbidopa/Levodopa 25/250 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $2.42 , $1.33 , $1.94 , See APC Packaged Rates , $1.69 , $0.94 , $2.34 , $2.35 , $1.25 , See APC Packaged Rates , See APC Packaged Rates , $1.62 , $1.62 , See APC Packaged Rates , See APC Packaged Rates , $2.25 , $2.25 , $2.25 , $2.25 , See APC Packaged Rates , $0.85 , $1.45 , $0.85 , $2.35 , $1.69
,5710010406,Hospital Chargemaster,Carbidopa/Levodopa CR 25/100,Outpatient,Outpatient Default Percent / Case Rate,259, $2.52 , $1.39 , $2.02 , See APC Packaged Rates , $1.76 , $0.98 , $2.43 , $2.44 , $1.30 , See APC Packaged Rates , See APC Packaged Rates , $1.69 , $1.69 , See APC Packaged Rates , See APC Packaged Rates , $2.34 , $2.34 , $2.34 , $2.34 , See APC Packaged Rates , $0.88 , $1.51 , $0.88 , $2.44 , $1.76
,5710010407,Hospital Chargemaster,Carbidopa/Levodopa CR 50/200,Outpatient,Outpatient Default Percent / Case Rate,259, $4.03 , $2.22 , $3.22 , See APC Packaged Rates , $2.82 , $1.57 , $3.89 , $3.91 , $2.08 , See APC Packaged Rates , See APC Packaged Rates , $2.70 , $2.70 , See APC Packaged Rates , See APC Packaged Rates , $3.75 , $3.75 , $3.75 , $3.75 , See APC Packaged Rates , $1.41 , $2.42 , $1.41 , $3.91 , $2.82
,5710010412,Hospital Chargemaster,Carboxymethycell 0.4 mL Drop,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010418,Hospital Chargemaster,Carvedilol 12.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010420,Hospital Chargemaster,Carvedilol 3.125 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.16 , $2.84 , $4.13 , See APC Packaged Rates , $3.61 , $2.01 , $4.98 , $5.00 , $2.66 , See APC Packaged Rates , See APC Packaged Rates , $3.46 , $3.46 , See APC Packaged Rates , See APC Packaged Rates , $4.80 , $4.80 , $4.80 , $4.80 , See APC Packaged Rates , $1.81 , $3.10 , $1.81 , $5.00 , $3.61
,5710010435,Hospital Chargemaster,Cefdinir 1500 mg/60 mL Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $130.05 , $71.53 , $104.04 , See APC Packaged Rates , $91.04 , $50.72 , $125.49 , $126.03 , $66.98 , See APC Packaged Rates , See APC Packaged Rates , $87.26 , $87.26 , See APC Packaged Rates , See APC Packaged Rates , $120.95 , $120.95 , $120.95 , $120.95 , See APC Packaged Rates , $45.52 , $78.03 , $45.52 , $126.03 , $91.04
,5710010452,Hospital Chargemaster,Cefpodoxime 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $16.99 , $9.34 , $13.59 , See APC Packaged Rates , $11.89 , $6.63 , $16.39 , $16.47 , $8.75 , See APC Packaged Rates , See APC Packaged Rates , $11.40 , $11.40 , See APC Packaged Rates , See APC Packaged Rates , $15.80 , $15.80 , $15.80 , $15.80 , See APC Packaged Rates , $5.95 , $10.19 , $5.95 , $16.47 , $11.89
,5710010471,Hospital Chargemaster,cefUROXime axetil 250 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $11.22 , $6.17 , $8.98 , See APC Packaged Rates , $7.85 , $4.38 , $10.83 , $10.87 , $5.78 , See APC Packaged Rates , See APC Packaged Rates , $7.53 , $7.53 , See APC Packaged Rates , See APC Packaged Rates , $10.43 , $10.43 , $10.43 , $10.43 , See APC Packaged Rates , $3.93 , $6.73 , $3.93 , $10.87 , $7.85
,5710010474,Hospital Chargemaster,Celecoxib 100 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $3.09 , $1.70 , $2.47 , See APC Packaged Rates , $2.16 , $1.21 , $2.98 , $2.99 , $1.59 , See APC Packaged Rates , See APC Packaged Rates , $2.07 , $2.07 , See APC Packaged Rates , See APC Packaged Rates , $2.87 , $2.87 , $2.87 , $2.87 , See APC Packaged Rates , $1.08 , $1.85 , $1.08 , $2.99 , $2.16
,5710010475,Hospital Chargemaster,Celecoxib 200 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $19.17 , $10.54 , $15.34 , See APC Packaged Rates , $13.42 , $7.48 , $18.50 , $18.58 , $9.87 , See APC Packaged Rates , See APC Packaged Rates , $12.86 , $12.86 , See APC Packaged Rates , See APC Packaged Rates , $17.83 , $17.83 , $17.83 , $17.83 , See APC Packaged Rates , $6.71 , $11.50 , $6.71 , $18.58 , $13.42
,5710010477,Hospital Chargemaster,cephALEXin 250 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $6.28 , $3.45 , $5.02 , See APC Packaged Rates , $4.40 , $2.45 , $6.06 , $6.09 , $3.23 , See APC Packaged Rates , See APC Packaged Rates , $4.21 , $4.21 , See APC Packaged Rates , See APC Packaged Rates , $5.84 , $5.84 , $5.84 , $5.84 , See APC Packaged Rates , $2.20 , $3.77 , $2.20 , $6.09 , $4.40
,5710010478,Hospital Chargemaster,cephALEXin 500 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $3.46 , $1.90 , $2.77 , See APC Packaged Rates , $2.42 , $1.35 , $3.34 , $3.35 , $1.78 , See APC Packaged Rates , See APC Packaged Rates , $2.32 , $2.32 , See APC Packaged Rates , See APC Packaged Rates , $3.22 , $3.22 , $3.22 , $3.22 , See APC Packaged Rates , $1.21 , $2.08 , $1.21 , $3.35 , $2.42
,5710010479,Hospital Chargemaster,cephALEXin 2500 mg/100 mL Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $60.56 , $33.31 , $48.45 , See APC Packaged Rates , $42.39 , $23.62 , $58.43 , $58.69 , $31.19 , See APC Packaged Rates , See APC Packaged Rates , $40.64 , $40.64 , See APC Packaged Rates , See APC Packaged Rates , $56.32 , $56.32 , $56.32 , $56.32 , See APC Packaged Rates , $21.20 , $36.34 , $21.20 , $58.69 , $42.39
,5710010481,Hospital Chargemaster,Cetirizine 5 mg/5 mL Solution,Outpatient,Outpatient Default Percent / Case Rate,259, $6.71 , $3.69 , $5.37 , See APC Packaged Rates , $4.70 , $2.62 , $6.47 , $6.50 , $3.46 , See APC Packaged Rates , See APC Packaged Rates , $4.50 , $4.50 , See APC Packaged Rates , See APC Packaged Rates , $6.24 , $6.24 , $6.24 , $6.24 , See APC Packaged Rates , $2.35 , $4.03 , $2.35 , $6.50 , $4.70
,5710010482,Hospital Chargemaster,Cetirizine 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.08 , $3.34 , $4.86 , See APC Packaged Rates , $4.26 , $2.37 , $5.87 , $5.89 , $3.13 , See APC Packaged Rates , See APC Packaged Rates , $4.08 , $4.08 , See APC Packaged Rates , See APC Packaged Rates , $5.65 , $5.65 , $5.65 , $5.65 , See APC Packaged Rates , $2.13 , $3.65 , $2.13 , $5.89 , $4.26
,5710010486,Hospital Chargemaster,Charcoal/Sorb 50 gm/240mL Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $60.31 , $33.17 , $48.25 , See APC Packaged Rates , $42.22 , $23.52 , $58.19 , $58.45 , $31.06 , See APC Packaged Rates , See APC Packaged Rates , $40.47 , $40.47 , See APC Packaged Rates , See APC Packaged Rates , $56.09 , $56.09 , $56.09 , $56.09 , See APC Packaged Rates , $21.11 , $36.19 , $21.11 , $58.45 , $42.22
,5710010491,Hospital Chargemaster,chlordiazePOXIDE 25 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.58 , $0.87 , $1.26 , See APC Packaged Rates , $1.11 , $0.62 , $1.52 , $1.53 , $0.81 , See APC Packaged Rates , See APC Packaged Rates , $1.06 , $1.06 , See APC Packaged Rates , See APC Packaged Rates , $1.47 , $1.47 , $1.47 , $1.47 , See APC Packaged Rates , $0.55 , $0.95 , $0.55 , $1.53 , $1.11
,5710010492,Hospital Chargemaster,chlordiazePOXIDE 5 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $2.07 , $1.14 , $1.66 , See APC Packaged Rates , $1.45 , $0.81 , $2.00 , $2.01 , $1.07 , See APC Packaged Rates , See APC Packaged Rates , $1.39 , $1.39 , See APC Packaged Rates , See APC Packaged Rates , $1.93 , $1.93 , $1.93 , $1.93 , See APC Packaged Rates , $0.72 , $1.24 , $0.72 , $2.01 , $1.45
,5710010503,Hospital Chargemaster,chlorproMAZINE 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $36.68 , $20.17 , $29.34 , See APC Packaged Rates , $25.68 , $14.31 , $35.39 , $35.55 , $18.89 , See APC Packaged Rates , See APC Packaged Rates , $24.61 , $24.61 , See APC Packaged Rates , See APC Packaged Rates , $34.11 , $34.11 , $34.11 , $34.11 , See APC Packaged Rates , $12.84 , $22.01 , $12.84 , $35.55 , $25.68
,5710010505,Hospital Chargemaster,chlorproMAZINE 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $19.48 , $10.71 , $15.58 , See APC Packaged Rates , $13.64 , $7.60 , $18.80 , $18.88 , $10.03 , See APC Packaged Rates , See APC Packaged Rates , $13.07 , $13.07 , See APC Packaged Rates , See APC Packaged Rates , $18.12 , $18.12 , $18.12 , $18.12 , See APC Packaged Rates , $6.82 , $11.69 , $6.82 , $18.88 , $13.64
,5710010506,Hospital Chargemaster,Chlorthalidone 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.87 , $3.23 , $4.70 , See APC Packaged Rates , $4.11 , $2.29 , $5.66 , $5.69 , $3.02 , See APC Packaged Rates , See APC Packaged Rates , $3.94 , $3.94 , See APC Packaged Rates , See APC Packaged Rates , $5.46 , $5.46 , $5.46 , $5.46 , See APC Packaged Rates , $2.05 , $3.52 , $2.05 , $5.69 , $4.11
,5710010507,Hospital Chargemaster,Cholecal (Vit D3) 5000Unit Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010508,Hospital Chargemaster,Cholecal (Vit D3) 400IU/mL,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010509,Hospital Chargemaster,Cholecal (Vit D3) 1000Unit Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $0.99 , $0.54 , $0.79 , See APC Packaged Rates , $0.69 , $0.39 , $0.96 , $0.96 , $0.51 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.92 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , $0.35 , $0.59 , $0.35 , $0.96 , $0.69
,5710010510,Hospital Chargemaster,Cholecal (Vit D3) 400 Unit Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $0.97 , $0.53 , $0.78 , See APC Packaged Rates , $0.68 , $0.38 , $0.94 , $0.94 , $0.50 , See APC Packaged Rates , See APC Packaged Rates , $0.65 , $0.65 , See APC Packaged Rates , See APC Packaged Rates , $0.90 , $0.90 , $0.90 , $0.90 , See APC Packaged Rates , $0.34 , $0.58 , $0.34 , $0.94 , $0.68
,5710010511,Hospital Chargemaster,Cholestyramine 4 gm Powder,Outpatient,Outpatient Default Percent / Case Rate,259, $8.29 , $4.56 , $6.63 , See APC Packaged Rates , $5.80 , $3.23 , $8.00 , $8.03 , $4.27 , See APC Packaged Rates , See APC Packaged Rates , $5.56 , $5.56 , See APC Packaged Rates , See APC Packaged Rates , $7.71 , $7.71 , $7.71 , $7.71 , See APC Packaged Rates , $2.90 , $4.97 , $2.90 , $8.03 , $5.80
,5710010516,Hospital Chargemaster,Cilostazol 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.64 , $2.55 , $3.71 , See APC Packaged Rates , $3.25 , $1.81 , $4.48 , $4.50 , $2.39 , See APC Packaged Rates , See APC Packaged Rates , $3.11 , $3.11 , See APC Packaged Rates , See APC Packaged Rates , $4.32 , $4.32 , $4.32 , $4.32 , See APC Packaged Rates , $1.62 , $2.78 , $1.62 , $4.50 , $3.25
,5710010520,Hospital Chargemaster,Ciprofloxacin 6% Otic 1 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,259, $722.16 , $397.19 , $577.73 , See APC Packaged Rates , $505.51 , $281.64 , $696.81 , $699.85 , $371.93 , See APC Packaged Rates , See APC Packaged Rates , $484.57 , $484.57 , See APC Packaged Rates , See APC Packaged Rates , $671.61 , $671.61 , $671.61 , $671.61 , See APC Packaged Rates , $252.76 , $433.30 , $252.76 , $699.85 , $505.51
,5710010522,Hospital Chargemaster,Ciprofloxacin 250 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $11.58 , $6.37 , $9.26 , See APC Packaged Rates , $8.11 , $4.52 , $11.17 , $11.22 , $5.96 , See APC Packaged Rates , See APC Packaged Rates , $7.77 , $7.77 , See APC Packaged Rates , See APC Packaged Rates , $10.77 , $10.77 , $10.77 , $10.77 , See APC Packaged Rates , $4.05 , $6.95 , $4.05 , $11.22 , $8.11
,5710010524,Hospital Chargemaster,Ciproflox 0.3% 3.5 gm Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $78.08 , $42.94 , $62.46 , See APC Packaged Rates , $54.66 , $30.45 , $75.34 , $75.67 , $40.21 , See APC Packaged Rates , See APC Packaged Rates , $52.39 , $52.39 , See APC Packaged Rates , See APC Packaged Rates , $72.61 , $72.61 , $72.61 , $72.61 , See APC Packaged Rates , $27.33 , $46.85 , $27.33 , $75.67 , $54.66
,5710010525,Hospital Chargemaster,Ciproflox 0.3% 5 mL Drops,Outpatient,Outpatient Default Percent / Case Rate,259, $61.66 , $33.91 , $49.33 , See APC Packaged Rates , $43.16 , $24.05 , $59.50 , $59.75 , $31.76 , See APC Packaged Rates , See APC Packaged Rates , $41.37 , $41.37 , See APC Packaged Rates , See APC Packaged Rates , $57.34 , $57.34 , $57.34 , $57.34 , See APC Packaged Rates , $21.58 , $37.00 , $21.58 , $59.75 , $43.16
,5710010529,Hospital Chargemaster,Ciproflox 0.2%/H-Cort1% Otic,Outpatient,Outpatient Default Percent / Case Rate,259, $80.55 , $44.30 , $64.44 , See APC Packaged Rates , $56.39 , $31.41 , $77.72 , $78.06 , $41.48 , See APC Packaged Rates , See APC Packaged Rates , $54.05 , $54.05 , See APC Packaged Rates , See APC Packaged Rates , $74.91 , $74.91 , $74.91 , $74.91 , See APC Packaged Rates , $28.19 , $48.33 , $28.19 , $78.06 , $56.39
,5710010534,Hospital Chargemaster,Citalopram 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.22 , $3.42 , $4.98 , See APC Packaged Rates , $4.35 , $2.43 , $6.00 , $6.03 , $3.20 , See APC Packaged Rates , See APC Packaged Rates , $4.17 , $4.17 , See APC Packaged Rates , See APC Packaged Rates , $5.78 , $5.78 , $5.78 , $5.78 , See APC Packaged Rates , $2.18 , $3.73 , $2.18 , $6.03 , $4.35
,5710010535,Hospital Chargemaster,Citalopram 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010539,Hospital Chargemaster,Citric Ac/Na Cit 3-2 gm 30 mL,Outpatient,Outpatient Default Percent / Case Rate,259, $10.86 , $5.97 , $8.69 , See APC Packaged Rates , $7.60 , $4.24 , $10.48 , $10.52 , $5.59 , See APC Packaged Rates , See APC Packaged Rates , $7.29 , $7.29 , See APC Packaged Rates , See APC Packaged Rates , $10.10 , $10.10 , $10.10 , $10.10 , See APC Packaged Rates , $3.80 , $6.52 , $3.80 , $10.52 , $7.60
,5710010544,Hospital Chargemaster,Clindamycin 150 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010558,Hospital Chargemaster,clonazePAM 0.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010559,Hospital Chargemaster,clonazePAM 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.16 , $1.19 , $1.73 , See APC Packaged Rates , $1.51 , $0.84 , $2.08 , $2.09 , $1.11 , See APC Packaged Rates , See APC Packaged Rates , $1.45 , $1.45 , See APC Packaged Rates , See APC Packaged Rates , $2.01 , $2.01 , $2.01 , $2.01 , See APC Packaged Rates , $0.76 , $1.30 , $0.76 , $2.09 , $1.51
,5710010560,Hospital Chargemaster,cloNIDine 0.1 mg/24 hr Patch,Outpatient,Outpatient Default Percent / Case Rate,259, $70.50 , $38.78 , $56.40 , See APC Packaged Rates , $49.35 , $27.50 , $68.03 , $68.32 , $36.31 , See APC Packaged Rates , See APC Packaged Rates , $47.31 , $47.31 , See APC Packaged Rates , See APC Packaged Rates , $65.57 , $65.57 , $65.57 , $65.57 , See APC Packaged Rates , $24.68 , $42.30 , $24.68 , $68.32 , $49.35
,5710010562,Hospital Chargemaster,cloNIDine 0.2 mg/24 hr Patch,Outpatient,Outpatient Default Percent / Case Rate,259, $142.21 , $78.22 , $113.77 , See APC Packaged Rates , $99.55 , $55.46 , $137.22 , $137.82 , $73.24 , See APC Packaged Rates , See APC Packaged Rates , $95.42 , $95.42 , See APC Packaged Rates , See APC Packaged Rates , $132.26 , $132.26 , $132.26 , $132.26 , See APC Packaged Rates , $49.77 , $85.33 , $49.77 , $137.82 , $99.55
,5710010564,Hospital Chargemaster,cloNIDine HCl 10 mcg/1 ml Oral,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010565,Hospital Chargemaster,cloNIDine HCl 0.2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010567,Hospital Chargemaster,Clopidogrel 300 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $33.89 , $18.64 , $27.11 , See APC Packaged Rates , $23.72 , $13.22 , $32.70 , $32.84 , $17.45 , See APC Packaged Rates , See APC Packaged Rates , $22.74 , $22.74 , See APC Packaged Rates , See APC Packaged Rates , $31.52 , $31.52 , $31.52 , $31.52 , See APC Packaged Rates , $11.86 , $20.33 , $11.86 , $32.84 , $23.72
,5710010568,Hospital Chargemaster,Clopidogrel 75 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010572,Hospital Chargemaster,Clotrim/Beta1%/0.05% 15gm Cr,Outpatient,Outpatient Default Percent / Case Rate,259, $2.86 , $1.57 , $2.29 , See APC Packaged Rates , $2.00 , $1.12 , $2.76 , $2.77 , $1.47 , See APC Packaged Rates , See APC Packaged Rates , $1.92 , $1.92 , See APC Packaged Rates , See APC Packaged Rates , $2.66 , $2.66 , $2.66 , $2.66 , See APC Packaged Rates , $1.00 , $1.72 , $1.00 , $2.77 , $2.00
,5710010574,Hospital Chargemaster,cloZAPine 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $8.41 , $4.63 , $6.73 , See APC Packaged Rates , $5.89 , $3.28 , $8.11 , $8.15 , $4.33 , See APC Packaged Rates , See APC Packaged Rates , $5.64 , $5.64 , See APC Packaged Rates , See APC Packaged Rates , $7.82 , $7.82 , $7.82 , $7.82 , See APC Packaged Rates , $2.94 , $5.05 , $2.94 , $8.15 , $5.89
,5710010575,Hospital Chargemaster,cloZAPine 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.31 , $1.82 , $2.65 , See APC Packaged Rates , $2.32 , $1.29 , $3.19 , $3.21 , $1.70 , See APC Packaged Rates , See APC Packaged Rates , $2.22 , $2.22 , See APC Packaged Rates , See APC Packaged Rates , $3.08 , $3.08 , $3.08 , $3.08 , See APC Packaged Rates , $1.16 , $1.99 , $1.16 , $3.21 , $2.32
,5710010582,Hospital Chargemaster,Cod Liver/Zinc Ox 60gm Paste,Outpatient,Outpatient Default Percent / Case Rate,259, $2.63 , $1.45 , $2.10 , See APC Packaged Rates , $1.84 , $1.03 , $2.54 , $2.55 , $1.35 , See APC Packaged Rates , See APC Packaged Rates , $1.76 , $1.76 , See APC Packaged Rates , See APC Packaged Rates , $2.45 , $2.45 , $2.45 , $2.45 , See APC Packaged Rates , $0.92 , $1.58 , $0.92 , $2.55 , $1.84
,5710010584,Hospital Chargemaster,guaiFEN/Cod 200/20/10mL Liq,Outpatient,Outpatient Default Percent / Case Rate,259, $1.89 , $1.04 , $1.51 , See APC Packaged Rates , $1.32 , $0.74 , $1.82 , $1.83 , $0.97 , See APC Packaged Rates , See APC Packaged Rates , $1.27 , $1.27 , See APC Packaged Rates , See APC Packaged Rates , $1.76 , $1.76 , $1.76 , $1.76 , See APC Packaged Rates , $0.66 , $1.13 , $0.66 , $1.83 , $1.32
,5710010587,Hospital Chargemaster,Colchicine 0.6 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $18.33 , $10.08 , $14.66 , See APC Packaged Rates , $12.83 , $7.15 , $17.69 , $17.76 , $9.44 , See APC Packaged Rates , See APC Packaged Rates , $12.30 , $12.30 , See APC Packaged Rates , See APC Packaged Rates , $17.05 , $17.05 , $17.05 , $17.05 , See APC Packaged Rates , $6.42 , $11.00 , $6.42 , $17.76 , $12.83
,5710010590,Hospital Chargemaster,Collagenase Clost Hist 30gm Oi,Outpatient,Outpatient Default Percent / Case Rate,259, $71.97 , $39.58 , $57.58 , See APC Packaged Rates , $50.38 , $28.07 , $69.44 , $69.75 , $37.07 , See APC Packaged Rates , See APC Packaged Rates , $48.29 , $48.29 , See APC Packaged Rates , See APC Packaged Rates , $66.93 , $66.93 , $66.93 , $66.93 , See APC Packaged Rates , $25.19 , $43.18 , $25.19 , $69.75 , $50.38
,5710010602,Hospital Chargemaster,Cyanocob (Vit B12) 100 mcg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010603,Hospital Chargemaster,Cyanocob (Vit B12) 250 mcg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010604,Hospital Chargemaster,Cyanocob (Vit B12) 500 mcg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $0.99 , $0.54 , $0.79 , See APC Packaged Rates , $0.69 , $0.39 , $0.96 , $0.96 , $0.51 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.92 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , $0.35 , $0.59 , $0.35 , $0.96 , $0.69
,5710010606,Hospital Chargemaster,Cyclobenzaprine 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.39 , $2.41 , $3.51 , See APC Packaged Rates , $3.07 , $1.71 , $4.24 , $4.25 , $2.26 , See APC Packaged Rates , See APC Packaged Rates , $2.95 , $2.95 , See APC Packaged Rates , See APC Packaged Rates , $4.08 , $4.08 , $4.08 , $4.08 , See APC Packaged Rates , $1.54 , $2.63 , $1.54 , $4.25 , $3.07
,5710010607,Hospital Chargemaster,Cyclobenzaprine 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.47 , $1.36 , $1.98 , See APC Packaged Rates , $1.73 , $0.96 , $2.38 , $2.39 , $1.27 , See APC Packaged Rates , See APC Packaged Rates , $1.66 , $1.66 , See APC Packaged Rates , See APC Packaged Rates , $2.30 , $2.30 , $2.30 , $2.30 , See APC Packaged Rates , $0.86 , $1.48 , $0.86 , $2.39 , $1.73
,5710010618,Hospital Chargemaster,cycloSPORINE 0.05% 0.4mL Drops,Outpatient,Outpatient Default Percent / Case Rate,259, $25.92 , $14.26 , $20.74 , See APC Packaged Rates , $18.14 , $10.11 , $25.01 , $25.12 , $13.35 , See APC Packaged Rates , See APC Packaged Rates , $17.39 , $17.39 , See APC Packaged Rates , See APC Packaged Rates , $24.11 , $24.11 , $24.11 , $24.11 , See APC Packaged Rates , $9.07 , $15.55 , $9.07 , $25.12 , $18.14
,5710010624,Hospital Chargemaster,Dabigatran 75 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $19.97 , $10.98 , $15.98 , See APC Packaged Rates , $13.98 , $7.79 , $19.27 , $19.35 , $10.28 , See APC Packaged Rates , See APC Packaged Rates , $13.40 , $13.40 , See APC Packaged Rates , See APC Packaged Rates , $18.57 , $18.57 , $18.57 , $18.57 , See APC Packaged Rates , $6.99 , $11.98 , $6.99 , $19.35 , $13.98
,5710010631,Hospital Chargemaster,Dantrolene 25 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $4.95 , $2.72 , $3.96 , See APC Packaged Rates , $3.47 , $1.93 , $4.78 , $4.80 , $2.55 , See APC Packaged Rates , See APC Packaged Rates , $3.32 , $3.32 , See APC Packaged Rates , See APC Packaged Rates , $4.60 , $4.60 , $4.60 , $4.60 , See APC Packaged Rates , $1.73 , $2.97 , $1.73 , $4.80 , $3.47
,5710010653,Hospital Chargemaster,Desmopressin 0.2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $19.43 , $10.69 , $15.54 , See APC Packaged Rates , $13.60 , $7.58 , $18.75 , $18.83 , $10.01 , See APC Packaged Rates , See APC Packaged Rates , $13.04 , $13.04 , See APC Packaged Rates , See APC Packaged Rates , $18.07 , $18.07 , $18.07 , $18.07 , See APC Packaged Rates , $6.80 , $11.66 , $6.80 , $18.83 , $13.60
,5710010682,Hospital Chargemaster,Glucose 15 gm Gel,Outpatient,Outpatient Default Percent / Case Rate,259, $4.03 , $2.22 , $3.22 , See APC Packaged Rates , $2.82 , $1.57 , $3.89 , $3.91 , $2.08 , See APC Packaged Rates , See APC Packaged Rates , $2.70 , $2.70 , See APC Packaged Rates , See APC Packaged Rates , $3.75 , $3.75 , $3.75 , $3.75 , See APC Packaged Rates , $1.41 , $2.42 , $1.41 , $3.91 , $2.82
,5710010725,Hospital Chargemaster,diazePAM 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010726,Hospital Chargemaster,diazePAM 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010730,Hospital Chargemaster,Diclofenac 1% 100 gm Gel,Outpatient,Outpatient Default Percent / Case Rate,259, $41.20 , $22.66 , $32.96 , See APC Packaged Rates , $28.84 , $16.07 , $39.75 , $39.93 , $21.22 , See APC Packaged Rates , See APC Packaged Rates , $27.65 , $27.65 , See APC Packaged Rates , See APC Packaged Rates , $38.32 , $38.32 , $38.32 , $38.32 , See APC Packaged Rates , $14.42 , $24.72 , $14.42 , $39.93 , $28.84
,5710010731,Hospital Chargemaster,Diclofenac Sod DR 75 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.67 , $2.02 , $2.94 , See APC Packaged Rates , $2.57 , $1.43 , $3.54 , $3.56 , $1.89 , See APC Packaged Rates , See APC Packaged Rates , $2.46 , $2.46 , See APC Packaged Rates , See APC Packaged Rates , $3.41 , $3.41 , $3.41 , $3.41 , See APC Packaged Rates , $1.28 , $2.20 , $1.28 , $3.56 , $2.57
,5710010735,Hospital Chargemaster,Dicyclomine 10 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.53 , $0.84 , $1.22 , See APC Packaged Rates , $1.07 , $0.60 , $1.48 , $1.48 , $0.79 , See APC Packaged Rates , See APC Packaged Rates , $1.03 , $1.03 , See APC Packaged Rates , See APC Packaged Rates , $1.42 , $1.42 , $1.42 , $1.42 , See APC Packaged Rates , $0.54 , $0.92 , $0.54 , $1.48 , $1.07
,5710010742,Hospital Chargemaster,Digoxin 0.125 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010743,Hospital Chargemaster,Digoxin 0.25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.19 , $1.75 , $2.55 , See APC Packaged Rates , $2.23 , $1.24 , $3.08 , $3.09 , $1.64 , See APC Packaged Rates , See APC Packaged Rates , $2.14 , $2.14 , See APC Packaged Rates , See APC Packaged Rates , $2.97 , $2.97 , $2.97 , $2.97 , See APC Packaged Rates , $1.12 , $1.91 , $1.12 , $3.09 , $2.23
,5710010746,Hospital Chargemaster,dilTIAZem 30 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.14 , $0.63 , $0.91 , See APC Packaged Rates , $0.80 , $0.44 , $1.10 , $1.10 , $0.59 , See APC Packaged Rates , See APC Packaged Rates , $0.76 , $0.76 , See APC Packaged Rates , See APC Packaged Rates , $1.06 , $1.06 , $1.06 , $1.06 , See APC Packaged Rates , $0.40 , $0.68 , $0.40 , $1.10 , $0.80
,5710010752,Hospital Chargemaster,dilTIAZem CD 180 mg Cap ER 24H,Outpatient,Outpatient Default Percent / Case Rate,259, $78.97 , $43.43 , $63.18 , See APC Packaged Rates , $55.28 , $30.80 , $76.20 , $76.53 , $40.67 , See APC Packaged Rates , See APC Packaged Rates , $52.99 , $52.99 , See APC Packaged Rates , See APC Packaged Rates , $73.44 , $73.44 , $73.44 , $73.44 , See APC Packaged Rates , $27.64 , $47.38 , $27.64 , $76.53 , $55.28
,5710010753,Hospital Chargemaster,dilTIAZem CD 300 mg Cap ER 24H,Outpatient,Outpatient Default Percent / Case Rate,259, $5.73 , $3.15 , $4.58 , See APC Packaged Rates , $4.01 , $2.23 , $5.53 , $5.55 , $2.95 , See APC Packaged Rates , See APC Packaged Rates , $3.84 , $3.84 , See APC Packaged Rates , See APC Packaged Rates , $5.33 , $5.33 , $5.33 , $5.33 , See APC Packaged Rates , $2.01 , $3.44 , $2.01 , $5.55 , $4.01
,5710010754,Hospital Chargemaster,dilTIAZem CD 120 mg Cap ER DEG,Outpatient,Outpatient Default Percent / Case Rate,259, $64.72 , $35.60 , $51.78 , See APC Packaged Rates , $45.30 , $25.24 , $62.45 , $62.72 , $33.33 , See APC Packaged Rates , See APC Packaged Rates , $43.43 , $43.43 , See APC Packaged Rates , See APC Packaged Rates , $60.19 , $60.19 , $60.19 , $60.19 , See APC Packaged Rates , $22.65 , $38.83 , $22.65 , $62.72 , $45.30
,5710010755,Hospital Chargemaster,dilTIAZem CD 240 mg Cap ER DEG,Outpatient,Outpatient Default Percent / Case Rate,259, $1.24 , $0.68 , $0.99 , See APC Packaged Rates , $0.87 , $0.48 , $1.20 , $1.20 , $0.64 , See APC Packaged Rates , See APC Packaged Rates , $0.83 , $0.83 , See APC Packaged Rates , See APC Packaged Rates , $1.15 , $1.15 , $1.15 , $1.15 , See APC Packaged Rates , $0.43 , $0.74 , $0.43 , $1.20 , $0.87
,5710010767,Hospital Chargemaster,diphenhydrAMINE 25 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010773,Hospital Chargemaster,diphenhydrAMINE 2% 30gm Cream,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010774,Hospital Chargemaster,Diphenox/Atrop 2.5/0.025 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $2.24 , $1.23 , $1.79 , See APC Packaged Rates , $1.57 , $0.87 , $2.16 , $2.17 , $1.15 , See APC Packaged Rates , See APC Packaged Rates , $1.50 , $1.50 , See APC Packaged Rates , See APC Packaged Rates , $2.08 , $2.08 , $2.08 , $2.08 , See APC Packaged Rates , $0.78 , $1.34 , $0.78 , $2.17 , $1.57
,5710010784,Hospital Chargemaster,Divalproex Sod DR 250 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $0.99 , $0.54 , $0.79 , See APC Packaged Rates , $0.69 , $0.39 , $0.96 , $0.96 , $0.51 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.92 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , $0.35 , $0.59 , $0.35 , $0.96 , $0.69
,5710010785,Hospital Chargemaster,Divalproex Sod DR 500 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010786,Hospital Chargemaster,Divalproex Sod ER 250 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $6.17 , $3.39 , $4.94 , See APC Packaged Rates , $4.32 , $2.41 , $5.95 , $5.98 , $3.18 , See APC Packaged Rates , See APC Packaged Rates , $4.14 , $4.14 , See APC Packaged Rates , See APC Packaged Rates , $5.74 , $5.74 , $5.74 , $5.74 , See APC Packaged Rates , $2.16 , $3.70 , $2.16 , $5.98 , $4.32
,5710010787,Hospital Chargemaster,Divalproex Sod ER 500 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $10.02 , $5.51 , $8.02 , See APC Packaged Rates , $7.01 , $3.91 , $9.67 , $9.71 , $5.16 , See APC Packaged Rates , See APC Packaged Rates , $6.72 , $6.72 , See APC Packaged Rates , See APC Packaged Rates , $9.32 , $9.32 , $9.32 , $9.32 , See APC Packaged Rates , $3.51 , $6.01 , $3.51 , $9.71 , $7.01
,5710010788,Hospital Chargemaster,Divalproex Sod DR 125mg Sprink,Outpatient,Outpatient Default Percent / Case Rate,259, $3.62 , $1.99 , $2.90 , See APC Packaged Rates , $2.53 , $1.41 , $3.49 , $3.51 , $1.86 , See APC Packaged Rates , See APC Packaged Rates , $2.43 , $2.43 , See APC Packaged Rates , See APC Packaged Rates , $3.37 , $3.37 , $3.37 , $3.37 , See APC Packaged Rates , $1.27 , $2.17 , $1.27 , $3.51 , $2.53
,5710010797,Hospital Chargemaster,Docosanol 10 % 2 gm Cream,Outpatient,Outpatient Default Percent / Case Rate,259, $19.71 , $10.84 , $15.77 , See APC Packaged Rates , $13.80 , $7.69 , $19.02 , $19.10 , $10.15 , See APC Packaged Rates , See APC Packaged Rates , $13.23 , $13.23 , See APC Packaged Rates , See APC Packaged Rates , $18.33 , $18.33 , $18.33 , $18.33 , See APC Packaged Rates , $6.90 , $11.83 , $6.90 , $19.10 , $13.80
,5710010798,Hospital Chargemaster,Docusate Sod 100 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010799,Hospital Chargemaster,Docusate Sod 100 mg/10 mL Liq,Outpatient,Outpatient Default Percent / Case Rate,259, $1.70 , $0.94 , $1.36 , See APC Packaged Rates , $1.19 , $0.66 , $1.64 , $1.65 , $0.88 , See APC Packaged Rates , See APC Packaged Rates , $1.14 , $1.14 , See APC Packaged Rates , See APC Packaged Rates , $1.58 , $1.58 , $1.58 , $1.58 , See APC Packaged Rates , $0.60 , $1.02 , $0.60 , $1.65 , $1.19
,5710010802,Hospital Chargemaster,Dofetilide 250 mcg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $26.65 , $14.66 , $21.32 , See APC Packaged Rates , $18.66 , $10.39 , $25.71 , $25.83 , $13.73 , See APC Packaged Rates , See APC Packaged Rates , $17.88 , $17.88 , See APC Packaged Rates , See APC Packaged Rates , $24.78 , $24.78 , $24.78 , $24.78 , See APC Packaged Rates , $9.33 , $15.99 , $9.33 , $25.83 , $18.66
,5710010804,Hospital Chargemaster,Dolutegravir 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $162.92 , $89.61 , $130.34 , See APC Packaged Rates , $114.04 , $63.54 , $157.20 , $157.89 , $83.91 , See APC Packaged Rates , See APC Packaged Rates , $109.32 , $109.32 , See APC Packaged Rates , See APC Packaged Rates , $151.52 , $151.52 , $151.52 , $151.52 , See APC Packaged Rates , $57.02 , $97.75 , $57.02 , $157.89 , $114.04
,5710010805,Hospital Chargemaster,Donepezil 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $22.00 , $12.10 , $17.60 , See APC Packaged Rates , $15.40 , $8.58 , $21.23 , $21.32 , $11.33 , See APC Packaged Rates , See APC Packaged Rates , $14.76 , $14.76 , See APC Packaged Rates , See APC Packaged Rates , $20.46 , $20.46 , $20.46 , $20.46 , See APC Packaged Rates , $7.70 , $13.20 , $7.70 , $21.32 , $15.40
,5710010806,Hospital Chargemaster,Donepezil 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.99 , $1.09 , $1.59 , See APC Packaged Rates , $1.39 , $0.78 , $1.92 , $1.93 , $1.02 , See APC Packaged Rates , See APC Packaged Rates , $1.34 , $1.34 , See APC Packaged Rates , See APC Packaged Rates , $1.85 , $1.85 , $1.85 , $1.85 , See APC Packaged Rates , $0.70 , $1.19 , $0.70 , $1.93 , $1.39
,5710010813,Hospital Chargemaster,Dorzolamide 2 % Oph 10 mL,Outpatient,Outpatient Default Percent / Case Rate,259, $17.03 , $9.37 , $13.62 , See APC Packaged Rates , $11.92 , $6.64 , $16.43 , $16.50 , $8.77 , See APC Packaged Rates , See APC Packaged Rates , $11.43 , $11.43 , See APC Packaged Rates , See APC Packaged Rates , $15.84 , $15.84 , $15.84 , $15.84 , See APC Packaged Rates , $5.96 , $10.22 , $5.96 , $16.50 , $11.92
,5710010814,Hospital Chargemaster,Dorzolamide/Timolol Oph 10 mL,Outpatient,Outpatient Default Percent / Case Rate,259, $17.21 , $9.47 , $13.77 , See APC Packaged Rates , $12.05 , $6.71 , $16.61 , $16.68 , $8.86 , See APC Packaged Rates , See APC Packaged Rates , $11.55 , $11.55 , See APC Packaged Rates , See APC Packaged Rates , $16.01 , $16.01 , $16.01 , $16.01 , See APC Packaged Rates , $6.02 , $10.33 , $6.02 , $16.68 , $12.05
,5710010815,Hospital Chargemaster,Doxazosin 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.51 , $1.38 , $2.01 , See APC Packaged Rates , $1.76 , $0.98 , $2.42 , $2.43 , $1.29 , See APC Packaged Rates , See APC Packaged Rates , $1.68 , $1.68 , See APC Packaged Rates , See APC Packaged Rates , $2.33 , $2.33 , $2.33 , $2.33 , See APC Packaged Rates , $0.88 , $1.51 , $0.88 , $2.43 , $1.76
,5710010816,Hospital Chargemaster,Doxazosin 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $9.46 , $5.20 , $7.57 , See APC Packaged Rates , $6.62 , $3.69 , $9.13 , $9.17 , $4.87 , See APC Packaged Rates , See APC Packaged Rates , $6.35 , $6.35 , See APC Packaged Rates , See APC Packaged Rates , $8.80 , $8.80 , $8.80 , $8.80 , See APC Packaged Rates , $3.31 , $5.68 , $3.31 , $9.17 , $6.62
,5710010818,Hospital Chargemaster,Doxepin 10 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.63 , $0.90 , $1.30 , See APC Packaged Rates , $1.14 , $0.64 , $1.57 , $1.58 , $0.84 , See APC Packaged Rates , See APC Packaged Rates , $1.09 , $1.09 , See APC Packaged Rates , See APC Packaged Rates , $1.52 , $1.52 , $1.52 , $1.52 , See APC Packaged Rates , $0.57 , $0.98 , $0.57 , $1.58 , $1.14
,5710010819,Hospital Chargemaster,Doxepin 25 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $2.06 , $1.13 , $1.65 , See APC Packaged Rates , $1.44 , $0.80 , $1.99 , $2.00 , $1.06 , See APC Packaged Rates , See APC Packaged Rates , $1.38 , $1.38 , See APC Packaged Rates , See APC Packaged Rates , $1.92 , $1.92 , $1.92 , $1.92 , See APC Packaged Rates , $0.72 , $1.24 , $0.72 , $2.00 , $1.44
,5710010823,Hospital Chargemaster,Doxycycline Hyclate 100 mg Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $3.04 , $1.67 , $2.43 , See APC Packaged Rates , $2.13 , $1.19 , $2.93 , $2.95 , $1.57 , See APC Packaged Rates , See APC Packaged Rates , $2.04 , $2.04 , See APC Packaged Rates , See APC Packaged Rates , $2.83 , $2.83 , $2.83 , $2.83 , See APC Packaged Rates , $1.06 , $1.82 , $1.06 , $2.95 , $2.13
,5710010829,Hospital Chargemaster,Doxylamine 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010833,Hospital Chargemaster,DULoxetine 20 mg Capsule.DR,Outpatient,Outpatient Default Percent / Case Rate,259, $17.85 , $9.82 , $14.28 , See APC Packaged Rates , $12.50 , $6.96 , $17.22 , $17.30 , $9.19 , See APC Packaged Rates , See APC Packaged Rates , $11.98 , $11.98 , See APC Packaged Rates , See APC Packaged Rates , $16.60 , $16.60 , $16.60 , $16.60 , See APC Packaged Rates , $6.25 , $10.71 , $6.25 , $17.30 , $12.50
,5710010834,Hospital Chargemaster,DULoxetine 30 mg Capsule.DR,Outpatient,Outpatient Default Percent / Case Rate,259, $18.73 , $10.30 , $14.98 , See APC Packaged Rates , $13.11 , $7.30 , $18.07 , $18.15 , $9.65 , See APC Packaged Rates , See APC Packaged Rates , $12.57 , $12.57 , See APC Packaged Rates , See APC Packaged Rates , $17.42 , $17.42 , $17.42 , $17.42 , See APC Packaged Rates , $6.56 , $11.24 , $6.56 , $18.15 , $13.11
,5710010835,Hospital Chargemaster,DULoxetine 60 mg Capsule.DR,Outpatient,Outpatient Default Percent / Case Rate,259, $18.99 , $10.44 , $15.19 , See APC Packaged Rates , $13.29 , $7.41 , $18.32 , $18.40 , $9.78 , See APC Packaged Rates , See APC Packaged Rates , $12.74 , $12.74 , See APC Packaged Rates , See APC Packaged Rates , $17.66 , $17.66 , $17.66 , $17.66 , See APC Packaged Rates , $6.65 , $11.39 , $6.65 , $18.40 , $13.29
,5710010857,Hospital Chargemaster,Emtricitab/Tenof 200/300 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $156.60 , $86.13 , $125.28 , See APC Packaged Rates , $109.62 , $61.07 , $151.10 , $151.76 , $80.65 , See APC Packaged Rates , See APC Packaged Rates , $105.08 , $105.08 , See APC Packaged Rates , See APC Packaged Rates , $145.64 , $145.64 , $145.64 , $145.64 , See APC Packaged Rates , $54.81 , $93.96 , $54.81 , $151.76 , $109.62
,5710010858,Hospital Chargemaster,Enalapril 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.28 , $0.70 , $1.02 , See APC Packaged Rates , $0.90 , $0.50 , $1.24 , $1.24 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.86 , $0.86 , See APC Packaged Rates , See APC Packaged Rates , $1.19 , $1.19 , $1.19 , $1.19 , See APC Packaged Rates , $0.45 , $0.77 , $0.45 , $1.24 , $0.90
,5710010870,Hospital Chargemaster,Entacapone 200 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $17.37 , $9.55 , $13.90 , See APC Packaged Rates , $12.16 , $6.77 , $16.76 , $16.83 , $8.95 , See APC Packaged Rates , See APC Packaged Rates , $11.66 , $11.66 , See APC Packaged Rates , See APC Packaged Rates , $16.15 , $16.15 , $16.15 , $16.15 , See APC Packaged Rates , $6.08 , $10.42 , $6.08 , $16.83 , $12.16
J0171,5710010876,Hospital Chargemaster,"EPINEPHrine, adrenaline, 0.1mg",Outpatient,Outpatient Default Percent / Case Rate,259, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.88 , $0.88 , $0.88 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.88 , $-
,5710010880,Hospital Chargemaster,Zonisamide 50 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $2.81 , $1.55 , $2.25 , See APC Packaged Rates , $1.97 , $1.10 , $2.71 , $2.72 , $1.45 , See APC Packaged Rates , See APC Packaged Rates , $1.89 , $1.89 , See APC Packaged Rates , See APC Packaged Rates , $2.61 , $2.61 , $2.61 , $2.61 , See APC Packaged Rates , $0.98 , $1.69 , $0.98 , $2.72 , $1.97
,5710010892,Hospital Chargemaster,Ergocalciferol 50000 Unit Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $3.64 , $2.00 , $2.91 , See APC Packaged Rates , $2.55 , $1.42 , $3.51 , $3.53 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $2.44 , $2.44 , See APC Packaged Rates , See APC Packaged Rates , $3.39 , $3.39 , $3.39 , $3.39 , See APC Packaged Rates , $1.27 , $2.18 , $1.27 , $3.53 , $2.55
,5710010896,Hospital Chargemaster,Erythromycin Base 250 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $29.58 , $16.27 , $23.66 , See APC Packaged Rates , $20.71 , $11.54 , $28.54 , $28.67 , $15.23 , See APC Packaged Rates , See APC Packaged Rates , $19.85 , $19.85 , See APC Packaged Rates , See APC Packaged Rates , $27.51 , $27.51 , $27.51 , $27.51 , See APC Packaged Rates , $10.35 , $17.75 , $10.35 , $28.67 , $20.71
,5710010897,Hospital Chargemaster,Erythromycin 0.5% 1 gm Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $31.58 , $17.37 , $25.26 , See APC Packaged Rates , $22.11 , $12.32 , $30.47 , $30.60 , $16.26 , See APC Packaged Rates , See APC Packaged Rates , $21.19 , $21.19 , See APC Packaged Rates , See APC Packaged Rates , $29.37 , $29.37 , $29.37 , $29.37 , See APC Packaged Rates , $11.05 , $18.95 , $11.05 , $30.60 , $22.11
,5710010902,Hospital Chargemaster,Escitalopram 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $10.36 , $5.70 , $8.29 , See APC Packaged Rates , $7.25 , $4.04 , $10.00 , $10.04 , $5.34 , See APC Packaged Rates , See APC Packaged Rates , $6.95 , $6.95 , See APC Packaged Rates , See APC Packaged Rates , $9.63 , $9.63 , $9.63 , $9.63 , See APC Packaged Rates , $3.63 , $6.22 , $3.63 , $10.04 , $7.25
,5710010904,Hospital Chargemaster,Escitalopram 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $10.58 , $5.82 , $8.46 , See APC Packaged Rates , $7.41 , $4.13 , $10.21 , $10.25 , $5.45 , See APC Packaged Rates , See APC Packaged Rates , $7.10 , $7.10 , See APC Packaged Rates , See APC Packaged Rates , $9.84 , $9.84 , $9.84 , $9.84 , See APC Packaged Rates , $3.70 , $6.35 , $3.70 , $10.25 , $7.41
,5710010910,Hospital Chargemaster,Estradiol 0.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.48 , $0.81 , $1.18 , See APC Packaged Rates , $1.04 , $0.58 , $1.43 , $1.43 , $0.76 , See APC Packaged Rates , See APC Packaged Rates , $0.99 , $0.99 , See APC Packaged Rates , See APC Packaged Rates , $1.38 , $1.38 , $1.38 , $1.38 , See APC Packaged Rates , $0.52 , $0.89 , $0.52 , $1.43 , $1.04
,5710010913,Hospital Chargemaster,"Estrogens, Conj 30 gm Vag Cr",Outpatient,Outpatient Default Percent / Case Rate,259, $34.35 , $18.89 , $27.48 , See APC Packaged Rates , $24.05 , $13.40 , $33.14 , $33.29 , $17.69 , See APC Packaged Rates , See APC Packaged Rates , $23.05 , $23.05 , See APC Packaged Rates , See APC Packaged Rates , $31.95 , $31.95 , $31.95 , $31.95 , See APC Packaged Rates , $12.02 , $20.61 , $12.02 , $33.29 , $24.05
,5710010914,Hospital Chargemaster,"Estrogens, Conj 0.3 mg Tab",Outpatient,Outpatient Default Percent / Case Rate,259, $15.81 , $8.70 , $12.65 , See APC Packaged Rates , $11.07 , $6.17 , $15.26 , $15.32 , $8.14 , See APC Packaged Rates , See APC Packaged Rates , $10.61 , $10.61 , See APC Packaged Rates , See APC Packaged Rates , $14.70 , $14.70 , $14.70 , $14.70 , See APC Packaged Rates , $5.53 , $9.49 , $5.53 , $15.32 , $11.07
,5710010923,Hospital Chargemaster,Ethyl chloride Spray,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710010933,Hospital Chargemaster,Ezetimibe 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $28.45 , $15.65 , $22.76 , See APC Packaged Rates , $19.92 , $11.10 , $27.45 , $27.57 , $14.65 , See APC Packaged Rates , See APC Packaged Rates , $19.09 , $19.09 , See APC Packaged Rates , See APC Packaged Rates , $26.46 , $26.46 , $26.46 , $26.46 , See APC Packaged Rates , $9.96 , $17.07 , $9.96 , $27.57 , $19.92
,5710010936,Hospital Chargemaster,Famotidine 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.37 , $2.40 , $3.50 , See APC Packaged Rates , $3.06 , $1.70 , $4.22 , $4.23 , $2.25 , See APC Packaged Rates , See APC Packaged Rates , $2.93 , $2.93 , See APC Packaged Rates , See APC Packaged Rates , $4.06 , $4.06 , $4.06 , $4.06 , See APC Packaged Rates , $1.53 , $2.62 , $1.53 , $4.23 , $3.06
,5710010947,Hospital Chargemaster,Fenofibrate Nano 145 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.63 , $1.45 , $2.10 , See APC Packaged Rates , $1.84 , $1.03 , $2.54 , $2.55 , $1.35 , See APC Packaged Rates , See APC Packaged Rates , $1.76 , $1.76 , See APC Packaged Rates , See APC Packaged Rates , $2.45 , $2.45 , $2.45 , $2.45 , See APC Packaged Rates , $0.92 , $1.58 , $0.92 , $2.55 , $1.84
,5710010948,Hospital Chargemaster,Fenofibrate Nano 48 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.87 , $2.68 , $3.90 , See APC Packaged Rates , $3.41 , $1.90 , $4.70 , $4.72 , $2.51 , See APC Packaged Rates , See APC Packaged Rates , $3.27 , $3.27 , See APC Packaged Rates , See APC Packaged Rates , $4.53 , $4.53 , $4.53 , $4.53 , See APC Packaged Rates , $1.70 , $2.92 , $1.70 , $4.72 , $3.41
,5710010950,Hospital Chargemaster,fentaNYL 25 mcg/hr Patch.TD72,Outpatient,Outpatient Default Percent / Case Rate,259, $54.24 , $29.83 , $43.39 , See APC Packaged Rates , $37.97 , $21.15 , $52.34 , $52.56 , $27.93 , See APC Packaged Rates , See APC Packaged Rates , $36.40 , $36.40 , See APC Packaged Rates , See APC Packaged Rates , $50.44 , $50.44 , $50.44 , $50.44 , See APC Packaged Rates , $18.98 , $32.54 , $18.98 , $52.56 , $37.97
,5710010951,Hospital Chargemaster,fentaNYL 12 mcg/hr Patch.TD72,Outpatient,Outpatient Default Percent / Case Rate,259, $51.77 , $28.47 , $41.42 , See APC Packaged Rates , $36.24 , $20.19 , $49.95 , $50.17 , $26.66 , See APC Packaged Rates , See APC Packaged Rates , $34.74 , $34.74 , See APC Packaged Rates , See APC Packaged Rates , $48.15 , $48.15 , $48.15 , $48.15 , See APC Packaged Rates , $18.12 , $31.06 , $18.12 , $50.17 , $36.24
,5710010952,Hospital Chargemaster,fentaNYL 50 mcg/hr Patch.TD72,Outpatient,Outpatient Default Percent / Case Rate,259, $99.14 , $54.53 , $79.31 , See APC Packaged Rates , $69.40 , $38.66 , $95.66 , $96.08 , $51.06 , See APC Packaged Rates , See APC Packaged Rates , $66.52 , $66.52 , See APC Packaged Rates , See APC Packaged Rates , $92.20 , $92.20 , $92.20 , $92.20 , See APC Packaged Rates , $34.70 , $59.48 , $34.70 , $96.08 , $69.40
,5710010953,Hospital Chargemaster,fentaNYL 75 mcg/hr Patch.TD72,Outpatient,Outpatient Default Percent / Case Rate,259, $151.24 , $83.18 , $120.99 , See APC Packaged Rates , $105.87 , $58.98 , $145.93 , $146.57 , $77.89 , See APC Packaged Rates , See APC Packaged Rates , $101.48 , $101.48 , See APC Packaged Rates , See APC Packaged Rates , $140.65 , $140.65 , $140.65 , $140.65 , See APC Packaged Rates , $52.93 , $90.74 , $52.93 , $146.57 , $105.87
,5710010954,Hospital Chargemaster,fentaNYL 100 mcg/hr Patch.TD72,Outpatient,Outpatient Default Percent / Case Rate,259, $188.51 , $103.68 , $150.81 , See APC Packaged Rates , $131.96 , $73.52 , $181.89 , $182.69 , $97.09 , See APC Packaged Rates , See APC Packaged Rates , $126.49 , $126.49 , See APC Packaged Rates , See APC Packaged Rates , $175.31 , $175.31 , $175.31 , $175.31 , See APC Packaged Rates , $65.98 , $113.11 , $65.98 , $182.69 , $131.96
,5710010966,Hospital Chargemaster,Ferrous Sulf 300 mg/5mL Liquid,Outpatient,Outpatient Default Percent / Case Rate,259, $7.25 , $3.99 , $5.80 , See APC Packaged Rates , $5.08 , $2.83 , $7.00 , $7.03 , $3.73 , See APC Packaged Rates , See APC Packaged Rates , $4.86 , $4.86 , See APC Packaged Rates , See APC Packaged Rates , $6.74 , $6.74 , $6.74 , $6.74 , See APC Packaged Rates , $2.54 , $4.35 , $2.54 , $7.03 , $5.08
,5710010967,Hospital Chargemaster,Ferrous Sulf 324 mg Tablet DR,Outpatient,Outpatient Default Percent / Case Rate,259, $0.98 , $0.54 , $0.78 , See APC Packaged Rates , $0.69 , $0.38 , $0.95 , $0.95 , $0.50 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.91 , $0.91 , $0.91 , $0.91 , See APC Packaged Rates , $0.34 , $0.59 , $0.34 , $0.95 , $0.69
,5710010975,Hospital Chargemaster,Finasteride 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $12.01 , $6.61 , $9.61 , See APC Packaged Rates , $8.41 , $4.68 , $11.59 , $11.64 , $6.19 , See APC Packaged Rates , See APC Packaged Rates , $8.06 , $8.06 , See APC Packaged Rates , See APC Packaged Rates , $11.17 , $11.17 , $11.17 , $11.17 , See APC Packaged Rates , $4.20 , $7.21 , $4.20 , $11.64 , $8.41
,5710010977,Hospital Chargemaster,Flecainide 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.80 , $2.09 , $3.04 , See APC Packaged Rates , $2.66 , $1.48 , $3.67 , $3.68 , $1.96 , See APC Packaged Rates , See APC Packaged Rates , $2.55 , $2.55 , See APC Packaged Rates , See APC Packaged Rates , $3.53 , $3.53 , $3.53 , $3.53 , See APC Packaged Rates , $1.33 , $2.28 , $1.33 , $3.68 , $2.66
,5710010981,Hospital Chargemaster,Fluconazole 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $11.91 , $6.55 , $9.53 , See APC Packaged Rates , $8.34 , $4.64 , $11.49 , $11.54 , $6.13 , See APC Packaged Rates , See APC Packaged Rates , $7.99 , $7.99 , See APC Packaged Rates , See APC Packaged Rates , $11.08 , $11.08 , $11.08 , $11.08 , See APC Packaged Rates , $4.17 , $7.15 , $4.17 , $11.54 , $8.34
,5710010983,Hospital Chargemaster,Fluconazole 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $14.20 , $7.81 , $11.36 , See APC Packaged Rates , $9.94 , $5.54 , $13.70 , $13.76 , $7.31 , See APC Packaged Rates , See APC Packaged Rates , $9.53 , $9.53 , See APC Packaged Rates , See APC Packaged Rates , $13.21 , $13.21 , $13.21 , $13.21 , See APC Packaged Rates , $4.97 , $8.52 , $4.97 , $13.76 , $9.94
,5710010988,Hospital Chargemaster,Fludrocortisone 0.1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.98 , $1.09 , $1.58 , See APC Packaged Rates , $1.39 , $0.77 , $1.91 , $1.92 , $1.02 , See APC Packaged Rates , See APC Packaged Rates , $1.33 , $1.33 , See APC Packaged Rates , See APC Packaged Rates , $1.84 , $1.84 , $1.84 , $1.84 , See APC Packaged Rates , $0.69 , $1.19 , $0.69 , $1.92 , $1.39
,5710011003,Hospital Chargemaster,FLUoxetine 20 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011010,Hospital Chargemaster,fluPHENAZine 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.48 , $0.81 , $1.18 , See APC Packaged Rates , $1.04 , $0.58 , $1.43 , $1.43 , $0.76 , See APC Packaged Rates , See APC Packaged Rates , $0.99 , $0.99 , See APC Packaged Rates , See APC Packaged Rates , $1.38 , $1.38 , $1.38 , $1.38 , See APC Packaged Rates , $0.52 , $0.89 , $0.52 , $1.43 , $1.04
,5710011012,Hospital Chargemaster,fluPHENAZine 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $23.46 , $12.90 , $18.77 , See APC Packaged Rates , $16.42 , $9.15 , $22.64 , $22.74 , $12.08 , See APC Packaged Rates , See APC Packaged Rates , $15.74 , $15.74 , See APC Packaged Rates , See APC Packaged Rates , $21.82 , $21.82 , $21.82 , $21.82 , See APC Packaged Rates , $8.21 , $14.08 , $8.21 , $22.74 , $16.42
,5710011025,Hospital Chargemaster,Fluticasone Nasal Spray.Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $13.34 , $7.34 , $10.67 , See APC Packaged Rates , $9.34 , $5.20 , $12.87 , $12.93 , $6.87 , See APC Packaged Rates , See APC Packaged Rates , $8.95 , $8.95 , See APC Packaged Rates , See APC Packaged Rates , $12.41 , $12.41 , $12.41 , $12.41 , See APC Packaged Rates , $4.67 , $8.00 , $4.67 , $12.93 , $9.34
,5710011028,Hospital Chargemaster,fluvoxaMINE 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.87 , $3.23 , $4.70 , See APC Packaged Rates , $4.11 , $2.29 , $5.66 , $5.69 , $3.02 , See APC Packaged Rates , See APC Packaged Rates , $3.94 , $3.94 , See APC Packaged Rates , See APC Packaged Rates , $5.46 , $5.46 , $5.46 , $5.46 , See APC Packaged Rates , $2.05 , $3.52 , $2.05 , $5.69 , $4.11
,5710011029,Hospital Chargemaster,fluvoxaMINE 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.55 , $3.60 , $5.24 , See APC Packaged Rates , $4.59 , $2.55 , $6.32 , $6.35 , $3.37 , See APC Packaged Rates , See APC Packaged Rates , $4.40 , $4.40 , See APC Packaged Rates , See APC Packaged Rates , $6.09 , $6.09 , $6.09 , $6.09 , See APC Packaged Rates , $2.29 , $3.93 , $2.29 , $6.35 , $4.59
,5710011030,Hospital Chargemaster,Folic Acid 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011044,Hospital Chargemaster,Furosemide 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.29 , $0.71 , $1.03 , See APC Packaged Rates , $0.90 , $0.50 , $1.24 , $1.25 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.87 , $0.87 , See APC Packaged Rates , See APC Packaged Rates , $1.20 , $1.20 , $1.20 , $1.20 , See APC Packaged Rates , $0.45 , $0.77 , $0.45 , $1.25 , $0.90
,5710011045,Hospital Chargemaster,Furosemide 40 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011050,Hospital Chargemaster,Gabapentin 300 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $2.12 , $1.17 , $1.70 , See APC Packaged Rates , $1.48 , $0.83 , $2.05 , $2.05 , $1.09 , See APC Packaged Rates , See APC Packaged Rates , $1.42 , $1.42 , See APC Packaged Rates , See APC Packaged Rates , $1.97 , $1.97 , $1.97 , $1.97 , See APC Packaged Rates , $0.74 , $1.27 , $0.74 , $2.05 , $1.48
,5710011051,Hospital Chargemaster,Gabapentin 400 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.71 , $0.94 , $1.37 , See APC Packaged Rates , $1.20 , $0.67 , $1.65 , $1.66 , $0.88 , See APC Packaged Rates , See APC Packaged Rates , $1.15 , $1.15 , See APC Packaged Rates , See APC Packaged Rates , $1.59 , $1.59 , $1.59 , $1.59 , See APC Packaged Rates , $0.60 , $1.03 , $0.60 , $1.66 , $1.20
,5710011052,Hospital Chargemaster,Gabapentin 100 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.15 , $0.63 , $0.92 , See APC Packaged Rates , $0.81 , $0.45 , $1.11 , $1.11 , $0.59 , See APC Packaged Rates , See APC Packaged Rates , $0.77 , $0.77 , See APC Packaged Rates , See APC Packaged Rates , $1.07 , $1.07 , $1.07 , $1.07 , See APC Packaged Rates , $0.40 , $0.69 , $0.40 , $1.11 , $0.81
,5710011070,Hospital Chargemaster,Galantamine 4 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $10.11 , $5.56 , $8.09 , See APC Packaged Rates , $7.08 , $3.94 , $9.76 , $9.80 , $5.21 , See APC Packaged Rates , See APC Packaged Rates , $6.78 , $6.78 , See APC Packaged Rates , See APC Packaged Rates , $9.40 , $9.40 , $9.40 , $9.40 , See APC Packaged Rates , $3.54 , $6.07 , $3.54 , $9.80 , $7.08
,5710011071,Hospital Chargemaster,Galantamine ER 8 mg Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $10.53 , $5.79 , $8.42 , See APC Packaged Rates , $7.37 , $4.11 , $10.16 , $10.20 , $5.42 , See APC Packaged Rates , See APC Packaged Rates , $7.07 , $7.07 , See APC Packaged Rates , See APC Packaged Rates , $9.79 , $9.79 , $9.79 , $9.79 , See APC Packaged Rates , $3.69 , $6.32 , $3.69 , $10.20 , $7.37
,5710011079,Hospital Chargemaster,gemfiBROZIL 600 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.92 , $3.26 , $4.74 , See APC Packaged Rates , $4.14 , $2.31 , $5.71 , $5.74 , $3.05 , See APC Packaged Rates , See APC Packaged Rates , $3.97 , $3.97 , See APC Packaged Rates , See APC Packaged Rates , $5.51 , $5.51 , $5.51 , $5.51 , See APC Packaged Rates , $2.07 , $3.55 , $2.07 , $5.74 , $4.14
,5710011084,Hospital Chargemaster,Gentamicin 0.1 % 15 gm Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $8.39 , $4.61 , $6.71 , See APC Packaged Rates , $5.87 , $3.27 , $8.10 , $8.13 , $4.32 , See APC Packaged Rates , See APC Packaged Rates , $5.63 , $5.63 , See APC Packaged Rates , See APC Packaged Rates , $7.80 , $7.80 , $7.80 , $7.80 , See APC Packaged Rates , $2.94 , $5.03 , $2.94 , $8.13 , $5.87
,5710011085,Hospital Chargemaster,Gentamicin 0.3 % 3.5 gm Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $12.90 , $7.10 , $10.32 , See APC Packaged Rates , $9.03 , $5.03 , $12.45 , $12.50 , $6.64 , See APC Packaged Rates , See APC Packaged Rates , $8.66 , $8.66 , See APC Packaged Rates , See APC Packaged Rates , $12.00 , $12.00 , $12.00 , $12.00 , See APC Packaged Rates , $4.52 , $7.74 , $4.52 , $12.50 , $9.03
,5710011086,Hospital Chargemaster,Gentamicin 0.3 % mL Drops,Outpatient,Outpatient Default Percent / Case Rate,259, $11.07 , $6.09 , $8.86 , See APC Packaged Rates , $7.75 , $4.32 , $10.68 , $10.73 , $5.70 , See APC Packaged Rates , See APC Packaged Rates , $7.43 , $7.43 , See APC Packaged Rates , See APC Packaged Rates , $10.30 , $10.30 , $10.30 , $10.30 , See APC Packaged Rates , $3.87 , $6.64 , $3.87 , $10.73 , $7.75
,5710011092,Hospital Chargemaster,glipiZIDE 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $0.97 , $0.53 , $0.78 , See APC Packaged Rates , $0.68 , $0.38 , $0.94 , $0.94 , $0.50 , See APC Packaged Rates , See APC Packaged Rates , $0.65 , $0.65 , See APC Packaged Rates , See APC Packaged Rates , $0.90 , $0.90 , $0.90 , $0.90 , See APC Packaged Rates , $0.34 , $0.58 , $0.34 , $0.94 , $0.68
,5710011102,Hospital Chargemaster,Glycerin Adult Supp,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011103,Hospital Chargemaster,Glycerin Pediatric Sol.PF.APP,Outpatient,Outpatient Default Percent / Case Rate,259, $2.93 , $1.61 , $2.34 , See APC Packaged Rates , $2.05 , $1.14 , $2.83 , $2.84 , $1.51 , See APC Packaged Rates , See APC Packaged Rates , $1.97 , $1.97 , See APC Packaged Rates , See APC Packaged Rates , $2.72 , $2.72 , $2.72 , $2.72 , See APC Packaged Rates , $1.03 , $1.76 , $1.03 , $2.84 , $2.05
,5710011104,Hospital Chargemaster,Glycerin/Witch Hazel MED..PAD,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011113,Hospital Chargemaster,guaiFENesin 200 mg/10 mL Liq,Outpatient,Outpatient Default Percent / Case Rate,259, $1.62 , $0.89 , $1.30 , See APC Packaged Rates , $1.13 , $0.63 , $1.56 , $1.57 , $0.83 , See APC Packaged Rates , See APC Packaged Rates , $1.09 , $1.09 , See APC Packaged Rates , See APC Packaged Rates , $1.51 , $1.51 , $1.51 , $1.51 , See APC Packaged Rates , $0.57 , $0.97 , $0.57 , $1.57 , $1.13
,5710011114,Hospital Chargemaster,guaiFEN LA 600 mg Tab.ER.12H,Outpatient,Outpatient Default Percent / Case Rate,259, $1.61 , $0.89 , $1.29 , See APC Packaged Rates , $1.13 , $0.63 , $1.55 , $1.56 , $0.83 , See APC Packaged Rates , See APC Packaged Rates , $1.08 , $1.08 , See APC Packaged Rates , See APC Packaged Rates , $1.50 , $1.50 , $1.50 , $1.50 , See APC Packaged Rates , $0.56 , $0.97 , $0.56 , $1.56 , $1.13
,5710011116,Hospital Chargemaster,guaiFEN DM 200/20/10 mL Syrup,Outpatient,Outpatient Default Percent / Case Rate,259, $6.62 , $3.64 , $5.30 , See APC Packaged Rates , $4.63 , $2.58 , $6.39 , $6.42 , $3.41 , See APC Packaged Rates , See APC Packaged Rates , $4.44 , $4.44 , See APC Packaged Rates , See APC Packaged Rates , $6.16 , $6.16 , $6.16 , $6.16 , See APC Packaged Rates , $2.32 , $3.97 , $2.32 , $6.42 , $4.63
,5710011119,Hospital Chargemaster,Guanfacine HCl 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.22 , $1.22 , $1.78 , See APC Packaged Rates , $1.55 , $0.87 , $2.14 , $2.15 , $1.14 , See APC Packaged Rates , See APC Packaged Rates , $1.49 , $1.49 , See APC Packaged Rates , See APC Packaged Rates , $2.06 , $2.06 , $2.06 , $2.06 , See APC Packaged Rates , $0.78 , $1.33 , $0.78 , $2.15 , $1.55
,5710011122,Hospital Chargemaster,Haloperidol 0.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011123,Hospital Chargemaster,Haloperidol 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.25 , $0.69 , $1.00 , See APC Packaged Rates , $0.88 , $0.49 , $1.21 , $1.21 , $0.64 , See APC Packaged Rates , See APC Packaged Rates , $0.84 , $0.84 , See APC Packaged Rates , See APC Packaged Rates , $1.16 , $1.16 , $1.16 , $1.16 , See APC Packaged Rates , $0.44 , $0.75 , $0.44 , $1.21 , $0.88
,5710011124,Hospital Chargemaster,Haloperidol 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.68 , $0.92 , $1.34 , See APC Packaged Rates , $1.18 , $0.66 , $1.62 , $1.63 , $0.87 , See APC Packaged Rates , See APC Packaged Rates , $1.13 , $1.13 , See APC Packaged Rates , See APC Packaged Rates , $1.56 , $1.56 , $1.56 , $1.56 , See APC Packaged Rates , $0.59 , $1.01 , $0.59 , $1.63 , $1.18
,5710011125,Hospital Chargemaster,Haloperidol 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.70 , $1.49 , $2.16 , See APC Packaged Rates , $1.89 , $1.05 , $2.61 , $2.62 , $1.39 , See APC Packaged Rates , See APC Packaged Rates , $1.81 , $1.81 , See APC Packaged Rates , See APC Packaged Rates , $2.51 , $2.51 , $2.51 , $2.51 , See APC Packaged Rates , $0.95 , $1.62 , $0.95 , $2.62 , $1.89
,5710011128,Hospital Chargemaster,Haloperidol 10 mg/5 mL CONC,Outpatient,Outpatient Default Percent / Case Rate,259, $10.68 , $5.87 , $8.54 , See APC Packaged Rates , $7.48 , $4.17 , $10.31 , $10.35 , $5.50 , See APC Packaged Rates , See APC Packaged Rates , $7.17 , $7.17 , See APC Packaged Rates , See APC Packaged Rates , $9.93 , $9.93 , $9.93 , $9.93 , See APC Packaged Rates , $3.74 , $6.41 , $3.74 , $10.35 , $7.48
,5710011163,Hospital Chargemaster,hydrALAZINE 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011164,Hospital Chargemaster,hydrALAZINE 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.30 , $0.72 , $1.04 , See APC Packaged Rates , $0.91 , $0.51 , $1.25 , $1.26 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.87 , $0.87 , See APC Packaged Rates , See APC Packaged Rates , $1.21 , $1.21 , $1.21 , $1.21 , See APC Packaged Rates , $0.46 , $0.78 , $0.46 , $1.26 , $0.91
,5710011165,Hospital Chargemaster,hydrALAZINE 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.06 , $0.58 , $0.85 , See APC Packaged Rates , $0.74 , $0.41 , $1.02 , $1.03 , $0.55 , See APC Packaged Rates , See APC Packaged Rates , $0.71 , $0.71 , See APC Packaged Rates , See APC Packaged Rates , $0.99 , $0.99 , $0.99 , $0.99 , See APC Packaged Rates , $0.37 , $0.64 , $0.37 , $1.03 , $0.74
,5710011167,Hospital Chargemaster,hydroCHLOROthiazide 12.5mg Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $1.05 , $0.58 , $0.84 , See APC Packaged Rates , $0.74 , $0.41 , $1.01 , $1.02 , $0.54 , See APC Packaged Rates , See APC Packaged Rates , $0.70 , $0.70 , See APC Packaged Rates , See APC Packaged Rates , $0.98 , $0.98 , $0.98 , $0.98 , See APC Packaged Rates , $0.37 , $0.63 , $0.37 , $1.02 , $0.74
,5710011169,Hospital Chargemaster,hydroCHLOROthiazide 25 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011172,Hospital Chargemaster,HYDROcod/Acetam 7.5/325 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.58 , $0.87 , $1.26 , See APC Packaged Rates , $1.11 , $0.62 , $1.52 , $1.53 , $0.81 , See APC Packaged Rates , See APC Packaged Rates , $1.06 , $1.06 , See APC Packaged Rates , See APC Packaged Rates , $1.47 , $1.47 , $1.47 , $1.47 , See APC Packaged Rates , $0.55 , $0.95 , $0.55 , $1.53 , $1.11
,5710011173,Hospital Chargemaster,HYDROcod/Acetam 10/325 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.06 , $0.58 , $0.85 , See APC Packaged Rates , $0.74 , $0.41 , $1.02 , $1.03 , $0.55 , See APC Packaged Rates , See APC Packaged Rates , $0.71 , $0.71 , See APC Packaged Rates , See APC Packaged Rates , $0.99 , $0.99 , $0.99 , $0.99 , See APC Packaged Rates , $0.37 , $0.64 , $0.37 , $1.03 , $0.74
,5710011174,Hospital Chargemaster,HYDROcod/Acetam 5/325 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $2.04 , $1.12 , $1.63 , See APC Packaged Rates , $1.43 , $0.80 , $1.97 , $1.98 , $1.05 , See APC Packaged Rates , See APC Packaged Rates , $1.37 , $1.37 , See APC Packaged Rates , See APC Packaged Rates , $1.90 , $1.90 , $1.90 , $1.90 , See APC Packaged Rates , $0.71 , $1.22 , $0.71 , $1.98 , $1.43
,5710011176,Hospital Chargemaster,Hydrocortisone 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.26 , $2.34 , $3.41 , See APC Packaged Rates , $2.98 , $1.66 , $4.11 , $4.13 , $2.19 , See APC Packaged Rates , See APC Packaged Rates , $2.86 , $2.86 , See APC Packaged Rates , See APC Packaged Rates , $3.96 , $3.96 , $3.96 , $3.96 , See APC Packaged Rates , $1.49 , $2.56 , $1.49 , $4.13 , $2.98
,5710011178,Hospital Chargemaster,Hydrocortisone 1 % 30 gm Cr,Outpatient,Outpatient Default Percent / Case Rate,259, $1.44 , $0.79 , $1.15 , See APC Packaged Rates , $1.01 , $0.56 , $1.39 , $1.40 , $0.74 , See APC Packaged Rates , See APC Packaged Rates , $0.97 , $0.97 , See APC Packaged Rates , See APC Packaged Rates , $1.34 , $1.34 , $1.34 , $1.34 , See APC Packaged Rates , $0.50 , $0.86 , $0.50 , $1.40 , $1.01
,5710011179,Hospital Chargemaster,Hydrocortisone 1 % 30 gm Oin,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011181,Hospital Chargemaster,Hydrocortisone 2.5 % Rectal,Outpatient,Outpatient Default Percent / Case Rate,259, $7.42 , $4.08 , $5.94 , See APC Packaged Rates , $5.19 , $2.89 , $7.16 , $7.19 , $3.82 , See APC Packaged Rates , See APC Packaged Rates , $4.98 , $4.98 , See APC Packaged Rates , See APC Packaged Rates , $6.90 , $6.90 , $6.90 , $6.90 , See APC Packaged Rates , $2.60 , $4.45 , $2.60 , $7.19 , $5.19
,5710011182,Hospital Chargemaster,Hydrocortisone 25 mg SUPP,Outpatient,Outpatient Default Percent / Case Rate,259, $54.85 , $30.17 , $43.88 , See APC Packaged Rates , $38.40 , $21.39 , $52.92 , $53.16 , $28.25 , See APC Packaged Rates , See APC Packaged Rates , $36.80 , $36.80 , See APC Packaged Rates , See APC Packaged Rates , $51.01 , $51.01 , $51.01 , $51.01 , See APC Packaged Rates , $19.20 , $32.91 , $19.20 , $53.16 , $38.40
,5710011191,Hospital Chargemaster,HYDROmorphone 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.06 , $0.58 , $0.85 , See APC Packaged Rates , $0.74 , $0.41 , $1.02 , $1.03 , $0.55 , See APC Packaged Rates , See APC Packaged Rates , $0.71 , $0.71 , See APC Packaged Rates , See APC Packaged Rates , $0.99 , $0.99 , $0.99 , $0.99 , See APC Packaged Rates , $0.37 , $0.64 , $0.37 , $1.03 , $0.74
,5710011199,Hospital Chargemaster,Hydroxychloroquine 200 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $10.87 , $5.98 , $8.70 , See APC Packaged Rates , $7.61 , $4.24 , $10.49 , $10.53 , $5.60 , See APC Packaged Rates , See APC Packaged Rates , $7.29 , $7.29 , See APC Packaged Rates , See APC Packaged Rates , $10.11 , $10.11 , $10.11 , $10.11 , See APC Packaged Rates , $3.80 , $6.52 , $3.80 , $10.53 , $7.61
,5710011201,Hospital Chargemaster,Hydroxyurea 500 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $3.26 , $1.79 , $2.61 , See APC Packaged Rates , $2.28 , $1.27 , $3.15 , $3.16 , $1.68 , See APC Packaged Rates , See APC Packaged Rates , $2.19 , $2.19 , See APC Packaged Rates , See APC Packaged Rates , $3.03 , $3.03 , $3.03 , $3.03 , See APC Packaged Rates , $1.14 , $1.96 , $1.14 , $3.16 , $2.28
,5710011203,Hospital Chargemaster,hydrOXYzine HCl 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011205,Hospital Chargemaster,hydrOXYzine HCl 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011208,Hospital Chargemaster,hydrOXYzine pam 25 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011209,Hospital Chargemaster,hydrOXYzine pam 50 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011212,Hospital Chargemaster,Hyoscyamine 0.125 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.17 , $1.19 , $1.74 , See APC Packaged Rates , $1.52 , $0.85 , $2.09 , $2.10 , $1.12 , See APC Packaged Rates , See APC Packaged Rates , $1.46 , $1.46 , See APC Packaged Rates , See APC Packaged Rates , $2.02 , $2.02 , $2.02 , $2.02 , See APC Packaged Rates , $0.76 , $1.30 , $0.76 , $2.10 , $1.52
,5710011216,Hospital Chargemaster,Ibuprofen 100 mg/5mL Oral,Outpatient,Outpatient Default Percent / Case Rate,259, $3.08 , $1.69 , $2.46 , See APC Packaged Rates , $2.16 , $1.20 , $2.97 , $2.98 , $1.59 , See APC Packaged Rates , See APC Packaged Rates , $2.07 , $2.07 , See APC Packaged Rates , See APC Packaged Rates , $2.86 , $2.86 , $2.86 , $2.86 , See APC Packaged Rates , $1.08 , $1.85 , $1.08 , $2.98 , $2.16
,5710011218,Hospital Chargemaster,Ibuprofen 100 mg Tab Chew,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011219,Hospital Chargemaster,Ibuprofen 200 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011220,Hospital Chargemaster,Ibuprofen 400 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011221,Hospital Chargemaster,Ibuprofen 800 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011222,Hospital Chargemaster,Ibuprofen 600 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011258,Hospital Chargemaster,Indomethacin 25 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.02 , $0.56 , $0.82 , See APC Packaged Rates , $0.71 , $0.40 , $0.98 , $0.99 , $0.53 , See APC Packaged Rates , See APC Packaged Rates , $0.68 , $0.68 , See APC Packaged Rates , See APC Packaged Rates , $0.95 , $0.95 , $0.95 , $0.95 , See APC Packaged Rates , $0.36 , $0.61 , $0.36 , $0.99 , $0.71
,5710011259,Hospital Chargemaster,Indomethacin 50 mg Supp,Outpatient,Outpatient Default Percent / Case Rate,259, $494.78 , $272.13 , $395.82 , See APC Packaged Rates , $346.35 , $192.96 , $477.41 , $479.49 , $254.82 , See APC Packaged Rates , See APC Packaged Rates , $332.00 , $332.00 , See APC Packaged Rates , See APC Packaged Rates , $460.15 , $460.15 , $460.15 , $460.15 , See APC Packaged Rates , $173.17 , $296.87 , $173.17 , $479.49 , $346.35
,5710011264,Hospital Chargemaster,Insulin Detemir 1 Unit,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011266,Hospital Chargemaster,Insulin Lispro 3 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,259, $9.17 , $5.04 , $7.34 , See APC Packaged Rates , $6.42 , $3.58 , $8.85 , $8.89 , $4.72 , See APC Packaged Rates , See APC Packaged Rates , $6.15 , $6.15 , See APC Packaged Rates , See APC Packaged Rates , $8.53 , $8.53 , $8.53 , $8.53 , See APC Packaged Rates , $3.21 , $5.50 , $3.21 , $8.89 , $6.42
,5710011268,Hospital Chargemaster,Insulin NPH/Reg 70/30 10 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,259, $37.92 , $20.86 , $30.34 , See APC Packaged Rates , $26.54 , $14.79 , $36.59 , $36.75 , $19.53 , See APC Packaged Rates , See APC Packaged Rates , $25.44 , $25.44 , See APC Packaged Rates , See APC Packaged Rates , $35.27 , $35.27 , $35.27 , $35.27 , See APC Packaged Rates , $13.27 , $22.75 , $13.27 , $36.75 , $26.54
,5710011269,Hospital Chargemaster,Insulin NPH Human 1 Unit,Outpatient,Outpatient Default Percent / Case Rate,259, $37.92 , $20.86 , $30.34 , See APC Packaged Rates , $26.54 , $14.79 , $36.59 , $36.75 , $19.53 , See APC Packaged Rates , See APC Packaged Rates , $25.44 , $25.44 , See APC Packaged Rates , See APC Packaged Rates , $35.27 , $35.27 , $35.27 , $35.27 , See APC Packaged Rates , $13.27 , $22.75 , $13.27 , $36.75 , $26.54
,5710011270,Hospital Chargemaster,Insulin Reg 500 Unit/1 mL,Outpatient,Outpatient Default Percent / Case Rate,259, $244.04 , $134.22 , $195.23 , See APC Packaged Rates , $170.83 , $95.18 , $235.47 , $236.50 , $125.69 , See APC Packaged Rates , See APC Packaged Rates , $163.75 , $163.75 , See APC Packaged Rates , See APC Packaged Rates , $226.96 , $226.96 , $226.96 , $226.96 , See APC Packaged Rates , $85.41 , $146.42 , $85.41 , $236.50 , $170.83
,5710011271,Hospital Chargemaster,Insulin Regular 3 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,259, $1.09 , $0.60 , $0.87 , See APC Packaged Rates , $0.76 , $0.43 , $1.05 , $1.06 , $0.56 , See APC Packaged Rates , See APC Packaged Rates , $0.73 , $0.73 , See APC Packaged Rates , See APC Packaged Rates , $1.01 , $1.01 , $1.01 , $1.01 , See APC Packaged Rates , $0.38 , $0.65 , $0.38 , $1.06 , $0.76
,5710011289,Hospital Chargemaster,Ipratropium 0.5 mg/2.5 mL Neb,Outpatient,Outpatient Default Percent / Case Rate,259, $3.20 , $1.76 , $2.56 , See APC Packaged Rates , $2.24 , $1.25 , $3.09 , $3.10 , $1.65 , See APC Packaged Rates , See APC Packaged Rates , $2.15 , $2.15 , See APC Packaged Rates , See APC Packaged Rates , $2.98 , $2.98 , $2.98 , $2.98 , See APC Packaged Rates , $1.12 , $1.92 , $1.12 , $3.10 , $2.24
,5710011290,Hospital Chargemaster,Ipratropium 0.03 % 30 mL Spray,Outpatient,Outpatient Default Percent / Case Rate,259, $9.49 , $5.22 , $7.59 , See APC Packaged Rates , $6.64 , $3.70 , $9.16 , $9.20 , $4.89 , See APC Packaged Rates , See APC Packaged Rates , $6.37 , $6.37 , See APC Packaged Rates , See APC Packaged Rates , $8.83 , $8.83 , $8.83 , $8.83 , See APC Packaged Rates , $3.32 , $5.69 , $3.32 , $9.20 , $6.64
,5710011292,Hospital Chargemaster,Albuterol/Ipratrop 2.5/0.5 3mL,Outpatient,Outpatient Default Percent / Case Rate,259, $5.53 , $3.04 , $4.42 , See APC Packaged Rates , $3.87 , $2.16 , $5.34 , $5.36 , $2.85 , See APC Packaged Rates , See APC Packaged Rates , $3.71 , $3.71 , See APC Packaged Rates , See APC Packaged Rates , $5.14 , $5.14 , $5.14 , $5.14 , See APC Packaged Rates , $1.94 , $3.32 , $1.94 , $5.36 , $3.87
,5710011295,Hospital Chargemaster,Iron Poly Cmplx 150 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011304,Hospital Chargemaster,Isosorbide Dinit 10 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $2.75 , $1.51 , $2.20 , See APC Packaged Rates , $1.93 , $1.07 , $2.65 , $2.67 , $1.42 , See APC Packaged Rates , See APC Packaged Rates , $1.85 , $1.85 , See APC Packaged Rates , See APC Packaged Rates , $2.56 , $2.56 , $2.56 , $2.56 , See APC Packaged Rates , $0.96 , $1.65 , $0.96 , $2.67 , $1.93
,5710011305,Hospital Chargemaster,Isosorbide Dinit 20 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $3.44 , $1.89 , $2.75 , See APC Packaged Rates , $2.41 , $1.34 , $3.32 , $3.33 , $1.77 , See APC Packaged Rates , See APC Packaged Rates , $2.31 , $2.31 , See APC Packaged Rates , See APC Packaged Rates , $3.20 , $3.20 , $3.20 , $3.20 , See APC Packaged Rates , $1.20 , $2.06 , $1.20 , $3.33 , $2.41
,5710011308,Hospital Chargemaster,Isosorbide Mononit 30 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $3.99 , $2.19 , $3.19 , See APC Packaged Rates , $2.79 , $1.56 , $3.85 , $3.87 , $2.05 , See APC Packaged Rates , See APC Packaged Rates , $2.68 , $2.68 , See APC Packaged Rates , See APC Packaged Rates , $3.71 , $3.71 , $3.71 , $3.71 , See APC Packaged Rates , $1.40 , $2.39 , $1.40 , $3.87 , $2.79
,5710011310,Hospital Chargemaster,Isosorbide Mononit 20 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $2.27 , $1.25 , $1.82 , See APC Packaged Rates , $1.59 , $0.89 , $2.19 , $2.20 , $1.17 , See APC Packaged Rates , See APC Packaged Rates , $1.52 , $1.52 , See APC Packaged Rates , See APC Packaged Rates , $2.11 , $2.11 , $2.11 , $2.11 , See APC Packaged Rates , $0.79 , $1.36 , $0.79 , $2.20 , $1.59
,5710011314,Hospital Chargemaster,Ivermectin 3 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $8.44 , $4.64 , $6.75 , See APC Packaged Rates , $5.91 , $3.29 , $8.14 , $8.18 , $4.35 , See APC Packaged Rates , See APC Packaged Rates , $5.66 , $5.66 , See APC Packaged Rates , See APC Packaged Rates , $7.85 , $7.85 , $7.85 , $7.85 , See APC Packaged Rates , $2.95 , $5.06 , $2.95 , $8.18 , $5.91
,5710011323,Hospital Chargemaster,Ketoconazole 2 % 120mL SHAmpOO,Outpatient,Outpatient Default Percent / Case Rate,259, $2.93 , $1.61 , $2.34 , See APC Packaged Rates , $2.05 , $1.14 , $2.83 , $2.84 , $1.51 , See APC Packaged Rates , See APC Packaged Rates , $1.97 , $1.97 , See APC Packaged Rates , See APC Packaged Rates , $2.72 , $2.72 , $2.72 , $2.72 , See APC Packaged Rates , $1.03 , $1.76 , $1.03 , $2.84 , $2.05
,5710011324,Hospital Chargemaster,Ketoconazole 2 % 30 gm Cream,Outpatient,Outpatient Default Percent / Case Rate,259, $4.54 , $2.50 , $3.63 , See APC Packaged Rates , $3.18 , $1.77 , $4.38 , $4.40 , $2.34 , See APC Packaged Rates , See APC Packaged Rates , $3.05 , $3.05 , See APC Packaged Rates , See APC Packaged Rates , $4.22 , $4.22 , $4.22 , $4.22 , See APC Packaged Rates , $1.59 , $2.72 , $1.59 , $4.40 , $3.18
,5710011325,Hospital Chargemaster,Ketorolac 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.51 , $3.03 , $4.41 , See APC Packaged Rates , $3.86 , $2.15 , $5.32 , $5.34 , $2.84 , See APC Packaged Rates , See APC Packaged Rates , $3.70 , $3.70 , See APC Packaged Rates , See APC Packaged Rates , $5.12 , $5.12 , $5.12 , $5.12 , See APC Packaged Rates , $1.93 , $3.31 , $1.93 , $5.34 , $3.86
,5710011329,Hospital Chargemaster,Ketorolac 0.5 % Op 5 mL Drops,Outpatient,Outpatient Default Percent / Case Rate,259, $118.09 , $64.95 , $94.47 , See APC Packaged Rates , $82.66 , $46.06 , $113.95 , $114.44 , $60.82 , See APC Packaged Rates , See APC Packaged Rates , $79.24 , $79.24 , See APC Packaged Rates , See APC Packaged Rates , $109.82 , $109.82 , $109.82 , $109.82 , See APC Packaged Rates , $41.33 , $70.85 , $41.33 , $114.44 , $82.66
,5710011333,Hospital Chargemaster,Labetalol 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.20 , $0.66 , $0.96 , See APC Packaged Rates , $0.84 , $0.47 , $1.16 , $1.16 , $0.62 , See APC Packaged Rates , See APC Packaged Rates , $0.81 , $0.81 , See APC Packaged Rates , See APC Packaged Rates , $1.12 , $1.12 , $1.12 , $1.12 , See APC Packaged Rates , $0.42 , $0.72 , $0.42 , $1.16 , $0.84
,5710011334,Hospital Chargemaster,Labetalol 200 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.73 , $0.95 , $1.38 , See APC Packaged Rates , $1.21 , $0.67 , $1.67 , $1.68 , $0.89 , See APC Packaged Rates , See APC Packaged Rates , $1.16 , $1.16 , See APC Packaged Rates , See APC Packaged Rates , $1.61 , $1.61 , $1.61 , $1.61 , See APC Packaged Rates , $0.61 , $1.04 , $0.61 , $1.68 , $1.21
,5710011337,Hospital Chargemaster,Lacosamide 50 mg/5 mL Solution,Outpatient,Outpatient Default Percent / Case Rate,259, $23.54 , $12.95 , $18.83 , See APC Packaged Rates , $16.48 , $9.18 , $22.71 , $22.81 , $12.12 , See APC Packaged Rates , See APC Packaged Rates , $15.80 , $15.80 , See APC Packaged Rates , See APC Packaged Rates , $21.89 , $21.89 , $21.89 , $21.89 , See APC Packaged Rates , $8.24 , $14.12 , $8.24 , $22.81 , $16.48
,5710011339,Hospital Chargemaster,Lactase 3000 Unit Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $0.97 , $0.53 , $0.78 , See APC Packaged Rates , $0.68 , $0.38 , $0.94 , $0.94 , $0.50 , See APC Packaged Rates , See APC Packaged Rates , $0.65 , $0.65 , See APC Packaged Rates , See APC Packaged Rates , $0.90 , $0.90 , $0.90 , $0.90 , See APC Packaged Rates , $0.34 , $0.58 , $0.34 , $0.94 , $0.68
,5710011341,Hospital Chargemaster,Lactobacillus Rham Cap.SPRINK,Outpatient,Outpatient Default Percent / Case Rate,259, $2.42 , $1.33 , $1.94 , See APC Packaged Rates , $1.69 , $0.94 , $2.34 , $2.35 , $1.25 , See APC Packaged Rates , See APC Packaged Rates , $1.62 , $1.62 , See APC Packaged Rates , See APC Packaged Rates , $2.25 , $2.25 , $2.25 , $2.25 , See APC Packaged Rates , $0.85 , $1.45 , $0.85 , $2.35 , $1.69
,5710011343,Hospital Chargemaster,Lactulose 20 gm/30 mL Solution,Outpatient,Outpatient Default Percent / Case Rate,259, $2.49 , $1.37 , $1.99 , See APC Packaged Rates , $1.74 , $0.97 , $2.40 , $2.41 , $1.28 , See APC Packaged Rates , See APC Packaged Rates , $1.67 , $1.67 , See APC Packaged Rates , See APC Packaged Rates , $2.32 , $2.32 , $2.32 , $2.32 , See APC Packaged Rates , $0.87 , $1.49 , $0.87 , $2.41 , $1.74
,5710011348,Hospital Chargemaster,lamoTRIgine 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011350,Hospital Chargemaster,lamoTRIgine 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $0.96 , $0.53 , $0.77 , See APC Packaged Rates , $0.67 , $0.37 , $0.93 , $0.93 , $0.49 , See APC Packaged Rates , See APC Packaged Rates , $0.64 , $0.64 , See APC Packaged Rates , See APC Packaged Rates , $0.89 , $0.89 , $0.89 , $0.89 , See APC Packaged Rates , $0.34 , $0.58 , $0.34 , $0.93 , $0.67
,5710011353,Hospital Chargemaster,Lansoprazole 15 mg Tab.RAP.DR,Outpatient,Outpatient Default Percent / Case Rate,259, $31.92 , $17.56 , $25.54 , See APC Packaged Rates , $22.34 , $12.45 , $30.80 , $30.93 , $16.44 , See APC Packaged Rates , See APC Packaged Rates , $21.42 , $21.42 , See APC Packaged Rates , See APC Packaged Rates , $29.69 , $29.69 , $29.69 , $29.69 , See APC Packaged Rates , $11.17 , $19.15 , $11.17 , $30.93 , $22.34
,5710011354,Hospital Chargemaster,Latanoprost 0.005 % 2.5mL Drop,Outpatient,Outpatient Default Percent / Case Rate,259, $95.85 , $52.72 , $76.68 , See APC Packaged Rates , $67.10 , $37.38 , $92.49 , $92.89 , $49.36 , See APC Packaged Rates , See APC Packaged Rates , $64.32 , $64.32 , See APC Packaged Rates , See APC Packaged Rates , $89.14 , $89.14 , $89.14 , $89.14 , See APC Packaged Rates , $33.55 , $57.51 , $33.55 , $92.89 , $67.10
,5710011356,Hospital Chargemaster,Letrozole 2.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $46.18 , $25.40 , $36.94 , See APC Packaged Rates , $32.33 , $18.01 , $44.56 , $44.75 , $23.78 , See APC Packaged Rates , See APC Packaged Rates , $30.99 , $30.99 , See APC Packaged Rates , See APC Packaged Rates , $42.95 , $42.95 , $42.95 , $42.95 , See APC Packaged Rates , $16.16 , $27.71 , $16.16 , $44.75 , $32.33
,5710011374,Hospital Chargemaster,Levalbuterol 0.63 mg/3 mL Neb,Outpatient,Outpatient Default Percent / Case Rate,259, $3.70 , $2.04 , $2.96 , See APC Packaged Rates , $2.59 , $1.44 , $3.57 , $3.59 , $1.91 , See APC Packaged Rates , See APC Packaged Rates , $2.48 , $2.48 , See APC Packaged Rates , See APC Packaged Rates , $3.44 , $3.44 , $3.44 , $3.44 , See APC Packaged Rates , $1.30 , $2.22 , $1.30 , $3.59 , $2.59
,5710011375,Hospital Chargemaster,Levalbuterol 1.25 mg/3 mL Neb,Outpatient,Outpatient Default Percent / Case Rate,259, $5.10 , $2.81 , $4.08 , See APC Packaged Rates , $3.57 , $1.99 , $4.92 , $4.94 , $2.63 , See APC Packaged Rates , See APC Packaged Rates , $3.42 , $3.42 , See APC Packaged Rates , See APC Packaged Rates , $4.74 , $4.74 , $4.74 , $4.74 , See APC Packaged Rates , $1.79 , $3.06 , $1.79 , $4.94 , $3.57
,5710011376,Hospital Chargemaster,levETIRAcetam 500 mg/5 mL Oral,Outpatient,Outpatient Default Percent / Case Rate,259, $17.54 , $9.65 , $14.03 , See APC Packaged Rates , $12.28 , $6.84 , $16.92 , $17.00 , $9.03 , See APC Packaged Rates , See APC Packaged Rates , $11.77 , $11.77 , See APC Packaged Rates , See APC Packaged Rates , $16.31 , $16.31 , $16.31 , $16.31 , See APC Packaged Rates , $6.14 , $10.52 , $6.14 , $17.00 , $12.28
,5710011378,Hospital Chargemaster,levETIRAcetam 250 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.52 , $0.84 , $1.22 , See APC Packaged Rates , $1.06 , $0.59 , $1.47 , $1.47 , $0.78 , See APC Packaged Rates , See APC Packaged Rates , $1.02 , $1.02 , See APC Packaged Rates , See APC Packaged Rates , $1.41 , $1.41 , $1.41 , $1.41 , See APC Packaged Rates , $0.53 , $0.91 , $0.53 , $1.47 , $1.06
,5710011379,Hospital Chargemaster,levETIRAcetam 500 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $0.98 , $0.54 , $0.78 , See APC Packaged Rates , $0.69 , $0.38 , $0.95 , $0.95 , $0.50 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.91 , $0.91 , $0.91 , $0.91 , See APC Packaged Rates , $0.34 , $0.59 , $0.34 , $0.95 , $0.69
,5710011384,Hospital Chargemaster,levoFLOXacin 250 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011385,Hospital Chargemaster,levoFLOXacin 500 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011392,Hospital Chargemaster,Levonorgestrel 1.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $19.23 , $10.58 , $15.38 , See APC Packaged Rates , $13.46 , $7.50 , $18.56 , $18.64 , $9.90 , See APC Packaged Rates , See APC Packaged Rates , $12.90 , $12.90 , See APC Packaged Rates , See APC Packaged Rates , $17.88 , $17.88 , $17.88 , $17.88 , See APC Packaged Rates , $6.73 , $11.54 , $6.73 , $18.64 , $13.46
,5710011393,Hospital Chargemaster,Levothyroxine 100 mcg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.28 , $1.80 , $2.62 , See APC Packaged Rates , $2.30 , $1.28 , $3.16 , $3.18 , $1.69 , See APC Packaged Rates , See APC Packaged Rates , $2.20 , $2.20 , See APC Packaged Rates , See APC Packaged Rates , $3.05 , $3.05 , $3.05 , $3.05 , See APC Packaged Rates , $1.15 , $1.97 , $1.15 , $3.18 , $2.30
,5710011394,Hospital Chargemaster,Levothyroxine 112 mcg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.69 , $0.93 , $1.35 , See APC Packaged Rates , $1.18 , $0.66 , $1.63 , $1.64 , $0.87 , See APC Packaged Rates , See APC Packaged Rates , $1.13 , $1.13 , See APC Packaged Rates , See APC Packaged Rates , $1.57 , $1.57 , $1.57 , $1.57 , See APC Packaged Rates , $0.59 , $1.01 , $0.59 , $1.64 , $1.18
,5710011395,Hospital Chargemaster,Levothyroxine 125 mcg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.82 , $1.00 , $1.46 , See APC Packaged Rates , $1.27 , $0.71 , $1.76 , $1.76 , $0.94 , See APC Packaged Rates , See APC Packaged Rates , $1.22 , $1.22 , See APC Packaged Rates , See APC Packaged Rates , $1.69 , $1.69 , $1.69 , $1.69 , See APC Packaged Rates , $0.64 , $1.09 , $0.64 , $1.76 , $1.27
,5710011397,Hospital Chargemaster,Levothyroxine 150 mcg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.85 , $1.02 , $1.48 , See APC Packaged Rates , $1.30 , $0.72 , $1.79 , $1.79 , $0.95 , See APC Packaged Rates , See APC Packaged Rates , $1.24 , $1.24 , See APC Packaged Rates , See APC Packaged Rates , $1.72 , $1.72 , $1.72 , $1.72 , See APC Packaged Rates , $0.65 , $1.11 , $0.65 , $1.79 , $1.30
,5710011400,Hospital Chargemaster,Levothyroxine 25 mcg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.21 , $0.67 , $0.97 , See APC Packaged Rates , $0.85 , $0.47 , $1.17 , $1.17 , $0.62 , See APC Packaged Rates , See APC Packaged Rates , $0.81 , $0.81 , See APC Packaged Rates , See APC Packaged Rates , $1.13 , $1.13 , $1.13 , $1.13 , See APC Packaged Rates , $0.42 , $0.73 , $0.42 , $1.17 , $0.85
,5710011401,Hospital Chargemaster,Levothyroxine 50 mcg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.34 , $0.74 , $1.07 , See APC Packaged Rates , $0.94 , $0.52 , $1.29 , $1.30 , $0.69 , See APC Packaged Rates , See APC Packaged Rates , $0.90 , $0.90 , See APC Packaged Rates , See APC Packaged Rates , $1.25 , $1.25 , $1.25 , $1.25 , See APC Packaged Rates , $0.47 , $0.80 , $0.47 , $1.30 , $0.94
,5710011402,Hospital Chargemaster,Levothyroxine 75 mcg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.49 , $0.82 , $1.19 , See APC Packaged Rates , $1.04 , $0.58 , $1.44 , $1.44 , $0.77 , See APC Packaged Rates , See APC Packaged Rates , $1.00 , $1.00 , See APC Packaged Rates , See APC Packaged Rates , $1.39 , $1.39 , $1.39 , $1.39 , See APC Packaged Rates , $0.52 , $0.89 , $0.52 , $1.44 , $1.04
,5710011403,Hospital Chargemaster,Levothyroxine 88 mcg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.45 , $0.80 , $1.16 , See APC Packaged Rates , $1.02 , $0.57 , $1.40 , $1.41 , $0.75 , See APC Packaged Rates , See APC Packaged Rates , $0.97 , $0.97 , See APC Packaged Rates , See APC Packaged Rates , $1.35 , $1.35 , $1.35 , $1.35 , See APC Packaged Rates , $0.51 , $0.87 , $0.51 , $1.41 , $1.02
,5710011405,Hospital Chargemaster,Lidocaine 5 % ADH..PATCH,Outpatient,Outpatient Default Percent / Case Rate,259, $54.73 , $30.10 , $43.78 , See APC Packaged Rates , $38.31 , $21.34 , $52.81 , $53.04 , $28.19 , See APC Packaged Rates , See APC Packaged Rates , $36.72 , $36.72 , See APC Packaged Rates , See APC Packaged Rates , $50.90 , $50.90 , $50.90 , $50.90 , See APC Packaged Rates , $19.16 , $32.84 , $19.16 , $53.04 , $38.31
,5710011410,Hospital Chargemaster,Lidocaine 2 % 5 mL JELLY,Outpatient,Outpatient Default Percent / Case Rate,259, $21.42 , $11.78 , $17.14 , See APC Packaged Rates , $14.99 , $8.35 , $20.67 , $20.76 , $11.03 , See APC Packaged Rates , See APC Packaged Rates , $14.37 , $14.37 , See APC Packaged Rates , See APC Packaged Rates , $19.92 , $19.92 , $19.92 , $19.92 , See APC Packaged Rates , $7.50 , $12.85 , $7.50 , $20.76 , $14.99
,5710011415,Hospital Chargemaster,Lidocaine 2 % 30 mL JELLY,Outpatient,Outpatient Default Percent / Case Rate,259, $10.91 , $6.00 , $8.73 , See APC Packaged Rates , $7.64 , $4.25 , $10.53 , $10.57 , $5.62 , See APC Packaged Rates , See APC Packaged Rates , $7.32 , $7.32 , See APC Packaged Rates , See APC Packaged Rates , $10.15 , $10.15 , $10.15 , $10.15 , See APC Packaged Rates , $3.82 , $6.55 , $3.82 , $10.57 , $7.64
,5710011416,Hospital Chargemaster,Lidocaine 2 % 10 mL JEL.PF.APP,Outpatient,Outpatient Default Percent / Case Rate,259, $16.34 , $8.99 , $13.07 , See APC Packaged Rates , $11.44 , $6.37 , $15.77 , $15.84 , $8.42 , See APC Packaged Rates , See APC Packaged Rates , $10.96 , $10.96 , See APC Packaged Rates , See APC Packaged Rates , $15.20 , $15.20 , $15.20 , $15.20 , See APC Packaged Rates , $5.72 , $9.80 , $5.72 , $15.84 , $11.44
,5710011417,Hospital Chargemaster,Lidocaine 2 % 5 mL JEL.PF.APP,Outpatient,Outpatient Default Percent / Case Rate,259, $15.30 , $8.42 , $12.24 , See APC Packaged Rates , $10.71 , $5.97 , $14.76 , $14.83 , $7.88 , See APC Packaged Rates , See APC Packaged Rates , $10.27 , $10.27 , See APC Packaged Rates , See APC Packaged Rates , $14.23 , $14.23 , $14.23 , $14.23 , See APC Packaged Rates , $5.36 , $9.18 , $5.36 , $14.83 , $10.71
,5710011418,Hospital Chargemaster,Lidocaine 4 % 50 mL Solution,Outpatient,Outpatient Default Percent / Case Rate,259, $2.45 , $1.35 , $1.96 , See APC Packaged Rates , $1.72 , $0.96 , $2.36 , $2.37 , $1.26 , See APC Packaged Rates , See APC Packaged Rates , $1.64 , $1.64 , See APC Packaged Rates , See APC Packaged Rates , $2.28 , $2.28 , $2.28 , $2.28 , See APC Packaged Rates , $0.86 , $1.47 , $0.86 , $2.37 , $1.72
,5710011420,Hospital Chargemaster,Lidocaine Visc 2 % 15 mL Sol,Outpatient,Outpatient Default Percent / Case Rate,259, $2.87 , $1.58 , $2.30 , See APC Packaged Rates , $2.01 , $1.12 , $2.77 , $2.78 , $1.48 , See APC Packaged Rates , See APC Packaged Rates , $1.93 , $1.93 , See APC Packaged Rates , See APC Packaged Rates , $2.67 , $2.67 , $2.67 , $2.67 , See APC Packaged Rates , $1.00 , $1.72 , $1.00 , $2.78 , $2.01
,5710011450,Hospital Chargemaster,Lidoc 2.5%/Prilo 2.5% 5 gm Cr,Outpatient,Outpatient Default Percent / Case Rate,259, $4.21 , $2.32 , $3.37 , See APC Packaged Rates , $2.95 , $1.64 , $4.06 , $4.08 , $2.17 , See APC Packaged Rates , See APC Packaged Rates , $2.82 , $2.82 , See APC Packaged Rates , See APC Packaged Rates , $3.92 , $3.92 , $3.92 , $3.92 , See APC Packaged Rates , $1.47 , $2.53 , $1.47 , $4.08 , $2.95
,5710011452,Hospital Chargemaster,Linezolid 600 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $468.33 , $257.58 , $374.66 , See APC Packaged Rates , $327.83 , $182.65 , $451.89 , $453.86 , $241.20 , See APC Packaged Rates , See APC Packaged Rates , $314.25 , $314.25 , See APC Packaged Rates , See APC Packaged Rates , $435.55 , $435.55 , $435.55 , $435.55 , See APC Packaged Rates , $163.92 , $281.00 , $163.92 , $453.86 , $327.83
,5710011455,Hospital Chargemaster,Liothyronine 5 mcg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.17 , $2.29 , $3.34 , See APC Packaged Rates , $2.92 , $1.63 , $4.02 , $4.04 , $2.15 , See APC Packaged Rates , See APC Packaged Rates , $2.80 , $2.80 , See APC Packaged Rates , See APC Packaged Rates , $3.88 , $3.88 , $3.88 , $3.88 , See APC Packaged Rates , $1.46 , $2.50 , $1.46 , $4.04 , $2.92
,5710011456,Hospital Chargemaster,Lip/Prot/Amy 10.4-39.2K Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $8.17 , $4.49 , $6.54 , See APC Packaged Rates , $5.72 , $3.19 , $7.88 , $7.92 , $4.21 , See APC Packaged Rates , See APC Packaged Rates , $5.48 , $5.48 , See APC Packaged Rates , See APC Packaged Rates , $7.60 , $7.60 , $7.60 , $7.60 , See APC Packaged Rates , $2.86 , $4.90 , $2.86 , $7.92 , $5.72
,5710011457,Hospital Chargemaster,Lip/Prot/Amyl 24/76/120K Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $17.62 , $9.69 , $14.10 , See APC Packaged Rates , $12.33 , $6.87 , $17.00 , $17.08 , $9.07 , See APC Packaged Rates , See APC Packaged Rates , $11.82 , $11.82 , See APC Packaged Rates , See APC Packaged Rates , $16.39 , $16.39 , $16.39 , $16.39 , See APC Packaged Rates , $6.17 , $10.57 , $6.17 , $17.08 , $12.33
,5710011458,Hospital Chargemaster,Lip/Prot/Amyl 5/17/24K Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $4.82 , $2.65 , $3.86 , See APC Packaged Rates , $3.37 , $1.88 , $4.65 , $4.67 , $2.48 , See APC Packaged Rates , See APC Packaged Rates , $3.23 , $3.23 , See APC Packaged Rates , See APC Packaged Rates , $4.48 , $4.48 , $4.48 , $4.48 , See APC Packaged Rates , $1.69 , $2.89 , $1.69 , $4.67 , $3.37
,5710011459,Hospital Chargemaster,Lisinopril 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.50 , $1.38 , $2.00 , See APC Packaged Rates , $1.75 , $0.98 , $2.41 , $2.42 , $1.29 , See APC Packaged Rates , See APC Packaged Rates , $1.68 , $1.68 , See APC Packaged Rates , See APC Packaged Rates , $2.33 , $2.33 , $2.33 , $2.33 , See APC Packaged Rates , $0.88 , $1.50 , $0.88 , $2.42 , $1.75
,5710011460,Hospital Chargemaster,Lisinopril 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.42 , $1.33 , $1.94 , See APC Packaged Rates , $1.69 , $0.94 , $2.34 , $2.35 , $1.25 , See APC Packaged Rates , See APC Packaged Rates , $1.62 , $1.62 , See APC Packaged Rates , See APC Packaged Rates , $2.25 , $2.25 , $2.25 , $2.25 , See APC Packaged Rates , $0.85 , $1.45 , $0.85 , $2.35 , $1.69
,5710011461,Hospital Chargemaster,Lisinopril 2.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.60 , $0.88 , $1.28 , See APC Packaged Rates , $1.12 , $0.62 , $1.54 , $1.55 , $0.82 , See APC Packaged Rates , See APC Packaged Rates , $1.07 , $1.07 , See APC Packaged Rates , See APC Packaged Rates , $1.49 , $1.49 , $1.49 , $1.49 , See APC Packaged Rates , $0.56 , $0.96 , $0.56 , $1.55 , $1.12
,5710011463,Hospital Chargemaster,Lisinopril 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.25 , $1.79 , $2.60 , See APC Packaged Rates , $2.28 , $1.27 , $3.14 , $3.15 , $1.67 , See APC Packaged Rates , See APC Packaged Rates , $2.18 , $2.18 , See APC Packaged Rates , See APC Packaged Rates , $3.02 , $3.02 , $3.02 , $3.02 , See APC Packaged Rates , $1.14 , $1.95 , $1.14 , $3.15 , $2.28
,5710011464,Hospital Chargemaster,Lithium Carbonate 150 mg Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011465,Hospital Chargemaster,Lithium Carbonate 300 mg Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011468,Hospital Chargemaster,Lithium Carb ER 300 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.20 , $0.66 , $0.96 , See APC Packaged Rates , $0.84 , $0.47 , $1.16 , $1.16 , $0.62 , See APC Packaged Rates , See APC Packaged Rates , $0.81 , $0.81 , See APC Packaged Rates , See APC Packaged Rates , $1.12 , $1.12 , $1.12 , $1.12 , See APC Packaged Rates , $0.42 , $0.72 , $0.42 , $1.16 , $0.84
,5710011469,Hospital Chargemaster,Lithium Carbon ER 450 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.38 , $0.76 , $1.10 , See APC Packaged Rates , $0.97 , $0.54 , $1.33 , $1.34 , $0.71 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , See APC Packaged Rates , See APC Packaged Rates , $1.28 , $1.28 , $1.28 , $1.28 , See APC Packaged Rates , $0.48 , $0.83 , $0.48 , $1.34 , $0.97
,5710011471,Hospital Chargemaster,Loperamide 2 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $2.18 , $1.20 , $1.74 , See APC Packaged Rates , $1.53 , $0.85 , $2.10 , $2.11 , $1.12 , See APC Packaged Rates , See APC Packaged Rates , $1.46 , $1.46 , See APC Packaged Rates , See APC Packaged Rates , $2.03 , $2.03 , $2.03 , $2.03 , See APC Packaged Rates , $0.76 , $1.31 , $0.76 , $2.11 , $1.53
,5710011476,Hospital Chargemaster,Loratadine 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.75 , $0.96 , $1.40 , See APC Packaged Rates , $1.23 , $0.68 , $1.69 , $1.70 , $0.90 , See APC Packaged Rates , See APC Packaged Rates , $1.17 , $1.17 , See APC Packaged Rates , See APC Packaged Rates , $1.63 , $1.63 , $1.63 , $1.63 , See APC Packaged Rates , $0.61 , $1.05 , $0.61 , $1.70 , $1.23
,5710011478,Hospital Chargemaster,LORazepam 0.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.60 , $0.88 , $1.28 , See APC Packaged Rates , $1.12 , $0.62 , $1.54 , $1.55 , $0.82 , See APC Packaged Rates , See APC Packaged Rates , $1.07 , $1.07 , See APC Packaged Rates , See APC Packaged Rates , $1.49 , $1.49 , $1.49 , $1.49 , See APC Packaged Rates , $0.56 , $0.96 , $0.56 , $1.55 , $1.12
,5710011479,Hospital Chargemaster,LORazepam 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.39 , $1.31 , $1.91 , See APC Packaged Rates , $1.67 , $0.93 , $2.31 , $2.32 , $1.23 , See APC Packaged Rates , See APC Packaged Rates , $1.60 , $1.60 , See APC Packaged Rates , See APC Packaged Rates , $2.22 , $2.22 , $2.22 , $2.22 , See APC Packaged Rates , $0.84 , $1.43 , $0.84 , $2.32 , $1.67
,5710011480,Hospital Chargemaster,LORazepam 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.09 , $1.70 , $2.47 , See APC Packaged Rates , $2.16 , $1.21 , $2.98 , $2.99 , $1.59 , See APC Packaged Rates , See APC Packaged Rates , $2.07 , $2.07 , See APC Packaged Rates , See APC Packaged Rates , $2.87 , $2.87 , $2.87 , $2.87 , See APC Packaged Rates , $1.08 , $1.85 , $1.08 , $2.99 , $2.16
,5710011484,Hospital Chargemaster,Losartan 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.23 , $2.33 , $3.38 , See APC Packaged Rates , $2.96 , $1.65 , $4.08 , $4.10 , $2.18 , See APC Packaged Rates , See APC Packaged Rates , $2.84 , $2.84 , See APC Packaged Rates , See APC Packaged Rates , $3.93 , $3.93 , $3.93 , $3.93 , See APC Packaged Rates , $1.48 , $2.54 , $1.48 , $4.10 , $2.96
,5710011485,Hospital Chargemaster,Losartan 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.62 , $3.09 , $4.50 , See APC Packaged Rates , $3.93 , $2.19 , $5.42 , $5.45 , $2.89 , See APC Packaged Rates , See APC Packaged Rates , $3.77 , $3.77 , See APC Packaged Rates , See APC Packaged Rates , $5.23 , $5.23 , $5.23 , $5.23 , See APC Packaged Rates , $1.97 , $3.37 , $1.97 , $5.45 , $3.93
,5710011488,Hospital Chargemaster,Loxapine 25 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $4.90 , $2.70 , $3.92 , See APC Packaged Rates , $3.43 , $1.91 , $4.73 , $4.75 , $2.52 , See APC Packaged Rates , See APC Packaged Rates , $3.29 , $3.29 , See APC Packaged Rates , See APC Packaged Rates , $4.56 , $4.56 , $4.56 , $4.56 , See APC Packaged Rates , $1.72 , $2.94 , $1.72 , $4.75 , $3.43
,5710011491,Hospital Chargemaster,Lurasidone HCl 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $112.81 , $62.05 , $90.25 , See APC Packaged Rates , $78.97 , $44.00 , $108.85 , $109.32 , $58.10 , See APC Packaged Rates , See APC Packaged Rates , $75.70 , $75.70 , See APC Packaged Rates , See APC Packaged Rates , $104.91 , $104.91 , $104.91 , $104.91 , See APC Packaged Rates , $39.48 , $67.69 , $39.48 , $109.32 , $78.97
,5710011492,Hospital Chargemaster,Lurasidone HCl 40 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $111.33 , $61.23 , $89.06 , See APC Packaged Rates , $77.93 , $43.42 , $107.42 , $107.89 , $57.34 , See APC Packaged Rates , See APC Packaged Rates , $74.70 , $74.70 , See APC Packaged Rates , See APC Packaged Rates , $103.54 , $103.54 , $103.54 , $103.54 , See APC Packaged Rates , $38.97 , $66.80 , $38.97 , $107.89 , $77.93
,5710011495,Hospital Chargemaster,mg Hyd/Alum Hyd/Sim 30mL Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $9.44 , $5.19 , $7.55 , See APC Packaged Rates , $6.61 , $3.68 , $9.11 , $9.15 , $4.86 , See APC Packaged Rates , See APC Packaged Rates , $6.33 , $6.33 , See APC Packaged Rates , See APC Packaged Rates , $8.78 , $8.78 , $8.78 , $8.78 , See APC Packaged Rates , $3.30 , $5.66 , $3.30 , $9.15 , $6.61
,5710011497,Hospital Chargemaster,Magnesium Cit 300 mL Solution,Outpatient,Outpatient Default Percent / Case Rate,259, $8.82 , $4.85 , $7.06 , See APC Packaged Rates , $6.17 , $3.44 , $8.51 , $8.55 , $4.54 , See APC Packaged Rates , See APC Packaged Rates , $5.92 , $5.92 , See APC Packaged Rates , See APC Packaged Rates , $8.20 , $8.20 , $8.20 , $8.20 , See APC Packaged Rates , $3.09 , $5.29 , $3.09 , $8.55 , $6.17
,5710011498,Hospital Chargemaster,Magnesium Hydroxide 30 mL,Outpatient,Outpatient Default Percent / Case Rate,259, $5.77 , $3.17 , $4.62 , See APC Packaged Rates , $4.04 , $2.25 , $5.57 , $5.59 , $2.97 , See APC Packaged Rates , See APC Packaged Rates , $3.87 , $3.87 , See APC Packaged Rates , See APC Packaged Rates , $5.37 , $5.37 , $5.37 , $5.37 , See APC Packaged Rates , $2.02 , $3.46 , $2.02 , $5.59 , $4.04
,5710011499,Hospital Chargemaster,Magnesium Oxide 400 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011518,Hospital Chargemaster,Meclizine HCl 12.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.78 , $0.98 , $1.42 , See APC Packaged Rates , $1.25 , $0.69 , $1.72 , $1.72 , $0.92 , See APC Packaged Rates , See APC Packaged Rates , $1.19 , $1.19 , See APC Packaged Rates , See APC Packaged Rates , $1.66 , $1.66 , $1.66 , $1.66 , See APC Packaged Rates , $0.62 , $1.07 , $0.62 , $1.72 , $1.25
,5710011521,Hospital Chargemaster,medroxyPROGESTERone 2.5 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011526,Hospital Chargemaster,Megestrol 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.65 , $1.46 , $2.12 , See APC Packaged Rates , $1.86 , $1.03 , $2.56 , $2.57 , $1.36 , See APC Packaged Rates , See APC Packaged Rates , $1.78 , $1.78 , See APC Packaged Rates , See APC Packaged Rates , $2.46 , $2.46 , $2.46 , $2.46 , See APC Packaged Rates , $0.93 , $1.59 , $0.93 , $2.57 , $1.86
,5710011528,Hospital Chargemaster,Melatonin 3 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $0.98 , $0.54 , $0.78 , See APC Packaged Rates , $0.69 , $0.38 , $0.95 , $0.95 , $0.50 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.91 , $0.91 , $0.91 , $0.91 , See APC Packaged Rates , $0.34 , $0.59 , $0.34 , $0.95 , $0.69
,5710011529,Hospital Chargemaster,Meloxicam 15 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $12.34 , $6.79 , $9.87 , See APC Packaged Rates , $8.64 , $4.81 , $11.91 , $11.96 , $6.36 , See APC Packaged Rates , See APC Packaged Rates , $8.28 , $8.28 , See APC Packaged Rates , See APC Packaged Rates , $11.48 , $11.48 , $11.48 , $11.48 , See APC Packaged Rates , $4.32 , $7.40 , $4.32 , $11.96 , $8.64
,5710011530,Hospital Chargemaster,Meloxicam 7.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $23.72 , $13.05 , $18.98 , See APC Packaged Rates , $16.60 , $9.25 , $22.89 , $22.99 , $12.22 , See APC Packaged Rates , See APC Packaged Rates , $15.92 , $15.92 , See APC Packaged Rates , See APC Packaged Rates , $22.06 , $22.06 , $22.06 , $22.06 , See APC Packaged Rates , $8.30 , $14.23 , $8.30 , $22.99 , $16.60
,5710011532,Hospital Chargemaster,Memantine HCl 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $18.75 , $10.31 , $15.00 , See APC Packaged Rates , $13.13 , $7.31 , $18.09 , $18.17 , $9.66 , See APC Packaged Rates , See APC Packaged Rates , $12.58 , $12.58 , See APC Packaged Rates , See APC Packaged Rates , $17.44 , $17.44 , $17.44 , $17.44 , See APC Packaged Rates , $6.56 , $11.25 , $6.56 , $18.17 , $13.13
,5710011533,Hospital Chargemaster,Memantine HCl 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.04 , $1.12 , $1.63 , See APC Packaged Rates , $1.43 , $0.80 , $1.97 , $1.98 , $1.05 , See APC Packaged Rates , See APC Packaged Rates , $1.37 , $1.37 , See APC Packaged Rates , See APC Packaged Rates , $1.90 , $1.90 , $1.90 , $1.90 , See APC Packaged Rates , $0.71 , $1.22 , $0.71 , $1.98 , $1.43
,5710011536,Hospital Chargemaster,Menthol/Camphor 7.5 OZ Lotion,Outpatient,Outpatient Default Percent / Case Rate,259, $13.85 , $7.62 , $11.08 , See APC Packaged Rates , $9.70 , $5.40 , $13.36 , $13.42 , $7.13 , See APC Packaged Rates , See APC Packaged Rates , $9.29 , $9.29 , See APC Packaged Rates , See APC Packaged Rates , $12.88 , $12.88 , $12.88 , $12.88 , See APC Packaged Rates , $4.85 , $8.31 , $4.85 , $13.42 , $9.70
,5710011553,Hospital Chargemaster,Mesalamine 400 mg Capsule DR,Outpatient,Outpatient Default Percent / Case Rate,259, $9.89 , $5.44 , $7.91 , See APC Packaged Rates , $6.92 , $3.86 , $9.54 , $9.58 , $5.09 , See APC Packaged Rates , See APC Packaged Rates , $6.64 , $6.64 , See APC Packaged Rates , See APC Packaged Rates , $9.20 , $9.20 , $9.20 , $9.20 , See APC Packaged Rates , $3.46 , $5.93 , $3.46 , $9.58 , $6.92
,5710011554,Hospital Chargemaster,Mesalamine 250 mg Capsule ER,Outpatient,Outpatient Default Percent / Case Rate,259, $3.88 , $2.13 , $3.10 , See APC Packaged Rates , $2.72 , $1.51 , $3.74 , $3.76 , $2.00 , See APC Packaged Rates , See APC Packaged Rates , $2.60 , $2.60 , See APC Packaged Rates , See APC Packaged Rates , $3.61 , $3.61 , $3.61 , $3.61 , See APC Packaged Rates , $1.36 , $2.33 , $1.36 , $3.76 , $2.72
,5710011561,Hospital Chargemaster,metFORMIN HCl 500 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011564,Hospital Chargemaster,metFORMIN HCl ER 500 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.93 , $1.06 , $1.54 , See APC Packaged Rates , $1.35 , $0.75 , $1.86 , $1.87 , $0.99 , See APC Packaged Rates , See APC Packaged Rates , $1.30 , $1.30 , See APC Packaged Rates , See APC Packaged Rates , $1.79 , $1.79 , $1.79 , $1.79 , See APC Packaged Rates , $0.68 , $1.16 , $0.68 , $1.87 , $1.35
,5710011566,Hospital Chargemaster,Methacholine 100 mg Vial.Neb,Outpatient,Outpatient Default Percent / Case Rate,259, $197.93 , $108.86 , $158.34 , See APC Packaged Rates , $138.55 , $77.19 , $190.98 , $191.81 , $101.94 , See APC Packaged Rates , See APC Packaged Rates , $132.81 , $132.81 , See APC Packaged Rates , See APC Packaged Rates , $184.07 , $184.07 , $184.07 , $184.07 , See APC Packaged Rates , $69.28 , $118.76 , $69.28 , $191.81 , $138.55
,5710011568,Hospital Chargemaster,methADONE 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.32 , $0.73 , $1.06 , See APC Packaged Rates , $0.92 , $0.51 , $1.27 , $1.28 , $0.68 , See APC Packaged Rates , See APC Packaged Rates , $0.89 , $0.89 , See APC Packaged Rates , See APC Packaged Rates , $1.23 , $1.23 , $1.23 , $1.23 , See APC Packaged Rates , $0.46 , $0.79 , $0.46 , $1.28 , $0.92
,5710011569,Hospital Chargemaster,methADONE 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011574,Hospital Chargemaster,Methenamine Hippurate 1 gm Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $9.03 , $4.97 , $7.22 , See APC Packaged Rates , $6.32 , $3.52 , $8.71 , $8.75 , $4.65 , See APC Packaged Rates , See APC Packaged Rates , $6.06 , $6.06 , See APC Packaged Rates , See APC Packaged Rates , $8.40 , $8.40 , $8.40 , $8.40 , See APC Packaged Rates , $3.16 , $5.42 , $3.16 , $8.75 , $6.32
,5710011576,Hospital Chargemaster,methIMAzole 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.05 , $0.58 , $0.84 , See APC Packaged Rates , $0.74 , $0.41 , $1.01 , $1.02 , $0.54 , See APC Packaged Rates , See APC Packaged Rates , $0.70 , $0.70 , See APC Packaged Rates , See APC Packaged Rates , $0.98 , $0.98 , $0.98 , $0.98 , See APC Packaged Rates , $0.37 , $0.63 , $0.37 , $1.02 , $0.74
,5710011577,Hospital Chargemaster,Methocarbamol 500 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011578,Hospital Chargemaster,Methocarbamol 750 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.86 , $1.02 , $1.49 , See APC Packaged Rates , $1.30 , $0.73 , $1.79 , $1.80 , $0.96 , See APC Packaged Rates , See APC Packaged Rates , $1.25 , $1.25 , See APC Packaged Rates , See APC Packaged Rates , $1.73 , $1.73 , $1.73 , $1.73 , See APC Packaged Rates , $0.65 , $1.12 , $0.65 , $1.80 , $1.30
,5710011580,Hospital Chargemaster,metHOTREXate 2.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $15.91 , $8.75 , $12.73 , See APC Packaged Rates , $11.14 , $6.20 , $15.35 , $15.42 , $8.19 , See APC Packaged Rates , See APC Packaged Rates , $10.68 , $10.68 , See APC Packaged Rates , See APC Packaged Rates , $14.80 , $14.80 , $14.80 , $14.80 , See APC Packaged Rates , $5.57 , $9.55 , $5.57 , $15.42 , $11.14
,5710011585,Hospital Chargemaster,Methyl Salicy/Menthol 3 OZ Cr,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011590,Hospital Chargemaster,Methylergonovine Mal 0.2mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $158.74 , $87.31 , $126.99 , See APC Packaged Rates , $111.12 , $61.91 , $153.17 , $153.83 , $81.75 , See APC Packaged Rates , See APC Packaged Rates , $106.51 , $106.51 , See APC Packaged Rates , See APC Packaged Rates , $147.63 , $147.63 , $147.63 , $147.63 , See APC Packaged Rates , $55.56 , $95.24 , $55.56 , $153.83 , $111.12
,5710011592,Hospital Chargemaster,Methylphenidate 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.65 , $1.46 , $2.12 , See APC Packaged Rates , $1.86 , $1.03 , $2.56 , $2.57 , $1.36 , See APC Packaged Rates , See APC Packaged Rates , $1.78 , $1.78 , See APC Packaged Rates , See APC Packaged Rates , $2.46 , $2.46 , $2.46 , $2.46 , See APC Packaged Rates , $0.93 , $1.59 , $0.93 , $2.57 , $1.86
,5710011593,Hospital Chargemaster,Methylphenidate 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011595,Hospital Chargemaster,methylPREDNISolone 4 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.65 , $2.01 , $2.92 , See APC Packaged Rates , $2.56 , $1.42 , $3.52 , $3.54 , $1.88 , See APC Packaged Rates , See APC Packaged Rates , $2.45 , $2.45 , See APC Packaged Rates , See APC Packaged Rates , $3.39 , $3.39 , $3.39 , $3.39 , See APC Packaged Rates , $1.28 , $2.19 , $1.28 , $3.54 , $2.56
,5710011602,Hospital Chargemaster,Metoclopramide 10 mg/10mL Sol,Outpatient,Outpatient Default Percent / Case Rate,259, $5.69 , $3.13 , $4.55 , See APC Packaged Rates , $3.98 , $2.22 , $5.49 , $5.51 , $2.93 , See APC Packaged Rates , See APC Packaged Rates , $3.82 , $3.82 , See APC Packaged Rates , See APC Packaged Rates , $5.29 , $5.29 , $5.29 , $5.29 , See APC Packaged Rates , $1.99 , $3.41 , $1.99 , $5.51 , $3.98
,5710011603,Hospital Chargemaster,Metoclopramide 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.45 , $1.35 , $1.96 , See APC Packaged Rates , $1.72 , $0.96 , $2.36 , $2.37 , $1.26 , See APC Packaged Rates , See APC Packaged Rates , $1.64 , $1.64 , See APC Packaged Rates , See APC Packaged Rates , $2.28 , $2.28 , $2.28 , $2.28 , See APC Packaged Rates , $0.86 , $1.47 , $0.86 , $2.37 , $1.72
,5710011604,Hospital Chargemaster,Metoclopramide 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011606,Hospital Chargemaster,metOLazone 2.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $8.39 , $4.61 , $6.71 , See APC Packaged Rates , $5.87 , $3.27 , $8.10 , $8.13 , $4.32 , See APC Packaged Rates , See APC Packaged Rates , $5.63 , $5.63 , See APC Packaged Rates , See APC Packaged Rates , $7.80 , $7.80 , $7.80 , $7.80 , See APC Packaged Rates , $2.94 , $5.03 , $2.94 , $8.13 , $5.87
,5710011608,Hospital Chargemaster,Metoprolol Succ ER 100 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $3.04 , $1.67 , $2.43 , See APC Packaged Rates , $2.13 , $1.19 , $2.93 , $2.95 , $1.57 , See APC Packaged Rates , See APC Packaged Rates , $2.04 , $2.04 , See APC Packaged Rates , See APC Packaged Rates , $2.83 , $2.83 , $2.83 , $2.83 , See APC Packaged Rates , $1.06 , $1.82 , $1.06 , $2.95 , $2.13
,5710011609,Hospital Chargemaster,Metoprolol Succ ER 25 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $2.21 , $1.22 , $1.77 , See APC Packaged Rates , $1.55 , $0.86 , $2.13 , $2.14 , $1.14 , See APC Packaged Rates , See APC Packaged Rates , $1.48 , $1.48 , See APC Packaged Rates , See APC Packaged Rates , $2.06 , $2.06 , $2.06 , $2.06 , See APC Packaged Rates , $0.77 , $1.33 , $0.77 , $2.14 , $1.55
,5710011610,Hospital Chargemaster,Metoprolol Succ ER 50 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $2.80 , $1.54 , $2.24 , See APC Packaged Rates , $1.96 , $1.09 , $2.70 , $2.71 , $1.44 , See APC Packaged Rates , See APC Packaged Rates , $1.88 , $1.88 , See APC Packaged Rates , See APC Packaged Rates , $2.60 , $2.60 , $2.60 , $2.60 , See APC Packaged Rates , $0.98 , $1.68 , $0.98 , $2.71 , $1.96
,5710011612,Hospital Chargemaster,Zolpidem 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.39 , $2.41 , $3.51 , See APC Packaged Rates , $3.07 , $1.71 , $4.24 , $4.25 , $2.26 , See APC Packaged Rates , See APC Packaged Rates , $2.95 , $2.95 , See APC Packaged Rates , See APC Packaged Rates , $4.08 , $4.08 , $4.08 , $4.08 , See APC Packaged Rates , $1.54 , $2.63 , $1.54 , $4.25 , $3.07
,5710011613,Hospital Chargemaster,Metoprolol Tartrate 25 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011614,Hospital Chargemaster,Metoprolol Tartrate 50 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.43 , $0.79 , $1.14 , See APC Packaged Rates , $1.00 , $0.56 , $1.38 , $1.39 , $0.74 , See APC Packaged Rates , See APC Packaged Rates , $0.96 , $0.96 , See APC Packaged Rates , See APC Packaged Rates , $1.33 , $1.33 , $1.33 , $1.33 , See APC Packaged Rates , $0.50 , $0.86 , $0.50 , $1.39 , $1.00
,5710011616,Hospital Chargemaster,metroNIDAZOLE 250 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.03 , $0.57 , $0.82 , See APC Packaged Rates , $0.72 , $0.40 , $0.99 , $1.00 , $0.53 , See APC Packaged Rates , See APC Packaged Rates , $0.69 , $0.69 , See APC Packaged Rates , See APC Packaged Rates , $0.96 , $0.96 , $0.96 , $0.96 , See APC Packaged Rates , $0.36 , $0.62 , $0.36 , $1.00 , $0.72
,5710011623,Hospital Chargemaster,Miconazole 2 % 30 gm Cream,Outpatient,Outpatient Default Percent / Case Rate,259, $1.46 , $0.80 , $1.17 , See APC Packaged Rates , $1.02 , $0.57 , $1.41 , $1.41 , $0.75 , See APC Packaged Rates , See APC Packaged Rates , $0.98 , $0.98 , See APC Packaged Rates , See APC Packaged Rates , $1.36 , $1.36 , $1.36 , $1.36 , See APC Packaged Rates , $0.51 , $0.88 , $0.51 , $1.41 , $1.02
,5710011641,Hospital Chargemaster,Midodrine HCl 2.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.96 , $1.63 , $2.37 , See APC Packaged Rates , $2.07 , $1.15 , $2.86 , $2.87 , $1.52 , See APC Packaged Rates , See APC Packaged Rates , $1.99 , $1.99 , See APC Packaged Rates , See APC Packaged Rates , $2.75 , $2.75 , $2.75 , $2.75 , See APC Packaged Rates , $1.04 , $1.78 , $1.04 , $2.87 , $2.07
,5710011642,Hospital Chargemaster,Midodrine HCl 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.91 , $3.80 , $5.53 , See APC Packaged Rates , $4.84 , $2.69 , $6.67 , $6.70 , $3.56 , See APC Packaged Rates , See APC Packaged Rates , $4.64 , $4.64 , See APC Packaged Rates , See APC Packaged Rates , $6.43 , $6.43 , $6.43 , $6.43 , See APC Packaged Rates , $2.42 , $4.15 , $2.42 , $6.70 , $4.84
,5710011645,Hospital Chargemaster,Mineral Oil 25 mL OIL,Outpatient,Outpatient Default Percent / Case Rate,259, $13.90 , $7.65 , $11.12 , See APC Packaged Rates , $9.73 , $5.42 , $13.41 , $13.47 , $7.16 , See APC Packaged Rates , See APC Packaged Rates , $9.33 , $9.33 , See APC Packaged Rates , See APC Packaged Rates , $12.93 , $12.93 , $12.93 , $12.93 , See APC Packaged Rates , $4.87 , $8.34 , $4.87 , $13.47 , $9.73
,5710011646,Hospital Chargemaster,Mineral Oil 30 mL OIL,Outpatient,Outpatient Default Percent / Case Rate,259, $2.07 , $1.14 , $1.66 , See APC Packaged Rates , $1.45 , $0.81 , $2.00 , $2.01 , $1.07 , See APC Packaged Rates , See APC Packaged Rates , $1.39 , $1.39 , See APC Packaged Rates , See APC Packaged Rates , $1.93 , $1.93 , $1.93 , $1.93 , See APC Packaged Rates , $0.72 , $1.24 , $0.72 , $2.01 , $1.45
,5710011649,Hospital Chargemaster,Artificial Tears Oph 3.5gm Oin,Outpatient,Outpatient Default Percent / Case Rate,259, $3.01 , $1.66 , $2.41 , See APC Packaged Rates , $2.11 , $1.17 , $2.90 , $2.92 , $1.55 , See APC Packaged Rates , See APC Packaged Rates , $2.02 , $2.02 , See APC Packaged Rates , See APC Packaged Rates , $2.80 , $2.80 , $2.80 , $2.80 , See APC Packaged Rates , $1.05 , $1.81 , $1.05 , $2.92 , $2.11
,5710011650,Hospital Chargemaster,Moisturizing Cream 4 OZ,Outpatient,Outpatient Default Percent / Case Rate,259, $1.44 , $0.79 , $1.15 , See APC Packaged Rates , $1.01 , $0.56 , $1.39 , $1.40 , $0.74 , See APC Packaged Rates , See APC Packaged Rates , $0.97 , $0.97 , See APC Packaged Rates , See APC Packaged Rates , $1.34 , $1.34 , $1.34 , $1.34 , See APC Packaged Rates , $0.50 , $0.86 , $0.50 , $1.40 , $1.01
,5710011658,Hospital Chargemaster,Mirtazapine 15 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.75 , $3.71 , $5.40 , See APC Packaged Rates , $4.73 , $2.63 , $6.51 , $6.54 , $3.48 , See APC Packaged Rates , See APC Packaged Rates , $4.53 , $4.53 , See APC Packaged Rates , See APC Packaged Rates , $6.28 , $6.28 , $6.28 , $6.28 , See APC Packaged Rates , $2.36 , $4.05 , $2.36 , $6.54 , $4.73
,5710011660,Hospital Chargemaster,Mirtazapine 7.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.72 , $3.15 , $4.58 , See APC Packaged Rates , $4.00 , $2.23 , $5.52 , $5.54 , $2.95 , See APC Packaged Rates , See APC Packaged Rates , $3.84 , $3.84 , See APC Packaged Rates , See APC Packaged Rates , $5.32 , $5.32 , $5.32 , $5.32 , See APC Packaged Rates , $2.00 , $3.43 , $2.00 , $5.54 , $4.00
,5710011661,Hospital Chargemaster,miSOPROStol 100 mcg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.49 , $1.37 , $1.99 , See APC Packaged Rates , $1.74 , $0.97 , $2.40 , $2.41 , $1.28 , See APC Packaged Rates , See APC Packaged Rates , $1.67 , $1.67 , See APC Packaged Rates , See APC Packaged Rates , $2.32 , $2.32 , $2.32 , $2.32 , See APC Packaged Rates , $0.87 , $1.49 , $0.87 , $2.41 , $1.74
,5710011662,Hospital Chargemaster,miSOPROStol 200 mcg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.87 , $2.13 , $3.10 , See APC Packaged Rates , $2.71 , $1.51 , $3.73 , $3.75 , $1.99 , See APC Packaged Rates , See APC Packaged Rates , $2.60 , $2.60 , See APC Packaged Rates , See APC Packaged Rates , $3.60 , $3.60 , $3.60 , $3.60 , See APC Packaged Rates , $1.35 , $2.32 , $1.35 , $3.75 , $2.71
,5710011674,Hospital Chargemaster,Montelukast 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $14.43 , $7.94 , $11.54 , See APC Packaged Rates , $10.10 , $5.63 , $13.92 , $13.98 , $7.43 , See APC Packaged Rates , See APC Packaged Rates , $9.68 , $9.68 , See APC Packaged Rates , See APC Packaged Rates , $13.42 , $13.42 , $13.42 , $13.42 , See APC Packaged Rates , $5.05 , $8.66 , $5.05 , $13.98 , $10.10
,5710011679,Hospital Chargemaster,Morphine 10 mg/5 mL Solution,Outpatient,Outpatient Default Percent / Case Rate,259, $4.16 , $2.29 , $3.33 , See APC Packaged Rates , $2.91 , $1.62 , $4.01 , $4.03 , $2.14 , See APC Packaged Rates , See APC Packaged Rates , $2.79 , $2.79 , See APC Packaged Rates , See APC Packaged Rates , $3.87 , $3.87 , $3.87 , $3.87 , See APC Packaged Rates , $1.46 , $2.50 , $1.46 , $4.03 , $2.91
,5710011687,Hospital Chargemaster,Morphine ER 15 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.07 , $2.24 , $3.26 , See APC Packaged Rates , $2.85 , $1.59 , $3.93 , $3.94 , $2.10 , See APC Packaged Rates , See APC Packaged Rates , $2.73 , $2.73 , See APC Packaged Rates , See APC Packaged Rates , $3.79 , $3.79 , $3.79 , $3.79 , See APC Packaged Rates , $1.42 , $2.44 , $1.42 , $3.94 , $2.85
,5710011688,Hospital Chargemaster,Morphine ER 30 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.87 , $3.78 , $5.50 , See APC Packaged Rates , $4.81 , $2.68 , $6.63 , $6.66 , $3.54 , See APC Packaged Rates , See APC Packaged Rates , $4.61 , $4.61 , See APC Packaged Rates , See APC Packaged Rates , $6.39 , $6.39 , $6.39 , $6.39 , See APC Packaged Rates , $2.40 , $4.12 , $2.40 , $6.66 , $4.81
,5710011690,Hospital Chargemaster,Morphine Imm Release 15 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.33 , $0.73 , $1.06 , See APC Packaged Rates , $0.93 , $0.52 , $1.28 , $1.29 , $0.68 , See APC Packaged Rates , See APC Packaged Rates , $0.89 , $0.89 , See APC Packaged Rates , See APC Packaged Rates , $1.24 , $1.24 , $1.24 , $1.24 , See APC Packaged Rates , $0.47 , $0.80 , $0.47 , $1.29 , $0.93
,5710011698,Hospital Chargemaster,Moxifloxacin 0.5 % 3 mL Drops,Outpatient,Outpatient Default Percent / Case Rate,259, $148.00 , $81.40 , $118.40 , See APC Packaged Rates , $103.60 , $57.72 , $142.81 , $143.43 , $76.22 , See APC Packaged Rates , See APC Packaged Rates , $99.31 , $99.31 , See APC Packaged Rates , See APC Packaged Rates , $137.64 , $137.64 , $137.64 , $137.64 , See APC Packaged Rates , $51.80 , $88.80 , $51.80 , $143.43 , $103.60
,5710011701,Hospital Chargemaster,MVI-Min/Ferrous Gluc 15mL Liq,Outpatient,Outpatient Default Percent / Case Rate,259, $1.45 , $0.80 , $1.16 , See APC Packaged Rates , $1.02 , $0.57 , $1.40 , $1.41 , $0.75 , See APC Packaged Rates , See APC Packaged Rates , $0.97 , $0.97 , See APC Packaged Rates , See APC Packaged Rates , $1.35 , $1.35 , $1.35 , $1.35 , See APC Packaged Rates , $0.51 , $0.87 , $0.51 , $1.41 , $1.02
,5710011704,Hospital Chargemaster,Multivitamin Tab Chew,Outpatient,Outpatient Default Percent / Case Rate,259, $0.92 , $0.51 , $0.74 , See APC Packaged Rates , $0.64 , $0.36 , $0.89 , $0.89 , $0.47 , See APC Packaged Rates , See APC Packaged Rates , $0.62 , $0.62 , See APC Packaged Rates , See APC Packaged Rates , $0.86 , $0.86 , $0.86 , $0.86 , See APC Packaged Rates , $0.32 , $0.55 , $0.32 , $0.89 , $0.64
,5710011705,Hospital Chargemaster,Multivitamin Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $0.99 , $0.54 , $0.79 , See APC Packaged Rates , $0.69 , $0.39 , $0.96 , $0.96 , $0.51 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.92 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , $0.35 , $0.59 , $0.35 , $0.96 , $0.69
,5710011706,Hospital Chargemaster,Multivit/Minerals Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $0.97 , $0.53 , $0.78 , See APC Packaged Rates , $0.68 , $0.38 , $0.94 , $0.94 , $0.50 , See APC Packaged Rates , See APC Packaged Rates , $0.65 , $0.65 , See APC Packaged Rates , See APC Packaged Rates , $0.90 , $0.90 , $0.90 , $0.90 , See APC Packaged Rates , $0.34 , $0.58 , $0.34 , $0.94 , $0.68
,5710011707,Hospital Chargemaster,Mupirocin 2 % 22 gm Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $1.30 , $0.72 , $1.04 , See APC Packaged Rates , $0.91 , $0.51 , $1.25 , $1.26 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.87 , $0.87 , See APC Packaged Rates , See APC Packaged Rates , $1.21 , $1.21 , $1.21 , $1.21 , See APC Packaged Rates , $0.46 , $0.78 , $0.46 , $1.26 , $0.91
,5710011709,Hospital Chargemaster,Mycophenolate Mofet 250 mg Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $10.17 , $5.59 , $8.14 , See APC Packaged Rates , $7.12 , $3.97 , $9.81 , $9.86 , $5.24 , See APC Packaged Rates , See APC Packaged Rates , $6.82 , $6.82 , See APC Packaged Rates , See APC Packaged Rates , $9.46 , $9.46 , $9.46 , $9.46 , See APC Packaged Rates , $3.56 , $6.10 , $3.56 , $9.86 , $7.12
,5710011713,Hospital Chargemaster,Nabumetone 500 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.42 , $1.88 , $2.74 , See APC Packaged Rates , $2.39 , $1.33 , $3.30 , $3.31 , $1.76 , See APC Packaged Rates , See APC Packaged Rates , $2.29 , $2.29 , See APC Packaged Rates , See APC Packaged Rates , $3.18 , $3.18 , $3.18 , $3.18 , See APC Packaged Rates , $1.20 , $2.05 , $1.20 , $3.31 , $2.39
,5710011715,Hospital Chargemaster,Nadolol 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $15.78 , $8.68 , $12.62 , See APC Packaged Rates , $11.05 , $6.15 , $15.23 , $15.29 , $8.13 , See APC Packaged Rates , See APC Packaged Rates , $10.59 , $10.59 , See APC Packaged Rates , See APC Packaged Rates , $14.68 , $14.68 , $14.68 , $14.68 , See APC Packaged Rates , $5.52 , $9.47 , $5.52 , $15.29 , $11.05
,5710011725,Hospital Chargemaster,Naltrexone HCl 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $10.42 , $5.73 , $8.34 , See APC Packaged Rates , $7.29 , $4.06 , $10.05 , $10.10 , $5.37 , See APC Packaged Rates , See APC Packaged Rates , $6.99 , $6.99 , See APC Packaged Rates , See APC Packaged Rates , $9.69 , $9.69 , $9.69 , $9.69 , See APC Packaged Rates , $3.65 , $6.25 , $3.65 , $10.10 , $7.29
,5710011729,Hospital Chargemaster,NaPROXEN 250 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.98 , $1.09 , $1.58 , See APC Packaged Rates , $1.39 , $0.77 , $1.91 , $1.92 , $1.02 , See APC Packaged Rates , See APC Packaged Rates , $1.33 , $1.33 , See APC Packaged Rates , See APC Packaged Rates , $1.84 , $1.84 , $1.84 , $1.84 , See APC Packaged Rates , $0.69 , $1.19 , $0.69 , $1.92 , $1.39
,5710011743,Hospital Chargemaster,NeoMY/Polymyx/Bacit 28 gm Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011744,Hospital Chargemaster,NeoMY/Polymyx/Bacit 0.9gm Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011746,Hospital Chargemaster,NeoMY/Poly/Dex Oph 5 mL Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $14.96 , $8.23 , $11.97 , See APC Packaged Rates , $10.47 , $5.83 , $14.43 , $14.50 , $7.70 , See APC Packaged Rates , See APC Packaged Rates , $10.04 , $10.04 , See APC Packaged Rates , See APC Packaged Rates , $13.91 , $13.91 , $13.91 , $13.91 , See APC Packaged Rates , $5.24 , $8.98 , $5.24 , $14.50 , $10.47
,5710011757,Hospital Chargemaster,Niacin ER 500 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $12.45 , $6.85 , $9.96 , See APC Packaged Rates , $8.72 , $4.86 , $12.01 , $12.07 , $6.41 , See APC Packaged Rates , See APC Packaged Rates , $8.35 , $8.35 , See APC Packaged Rates , See APC Packaged Rates , $11.58 , $11.58 , $11.58 , $11.58 , See APC Packaged Rates , $4.36 , $7.47 , $4.36 , $12.07 , $8.72
,5710011764,Hospital Chargemaster,Nicotine 7 mg PATCH.TD24,Outpatient,Outpatient Default Percent / Case Rate,259, $4.44 , $2.44 , $3.55 , See APC Packaged Rates , $3.11 , $1.73 , $4.28 , $4.30 , $2.29 , See APC Packaged Rates , See APC Packaged Rates , $2.98 , $2.98 , See APC Packaged Rates , See APC Packaged Rates , $4.13 , $4.13 , $4.13 , $4.13 , See APC Packaged Rates , $1.55 , $2.66 , $1.55 , $4.30 , $3.11
,5710011765,Hospital Chargemaster,Nicotine 14 mg PATCH.TD24,Outpatient,Outpatient Default Percent / Case Rate,259, $4.51 , $2.48 , $3.61 , See APC Packaged Rates , $3.16 , $1.76 , $4.35 , $4.37 , $2.32 , See APC Packaged Rates , See APC Packaged Rates , $3.03 , $3.03 , See APC Packaged Rates , See APC Packaged Rates , $4.19 , $4.19 , $4.19 , $4.19 , See APC Packaged Rates , $1.58 , $2.71 , $1.58 , $4.37 , $3.16
,5710011766,Hospital Chargemaster,Nicotine 21 mg PATCH.TD24,Outpatient,Outpatient Default Percent / Case Rate,259, $4.04 , $2.22 , $3.23 , See APC Packaged Rates , $2.83 , $1.58 , $3.90 , $3.92 , $2.08 , See APC Packaged Rates , See APC Packaged Rates , $2.71 , $2.71 , See APC Packaged Rates , See APC Packaged Rates , $3.76 , $3.76 , $3.76 , $3.76 , See APC Packaged Rates , $1.41 , $2.42 , $1.41 , $3.92 , $2.83
,5710011767,Hospital Chargemaster,Nicotine Polacrilex 2 mg GUM,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011771,Hospital Chargemaster,NIFEdipine 10 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $2.73 , $1.50 , $2.18 , See APC Packaged Rates , $1.91 , $1.06 , $2.63 , $2.65 , $1.41 , See APC Packaged Rates , See APC Packaged Rates , $1.83 , $1.83 , See APC Packaged Rates , See APC Packaged Rates , $2.54 , $2.54 , $2.54 , $2.54 , See APC Packaged Rates , $0.96 , $1.64 , $0.96 , $2.65 , $1.91
,5710011772,Hospital Chargemaster,NIFEdipine ER 30 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.10 , $1.71 , $2.48 , See APC Packaged Rates , $2.17 , $1.21 , $2.99 , $3.00 , $1.60 , See APC Packaged Rates , See APC Packaged Rates , $2.08 , $2.08 , See APC Packaged Rates , See APC Packaged Rates , $2.88 , $2.88 , $2.88 , $2.88 , See APC Packaged Rates , $1.09 , $1.86 , $1.09 , $3.00 , $2.17
,5710011777,Hospital Chargemaster,Nitrofurantoin Macro 50 mg Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $5.79 , $3.18 , $4.63 , See APC Packaged Rates , $4.05 , $2.26 , $5.59 , $5.61 , $2.98 , See APC Packaged Rates , See APC Packaged Rates , $3.89 , $3.89 , See APC Packaged Rates , See APC Packaged Rates , $5.38 , $5.38 , $5.38 , $5.38 , See APC Packaged Rates , $2.03 , $3.47 , $2.03 , $5.61 , $4.05
,5710011778,Hospital Chargemaster,Nitrofurantoin Mono 100 mg Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $8.19 , $4.50 , $6.55 , See APC Packaged Rates , $5.73 , $3.19 , $7.90 , $7.94 , $4.22 , See APC Packaged Rates , See APC Packaged Rates , $5.50 , $5.50 , See APC Packaged Rates , See APC Packaged Rates , $7.62 , $7.62 , $7.62 , $7.62 , See APC Packaged Rates , $2.87 , $4.91 , $2.87 , $7.94 , $5.73
,5710011779,Hospital Chargemaster,Nitroglycerin 2 % 1 gm Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $7.04 , $3.87 , $5.63 , See APC Packaged Rates , $4.93 , $2.75 , $6.79 , $6.82 , $3.63 , See APC Packaged Rates , See APC Packaged Rates , $4.72 , $4.72 , See APC Packaged Rates , See APC Packaged Rates , $6.55 , $6.55 , $6.55 , $6.55 , See APC Packaged Rates , $2.46 , $4.22 , $2.46 , $6.82 , $4.93
,5710011782,Hospital Chargemaster,Nitroglycerin 0.2 mg/HR PAT,Outpatient,Outpatient Default Percent / Case Rate,259, $4.85 , $2.67 , $3.88 , See APC Packaged Rates , $3.40 , $1.89 , $4.68 , $4.70 , $2.50 , See APC Packaged Rates , See APC Packaged Rates , $3.25 , $3.25 , See APC Packaged Rates , See APC Packaged Rates , $4.51 , $4.51 , $4.51 , $4.51 , See APC Packaged Rates , $1.70 , $2.91 , $1.70 , $4.70 , $3.40
,5710011783,Hospital Chargemaster,Nitroglycerin 0.4 mg/HR PAT,Outpatient,Outpatient Default Percent / Case Rate,259, $4.89 , $2.69 , $3.91 , See APC Packaged Rates , $3.42 , $1.91 , $4.72 , $4.74 , $2.52 , See APC Packaged Rates , See APC Packaged Rates , $3.28 , $3.28 , See APC Packaged Rates , See APC Packaged Rates , $4.55 , $4.55 , $4.55 , $4.55 , See APC Packaged Rates , $1.71 , $2.93 , $1.71 , $4.74 , $3.42
,5710011787,Hospital Chargemaster,Nitroglycerin 0.4 mg Tab SL,Outpatient,Outpatient Default Percent / Case Rate,259, $3.46 , $1.90 , $2.77 , See APC Packaged Rates , $2.42 , $1.35 , $3.34 , $3.35 , $1.78 , See APC Packaged Rates , See APC Packaged Rates , $2.32 , $2.32 , See APC Packaged Rates , See APC Packaged Rates , $3.22 , $3.22 , $3.22 , $3.22 , See APC Packaged Rates , $1.21 , $2.08 , $1.21 , $3.35 , $2.42
,5710011803,Hospital Chargemaster,Nortriptyline 10 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.39 , $0.76 , $1.11 , See APC Packaged Rates , $0.97 , $0.54 , $1.34 , $1.35 , $0.72 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , See APC Packaged Rates , See APC Packaged Rates , $1.29 , $1.29 , $1.29 , $1.29 , See APC Packaged Rates , $0.49 , $0.83 , $0.49 , $1.35 , $0.97
,5710011804,Hospital Chargemaster,Nortriptyline 25 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $3.75 , $2.06 , $3.00 , See APC Packaged Rates , $2.63 , $1.46 , $3.62 , $3.63 , $1.93 , See APC Packaged Rates , See APC Packaged Rates , $2.52 , $2.52 , See APC Packaged Rates , See APC Packaged Rates , $3.49 , $3.49 , $3.49 , $3.49 , See APC Packaged Rates , $1.31 , $2.25 , $1.31 , $3.63 , $2.63
,5710011806,Hospital Chargemaster,Nystatin 500000 Unit/5 mL Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $4.16 , $2.29 , $3.33 , See APC Packaged Rates , $2.91 , $1.62 , $4.01 , $4.03 , $2.14 , See APC Packaged Rates , See APC Packaged Rates , $2.79 , $2.79 , See APC Packaged Rates , See APC Packaged Rates , $3.87 , $3.87 , $3.87 , $3.87 , See APC Packaged Rates , $1.46 , $2.50 , $1.46 , $4.03 , $2.91
,5710011807,Hospital Chargemaster,Nystatin 30 gm Cream,Outpatient,Outpatient Default Percent / Case Rate,259, $2.24 , $1.23 , $1.79 , See APC Packaged Rates , $1.57 , $0.87 , $2.16 , $2.17 , $1.15 , See APC Packaged Rates , See APC Packaged Rates , $1.50 , $1.50 , See APC Packaged Rates , See APC Packaged Rates , $2.08 , $2.08 , $2.08 , $2.08 , See APC Packaged Rates , $0.78 , $1.34 , $0.78 , $2.17 , $1.57
,5710011808,Hospital Chargemaster,Nystatin 15 gm Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $2.98 , $1.64 , $2.38 , See APC Packaged Rates , $2.09 , $1.16 , $2.88 , $2.89 , $1.53 , See APC Packaged Rates , See APC Packaged Rates , $2.00 , $2.00 , See APC Packaged Rates , See APC Packaged Rates , $2.77 , $2.77 , $2.77 , $2.77 , See APC Packaged Rates , $1.04 , $1.79 , $1.04 , $2.89 , $2.09
,5710011809,Hospital Chargemaster,Nystatin 15 gm Powder,Outpatient,Outpatient Default Percent / Case Rate,259, $4.49 , $2.47 , $3.59 , See APC Packaged Rates , $3.14 , $1.75 , $4.33 , $4.35 , $2.31 , See APC Packaged Rates , See APC Packaged Rates , $3.01 , $3.01 , See APC Packaged Rates , See APC Packaged Rates , $4.18 , $4.18 , $4.18 , $4.18 , See APC Packaged Rates , $1.57 , $2.69 , $1.57 , $4.35 , $3.14
,5710011810,Hospital Chargemaster,Nystatin/Triamcin 15 gm Cream,Outpatient,Outpatient Default Percent / Case Rate,259, $19.02 , $10.46 , $15.22 , See APC Packaged Rates , $13.31 , $7.42 , $18.35 , $18.43 , $9.80 , See APC Packaged Rates , See APC Packaged Rates , $12.76 , $12.76 , See APC Packaged Rates , See APC Packaged Rates , $17.69 , $17.69 , $17.69 , $17.69 , See APC Packaged Rates , $6.66 , $11.41 , $6.66 , $18.43 , $13.31
,5710011821,Hospital Chargemaster,OLANZapine 2.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011822,Hospital Chargemaster,OLANZapine 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011825,Hospital Chargemaster,OLANZapine ODT 10mg Tab.RapDis,Outpatient,Outpatient Default Percent / Case Rate,259, $53.47 , $29.41 , $42.78 , See APC Packaged Rates , $37.43 , $20.85 , $51.59 , $51.82 , $27.54 , See APC Packaged Rates , See APC Packaged Rates , $35.88 , $35.88 , See APC Packaged Rates , See APC Packaged Rates , $49.73 , $49.73 , $49.73 , $49.73 , See APC Packaged Rates , $18.71 , $32.08 , $18.71 , $51.82 , $37.43
,5710011826,Hospital Chargemaster,OLANZapine ODT 5 mg Tab.RapDis,Outpatient,Outpatient Default Percent / Case Rate,259, $33.30 , $18.32 , $26.64 , See APC Packaged Rates , $23.31 , $12.99 , $32.13 , $32.27 , $17.15 , See APC Packaged Rates , See APC Packaged Rates , $22.34 , $22.34 , See APC Packaged Rates , See APC Packaged Rates , $30.97 , $30.97 , $30.97 , $30.97 , See APC Packaged Rates , $11.66 , $19.98 , $11.66 , $32.27 , $23.31
,5710011832,Hospital Chargemaster,Olopatadine 0.1 % 5 mL Drops,Outpatient,Outpatient Default Percent / Case Rate,259, $5.87 , $3.23 , $4.70 , See APC Packaged Rates , $4.11 , $2.29 , $5.66 , $5.69 , $3.02 , See APC Packaged Rates , See APC Packaged Rates , $3.94 , $3.94 , See APC Packaged Rates , See APC Packaged Rates , $5.46 , $5.46 , $5.46 , $5.46 , See APC Packaged Rates , $2.05 , $3.52 , $2.05 , $5.69 , $4.11
,5710011837,Hospital Chargemaster,Omega-3 Fatty Ac/Fish Oil Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $0.25 , $0.14 , $0.20 , See APC Packaged Rates , $0.18 , $0.10 , $0.24 , $0.24 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $0.17 , $0.17 , See APC Packaged Rates , See APC Packaged Rates , $0.23 , $0.23 , $0.23 , $0.23 , See APC Packaged Rates , $0.09 , $0.15 , $0.09 , $0.24 , $0.18
,5710011843,Hospital Chargemaster,Ondansetron 8 mg Tab.RapDis,Outpatient,Outpatient Default Percent / Case Rate,259, $98.18 , $54.00 , $78.54 , See APC Packaged Rates , $68.73 , $38.29 , $94.73 , $95.15 , $50.56 , See APC Packaged Rates , See APC Packaged Rates , $65.88 , $65.88 , See APC Packaged Rates , See APC Packaged Rates , $91.31 , $91.31 , $91.31 , $91.31 , See APC Packaged Rates , $34.36 , $58.91 , $34.36 , $95.15 , $68.73
,5710011844,Hospital Chargemaster,Ondansetron 4 mg Tab.RapDis,Outpatient,Outpatient Default Percent / Case Rate,259, $56.84 , $31.26 , $45.47 , See APC Packaged Rates , $39.79 , $22.17 , $54.84 , $55.08 , $29.27 , See APC Packaged Rates , See APC Packaged Rates , $38.14 , $38.14 , See APC Packaged Rates , See APC Packaged Rates , $52.86 , $52.86 , $52.86 , $52.86 , See APC Packaged Rates , $19.89 , $34.10 , $19.89 , $55.08 , $39.79
,5710011849,Hospital Chargemaster,Opium 10 mg/1 mL TINCTURE,Outpatient,Outpatient Default Percent / Case Rate,259, $70.18 , $38.60 , $56.14 , See APC Packaged Rates , $49.13 , $27.37 , $67.72 , $68.01 , $36.14 , See APC Packaged Rates , See APC Packaged Rates , $47.09 , $47.09 , See APC Packaged Rates , See APC Packaged Rates , $65.27 , $65.27 , $65.27 , $65.27 , See APC Packaged Rates , $24.56 , $42.11 , $24.56 , $68.01 , $49.13
,5710011863,Hospital Chargemaster,OXcarbazepine 150 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.85 , $2.12 , $3.08 , See APC Packaged Rates , $2.70 , $1.50 , $3.71 , $3.73 , $1.98 , See APC Packaged Rates , See APC Packaged Rates , $2.58 , $2.58 , See APC Packaged Rates , See APC Packaged Rates , $3.58 , $3.58 , $3.58 , $3.58 , See APC Packaged Rates , $1.35 , $2.31 , $1.35 , $3.73 , $2.70
,5710011864,Hospital Chargemaster,OXcarbazepine 300 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.82 , $3.75 , $5.46 , See APC Packaged Rates , $4.77 , $2.66 , $6.58 , $6.61 , $3.51 , See APC Packaged Rates , See APC Packaged Rates , $4.58 , $4.58 , See APC Packaged Rates , See APC Packaged Rates , $6.34 , $6.34 , $6.34 , $6.34 , See APC Packaged Rates , $2.39 , $4.09 , $2.39 , $6.61 , $4.77
,5710011865,Hospital Chargemaster,Oxybutynin 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.51 , $0.83 , $1.21 , See APC Packaged Rates , $1.06 , $0.59 , $1.46 , $1.46 , $0.78 , See APC Packaged Rates , See APC Packaged Rates , $1.01 , $1.01 , See APC Packaged Rates , See APC Packaged Rates , $1.40 , $1.40 , $1.40 , $1.40 , See APC Packaged Rates , $0.53 , $0.91 , $0.53 , $1.46 , $1.06
,5710011866,Hospital Chargemaster,Oxybutynin ER 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $8.23 , $4.53 , $6.58 , See APC Packaged Rates , $5.76 , $3.21 , $7.94 , $7.98 , $4.24 , See APC Packaged Rates , See APC Packaged Rates , $5.52 , $5.52 , See APC Packaged Rates , See APC Packaged Rates , $7.65 , $7.65 , $7.65 , $7.65 , See APC Packaged Rates , $2.88 , $4.94 , $2.88 , $7.98 , $5.76
,5710011869,Hospital Chargemaster,oxyCODONE 5 mg/5 mL Solution,Outpatient,Outpatient Default Percent / Case Rate,259, $22.01 , $12.11 , $17.61 , See APC Packaged Rates , $15.41 , $8.58 , $21.24 , $21.33 , $11.34 , See APC Packaged Rates , See APC Packaged Rates , $14.77 , $14.77 , See APC Packaged Rates , See APC Packaged Rates , $20.47 , $20.47 , $20.47 , $20.47 , See APC Packaged Rates , $7.70 , $13.21 , $7.70 , $21.33 , $15.41
,5710011870,Hospital Chargemaster,oxyCODONE ER 10 mg Tab.ER.12H,Outpatient,Outpatient Default Percent / Case Rate,259, $11.48 , $6.31 , $9.18 , See APC Packaged Rates , $8.04 , $4.48 , $11.08 , $11.13 , $5.91 , See APC Packaged Rates , See APC Packaged Rates , $7.70 , $7.70 , See APC Packaged Rates , See APC Packaged Rates , $10.68 , $10.68 , $10.68 , $10.68 , See APC Packaged Rates , $4.02 , $6.89 , $4.02 , $11.13 , $8.04
,5710011871,Hospital Chargemaster,oxyCODONE ER 20 mg Tab.ER.12H,Outpatient,Outpatient Default Percent / Case Rate,259, $21.61 , $11.89 , $17.29 , See APC Packaged Rates , $15.13 , $8.43 , $20.85 , $20.94 , $11.13 , See APC Packaged Rates , See APC Packaged Rates , $14.50 , $14.50 , See APC Packaged Rates , See APC Packaged Rates , $20.10 , $20.10 , $20.10 , $20.10 , See APC Packaged Rates , $7.56 , $12.97 , $7.56 , $20.94 , $15.13
,5710011873,Hospital Chargemaster,oxyCODONE Imm Rel 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.27 , $1.25 , $1.82 , See APC Packaged Rates , $1.59 , $0.89 , $2.19 , $2.20 , $1.17 , See APC Packaged Rates , See APC Packaged Rates , $1.52 , $1.52 , See APC Packaged Rates , See APC Packaged Rates , $2.11 , $2.11 , $2.11 , $2.11 , See APC Packaged Rates , $0.79 , $1.36 , $0.79 , $2.20 , $1.59
,5710011875,Hospital Chargemaster,oxyCODONE Imm Rel 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.37 , $0.75 , $1.10 , See APC Packaged Rates , $0.96 , $0.53 , $1.32 , $1.33 , $0.71 , See APC Packaged Rates , See APC Packaged Rates , $0.92 , $0.92 , See APC Packaged Rates , See APC Packaged Rates , $1.27 , $1.27 , $1.27 , $1.27 , See APC Packaged Rates , $0.48 , $0.82 , $0.48 , $1.33 , $0.96
,5710011876,Hospital Chargemaster,oxyCODONE/Acetamin 10/325 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $9.05 , $4.98 , $7.24 , See APC Packaged Rates , $6.34 , $3.53 , $8.73 , $8.77 , $4.66 , See APC Packaged Rates , See APC Packaged Rates , $6.07 , $6.07 , See APC Packaged Rates , See APC Packaged Rates , $8.42 , $8.42 , $8.42 , $8.42 , See APC Packaged Rates , $3.17 , $5.43 , $3.17 , $8.77 , $6.34
,5710011877,Hospital Chargemaster,oxyCODONE/Acetamin 5/325 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $3.49 , $1.92 , $2.79 , See APC Packaged Rates , $2.44 , $1.36 , $3.37 , $3.38 , $1.80 , See APC Packaged Rates , See APC Packaged Rates , $2.34 , $2.34 , See APC Packaged Rates , See APC Packaged Rates , $3.25 , $3.25 , $3.25 , $3.25 , See APC Packaged Rates , $1.22 , $2.09 , $1.22 , $3.38 , $2.44
,5710011878,Hospital Chargemaster,oxyCODONE/Acetamin 7.5/325 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $6.94 , $3.82 , $5.55 , See APC Packaged Rates , $4.86 , $2.71 , $6.70 , $6.73 , $3.57 , See APC Packaged Rates , See APC Packaged Rates , $4.66 , $4.66 , See APC Packaged Rates , See APC Packaged Rates , $6.45 , $6.45 , $6.45 , $6.45 , See APC Packaged Rates , $2.43 , $4.16 , $2.43 , $6.73 , $4.86
,5710011879,Hospital Chargemaster,Oxymetazoline 0.05 % Nas Spray,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011901,Hospital Chargemaster,Pantoprazole 20 mg Tablet DR,Outpatient,Outpatient Default Percent / Case Rate,259, $9.64 , $5.30 , $7.71 , See APC Packaged Rates , $6.75 , $3.76 , $9.30 , $9.34 , $4.96 , See APC Packaged Rates , See APC Packaged Rates , $6.47 , $6.47 , See APC Packaged Rates , See APC Packaged Rates , $8.97 , $8.97 , $8.97 , $8.97 , See APC Packaged Rates , $3.37 , $5.78 , $3.37 , $9.34 , $6.75
,5710011902,Hospital Chargemaster,Pantoprazole 40 mg Tablet DR,Outpatient,Outpatient Default Percent / Case Rate,259, $7.83 , $4.31 , $6.26 , See APC Packaged Rates , $5.48 , $3.05 , $7.56 , $7.59 , $4.03 , See APC Packaged Rates , See APC Packaged Rates , $5.25 , $5.25 , See APC Packaged Rates , See APC Packaged Rates , $7.28 , $7.28 , $7.28 , $7.28 , See APC Packaged Rates , $2.74 , $4.70 , $2.74 , $7.59 , $5.48
,5710011906,Hospital Chargemaster,PARoxetine 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.88 , $3.23 , $4.70 , See APC Packaged Rates , $4.12 , $2.29 , $5.67 , $5.70 , $3.03 , See APC Packaged Rates , See APC Packaged Rates , $3.95 , $3.95 , See APC Packaged Rates , See APC Packaged Rates , $5.47 , $5.47 , $5.47 , $5.47 , See APC Packaged Rates , $2.06 , $3.53 , $2.06 , $5.70 , $4.12
,5710011907,Hospital Chargemaster,PARoxetine 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011911,Hospital Chargemaster,PEG 3350 4000 mL Sol.RECON,Outpatient,Outpatient Default Percent / Case Rate,259, $102.00 , $56.10 , $81.60 , See APC Packaged Rates , $71.40 , $39.78 , $98.42 , $98.85 , $52.53 , See APC Packaged Rates , See APC Packaged Rates , $68.44 , $68.44 , See APC Packaged Rates , See APC Packaged Rates , $94.86 , $94.86 , $94.86 , $94.86 , See APC Packaged Rates , $35.70 , $61.20 , $35.70 , $98.85 , $71.40
,5710011932,Hospital Chargemaster,Penicill VK 250 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.03 , $1.67 , $2.42 , See APC Packaged Rates , $2.12 , $1.18 , $2.92 , $2.94 , $1.56 , See APC Packaged Rates , See APC Packaged Rates , $2.03 , $2.03 , See APC Packaged Rates , See APC Packaged Rates , $2.82 , $2.82 , $2.82 , $2.82 , See APC Packaged Rates , $1.06 , $1.82 , $1.06 , $2.94 , $2.12
,5710011936,Hospital Chargemaster,Pentoxifylline ER 400 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $2.91 , $1.60 , $2.33 , See APC Packaged Rates , $2.04 , $1.13 , $2.81 , $2.82 , $1.50 , See APC Packaged Rates , See APC Packaged Rates , $1.95 , $1.95 , See APC Packaged Rates , See APC Packaged Rates , $2.71 , $2.71 , $2.71 , $2.71 , See APC Packaged Rates , $1.02 , $1.75 , $1.02 , $2.82 , $2.04
,5710011937,Hospital Chargemaster,Peppermint Oil 30 mL SPIRIT,Outpatient,Outpatient Default Percent / Case Rate,259, $24.22 , $13.32 , $19.38 , See APC Packaged Rates , $16.95 , $9.45 , $23.37 , $23.47 , $12.47 , See APC Packaged Rates , See APC Packaged Rates , $16.25 , $16.25 , See APC Packaged Rates , See APC Packaged Rates , $22.52 , $22.52 , $22.52 , $22.52 , See APC Packaged Rates , $8.48 , $14.53 , $8.48 , $23.47 , $16.95
,5710011940,Hospital Chargemaster,Permethrin 5 % 60 gm Cream,Outpatient,Outpatient Default Percent / Case Rate,259, $5.05 , $2.78 , $4.04 , See APC Packaged Rates , $3.54 , $1.97 , $4.87 , $4.89 , $2.60 , See APC Packaged Rates , See APC Packaged Rates , $3.39 , $3.39 , See APC Packaged Rates , See APC Packaged Rates , $4.70 , $4.70 , $4.70 , $4.70 , See APC Packaged Rates , $1.77 , $3.03 , $1.77 , $4.89 , $3.54
,5710011941,Hospital Chargemaster,Perphenazine 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.00 , $2.75 , $4.00 , See APC Packaged Rates , $3.50 , $1.95 , $4.82 , $4.85 , $2.58 , See APC Packaged Rates , See APC Packaged Rates , $3.36 , $3.36 , See APC Packaged Rates , See APC Packaged Rates , $4.65 , $4.65 , $4.65 , $4.65 , See APC Packaged Rates , $1.75 , $3.00 , $1.75 , $4.85 , $3.50
,5710011942,Hospital Chargemaster,Perphenazine 4 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.91 , $2.70 , $3.93 , See APC Packaged Rates , $3.44 , $1.91 , $4.74 , $4.76 , $2.53 , See APC Packaged Rates , See APC Packaged Rates , $3.29 , $3.29 , See APC Packaged Rates , See APC Packaged Rates , $4.57 , $4.57 , $4.57 , $4.57 , See APC Packaged Rates , $1.72 , $2.95 , $1.72 , $4.76 , $3.44
,5710011947,Hospital Chargemaster,Phenazopyridine 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.12 , $3.37 , $4.90 , See APC Packaged Rates , $4.28 , $2.39 , $5.91 , $5.93 , $3.15 , See APC Packaged Rates , See APC Packaged Rates , $4.11 , $4.11 , See APC Packaged Rates , See APC Packaged Rates , $5.69 , $5.69 , $5.69 , $5.69 , See APC Packaged Rates , $2.14 , $3.67 , $2.14 , $5.93 , $4.28
,5710011951,Hospital Chargemaster,PHENob/Hyos/Atrop/Scop 5 mL,Outpatient,Outpatient Default Percent / Case Rate,259, $43.42 , $23.88 , $34.74 , See APC Packaged Rates , $30.39 , $16.93 , $41.90 , $42.08 , $22.36 , See APC Packaged Rates , See APC Packaged Rates , $29.13 , $29.13 , See APC Packaged Rates , See APC Packaged Rates , $40.38 , $40.38 , $40.38 , $40.38 , See APC Packaged Rates , $15.20 , $26.05 , $15.20 , $42.08 , $30.39
,5710011956,Hospital Chargemaster,PHENobarbital 15 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011957,Hospital Chargemaster,PHENobarbital 30 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $0.99 , $0.54 , $0.79 , See APC Packaged Rates , $0.69 , $0.39 , $0.96 , $0.96 , $0.51 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.92 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , $0.35 , $0.59 , $0.35 , $0.96 , $0.69
,5710011960,Hospital Chargemaster,Throat Spray 6 OZ,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011963,Hospital Chargemaster,Hemorrhoidal 60 gm Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $0.91 , $0.50 , $0.73 , See APC Packaged Rates , $0.64 , $0.35 , $0.88 , $0.88 , $0.47 , See APC Packaged Rates , See APC Packaged Rates , $0.61 , $0.61 , See APC Packaged Rates , See APC Packaged Rates , $0.85 , $0.85 , $0.85 , $0.85 , See APC Packaged Rates , $0.32 , $0.55 , $0.32 , $0.88 , $0.64
,5710011968,Hospital Chargemaster,Phenylephrine 0.25 % 15 mL SPR,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011969,Hospital Chargemaster,Phenylephrine 0.5 % 15mL Spray,Outpatient,Outpatient Default Percent / Case Rate,259, $1.10 , $0.61 , $0.88 , See APC Packaged Rates , $0.77 , $0.43 , $1.06 , $1.07 , $0.57 , See APC Packaged Rates , See APC Packaged Rates , $0.74 , $0.74 , See APC Packaged Rates , See APC Packaged Rates , $1.02 , $1.02 , $1.02 , $1.02 , See APC Packaged Rates , $0.39 , $0.66 , $0.39 , $1.07 , $0.77
,5710011970,Hospital Chargemaster,Phenylephrine 1 % 15mL Spray,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710011975,Hospital Chargemaster,Phenytoin 50 mg Tab Chew,Outpatient,Outpatient Default Percent / Case Rate,259, $4.71 , $2.59 , $3.77 , See APC Packaged Rates , $3.30 , $1.84 , $4.54 , $4.56 , $2.43 , See APC Packaged Rates , See APC Packaged Rates , $3.16 , $3.16 , See APC Packaged Rates , See APC Packaged Rates , $4.38 , $4.38 , $4.38 , $4.38 , See APC Packaged Rates , $1.65 , $2.83 , $1.65 , $4.56 , $3.30
,5710011978,Hospital Chargemaster,Phenytoin Sod Ext 100 mg Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $3.96 , $2.18 , $3.17 , See APC Packaged Rates , $2.77 , $1.54 , $3.82 , $3.84 , $2.04 , See APC Packaged Rates , See APC Packaged Rates , $2.66 , $2.66 , See APC Packaged Rates , See APC Packaged Rates , $3.68 , $3.68 , $3.68 , $3.68 , See APC Packaged Rates , $1.39 , $2.38 , $1.39 , $3.84 , $2.77
,5710011979,Hospital Chargemaster,Phenytoin 30 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $2.98 , $1.64 , $2.38 , See APC Packaged Rates , $2.09 , $1.16 , $2.88 , $2.89 , $1.53 , See APC Packaged Rates , See APC Packaged Rates , $2.00 , $2.00 , See APC Packaged Rates , See APC Packaged Rates , $2.77 , $2.77 , $2.77 , $2.77 , See APC Packaged Rates , $1.04 , $1.79 , $1.04 , $2.89 , $2.09
,5710011983,Hospital Chargemaster,Phytonadione 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $149.84 , $82.41 , $119.87 , See APC Packaged Rates , $104.89 , $58.44 , $144.58 , $145.21 , $77.17 , See APC Packaged Rates , See APC Packaged Rates , $100.54 , $100.54 , See APC Packaged Rates , See APC Packaged Rates , $139.35 , $139.35 , $139.35 , $139.35 , See APC Packaged Rates , $52.44 , $89.90 , $52.44 , $145.21 , $104.89
,5710011984,Hospital Chargemaster,Pilocarpine 1 % 15 mL Drops,Outpatient,Outpatient Default Percent / Case Rate,259, $16.75 , $9.21 , $13.40 , See APC Packaged Rates , $11.73 , $6.53 , $16.16 , $16.23 , $8.63 , See APC Packaged Rates , See APC Packaged Rates , $11.24 , $11.24 , See APC Packaged Rates , See APC Packaged Rates , $15.58 , $15.58 , $15.58 , $15.58 , See APC Packaged Rates , $5.86 , $10.05 , $5.86 , $16.23 , $11.73
,5710011988,Hospital Chargemaster,Pioglitazone HCl 15 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $17.88 , $9.83 , $14.30 , See APC Packaged Rates , $12.52 , $6.97 , $17.25 , $17.33 , $9.21 , See APC Packaged Rates , See APC Packaged Rates , $12.00 , $12.00 , See APC Packaged Rates , See APC Packaged Rates , $16.63 , $16.63 , $16.63 , $16.63 , See APC Packaged Rates , $6.26 , $10.73 , $6.26 , $17.33 , $12.52
,5710012000,Hospital Chargemaster,Polyeth Glyc 3350 119 gm POWD,Outpatient,Outpatient Default Percent / Case Rate,259, $13.08 , $7.19 , $10.46 , See APC Packaged Rates , $9.16 , $5.10 , $12.62 , $12.68 , $6.74 , See APC Packaged Rates , See APC Packaged Rates , $8.78 , $8.78 , See APC Packaged Rates , See APC Packaged Rates , $12.16 , $12.16 , $12.16 , $12.16 , See APC Packaged Rates , $4.58 , $7.85 , $4.58 , $12.68 , $9.16
,5710012001,Hospital Chargemaster,Polyeth Glyc 3350 17 gm PACK,Outpatient,Outpatient Default Percent / Case Rate,259, $4.72 , $2.60 , $3.78 , See APC Packaged Rates , $3.30 , $1.84 , $4.55 , $4.57 , $2.43 , See APC Packaged Rates , See APC Packaged Rates , $3.17 , $3.17 , See APC Packaged Rates , See APC Packaged Rates , $4.39 , $4.39 , $4.39 , $4.39 , See APC Packaged Rates , $1.65 , $2.83 , $1.65 , $4.57 , $3.30
,5710012002,Hospital Chargemaster,Polyeth Glyc 3350 238 gm POWD,Outpatient,Outpatient Default Percent / Case Rate,259, $23.13 , $12.72 , $18.50 , See APC Packaged Rates , $16.19 , $9.02 , $22.32 , $22.42 , $11.91 , See APC Packaged Rates , See APC Packaged Rates , $15.52 , $15.52 , See APC Packaged Rates , See APC Packaged Rates , $21.51 , $21.51 , $21.51 , $21.51 , See APC Packaged Rates , $8.10 , $13.88 , $8.10 , $22.42 , $16.19
,5710012005,Hospital Chargemaster,Artificial Tears 15 mL Sol,Outpatient,Outpatient Default Percent / Case Rate,259, $1.05 , $0.58 , $0.84 , See APC Packaged Rates , $0.74 , $0.41 , $1.01 , $1.02 , $0.54 , See APC Packaged Rates , See APC Packaged Rates , $0.70 , $0.70 , See APC Packaged Rates , See APC Packaged Rates , $0.98 , $0.98 , $0.98 , $0.98 , See APC Packaged Rates , $0.37 , $0.63 , $0.37 , $1.02 , $0.74
,5710012011,Hospital Chargemaster,Potassium Chl 20 mEq Packet,Outpatient,Outpatient Default Percent / Case Rate,259, $26.94 , $14.82 , $21.55 , See APC Packaged Rates , $18.86 , $10.51 , $25.99 , $26.11 , $13.87 , See APC Packaged Rates , See APC Packaged Rates , $18.08 , $18.08 , See APC Packaged Rates , See APC Packaged Rates , $25.05 , $25.05 , $25.05 , $25.05 , See APC Packaged Rates , $9.43 , $16.16 , $9.43 , $26.11 , $18.86
,5710012046,Hospital Chargemaster,Pramipexole 0.125 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $7.33 , $4.03 , $5.86 , See APC Packaged Rates , $5.13 , $2.86 , $7.07 , $7.10 , $3.78 , See APC Packaged Rates , See APC Packaged Rates , $4.92 , $4.92 , See APC Packaged Rates , See APC Packaged Rates , $6.82 , $6.82 , $6.82 , $6.82 , See APC Packaged Rates , $2.57 , $4.40 , $2.57 , $7.10 , $5.13
,5710012047,Hospital Chargemaster,Pramipexole 0.25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $18.58 , $10.22 , $14.86 , See APC Packaged Rates , $13.01 , $7.25 , $17.93 , $18.01 , $9.57 , See APC Packaged Rates , See APC Packaged Rates , $12.47 , $12.47 , See APC Packaged Rates , See APC Packaged Rates , $17.28 , $17.28 , $17.28 , $17.28 , See APC Packaged Rates , $6.50 , $11.15 , $6.50 , $18.01 , $13.01
,5710012048,Hospital Chargemaster,Pramipexole 0.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $7.52 , $4.14 , $6.02 , See APC Packaged Rates , $5.26 , $2.93 , $7.26 , $7.29 , $3.87 , See APC Packaged Rates , See APC Packaged Rates , $5.05 , $5.05 , See APC Packaged Rates , See APC Packaged Rates , $6.99 , $6.99 , $6.99 , $6.99 , See APC Packaged Rates , $2.63 , $4.51 , $2.63 , $7.29 , $5.26
,5710012049,Hospital Chargemaster,Pramipexole 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $8.52 , $4.69 , $6.82 , See APC Packaged Rates , $5.96 , $3.32 , $8.22 , $8.26 , $4.39 , See APC Packaged Rates , See APC Packaged Rates , $5.72 , $5.72 , See APC Packaged Rates , See APC Packaged Rates , $7.92 , $7.92 , $7.92 , $7.92 , See APC Packaged Rates , $2.98 , $5.11 , $2.98 , $8.26 , $5.96
,5710012051,Hospital Chargemaster,Prasugrel HCl 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $39.02 , $21.46 , $31.22 , See APC Packaged Rates , $27.31 , $15.22 , $37.65 , $37.81 , $20.10 , See APC Packaged Rates , See APC Packaged Rates , $26.18 , $26.18 , See APC Packaged Rates , See APC Packaged Rates , $36.29 , $36.29 , $36.29 , $36.29 , See APC Packaged Rates , $13.66 , $23.41 , $13.66 , $37.81 , $27.31
,5710012053,Hospital Chargemaster,Pravastatin 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $8.18 , $4.50 , $6.54 , See APC Packaged Rates , $5.73 , $3.19 , $7.89 , $7.93 , $4.21 , See APC Packaged Rates , See APC Packaged Rates , $5.49 , $5.49 , See APC Packaged Rates , See APC Packaged Rates , $7.61 , $7.61 , $7.61 , $7.61 , See APC Packaged Rates , $2.86 , $4.91 , $2.86 , $7.93 , $5.73
,5710012057,Hospital Chargemaster,Prazosin HCl 1 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $4.53 , $2.49 , $3.62 , See APC Packaged Rates , $3.17 , $1.77 , $4.37 , $4.39 , $2.33 , See APC Packaged Rates , See APC Packaged Rates , $3.04 , $3.04 , See APC Packaged Rates , See APC Packaged Rates , $4.21 , $4.21 , $4.21 , $4.21 , See APC Packaged Rates , $1.59 , $2.72 , $1.59 , $4.39 , $3.17
,5710012058,Hospital Chargemaster,Prazosin HCl 5 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $5.53 , $3.04 , $4.42 , See APC Packaged Rates , $3.87 , $2.16 , $5.34 , $5.36 , $2.85 , See APC Packaged Rates , See APC Packaged Rates , $3.71 , $3.71 , See APC Packaged Rates , See APC Packaged Rates , $5.14 , $5.14 , $5.14 , $5.14 , See APC Packaged Rates , $1.94 , $3.32 , $1.94 , $5.36 , $3.87
,5710012059,Hospital Chargemaster,prednisoLONE Acet 1% 5mL Ophth,Outpatient,Outpatient Default Percent / Case Rate,259, $28.20 , $15.51 , $22.56 , See APC Packaged Rates , $19.74 , $11.00 , $27.21 , $27.33 , $14.52 , See APC Packaged Rates , See APC Packaged Rates , $18.92 , $18.92 , See APC Packaged Rates , See APC Packaged Rates , $26.23 , $26.23 , $26.23 , $26.23 , See APC Packaged Rates , $9.87 , $16.92 , $9.87 , $27.33 , $19.74
,5710012060,Hospital Chargemaster,prednisoLONE 15 mg/5 mL Sol,Outpatient,Outpatient Default Percent / Case Rate,259, $4.00 , $2.20 , $3.20 , See APC Packaged Rates , $2.80 , $1.56 , $3.86 , $3.88 , $2.06 , See APC Packaged Rates , See APC Packaged Rates , $2.68 , $2.68 , See APC Packaged Rates , See APC Packaged Rates , $3.72 , $3.72 , $3.72 , $3.72 , See APC Packaged Rates , $1.40 , $2.40 , $1.40 , $3.88 , $2.80
,5710012061,Hospital Chargemaster,predniSONE 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012062,Hospital Chargemaster,predniSONE 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012063,Hospital Chargemaster,predniSONE 2.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $0.94 , $0.52 , $0.75 , See APC Packaged Rates , $0.66 , $0.37 , $0.91 , $0.91 , $0.48 , See APC Packaged Rates , See APC Packaged Rates , $0.63 , $0.63 , See APC Packaged Rates , See APC Packaged Rates , $0.87 , $0.87 , $0.87 , $0.87 , See APC Packaged Rates , $0.33 , $0.56 , $0.33 , $0.91 , $0.66
,5710012064,Hospital Chargemaster,predniSONE 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012065,Hospital Chargemaster,predniSONE 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012069,Hospital Chargemaster,Pregabalin 25 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $19.42 , $10.68 , $15.54 , See APC Packaged Rates , $13.59 , $7.57 , $18.74 , $18.82 , $10.00 , See APC Packaged Rates , See APC Packaged Rates , $13.03 , $13.03 , See APC Packaged Rates , See APC Packaged Rates , $18.06 , $18.06 , $18.06 , $18.06 , See APC Packaged Rates , $6.80 , $11.65 , $6.80 , $18.82 , $13.59
,5710012072,Hospital Chargemaster,Pregabalin 75 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $23.04 , $12.67 , $18.43 , See APC Packaged Rates , $16.13 , $8.99 , $22.23 , $22.33 , $11.87 , See APC Packaged Rates , See APC Packaged Rates , $15.46 , $15.46 , See APC Packaged Rates , See APC Packaged Rates , $21.43 , $21.43 , $21.43 , $21.43 , See APC Packaged Rates , $8.06 , $13.82 , $8.06 , $22.33 , $16.13
,5710012073,Hospital Chargemaster,Prenatal Vitamin Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $0.99 , $0.54 , $0.79 , See APC Packaged Rates , $0.69 , $0.39 , $0.96 , $0.96 , $0.51 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.92 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , $0.35 , $0.59 , $0.35 , $0.96 , $0.69
,5710012075,Hospital Chargemaster,Primidone 250 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $140.61 , $77.34 , $112.49 , See APC Packaged Rates , $98.43 , $54.84 , $135.67 , $136.27 , $72.42 , See APC Packaged Rates , See APC Packaged Rates , $94.35 , $94.35 , See APC Packaged Rates , See APC Packaged Rates , $130.77 , $130.77 , $130.77 , $130.77 , See APC Packaged Rates , $49.21 , $84.37 , $49.21 , $136.27 , $98.43
,5710012076,Hospital Chargemaster,Primidone 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.11 , $0.61 , $0.89 , See APC Packaged Rates , $0.78 , $0.43 , $1.07 , $1.08 , $0.57 , See APC Packaged Rates , See APC Packaged Rates , $0.74 , $0.74 , See APC Packaged Rates , See APC Packaged Rates , $1.03 , $1.03 , $1.03 , $1.03 , See APC Packaged Rates , $0.39 , $0.67 , $0.39 , $1.08 , $0.78
,5710012077,Hospital Chargemaster,Probenecid 500 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $9.51 , $5.23 , $7.61 , See APC Packaged Rates , $6.66 , $3.71 , $9.18 , $9.22 , $4.90 , See APC Packaged Rates , See APC Packaged Rates , $6.38 , $6.38 , See APC Packaged Rates , See APC Packaged Rates , $8.84 , $8.84 , $8.84 , $8.84 , See APC Packaged Rates , $3.33 , $5.71 , $3.33 , $9.22 , $6.66
,5710012082,Hospital Chargemaster,Prochlorperazine 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.47 , $1.36 , $1.98 , See APC Packaged Rates , $1.73 , $0.96 , $2.38 , $2.39 , $1.27 , See APC Packaged Rates , See APC Packaged Rates , $1.66 , $1.66 , See APC Packaged Rates , See APC Packaged Rates , $2.30 , $2.30 , $2.30 , $2.30 , See APC Packaged Rates , $0.86 , $1.48 , $0.86 , $2.39 , $1.73
,5710012083,Hospital Chargemaster,Prochlorperazine 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.50 , $0.83 , $1.20 , See APC Packaged Rates , $1.05 , $0.59 , $1.45 , $1.45 , $0.77 , See APC Packaged Rates , See APC Packaged Rates , $1.01 , $1.01 , See APC Packaged Rates , See APC Packaged Rates , $1.40 , $1.40 , $1.40 , $1.40 , See APC Packaged Rates , $0.53 , $0.90 , $0.53 , $1.45 , $1.05
,5710012088,Hospital Chargemaster,Promethazine 25 mg Supp,Outpatient,Outpatient Default Percent / Case Rate,259, $45.16 , $24.84 , $36.13 , See APC Packaged Rates , $31.61 , $17.61 , $43.57 , $43.76 , $23.26 , See APC Packaged Rates , See APC Packaged Rates , $30.30 , $30.30 , See APC Packaged Rates , See APC Packaged Rates , $42.00 , $42.00 , $42.00 , $42.00 , See APC Packaged Rates , $15.81 , $27.10 , $15.81 , $43.76 , $31.61
,5710012089,Hospital Chargemaster,Promethazine 12.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.25 , $0.69 , $1.00 , See APC Packaged Rates , $0.88 , $0.49 , $1.21 , $1.21 , $0.64 , See APC Packaged Rates , See APC Packaged Rates , $0.84 , $0.84 , See APC Packaged Rates , See APC Packaged Rates , $1.16 , $1.16 , $1.16 , $1.16 , See APC Packaged Rates , $0.44 , $0.75 , $0.44 , $1.21 , $0.88
,5710012090,Hospital Chargemaster,Promethazine 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.38 , $0.76 , $1.10 , See APC Packaged Rates , $0.97 , $0.54 , $1.33 , $1.34 , $0.71 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , See APC Packaged Rates , See APC Packaged Rates , $1.28 , $1.28 , $1.28 , $1.28 , See APC Packaged Rates , $0.48 , $0.83 , $0.48 , $1.34 , $0.97
,5710012098,Hospital Chargemaster,Propranolol HCl 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.85 , $1.57 , $2.28 , See APC Packaged Rates , $2.00 , $1.11 , $2.75 , $2.76 , $1.47 , See APC Packaged Rates , See APC Packaged Rates , $1.91 , $1.91 , See APC Packaged Rates , See APC Packaged Rates , $2.65 , $2.65 , $2.65 , $2.65 , See APC Packaged Rates , $1.00 , $1.71 , $1.00 , $2.76 , $2.00
,5710012099,Hospital Chargemaster,Propranolol HCl 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.30 , $0.72 , $1.04 , See APC Packaged Rates , $0.91 , $0.51 , $1.25 , $1.26 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.87 , $0.87 , See APC Packaged Rates , See APC Packaged Rates , $1.21 , $1.21 , $1.21 , $1.21 , See APC Packaged Rates , $0.46 , $0.78 , $0.46 , $1.26 , $0.91
,5710012105,Hospital Chargemaster,Propranolol LA 60 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $5.19 , $2.85 , $4.15 , See APC Packaged Rates , $3.63 , $2.02 , $5.01 , $5.03 , $2.67 , See APC Packaged Rates , See APC Packaged Rates , $3.48 , $3.48 , See APC Packaged Rates , See APC Packaged Rates , $4.83 , $4.83 , $4.83 , $4.83 , See APC Packaged Rates , $1.82 , $3.11 , $1.82 , $5.03 , $3.63
,5710012106,Hospital Chargemaster,Propranolol LA 80 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $6.15 , $3.38 , $4.92 , See APC Packaged Rates , $4.31 , $2.40 , $5.93 , $5.96 , $3.17 , See APC Packaged Rates , See APC Packaged Rates , $4.13 , $4.13 , See APC Packaged Rates , See APC Packaged Rates , $5.72 , $5.72 , $5.72 , $5.72 , See APC Packaged Rates , $2.15 , $3.69 , $2.15 , $5.96 , $4.31
,5710012111,Hospital Chargemaster,Pseudoephedrine 30 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012112,Hospital Chargemaster,Psyllium Seed 3.4 gm Powd Pack,Outpatient,Outpatient Default Percent / Case Rate,259, $0.99 , $0.54 , $0.79 , See APC Packaged Rates , $0.69 , $0.39 , $0.96 , $0.96 , $0.51 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.92 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , $0.35 , $0.59 , $0.35 , $0.96 , $0.69
,5710012115,Hospital Chargemaster,Pyridostigmine 60 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.26 , $1.79 , $2.61 , See APC Packaged Rates , $2.28 , $1.27 , $3.15 , $3.16 , $1.68 , See APC Packaged Rates , See APC Packaged Rates , $2.19 , $2.19 , See APC Packaged Rates , See APC Packaged Rates , $3.03 , $3.03 , $3.03 , $3.03 , See APC Packaged Rates , $1.14 , $1.96 , $1.14 , $3.16 , $2.28
,5710012119,Hospital Chargemaster,QUEtiapine 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $17.01 , $9.36 , $13.61 , See APC Packaged Rates , $11.91 , $6.63 , $16.41 , $16.48 , $8.76 , See APC Packaged Rates , See APC Packaged Rates , $11.41 , $11.41 , See APC Packaged Rates , See APC Packaged Rates , $15.82 , $15.82 , $15.82 , $15.82 , See APC Packaged Rates , $5.95 , $10.21 , $5.95 , $16.48 , $11.91
,5710012120,Hospital Chargemaster,QUEtiapine 200 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $30.27 , $16.65 , $24.22 , See APC Packaged Rates , $21.19 , $11.81 , $29.21 , $29.33 , $15.59 , See APC Packaged Rates , See APC Packaged Rates , $20.31 , $20.31 , See APC Packaged Rates , See APC Packaged Rates , $28.15 , $28.15 , $28.15 , $28.15 , See APC Packaged Rates , $10.59 , $18.16 , $10.59 , $29.33 , $21.19
,5710012121,Hospital Chargemaster,QUEtiapine 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012124,Hospital Chargemaster,QUEtiapine 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.20 , $0.66 , $0.96 , See APC Packaged Rates , $0.84 , $0.47 , $1.16 , $1.16 , $0.62 , See APC Packaged Rates , See APC Packaged Rates , $0.81 , $0.81 , See APC Packaged Rates , See APC Packaged Rates , $1.12 , $1.12 , $1.12 , $1.12 , See APC Packaged Rates , $0.42 , $0.72 , $0.42 , $1.16 , $0.84
,5710012126,Hospital Chargemaster,QUEtiapine XR 200 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $41.39 , $22.76 , $33.11 , See APC Packaged Rates , $28.97 , $16.14 , $39.94 , $40.11 , $21.32 , See APC Packaged Rates , See APC Packaged Rates , $27.77 , $27.77 , See APC Packaged Rates , See APC Packaged Rates , $38.49 , $38.49 , $38.49 , $38.49 , See APC Packaged Rates , $14.49 , $24.83 , $14.49 , $40.11 , $28.97
,5710012129,Hospital Chargemaster,QUEtiapine XR 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $16.88 , $9.28 , $13.50 , See APC Packaged Rates , $11.82 , $6.58 , $16.29 , $16.36 , $8.69 , See APC Packaged Rates , See APC Packaged Rates , $11.33 , $11.33 , See APC Packaged Rates , See APC Packaged Rates , $15.70 , $15.70 , $15.70 , $15.70 , See APC Packaged Rates , $5.91 , $10.13 , $5.91 , $16.36 , $11.82
,5710012135,Hospital Chargemaster,quiNINE sulfate 324 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $16.70 , $9.19 , $13.36 , See APC Packaged Rates , $11.69 , $6.51 , $16.11 , $16.18 , $8.60 , See APC Packaged Rates , See APC Packaged Rates , $11.21 , $11.21 , See APC Packaged Rates , See APC Packaged Rates , $15.53 , $15.53 , $15.53 , $15.53 , See APC Packaged Rates , $5.85 , $10.02 , $5.85 , $16.18 , $11.69
,5710012141,Hospital Chargemaster,Racepinephrine HCl 0.5 mL Neb,Outpatient,Outpatient Default Percent / Case Rate,259, $3.07 , $1.69 , $2.46 , See APC Packaged Rates , $2.15 , $1.20 , $2.96 , $2.98 , $1.58 , See APC Packaged Rates , See APC Packaged Rates , $2.06 , $2.06 , See APC Packaged Rates , See APC Packaged Rates , $2.86 , $2.86 , $2.86 , $2.86 , See APC Packaged Rates , $1.07 , $1.84 , $1.07 , $2.98 , $2.15
,5710012142,Hospital Chargemaster,Raloxifene HCl 60 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $8.57 , $4.71 , $6.86 , See APC Packaged Rates , $6.00 , $3.34 , $8.27 , $8.31 , $4.41 , See APC Packaged Rates , See APC Packaged Rates , $5.75 , $5.75 , See APC Packaged Rates , See APC Packaged Rates , $7.97 , $7.97 , $7.97 , $7.97 , See APC Packaged Rates , $3.00 , $5.14 , $3.00 , $8.31 , $6.00
,5710012144,Hospital Chargemaster,Raltegravir 400 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $73.75 , $40.56 , $59.00 , See APC Packaged Rates , $51.63 , $28.76 , $71.16 , $71.47 , $37.98 , See APC Packaged Rates , See APC Packaged Rates , $49.49 , $49.49 , See APC Packaged Rates , See APC Packaged Rates , $68.59 , $68.59 , $68.59 , $68.59 , See APC Packaged Rates , $25.81 , $44.25 , $25.81 , $71.47 , $51.63
,5710012150,Hospital Chargemaster,Ranolazine 500 mg Tab.ER.12H,Outpatient,Outpatient Default Percent / Case Rate,259, $16.69 , $9.18 , $13.35 , See APC Packaged Rates , $11.68 , $6.51 , $16.10 , $16.17 , $8.60 , See APC Packaged Rates , See APC Packaged Rates , $11.20 , $11.20 , See APC Packaged Rates , See APC Packaged Rates , $15.52 , $15.52 , $15.52 , $15.52 , See APC Packaged Rates , $5.84 , $10.01 , $5.84 , $16.17 , $11.68
,5710012165,Hospital Chargemaster,rifAXIMin 550 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $117.10 , $64.41 , $93.68 , See APC Packaged Rates , $81.97 , $45.67 , $112.99 , $113.48 , $60.31 , See APC Packaged Rates , See APC Packaged Rates , $78.57 , $78.57 , See APC Packaged Rates , See APC Packaged Rates , $108.90 , $108.90 , $108.90 , $108.90 , See APC Packaged Rates , $40.99 , $70.26 , $40.99 , $113.48 , $81.97
,5710012173,Hospital Chargemaster,risperiDONE 0.25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $9.11 , $5.01 , $7.29 , See APC Packaged Rates , $6.38 , $3.55 , $8.79 , $8.83 , $4.69 , See APC Packaged Rates , See APC Packaged Rates , $6.11 , $6.11 , See APC Packaged Rates , See APC Packaged Rates , $8.47 , $8.47 , $8.47 , $8.47 , See APC Packaged Rates , $3.19 , $5.47 , $3.19 , $8.83 , $6.38
,5710012174,Hospital Chargemaster,risperiDONE 0.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $10.37 , $5.70 , $8.30 , See APC Packaged Rates , $7.26 , $4.04 , $10.01 , $10.05 , $5.34 , See APC Packaged Rates , See APC Packaged Rates , $6.96 , $6.96 , See APC Packaged Rates , See APC Packaged Rates , $9.64 , $9.64 , $9.64 , $9.64 , See APC Packaged Rates , $3.63 , $6.22 , $3.63 , $10.05 , $7.26
,5710012175,Hospital Chargemaster,risperiDONE 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $11.33 , $6.23 , $9.06 , See APC Packaged Rates , $7.93 , $4.42 , $10.93 , $10.98 , $5.84 , See APC Packaged Rates , See APC Packaged Rates , $7.60 , $7.60 , See APC Packaged Rates , See APC Packaged Rates , $10.54 , $10.54 , $10.54 , $10.54 , See APC Packaged Rates , $3.97 , $6.80 , $3.97 , $10.98 , $7.93
,5710012176,Hospital Chargemaster,risperiDONE 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $18.17 , $9.99 , $14.54 , See APC Packaged Rates , $12.72 , $7.09 , $17.53 , $17.61 , $9.36 , See APC Packaged Rates , See APC Packaged Rates , $12.19 , $12.19 , See APC Packaged Rates , See APC Packaged Rates , $16.90 , $16.90 , $16.90 , $16.90 , See APC Packaged Rates , $6.36 , $10.90 , $6.36 , $17.61 , $12.72
,5710012177,Hospital Chargemaster,risperiDONE 3 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $20.75 , $11.41 , $16.60 , See APC Packaged Rates , $14.53 , $8.09 , $20.02 , $20.11 , $10.69 , See APC Packaged Rates , See APC Packaged Rates , $13.92 , $13.92 , See APC Packaged Rates , See APC Packaged Rates , $19.30 , $19.30 , $19.30 , $19.30 , See APC Packaged Rates , $7.26 , $12.45 , $7.26 , $20.11 , $14.53
,5710012179,Hospital Chargemaster,risperiDONE ODT 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $14.03 , $7.72 , $11.22 , See APC Packaged Rates , $9.82 , $5.47 , $13.54 , $13.60 , $7.23 , See APC Packaged Rates , See APC Packaged Rates , $9.41 , $9.41 , See APC Packaged Rates , See APC Packaged Rates , $13.05 , $13.05 , $13.05 , $13.05 , See APC Packaged Rates , $4.91 , $8.42 , $4.91 , $13.60 , $9.82
,5710012187,Hospital Chargemaster,Ritonavir 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $21.85 , $12.02 , $17.48 , See APC Packaged Rates , $15.30 , $8.52 , $21.08 , $21.17 , $11.25 , See APC Packaged Rates , See APC Packaged Rates , $14.66 , $14.66 , See APC Packaged Rates , See APC Packaged Rates , $20.32 , $20.32 , $20.32 , $20.32 , See APC Packaged Rates , $7.65 , $13.11 , $7.65 , $21.17 , $15.30
,5710012190,Hospital Chargemaster,Rivaroxaban 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $41.23 , $22.68 , $32.98 , See APC Packaged Rates , $28.86 , $16.08 , $39.78 , $39.96 , $21.23 , See APC Packaged Rates , See APC Packaged Rates , $27.67 , $27.67 , See APC Packaged Rates , See APC Packaged Rates , $38.34 , $38.34 , $38.34 , $38.34 , See APC Packaged Rates , $14.43 , $24.74 , $14.43 , $39.96 , $28.86
,5710012191,Hospital Chargemaster,Rivaroxaban 15 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $41.68 , $22.92 , $33.34 , See APC Packaged Rates , $29.18 , $16.26 , $40.22 , $40.39 , $21.47 , See APC Packaged Rates , See APC Packaged Rates , $27.97 , $27.97 , See APC Packaged Rates , See APC Packaged Rates , $38.76 , $38.76 , $38.76 , $38.76 , See APC Packaged Rates , $14.59 , $25.01 , $14.59 , $40.39 , $29.18
,5710012193,Hospital Chargemaster,Rivastigmine 1.5 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $10.75 , $5.91 , $8.60 , See APC Packaged Rates , $7.53 , $4.19 , $10.37 , $10.42 , $5.54 , See APC Packaged Rates , See APC Packaged Rates , $7.21 , $7.21 , See APC Packaged Rates , See APC Packaged Rates , $10.00 , $10.00 , $10.00 , $10.00 , See APC Packaged Rates , $3.76 , $6.45 , $3.76 , $10.42 , $7.53
,5710012200,Hospital Chargemaster,rOPINIRole HCl 0.25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.67 , $3.12 , $4.54 , See APC Packaged Rates , $3.97 , $2.21 , $5.47 , $5.49 , $2.92 , See APC Packaged Rates , See APC Packaged Rates , $3.80 , $3.80 , See APC Packaged Rates , See APC Packaged Rates , $5.27 , $5.27 , $5.27 , $5.27 , See APC Packaged Rates , $1.98 , $3.40 , $1.98 , $5.49 , $3.97
,5710012202,Hospital Chargemaster,rOPINIRole HCl 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.40 , $3.52 , $5.12 , See APC Packaged Rates , $4.48 , $2.50 , $6.18 , $6.20 , $3.30 , See APC Packaged Rates , See APC Packaged Rates , $4.29 , $4.29 , See APC Packaged Rates , See APC Packaged Rates , $5.95 , $5.95 , $5.95 , $5.95 , See APC Packaged Rates , $2.24 , $3.84 , $2.24 , $6.20 , $4.48
,5710012206,Hospital Chargemaster,Rosuvastatin 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $22.82 , $12.55 , $18.26 , See APC Packaged Rates , $15.97 , $8.90 , $22.02 , $22.11 , $11.75 , See APC Packaged Rates , See APC Packaged Rates , $15.31 , $15.31 , See APC Packaged Rates , See APC Packaged Rates , $21.22 , $21.22 , $21.22 , $21.22 , See APC Packaged Rates , $7.99 , $13.69 , $7.99 , $22.11 , $15.97
,5710012207,Hospital Chargemaster,Saccharomyces 250 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $2.36 , $1.30 , $1.89 , See APC Packaged Rates , $1.65 , $0.92 , $2.28 , $2.29 , $1.22 , See APC Packaged Rates , See APC Packaged Rates , $1.58 , $1.58 , See APC Packaged Rates , See APC Packaged Rates , $2.19 , $2.19 , $2.19 , $2.19 , See APC Packaged Rates , $0.83 , $1.42 , $0.83 , $2.29 , $1.65
,5710012209,Hospital Chargemaster,Sacubitril/Valsartan 24/26 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $23.76 , $13.07 , $19.01 , See APC Packaged Rates , $16.63 , $9.27 , $22.93 , $23.03 , $12.24 , See APC Packaged Rates , See APC Packaged Rates , $15.94 , $15.94 , See APC Packaged Rates , See APC Packaged Rates , $22.10 , $22.10 , $22.10 , $22.10 , See APC Packaged Rates , $8.32 , $14.26 , $8.32 , $23.03 , $16.63
,5710012212,Hospital Chargemaster,Saliva Substitute Comb SPR,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012218,Hospital Chargemaster,Scopolamine 1.5 mg/72 hr Patch,Outpatient,Outpatient Default Percent / Case Rate,259, $54.32 , $29.88 , $43.46 , See APC Packaged Rates , $38.02 , $21.18 , $52.41 , $52.64 , $27.98 , See APC Packaged Rates , See APC Packaged Rates , $36.45 , $36.45 , See APC Packaged Rates , See APC Packaged Rates , $50.52 , $50.52 , $50.52 , $50.52 , See APC Packaged Rates , $19.01 , $32.59 , $19.01 , $52.64 , $38.02
,5710012220,Hospital Chargemaster,Selenium Sulfide 2.5% Lotion,Outpatient,Outpatient Default Percent / Case Rate,259, $12.78 , $7.03 , $10.22 , See APC Packaged Rates , $8.95 , $4.98 , $12.33 , $12.39 , $6.58 , See APC Packaged Rates , See APC Packaged Rates , $8.58 , $8.58 , See APC Packaged Rates , See APC Packaged Rates , $11.89 , $11.89 , $11.89 , $11.89 , See APC Packaged Rates , $4.47 , $7.67 , $4.47 , $12.39 , $8.95
,5710012222,Hospital Chargemaster,Sennosides 8.6 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012223,Hospital Chargemaster,Sennosides/Doc 8.6/50 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012225,Hospital Chargemaster,Sertraline HCl 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $7.22 , $3.97 , $5.78 , See APC Packaged Rates , $5.05 , $2.82 , $6.97 , $7.00 , $3.72 , See APC Packaged Rates , See APC Packaged Rates , $4.84 , $4.84 , See APC Packaged Rates , See APC Packaged Rates , $6.71 , $6.71 , $6.71 , $6.71 , See APC Packaged Rates , $2.53 , $4.33 , $2.53 , $7.00 , $5.05
,5710012226,Hospital Chargemaster,Sertraline HCl 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.02 , $0.56 , $0.82 , See APC Packaged Rates , $0.71 , $0.40 , $0.98 , $0.99 , $0.53 , See APC Packaged Rates , See APC Packaged Rates , $0.68 , $0.68 , See APC Packaged Rates , See APC Packaged Rates , $0.95 , $0.95 , $0.95 , $0.95 , See APC Packaged Rates , $0.36 , $0.61 , $0.36 , $0.99 , $0.71
,5710012235,Hospital Chargemaster,Silver Nitrate Applicator,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012239,Hospital Chargemaster,Simethicone 80 mg Tab Chew,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012240,Hospital Chargemaster,Simvastatin 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $7.00 , $3.85 , $5.60 , See APC Packaged Rates , $4.90 , $2.73 , $6.75 , $6.78 , $3.61 , See APC Packaged Rates , See APC Packaged Rates , $4.70 , $4.70 , See APC Packaged Rates , See APC Packaged Rates , $6.51 , $6.51 , $6.51 , $6.51 , See APC Packaged Rates , $2.45 , $4.20 , $2.45 , $6.78 , $4.90
,5710012241,Hospital Chargemaster,Simvastatin 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $12.55 , $6.90 , $10.04 , See APC Packaged Rates , $8.79 , $4.89 , $12.11 , $12.16 , $6.46 , See APC Packaged Rates , See APC Packaged Rates , $8.42 , $8.42 , See APC Packaged Rates , See APC Packaged Rates , $11.67 , $11.67 , $11.67 , $11.67 , See APC Packaged Rates , $4.39 , $7.53 , $4.39 , $12.16 , $8.79
,5710012242,Hospital Chargemaster,Simvastatin 40 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $12.08 , $6.64 , $9.66 , See APC Packaged Rates , $8.46 , $4.71 , $11.66 , $11.71 , $6.22 , See APC Packaged Rates , See APC Packaged Rates , $8.11 , $8.11 , See APC Packaged Rates , See APC Packaged Rates , $11.23 , $11.23 , $11.23 , $11.23 , See APC Packaged Rates , $4.23 , $7.25 , $4.23 , $11.71 , $8.46
,5710012243,Hospital Chargemaster,Simvastatin 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012248,Hospital Chargemaster,SITagliptin 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $41.61 , $22.89 , $33.29 , See APC Packaged Rates , $29.13 , $16.23 , $40.15 , $40.32 , $21.43 , See APC Packaged Rates , See APC Packaged Rates , $27.92 , $27.92 , See APC Packaged Rates , See APC Packaged Rates , $38.70 , $38.70 , $38.70 , $38.70 , See APC Packaged Rates , $14.56 , $24.97 , $14.56 , $40.32 , $29.13
,5710012250,Hospital Chargemaster,Eye Irrigation Solution 120 mL,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012254,Hospital Chargemaster,Sodium Bicarbonate 650 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012260,Hospital Chargemaster,Sodium Chloride 1 gm Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012262,Hospital Chargemaster,Sodium Chl 0.65 % Nasal Spray,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012272,Hospital Chargemaster,Sodium Chloride 3 % 3 mL Inh,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012281,Hospital Chargemaster,Sodium Phosphate 133 mL ENEMA,Outpatient,Outpatient Default Percent / Case Rate,259, $3.39 , $1.86 , $2.71 , See APC Packaged Rates , $2.37 , $1.32 , $3.27 , $3.29 , $1.75 , See APC Packaged Rates , See APC Packaged Rates , $2.27 , $2.27 , See APC Packaged Rates , See APC Packaged Rates , $3.15 , $3.15 , $3.15 , $3.15 , See APC Packaged Rates , $1.19 , $2.03 , $1.19 , $3.29 , $2.37
,5710012288,Hospital Chargemaster,"Sod,Potass Phosph Powd Pack",Outpatient,Outpatient Default Percent / Case Rate,259, $1.34 , $0.74 , $1.07 , See APC Packaged Rates , $0.94 , $0.52 , $1.29 , $1.30 , $0.69 , See APC Packaged Rates , See APC Packaged Rates , $0.90 , $0.90 , See APC Packaged Rates , See APC Packaged Rates , $1.25 , $1.25 , $1.25 , $1.25 , See APC Packaged Rates , $0.47 , $0.80 , $0.47 , $1.30 , $0.94
,5710012289,Hospital Chargemaster,Solifenacin 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $32.77 , $18.02 , $26.22 , See APC Packaged Rates , $22.94 , $12.78 , $31.62 , $31.76 , $16.88 , See APC Packaged Rates , See APC Packaged Rates , $21.99 , $21.99 , See APC Packaged Rates , See APC Packaged Rates , $30.48 , $30.48 , $30.48 , $30.48 , See APC Packaged Rates , $11.47 , $19.66 , $11.47 , $31.76 , $22.94
,5710012292,Hospital Chargemaster,Sotalol HCl 80 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.40 , $3.52 , $5.12 , See APC Packaged Rates , $4.48 , $2.50 , $6.18 , $6.20 , $3.30 , See APC Packaged Rates , See APC Packaged Rates , $4.29 , $4.29 , See APC Packaged Rates , See APC Packaged Rates , $5.95 , $5.95 , $5.95 , $5.95 , See APC Packaged Rates , $2.24 , $3.84 , $2.24 , $6.20 , $4.48
,5710012293,Hospital Chargemaster,Spironolactone 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.10 , $0.61 , $0.88 , See APC Packaged Rates , $0.77 , $0.43 , $1.06 , $1.07 , $0.57 , See APC Packaged Rates , See APC Packaged Rates , $0.74 , $0.74 , See APC Packaged Rates , See APC Packaged Rates , $1.02 , $1.02 , $1.02 , $1.02 , See APC Packaged Rates , $0.39 , $0.66 , $0.39 , $1.07 , $0.77
,5710012301,Hospital Chargemaster,Sucralfate 1 gm/10 mL Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $35.73 , $19.65 , $28.58 , See APC Packaged Rates , $25.01 , $13.93 , $34.48 , $34.63 , $18.40 , See APC Packaged Rates , See APC Packaged Rates , $23.97 , $23.97 , See APC Packaged Rates , See APC Packaged Rates , $33.23 , $33.23 , $33.23 , $33.23 , See APC Packaged Rates , $12.51 , $21.44 , $12.51 , $34.63 , $25.01
,5710012302,Hospital Chargemaster,Sucralfate 1 gm Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012308,Hospital Chargemaster,Sulfa/Trimet 800/160/20mL Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $23.23 , $12.78 , $18.58 , See APC Packaged Rates , $16.26 , $9.06 , $22.41 , $22.51 , $11.96 , See APC Packaged Rates , See APC Packaged Rates , $15.59 , $15.59 , See APC Packaged Rates , See APC Packaged Rates , $21.60 , $21.60 , $21.60 , $21.60 , See APC Packaged Rates , $8.13 , $13.94 , $8.13 , $22.51 , $16.26
,5710012309,Hospital Chargemaster,Sulfamethox/Trimeth 400/80 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.68 , $0.92 , $1.34 , See APC Packaged Rates , $1.18 , $0.66 , $1.62 , $1.63 , $0.87 , See APC Packaged Rates , See APC Packaged Rates , $1.13 , $1.13 , See APC Packaged Rates , See APC Packaged Rates , $1.56 , $1.56 , $1.56 , $1.56 , See APC Packaged Rates , $0.59 , $1.01 , $0.59 , $1.63 , $1.18
,5710012310,Hospital Chargemaster,Sulfamethox/Trimet 800/160 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $2.93 , $1.61 , $2.34 , See APC Packaged Rates , $2.05 , $1.14 , $2.83 , $2.84 , $1.51 , See APC Packaged Rates , See APC Packaged Rates , $1.97 , $1.97 , See APC Packaged Rates , See APC Packaged Rates , $2.72 , $2.72 , $2.72 , $2.72 , See APC Packaged Rates , $1.03 , $1.76 , $1.03 , $2.84 , $2.05
,5710012312,Hospital Chargemaster,sulfaSALAzine 500 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012314,Hospital Chargemaster,SUMAtriptan 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $68.98 , $37.94 , $55.18 , See APC Packaged Rates , $48.29 , $26.90 , $66.56 , $66.85 , $35.53 , See APC Packaged Rates , See APC Packaged Rates , $46.29 , $46.29 , See APC Packaged Rates , See APC Packaged Rates , $64.15 , $64.15 , $64.15 , $64.15 , See APC Packaged Rates , $24.14 , $41.39 , $24.14 , $66.85 , $48.29
,5710012318,Hospital Chargemaster,Tacrolimus 0.5 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $7.87 , $4.33 , $6.30 , See APC Packaged Rates , $5.51 , $3.07 , $7.59 , $7.63 , $4.05 , See APC Packaged Rates , See APC Packaged Rates , $5.28 , $5.28 , See APC Packaged Rates , See APC Packaged Rates , $7.32 , $7.32 , $7.32 , $7.32 , See APC Packaged Rates , $2.75 , $4.72 , $2.75 , $7.63 , $5.51
,5710012321,Hospital Chargemaster,Tamoxifen Citrate 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.82 , $2.65 , $3.86 , See APC Packaged Rates , $3.37 , $1.88 , $4.65 , $4.67 , $2.48 , See APC Packaged Rates , See APC Packaged Rates , $3.23 , $3.23 , See APC Packaged Rates , See APC Packaged Rates , $4.48 , $4.48 , $4.48 , $4.48 , See APC Packaged Rates , $1.69 , $2.89 , $1.69 , $4.67 , $3.37
,5710012322,Hospital Chargemaster,Tamsulosin HCl 0.4 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $10.67 , $5.87 , $8.54 , See APC Packaged Rates , $7.47 , $4.16 , $10.30 , $10.34 , $5.50 , See APC Packaged Rates , See APC Packaged Rates , $7.16 , $7.16 , See APC Packaged Rates , See APC Packaged Rates , $9.92 , $9.92 , $9.92 , $9.92 , See APC Packaged Rates , $3.73 , $6.40 , $3.73 , $10.34 , $7.47
,5710012325,Hospital Chargemaster,Temazepam 15 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.86 , $1.02 , $1.49 , See APC Packaged Rates , $1.30 , $0.73 , $1.79 , $1.80 , $0.96 , See APC Packaged Rates , See APC Packaged Rates , $1.25 , $1.25 , See APC Packaged Rates , See APC Packaged Rates , $1.73 , $1.73 , $1.73 , $1.73 , See APC Packaged Rates , $0.65 , $1.12 , $0.65 , $1.80 , $1.30
,5710012331,Hospital Chargemaster,Terazosin HCl 1 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $4.11 , $2.26 , $3.29 , See APC Packaged Rates , $2.88 , $1.60 , $3.97 , $3.98 , $2.12 , See APC Packaged Rates , See APC Packaged Rates , $2.76 , $2.76 , See APC Packaged Rates , See APC Packaged Rates , $3.82 , $3.82 , $3.82 , $3.82 , See APC Packaged Rates , $1.44 , $2.47 , $1.44 , $3.98 , $2.88
,5710012332,Hospital Chargemaster,Terazosin HCl 2 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $4.11 , $2.26 , $3.29 , See APC Packaged Rates , $2.88 , $1.60 , $3.97 , $3.98 , $2.12 , See APC Packaged Rates , See APC Packaged Rates , $2.76 , $2.76 , See APC Packaged Rates , See APC Packaged Rates , $3.82 , $3.82 , $3.82 , $3.82 , See APC Packaged Rates , $1.44 , $2.47 , $1.44 , $3.98 , $2.88
,5710012333,Hospital Chargemaster,Terazosin HCl 5 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $4.11 , $2.26 , $3.29 , See APC Packaged Rates , $2.88 , $1.60 , $3.97 , $3.98 , $2.12 , See APC Packaged Rates , See APC Packaged Rates , $2.76 , $2.76 , See APC Packaged Rates , See APC Packaged Rates , $3.82 , $3.82 , $3.82 , $3.82 , See APC Packaged Rates , $1.44 , $2.47 , $1.44 , $3.98 , $2.88
,5710012346,Hospital Chargemaster,Tetracaine 0.5 % 4 mL Drops,Outpatient,Outpatient Default Percent / Case Rate,259, $6.76 , $3.72 , $5.41 , See APC Packaged Rates , $4.73 , $2.64 , $6.52 , $6.55 , $3.48 , See APC Packaged Rates , See APC Packaged Rates , $4.54 , $4.54 , See APC Packaged Rates , See APC Packaged Rates , $6.29 , $6.29 , $6.29 , $6.29 , See APC Packaged Rates , $2.37 , $4.06 , $2.37 , $6.55 , $4.73
,5710012356,Hospital Chargemaster,Thiamine HCl 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $0.99 , $0.54 , $0.79 , See APC Packaged Rates , $0.69 , $0.39 , $0.96 , $0.96 , $0.51 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.92 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , $0.35 , $0.59 , $0.35 , $0.96 , $0.69
,5710012371,Hospital Chargemaster,Ticagrelor 90 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $17.20 , $9.46 , $13.76 , See APC Packaged Rates , $12.04 , $6.71 , $16.60 , $16.67 , $8.86 , See APC Packaged Rates , See APC Packaged Rates , $11.54 , $11.54 , See APC Packaged Rates , See APC Packaged Rates , $16.00 , $16.00 , $16.00 , $16.00 , See APC Packaged Rates , $6.02 , $10.32 , $6.02 , $16.67 , $12.04
,5710012374,Hospital Chargemaster,Timolol 0.25 % 5 mL Drops,Outpatient,Outpatient Default Percent / Case Rate,259, $6.64 , $3.65 , $5.31 , See APC Packaged Rates , $4.65 , $2.59 , $6.41 , $6.43 , $3.42 , See APC Packaged Rates , See APC Packaged Rates , $4.46 , $4.46 , See APC Packaged Rates , See APC Packaged Rates , $6.18 , $6.18 , $6.18 , $6.18 , See APC Packaged Rates , $2.32 , $3.98 , $2.32 , $6.43 , $4.65
,5710012375,Hospital Chargemaster,Timolol 0.5 % 5 mL Drops,Outpatient,Outpatient Default Percent / Case Rate,259, $8.35 , $4.59 , $6.68 , See APC Packaged Rates , $5.85 , $3.26 , $8.06 , $8.09 , $4.30 , See APC Packaged Rates , See APC Packaged Rates , $5.60 , $5.60 , See APC Packaged Rates , See APC Packaged Rates , $7.77 , $7.77 , $7.77 , $7.77 , See APC Packaged Rates , $2.92 , $5.01 , $2.92 , $8.09 , $5.85
,5710012378,Hospital Chargemaster,Tiotropium 18 mcg Cap.W.DEV,Outpatient,Outpatient Default Percent / Case Rate,259, $46.93 , $25.81 , $37.54 , See APC Packaged Rates , $32.85 , $18.30 , $45.28 , $45.48 , $24.17 , See APC Packaged Rates , See APC Packaged Rates , $31.49 , $31.49 , See APC Packaged Rates , See APC Packaged Rates , $43.64 , $43.64 , $43.64 , $43.64 , See APC Packaged Rates , $16.43 , $28.16 , $16.43 , $45.48 , $32.85
,5710012380,Hospital Chargemaster,TiZANidine HCl 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.27 , $2.90 , $4.22 , See APC Packaged Rates , $3.69 , $2.06 , $5.09 , $5.11 , $2.71 , See APC Packaged Rates , See APC Packaged Rates , $3.54 , $3.54 , See APC Packaged Rates , See APC Packaged Rates , $4.90 , $4.90 , $4.90 , $4.90 , See APC Packaged Rates , $1.84 , $3.16 , $1.84 , $5.11 , $3.69
,5710012392,Hospital Chargemaster,Tolterodine Tartrate 2 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $8.51 , $4.68 , $6.81 , See APC Packaged Rates , $5.96 , $3.32 , $8.21 , $8.25 , $4.38 , See APC Packaged Rates , See APC Packaged Rates , $5.71 , $5.71 , See APC Packaged Rates , See APC Packaged Rates , $7.91 , $7.91 , $7.91 , $7.91 , See APC Packaged Rates , $2.98 , $5.11 , $2.98 , $8.25 , $5.96
,5710012393,Hospital Chargemaster,Tolterodine Tartrate LA 2mg Ca,Outpatient,Outpatient Default Percent / Case Rate,259, $30.93 , $17.01 , $24.74 , See APC Packaged Rates , $21.65 , $12.06 , $29.84 , $29.97 , $15.93 , See APC Packaged Rates , See APC Packaged Rates , $20.75 , $20.75 , See APC Packaged Rates , See APC Packaged Rates , $28.76 , $28.76 , $28.76 , $28.76 , See APC Packaged Rates , $10.83 , $18.56 , $10.83 , $29.97 , $21.65
,5710012397,Hospital Chargemaster,Topiramate 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $15.81 , $8.70 , $12.65 , See APC Packaged Rates , $11.07 , $6.17 , $15.26 , $15.32 , $8.14 , See APC Packaged Rates , See APC Packaged Rates , $10.61 , $10.61 , See APC Packaged Rates , See APC Packaged Rates , $14.70 , $14.70 , $14.70 , $14.70 , See APC Packaged Rates , $5.53 , $9.49 , $5.53 , $15.32 , $11.07
,5710012398,Hospital Chargemaster,Topiramate 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.15 , $2.83 , $4.12 , See APC Packaged Rates , $3.61 , $2.01 , $4.97 , $4.99 , $2.65 , See APC Packaged Rates , See APC Packaged Rates , $3.46 , $3.46 , See APC Packaged Rates , See APC Packaged Rates , $4.79 , $4.79 , $4.79 , $4.79 , See APC Packaged Rates , $1.80 , $3.09 , $1.80 , $4.99 , $3.61
,5710012400,Hospital Chargemaster,Torsemide 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.79 , $0.98 , $1.43 , See APC Packaged Rates , $1.25 , $0.70 , $1.73 , $1.73 , $0.92 , See APC Packaged Rates , See APC Packaged Rates , $1.20 , $1.20 , See APC Packaged Rates , See APC Packaged Rates , $1.66 , $1.66 , $1.66 , $1.66 , See APC Packaged Rates , $0.63 , $1.07 , $0.63 , $1.73 , $1.25
,5710012403,Hospital Chargemaster,traMADol HCl 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.03 , $1.12 , $1.62 , See APC Packaged Rates , $1.42 , $0.79 , $1.96 , $1.97 , $1.05 , See APC Packaged Rates , See APC Packaged Rates , $1.36 , $1.36 , See APC Packaged Rates , See APC Packaged Rates , $1.89 , $1.89 , $1.89 , $1.89 , See APC Packaged Rates , $0.71 , $1.22 , $0.71 , $1.97 , $1.42
,5710012409,Hospital Chargemaster,traZODone HCl 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.47 , $1.91 , $2.78 , See APC Packaged Rates , $2.43 , $1.35 , $3.35 , $3.36 , $1.79 , See APC Packaged Rates , See APC Packaged Rates , $2.33 , $2.33 , See APC Packaged Rates , See APC Packaged Rates , $3.23 , $3.23 , $3.23 , $3.23 , See APC Packaged Rates , $1.21 , $2.08 , $1.21 , $3.36 , $2.43
,5710012410,Hospital Chargemaster,traZODone HCl 150 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.63 , $2.00 , $2.90 , See APC Packaged Rates , $2.54 , $1.42 , $3.50 , $3.52 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $2.44 , $2.44 , See APC Packaged Rates , See APC Packaged Rates , $3.38 , $3.38 , $3.38 , $3.38 , See APC Packaged Rates , $1.27 , $2.18 , $1.27 , $3.52 , $2.54
,5710012411,Hospital Chargemaster,traZODone HCl 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012412,Hospital Chargemaster,Triamcin 0.025 % 15 gm Cream,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012415,Hospital Chargemaster,Triamcin 0.1 % 15 gm Cream,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012418,Hospital Chargemaster,Triamcin 0.5 % 15 gm Cream,Outpatient,Outpatient Default Percent / Case Rate,259, $1.71 , $0.94 , $1.37 , See APC Packaged Rates , $1.20 , $0.67 , $1.65 , $1.66 , $0.88 , See APC Packaged Rates , See APC Packaged Rates , $1.15 , $1.15 , See APC Packaged Rates , See APC Packaged Rates , $1.59 , $1.59 , $1.59 , $1.59 , See APC Packaged Rates , $0.60 , $1.03 , $0.60 , $1.66 , $1.20
,5710012425,Hospital Chargemaster,Triamterene/HCTZ 37.5/25 Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $1.15 , $0.63 , $0.92 , See APC Packaged Rates , $0.81 , $0.45 , $1.11 , $1.11 , $0.59 , See APC Packaged Rates , See APC Packaged Rates , $0.77 , $0.77 , See APC Packaged Rates , See APC Packaged Rates , $1.07 , $1.07 , $1.07 , $1.07 , See APC Packaged Rates , $0.40 , $0.69 , $0.40 , $1.11 , $0.81
,5710012433,Hospital Chargemaster,Trihexyphenidyl 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012439,Hospital Chargemaster,Trolamine Sal 10 % 85 gm Cr,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012451,Hospital Chargemaster,Ursodiol 300 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $34.89 , $19.19 , $27.91 , See APC Packaged Rates , $24.42 , $13.61 , $33.67 , $33.81 , $17.97 , See APC Packaged Rates , See APC Packaged Rates , $23.41 , $23.41 , See APC Packaged Rates , See APC Packaged Rates , $32.45 , $32.45 , $32.45 , $32.45 , See APC Packaged Rates , $12.21 , $20.93 , $12.21 , $33.81 , $24.42
,5710012457,Hospital Chargemaster,valACYcyclovir 500 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $18.41 , $10.13 , $14.73 , See APC Packaged Rates , $12.89 , $7.18 , $17.76 , $17.84 , $9.48 , See APC Packaged Rates , See APC Packaged Rates , $12.35 , $12.35 , See APC Packaged Rates , See APC Packaged Rates , $17.12 , $17.12 , $17.12 , $17.12 , See APC Packaged Rates , $6.44 , $11.05 , $6.44 , $17.84 , $12.89
,5710012461,Hospital Chargemaster,Valproic Acid 250 mg/5 mL Sol,Outpatient,Outpatient Default Percent / Case Rate,259, $1.78 , $0.98 , $1.42 , See APC Packaged Rates , $1.25 , $0.69 , $1.72 , $1.72 , $0.92 , See APC Packaged Rates , See APC Packaged Rates , $1.19 , $1.19 , See APC Packaged Rates , See APC Packaged Rates , $1.66 , $1.66 , $1.66 , $1.66 , See APC Packaged Rates , $0.62 , $1.07 , $0.62 , $1.72 , $1.25
,5710012464,Hospital Chargemaster,Valsartan 160 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $12.27 , $6.75 , $9.82 , See APC Packaged Rates , $8.59 , $4.79 , $11.84 , $11.89 , $6.32 , See APC Packaged Rates , See APC Packaged Rates , $8.23 , $8.23 , See APC Packaged Rates , See APC Packaged Rates , $11.41 , $11.41 , $11.41 , $11.41 , See APC Packaged Rates , $4.29 , $7.36 , $4.29 , $11.89 , $8.59
,5710012466,Hospital Chargemaster,Valsartan 40 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $9.32 , $5.13 , $7.46 , See APC Packaged Rates , $6.52 , $3.63 , $8.99 , $9.03 , $4.80 , See APC Packaged Rates , See APC Packaged Rates , $6.25 , $6.25 , See APC Packaged Rates , See APC Packaged Rates , $8.67 , $8.67 , $8.67 , $8.67 , See APC Packaged Rates , $3.26 , $5.59 , $3.26 , $9.03 , $6.52
,5710012468,Hospital Chargemaster,Vancomycin 125 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $79.84 , $43.91 , $63.87 , See APC Packaged Rates , $55.89 , $31.14 , $77.04 , $77.37 , $41.12 , See APC Packaged Rates , See APC Packaged Rates , $53.57 , $53.57 , See APC Packaged Rates , See APC Packaged Rates , $74.25 , $74.25 , $74.25 , $74.25 , See APC Packaged Rates , $27.94 , $47.90 , $27.94 , $77.37 , $55.89
,5710012478,Hospital Chargemaster,Venlafaxine 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.95 , $2.72 , $3.96 , See APC Packaged Rates , $3.47 , $1.93 , $4.78 , $4.80 , $2.55 , See APC Packaged Rates , See APC Packaged Rates , $3.32 , $3.32 , See APC Packaged Rates , See APC Packaged Rates , $4.60 , $4.60 , $4.60 , $4.60 , See APC Packaged Rates , $1.73 , $2.97 , $1.73 , $4.80 , $3.47
,5710012481,Hospital Chargemaster,Venlafaxine 75 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.56 , $3.06 , $4.45 , See APC Packaged Rates , $3.89 , $2.17 , $5.36 , $5.39 , $2.86 , See APC Packaged Rates , See APC Packaged Rates , $3.73 , $3.73 , See APC Packaged Rates , See APC Packaged Rates , $5.17 , $5.17 , $5.17 , $5.17 , See APC Packaged Rates , $1.95 , $3.34 , $1.95 , $5.39 , $3.89
,5710012483,Hospital Chargemaster,Venlafaxine ER 37.5 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $9.54 , $5.25 , $7.63 , See APC Packaged Rates , $6.68 , $3.72 , $9.21 , $9.25 , $4.91 , See APC Packaged Rates , See APC Packaged Rates , $6.40 , $6.40 , See APC Packaged Rates , See APC Packaged Rates , $8.87 , $8.87 , $8.87 , $8.87 , See APC Packaged Rates , $3.34 , $5.72 , $3.34 , $9.25 , $6.68
,5710012484,Hospital Chargemaster,Venlafaxine ER 75 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $10.64 , $5.85 , $8.51 , See APC Packaged Rates , $7.45 , $4.15 , $10.27 , $10.31 , $5.48 , See APC Packaged Rates , See APC Packaged Rates , $7.14 , $7.14 , See APC Packaged Rates , See APC Packaged Rates , $9.90 , $9.90 , $9.90 , $9.90 , See APC Packaged Rates , $3.72 , $6.38 , $3.72 , $10.31 , $7.45
,5710012487,Hospital Chargemaster,Verapamil HCl 40 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012493,Hospital Chargemaster,Verapamil SR 180 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.35 , $3.49 , $5.08 , See APC Packaged Rates , $4.45 , $2.48 , $6.13 , $6.15 , $3.27 , See APC Packaged Rates , See APC Packaged Rates , $4.26 , $4.26 , See APC Packaged Rates , See APC Packaged Rates , $5.91 , $5.91 , $5.91 , $5.91 , See APC Packaged Rates , $2.22 , $3.81 , $2.22 , $6.15 , $4.45
,5710012507,Hospital Chargemaster,Vitamin E 200 Unit Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012511,Hospital Chargemaster,"Vits A,C,E/Lutein/Minerals Tab",Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012518,Hospital Chargemaster,Warfarin 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.56 , $0.86 , $1.25 , See APC Packaged Rates , $1.09 , $0.61 , $1.51 , $1.51 , $0.80 , See APC Packaged Rates , See APC Packaged Rates , $1.05 , $1.05 , See APC Packaged Rates , See APC Packaged Rates , $1.45 , $1.45 , $1.45 , $1.45 , See APC Packaged Rates , $0.55 , $0.94 , $0.55 , $1.51 , $1.09
,5710012519,Hospital Chargemaster,Warfarin 2.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.68 , $0.92 , $1.34 , See APC Packaged Rates , $1.18 , $0.66 , $1.62 , $1.63 , $0.87 , See APC Packaged Rates , See APC Packaged Rates , $1.13 , $1.13 , See APC Packaged Rates , See APC Packaged Rates , $1.56 , $1.56 , $1.56 , $1.56 , See APC Packaged Rates , $0.59 , $1.01 , $0.59 , $1.63 , $1.18
,5710012520,Hospital Chargemaster,Warfarin 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.59 , $0.87 , $1.27 , See APC Packaged Rates , $1.11 , $0.62 , $1.53 , $1.54 , $0.82 , See APC Packaged Rates , See APC Packaged Rates , $1.07 , $1.07 , See APC Packaged Rates , See APC Packaged Rates , $1.48 , $1.48 , $1.48 , $1.48 , See APC Packaged Rates , $0.56 , $0.95 , $0.56 , $1.54 , $1.11
,5710012521,Hospital Chargemaster,Warfarin 3 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.61 , $0.89 , $1.29 , See APC Packaged Rates , $1.13 , $0.63 , $1.55 , $1.56 , $0.83 , See APC Packaged Rates , See APC Packaged Rates , $1.08 , $1.08 , See APC Packaged Rates , See APC Packaged Rates , $1.50 , $1.50 , $1.50 , $1.50 , See APC Packaged Rates , $0.56 , $0.97 , $0.56 , $1.56 , $1.13
,5710012523,Hospital Chargemaster,Warfarin 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.76 , $0.97 , $1.41 , See APC Packaged Rates , $1.23 , $0.69 , $1.70 , $1.71 , $0.91 , See APC Packaged Rates , See APC Packaged Rates , $1.18 , $1.18 , See APC Packaged Rates , See APC Packaged Rates , $1.64 , $1.64 , $1.64 , $1.64 , See APC Packaged Rates , $0.62 , $1.06 , $0.62 , $1.71 , $1.23
,5710012542,Hospital Chargemaster,Zinc Oxide 20 % 30 gm Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012543,Hospital Chargemaster,Zinc Sulfate 220 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $0.99 , $0.54 , $0.79 , See APC Packaged Rates , $0.69 , $0.39 , $0.96 , $0.96 , $0.51 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.92 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , $0.35 , $0.59 , $0.35 , $0.96 , $0.69
,5710012547,Hospital Chargemaster,Ziprasidone 20 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $21.60 , $11.88 , $17.28 , See APC Packaged Rates , $15.12 , $8.42 , $20.84 , $20.93 , $11.12 , See APC Packaged Rates , See APC Packaged Rates , $14.49 , $14.49 , See APC Packaged Rates , See APC Packaged Rates , $20.09 , $20.09 , $20.09 , $20.09 , See APC Packaged Rates , $7.56 , $12.96 , $7.56 , $20.93 , $15.12
,5710012548,Hospital Chargemaster,Ziprasidone 40 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $21.29 , $11.71 , $17.03 , See APC Packaged Rates , $14.90 , $8.30 , $20.54 , $20.63 , $10.96 , See APC Packaged Rates , See APC Packaged Rates , $14.29 , $14.29 , See APC Packaged Rates , See APC Packaged Rates , $19.80 , $19.80 , $19.80 , $19.80 , See APC Packaged Rates , $7.45 , $12.77 , $7.45 , $20.63 , $14.90
,5710012564,Hospital Chargemaster,Metoprolol Tartrate 12.5Mg tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012566,Hospital Chargemaster,traZODone HCl,Outpatient,Outpatient Default Percent / Case Rate,259, $0.99 , $0.54 , $0.79 , See APC Packaged Rates , $0.69 , $0.39 , $0.96 , $0.96 , $0.51 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.92 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , $0.35 , $0.59 , $0.35 , $0.96 , $0.69
,5710012567,Hospital Chargemaster,Metoprolol Succinate ER,Outpatient,Outpatient Default Percent / Case Rate,259, $2.21 , $1.22 , $1.77 , See APC Packaged Rates , $1.55 , $0.86 , $2.13 , $2.14 , $1.14 , See APC Packaged Rates , See APC Packaged Rates , $1.48 , $1.48 , See APC Packaged Rates , See APC Packaged Rates , $2.06 , $2.06 , $2.06 , $2.06 , See APC Packaged Rates , $0.77 , $1.33 , $0.77 , $2.14 , $1.55
,5710012568,Hospital Chargemaster,Divalproex Sodium 125mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012569,Hospital Chargemaster,FLUoxetine HCl,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012580,Hospital Chargemaster,Acetaminophen Oral Suspension,Outpatient,Outpatient Default Percent / Case Rate,259, $3.54 , $1.95 , $2.83 , See APC Packaged Rates , $2.48 , $1.38 , $3.42 , $3.43 , $1.82 , See APC Packaged Rates , See APC Packaged Rates , $2.38 , $2.38 , See APC Packaged Rates , See APC Packaged Rates , $3.29 , $3.29 , $3.29 , $3.29 , See APC Packaged Rates , $1.24 , $2.12 , $1.24 , $3.43 , $2.48
,5710012583,Hospital Chargemaster,miSOPROStol 50 mcg halftab,Outpatient,Outpatient Default Percent / Case Rate,259, $2.50 , $1.38 , $2.00 , See APC Packaged Rates , $1.75 , $0.98 , $2.41 , $2.42 , $1.29 , See APC Packaged Rates , See APC Packaged Rates , $1.68 , $1.68 , See APC Packaged Rates , See APC Packaged Rates , $2.33 , $2.33 , $2.33 , $2.33 , See APC Packaged Rates , $0.88 , $1.50 , $0.88 , $2.42 , $1.75
,5710012584,Hospital Chargemaster,miSOPROStol 25 mcg quartertab,Outpatient,Outpatient Default Percent / Case Rate,259, $4.21 , $2.32 , $3.37 , See APC Packaged Rates , $2.95 , $1.64 , $4.06 , $4.08 , $2.17 , See APC Packaged Rates , See APC Packaged Rates , $2.82 , $2.82 , See APC Packaged Rates , See APC Packaged Rates , $3.92 , $3.92 , $3.92 , $3.92 , See APC Packaged Rates , $1.47 , $2.53 , $1.47 , $4.08 , $2.95
,5710012591,Hospital Chargemaster,Sodium Polystyrene Sulfon/Sorb,Outpatient,Outpatient Default Percent / Case Rate,259, $57.24 , $31.48 , $45.79 , See APC Packaged Rates , $40.07 , $22.32 , $55.23 , $55.47 , $29.48 , See APC Packaged Rates , See APC Packaged Rates , $38.41 , $38.41 , See APC Packaged Rates , See APC Packaged Rates , $53.23 , $53.23 , $53.23 , $53.23 , See APC Packaged Rates , $20.03 , $34.34 , $20.03 , $55.47 , $40.07
,5710012593,Hospital Chargemaster,Triamcinolone 0.1 % Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012594,Hospital Chargemaster,Triamcinolone 0.5 % Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $1.71 , $0.94 , $1.37 , See APC Packaged Rates , $1.20 , $0.67 , $1.65 , $1.66 , $0.88 , See APC Packaged Rates , See APC Packaged Rates , $1.15 , $1.15 , See APC Packaged Rates , See APC Packaged Rates , $1.59 , $1.59 , $1.59 , $1.59 , See APC Packaged Rates , $0.60 , $1.03 , $0.60 , $1.66 , $1.20
,5710012601,Hospital Chargemaster,Warfarin Sodium .5Mg Halftab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.56 , $0.86 , $1.25 , See APC Packaged Rates , $1.09 , $0.61 , $1.51 , $1.51 , $0.80 , See APC Packaged Rates , See APC Packaged Rates , $1.05 , $1.05 , See APC Packaged Rates , See APC Packaged Rates , $1.45 , $1.45 , $1.45 , $1.45 , See APC Packaged Rates , $0.55 , $0.94 , $0.55 , $1.51 , $1.09
,5710012610,Hospital Chargemaster,Lidocaine 5 % Ointment,Outpatient,Outpatient Default Percent / Case Rate,259, $22.80 , $12.54 , $18.24 , See APC Packaged Rates , $15.96 , $8.89 , $22.00 , $22.10 , $11.74 , See APC Packaged Rates , See APC Packaged Rates , $15.30 , $15.30 , See APC Packaged Rates , See APC Packaged Rates , $21.20 , $21.20 , $21.20 , $21.20 , See APC Packaged Rates , $7.98 , $13.68 , $7.98 , $22.10 , $15.96
,5710012615,Hospital Chargemaster,Non-Formulary Med,Outpatient,Outpatient Default Percent / Case Rate,259, $0.05 , $0.03 , $0.04 , See APC Packaged Rates , $0.04 , $0.02 , $0.05 , $0.05 , $0.03 , See APC Packaged Rates , See APC Packaged Rates , $0.03 , $0.03 , See APC Packaged Rates , See APC Packaged Rates , $0.05 , $0.05 , $0.05 , $0.05 , See APC Packaged Rates , $0.02 , $0.03 , $0.02 , $0.05 , $0.04
,5710012616,Hospital Chargemaster,OLANZapine 10mg,Outpatient,Outpatient Default Percent / Case Rate,259, $39.34 , $21.64 , $31.47 , See APC Packaged Rates , $27.54 , $15.34 , $37.96 , $38.12 , $20.26 , See APC Packaged Rates , See APC Packaged Rates , $26.40 , $26.40 , See APC Packaged Rates , See APC Packaged Rates , $36.59 , $36.59 , $36.59 , $36.59 , See APC Packaged Rates , $13.77 , $23.60 , $13.77 , $38.12 , $27.54
,5710012617,Hospital Chargemaster,diphenhydrAMINE HCl Liquid,Outpatient,Outpatient Default Percent / Case Rate,259, $5.00 , $2.75 , $4.00 , See APC Packaged Rates , $3.50 , $1.95 , $4.82 , $4.85 , $2.58 , See APC Packaged Rates , See APC Packaged Rates , $3.36 , $3.36 , See APC Packaged Rates , See APC Packaged Rates , $4.65 , $4.65 , $4.65 , $4.65 , See APC Packaged Rates , $1.75 , $3.00 , $1.75 , $4.85 , $3.50
,5710012628,Hospital Chargemaster,Oxycodone HCl,Outpatient,Outpatient Default Percent / Case Rate,259, $1.34 , $0.74 , $1.07 , See APC Packaged Rates , $0.94 , $0.52 , $1.29 , $1.30 , $0.69 , See APC Packaged Rates , See APC Packaged Rates , $0.90 , $0.90 , See APC Packaged Rates , See APC Packaged Rates , $1.25 , $1.25 , $1.25 , $1.25 , See APC Packaged Rates , $0.47 , $0.80 , $0.47 , $1.30 , $0.94
,5710012629,Hospital Chargemaster,Spironolactone,Outpatient,Outpatient Default Percent / Case Rate,259, $1.09 , $0.60 , $0.87 , See APC Packaged Rates , $0.76 , $0.43 , $1.05 , $1.06 , $0.56 , See APC Packaged Rates , See APC Packaged Rates , $0.73 , $0.73 , See APC Packaged Rates , See APC Packaged Rates , $1.01 , $1.01 , $1.01 , $1.01 , See APC Packaged Rates , $0.38 , $0.65 , $0.38 , $1.06 , $0.76
,5710012630,Hospital Chargemaster,LORazepam,Outpatient,Outpatient Default Percent / Case Rate,259, $1.63 , $0.90 , $1.30 , See APC Packaged Rates , $1.14 , $0.64 , $1.57 , $1.58 , $0.84 , See APC Packaged Rates , See APC Packaged Rates , $1.09 , $1.09 , See APC Packaged Rates , See APC Packaged Rates , $1.52 , $1.52 , $1.52 , $1.52 , See APC Packaged Rates , $0.57 , $0.98 , $0.57 , $1.58 , $1.14
,5710012644,Hospital Chargemaster,traZODone HCl,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012649,Hospital Chargemaster,Famotidine,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012651,Hospital Chargemaster,Amiodarone HCl,Outpatient,Outpatient Default Percent / Case Rate,259, $42.64 , $23.45 , $34.11 , See APC Packaged Rates , $29.85 , $16.63 , $41.14 , $41.32 , $21.96 , See APC Packaged Rates , See APC Packaged Rates , $28.61 , $28.61 , See APC Packaged Rates , See APC Packaged Rates , $39.66 , $39.66 , $39.66 , $39.66 , See APC Packaged Rates , $14.92 , $25.58 , $14.92 , $41.32 , $29.85
,5710012652,Hospital Chargemaster,clonazePAM 0.25Mg Half tab,Outpatient,Outpatient Default Percent / Case Rate,259, $3.15 , $1.73 , $2.52 , See APC Packaged Rates , $2.21 , $1.23 , $3.04 , $3.05 , $1.62 , See APC Packaged Rates , See APC Packaged Rates , $2.11 , $2.11 , See APC Packaged Rates , See APC Packaged Rates , $2.93 , $2.93 , $2.93 , $2.93 , See APC Packaged Rates , $1.10 , $1.89 , $1.10 , $3.05 , $2.21
,5710012653,Hospital Chargemaster,A & D Ointment,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012668,Hospital Chargemaster,Calcium Carbonate TUMS,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012677,Hospital Chargemaster,Potassium Chloride ER 10 Meq,Outpatient,Outpatient Default Percent / Case Rate,259, $2.52 , $1.39 , $2.02 , See APC Packaged Rates , $1.76 , $0.98 , $2.43 , $2.44 , $1.30 , See APC Packaged Rates , See APC Packaged Rates , $1.69 , $1.69 , See APC Packaged Rates , See APC Packaged Rates , $2.34 , $2.34 , $2.34 , $2.34 , See APC Packaged Rates , $0.88 , $1.51 , $0.88 , $2.44 , $1.76
,5710012689,Hospital Chargemaster,Chlorhexidine Oral Rinse 473mL,Outpatient,Outpatient Default Percent / Case Rate,259, $22.92 , $12.61 , $18.34 , See APC Packaged Rates , $16.04 , $8.94 , $22.12 , $22.21 , $11.80 , See APC Packaged Rates , See APC Packaged Rates , $15.38 , $15.38 , See APC Packaged Rates , See APC Packaged Rates , $21.32 , $21.32 , $21.32 , $21.32 , See APC Packaged Rates , $8.02 , $13.75 , $8.02 , $22.21 , $16.04
,5710012692,Hospital Chargemaster,Lactulose 10 gm/15 ml 946 mL,Outpatient,Outpatient Default Percent / Case Rate,259, $127.37 , $70.05 , $101.90 , See APC Packaged Rates , $89.16 , $49.67 , $122.90 , $123.43 , $65.60 , See APC Packaged Rates , See APC Packaged Rates , $85.47 , $85.47 , See APC Packaged Rates , See APC Packaged Rates , $118.45 , $118.45 , $118.45 , $118.45 , See APC Packaged Rates , $44.58 , $76.42 , $44.58 , $123.43 , $89.16
,5710012695,Hospital Chargemaster,LORazepam 1 mg/0.5mL Intens,Outpatient,Outpatient Default Percent / Case Rate,259, $2.04 , $1.12 , $1.63 , See APC Packaged Rates , $1.43 , $0.80 , $1.97 , $1.98 , $1.05 , See APC Packaged Rates , See APC Packaged Rates , $1.37 , $1.37 , See APC Packaged Rates , See APC Packaged Rates , $1.90 , $1.90 , $1.90 , $1.90 , See APC Packaged Rates , $0.71 , $1.22 , $0.71 , $1.98 , $1.43
,5710012696,Hospital Chargemaster,Morphine 0.4 mg/1 mL Solution,Outpatient,Outpatient Default Percent / Case Rate,259, $4.82 , $2.65 , $3.86 , See APC Packaged Rates , $3.37 , $1.88 , $4.65 , $4.67 , $2.48 , See APC Packaged Rates , See APC Packaged Rates , $3.23 , $3.23 , See APC Packaged Rates , See APC Packaged Rates , $4.48 , $4.48 , $4.48 , $4.48 , See APC Packaged Rates , $1.69 , $2.89 , $1.69 , $4.67 , $3.37
,5710012697,Hospital Chargemaster,Morphine 10 mg/0.5 mL Solution,Outpatient,Outpatient Default Percent / Case Rate,259, $6.89 , $3.79 , $5.51 , See APC Packaged Rates , $4.82 , $2.69 , $6.65 , $6.68 , $3.55 , See APC Packaged Rates , See APC Packaged Rates , $4.62 , $4.62 , See APC Packaged Rates , See APC Packaged Rates , $6.41 , $6.41 , $6.41 , $6.41 , See APC Packaged Rates , $2.41 , $4.13 , $2.41 , $6.68 , $4.82
,5710012708,Hospital Chargemaster,Glucose Gel Neonatal 15 ml,Outpatient,Outpatient Default Percent / Case Rate,259, $4.03 , $2.22 , $3.22 , See APC Packaged Rates , $2.82 , $1.57 , $3.89 , $3.91 , $2.08 , See APC Packaged Rates , See APC Packaged Rates , $2.70 , $2.70 , See APC Packaged Rates , See APC Packaged Rates , $3.75 , $3.75 , $3.75 , $3.75 , See APC Packaged Rates , $1.41 , $2.42 , $1.41 , $3.91 , $2.82
,5710012711,Hospital Chargemaster,Magic Mouthwas 10 ml Oral Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $12.75 , $7.01 , $10.20 , See APC Packaged Rates , $8.93 , $4.97 , $12.30 , $12.36 , $6.57 , See APC Packaged Rates , See APC Packaged Rates , $8.56 , $8.56 , See APC Packaged Rates , See APC Packaged Rates , $11.86 , $11.86 , $11.86 , $11.86 , See APC Packaged Rates , $4.46 , $7.65 , $4.46 , $12.36 , $8.93
,5710012714,Hospital Chargemaster,Sucrose 24% Soln 1 dose,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012715,Hospital Chargemaster,Phytonadione 2.5 mg HalfTb,Outpatient,Outpatient Default Percent / Case Rate,259, $149.84 , $82.41 , $119.87 , See APC Packaged Rates , $104.89 , $58.44 , $144.58 , $145.21 , $77.17 , See APC Packaged Rates , See APC Packaged Rates , $100.54 , $100.54 , See APC Packaged Rates , See APC Packaged Rates , $139.35 , $139.35 , $139.35 , $139.35 , See APC Packaged Rates , $52.44 , $89.90 , $52.44 , $145.21 , $104.89
,5710012724,Hospital Chargemaster,Silver Sulfadiazine 1 % 25 gm,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012725,Hospital Chargemaster,Nystatin Cream,Outpatient,Outpatient Default Percent / Case Rate,259, $2.98 , $1.64 , $2.38 , See APC Packaged Rates , $2.09 , $1.16 , $2.88 , $2.89 , $1.53 , See APC Packaged Rates , See APC Packaged Rates , $2.00 , $2.00 , See APC Packaged Rates , See APC Packaged Rates , $2.77 , $2.77 , $2.77 , $2.77 , See APC Packaged Rates , $1.04 , $1.79 , $1.04 , $2.89 , $2.09
,5710012735,Hospital Chargemaster,Verapamil SR 120 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $2.58 , $1.42 , $2.06 , See APC Packaged Rates , $1.81 , $1.01 , $2.49 , $2.50 , $1.33 , See APC Packaged Rates , See APC Packaged Rates , $1.73 , $1.73 , See APC Packaged Rates , See APC Packaged Rates , $2.40 , $2.40 , $2.40 , $2.40 , See APC Packaged Rates , $0.90 , $1.55 , $0.90 , $2.50 , $1.81
,5710012745,Hospital Chargemaster,Insulin Glargine 1 Unit,Outpatient,Outpatient Default Percent / Case Rate,259, $71.19 , $39.15 , $56.95 , See APC Packaged Rates , $49.83 , $27.76 , $68.69 , $68.99 , $36.66 , See APC Packaged Rates , See APC Packaged Rates , $47.77 , $47.77 , See APC Packaged Rates , See APC Packaged Rates , $66.21 , $66.21 , $66.21 , $66.21 , See APC Packaged Rates , $24.92 , $42.71 , $24.92 , $68.99 , $49.83
,5710012763,Hospital Chargemaster,Vancomycin HCL 50mg ml Oral,Outpatient,Outpatient Default Percent / Case Rate,259, $2.36 , $1.30 , $1.89 , See APC Packaged Rates , $1.65 , $0.92 , $2.28 , $2.29 , $1.22 , See APC Packaged Rates , See APC Packaged Rates , $1.58 , $1.58 , See APC Packaged Rates , See APC Packaged Rates , $2.19 , $2.19 , $2.19 , $2.19 , See APC Packaged Rates , $0.83 , $1.42 , $0.83 , $2.29 , $1.65
,5710012773,Hospital Chargemaster,Rivastigmine 1.5 mg capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $10.81 , $5.95 , $8.65 , See APC Packaged Rates , $7.57 , $4.22 , $10.43 , $10.48 , $5.57 , See APC Packaged Rates , See APC Packaged Rates , $7.25 , $7.25 , See APC Packaged Rates , See APC Packaged Rates , $10.05 , $10.05 , $10.05 , $10.05 , See APC Packaged Rates , $3.78 , $6.49 , $3.78 , $10.48 , $7.57
,5710012776,Hospital Chargemaster,Insulin Detemir 1 Unit,Outpatient,Outpatient Default Percent / Case Rate,259, $78.57 , $43.21 , $62.86 , See APC Packaged Rates , $55.00 , $30.64 , $75.81 , $76.14 , $40.47 , See APC Packaged Rates , See APC Packaged Rates , $52.72 , $52.72 , See APC Packaged Rates , See APC Packaged Rates , $73.07 , $73.07 , $73.07 , $73.07 , See APC Packaged Rates , $27.50 , $47.14 , $27.50 , $76.14 , $55.00
,5710012792,Hospital Chargemaster,Clotrimazole 1 % Cream,Outpatient,Outpatient Default Percent / Case Rate,259, $3.24 , $1.78 , $2.59 , See APC Packaged Rates , $2.27 , $1.26 , $3.13 , $3.14 , $1.67 , See APC Packaged Rates , See APC Packaged Rates , $2.17 , $2.17 , See APC Packaged Rates , See APC Packaged Rates , $3.01 , $3.01 , $3.01 , $3.01 , See APC Packaged Rates , $1.13 , $1.94 , $1.13 , $3.14 , $2.27
,5710012793,Hospital Chargemaster,Opium/Bellad 30mg/16.2mg SUPP,Outpatient,Outpatient Default Percent / Case Rate,259, $70.18 , $38.60 , $56.14 , See APC Packaged Rates , $49.13 , $27.37 , $67.72 , $68.01 , $36.14 , See APC Packaged Rates , See APC Packaged Rates , $47.09 , $47.09 , See APC Packaged Rates , See APC Packaged Rates , $65.27 , $65.27 , $65.27 , $65.27 , See APC Packaged Rates , $24.56 , $42.11 , $24.56 , $68.01 , $49.13
,5710012798,Hospital Chargemaster,Aquaphor 1.75 OZ Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012799,Hospital Chargemaster,Lactulose 320 gm/480 mL Sol,Outpatient,Outpatient Default Percent / Case Rate,259, $88.49 , $48.67 , $70.79 , See APC Packaged Rates , $61.94 , $34.51 , $85.38 , $85.76 , $45.57 , See APC Packaged Rates , See APC Packaged Rates , $59.38 , $59.38 , See APC Packaged Rates , See APC Packaged Rates , $82.30 , $82.30 , $82.30 , $82.30 , See APC Packaged Rates , $30.97 , $53.09 , $30.97 , $85.76 , $61.94
,5710012800,Hospital Chargemaster,Rosuvastatin 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $22.80 , $12.54 , $18.24 , See APC Packaged Rates , $15.96 , $8.89 , $22.00 , $22.10 , $11.74 , See APC Packaged Rates , See APC Packaged Rates , $15.30 , $15.30 , See APC Packaged Rates , See APC Packaged Rates , $21.20 , $21.20 , $21.20 , $21.20 , See APC Packaged Rates , $7.98 , $13.68 , $7.98 , $22.10 , $15.96
,5710012801,Hospital Chargemaster,Vitamin B Complex Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $0.99 , $0.54 , $0.79 , See APC Packaged Rates , $0.69 , $0.39 , $0.96 , $0.96 , $0.51 , See APC Packaged Rates , See APC Packaged Rates , $0.66 , $0.66 , See APC Packaged Rates , See APC Packaged Rates , $0.92 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , $0.35 , $0.59 , $0.35 , $0.96 , $0.69
,5710012802,Hospital Chargemaster,Melatonin 1 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012803,Hospital Chargemaster,Melatonin 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012825,Hospital Chargemaster,Lacosamide 50 mg tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $25.24 , $13.88 , $20.19 , See APC Packaged Rates , $17.67 , $9.84 , $24.35 , $24.46 , $13.00 , See APC Packaged Rates , See APC Packaged Rates , $16.94 , $16.94 , See APC Packaged Rates , See APC Packaged Rates , $23.47 , $23.47 , $23.47 , $23.47 , See APC Packaged Rates , $8.83 , $15.14 , $8.83 , $24.46 , $17.67
,5710012848,Hospital Chargemaster,Buprenorph/Naloxone 4/1 Film,Outpatient,Outpatient Default Percent / Case Rate,259, $22.90 , $12.60 , $18.32 , See APC Packaged Rates , $16.03 , $8.93 , $22.10 , $22.19 , $11.79 , See APC Packaged Rates , See APC Packaged Rates , $15.37 , $15.37 , See APC Packaged Rates , See APC Packaged Rates , $21.30 , $21.30 , $21.30 , $21.30 , See APC Packaged Rates , $8.02 , $13.74 , $8.02 , $22.19 , $16.03
,5710012851,Hospital Chargemaster,Buprenorph/Naloxone 2/0.5 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $14.87 , $8.18 , $11.90 , See APC Packaged Rates , $10.41 , $5.80 , $14.35 , $14.41 , $7.66 , See APC Packaged Rates , See APC Packaged Rates , $9.98 , $9.98 , See APC Packaged Rates , See APC Packaged Rates , $13.83 , $13.83 , $13.83 , $13.83 , See APC Packaged Rates , $5.20 , $8.92 , $5.20 , $14.41 , $10.41
,5710012852,Hospital Chargemaster,Buprenorph/Naloxone 8/2 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $26.43 , $14.54 , $21.14 , See APC Packaged Rates , $18.50 , $10.31 , $25.50 , $25.61 , $13.61 , See APC Packaged Rates , See APC Packaged Rates , $17.73 , $17.73 , See APC Packaged Rates , See APC Packaged Rates , $24.58 , $24.58 , $24.58 , $24.58 , See APC Packaged Rates , $9.25 , $15.86 , $9.25 , $25.61 , $18.50
,5710012855,Hospital Chargemaster,Miracle Mouthwash 5ml Oral Sus,Outpatient,Outpatient Default Percent / Case Rate,259, $12.75 , $7.01 , $10.20 , See APC Packaged Rates , $8.93 , $4.97 , $12.30 , $12.36 , $6.57 , See APC Packaged Rates , See APC Packaged Rates , $8.56 , $8.56 , See APC Packaged Rates , See APC Packaged Rates , $11.86 , $11.86 , $11.86 , $11.86 , See APC Packaged Rates , $4.46 , $7.65 , $4.46 , $12.36 , $8.93
,5710012863,Hospital Chargemaster,Aspirin/Acetamin/Caffeine tab,Outpatient,Outpatient Default Percent / Case Rate,259, $1.00 , $0.55 , $0.80 , See APC Packaged Rates , $0.70 , $0.39 , $0.96 , $0.97 , $0.52 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $0.60 , $0.35 , $0.97 , $0.70
,5710012874,Hospital Chargemaster,Insulin Lispro 3 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,259, $83.73 , $46.05 , $66.98 , See APC Packaged Rates , $58.61 , $32.65 , $80.79 , $81.14 , $43.12 , See APC Packaged Rates , See APC Packaged Rates , $56.18 , $56.18 , See APC Packaged Rates , See APC Packaged Rates , $77.87 , $77.87 , $77.87 , $77.87 , See APC Packaged Rates , $29.31 , $50.24 , $29.31 , $81.14 , $58.61
,5710012875,Hospital Chargemaster,Insulin Regular 3 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,259, $45.49 , $25.02 , $36.39 , See APC Packaged Rates , $31.84 , $17.74 , $43.89 , $44.08 , $23.43 , See APC Packaged Rates , See APC Packaged Rates , $30.52 , $30.52 , See APC Packaged Rates , See APC Packaged Rates , $42.31 , $42.31 , $42.31 , $42.31 , See APC Packaged Rates , $15.92 , $27.29 , $15.92 , $44.08 , $31.84
,5710012878,Hospital Chargemaster,Barium Sulfate 450mL Oral Prep,Outpatient,Outpatient Default Percent / Case Rate,259, $18.11 , $9.96 , $14.49 , See APC Packaged Rates , $12.68 , $7.06 , $17.47 , $17.55 , $9.33 , See APC Packaged Rates , See APC Packaged Rates , $12.15 , $12.15 , See APC Packaged Rates , See APC Packaged Rates , $16.84 , $16.84 , $16.84 , $16.84 , See APC Packaged Rates , $6.34 , $10.87 , $6.34 , $17.55 , $12.68
,5710012888,Hospital Chargemaster,Buspirone 7.5 mg tab,Outpatient,Outpatient Default Percent / Case Rate,259, $4.03 , $2.22 , $3.22 , See APC Packaged Rates , $2.82 , $1.57 , $3.89 , $3.91 , $2.08 , See APC Packaged Rates , See APC Packaged Rates , $2.70 , $2.70 , See APC Packaged Rates , See APC Packaged Rates , $3.75 , $3.75 , $3.75 , $3.75 , See APC Packaged Rates , $1.41 , $2.42 , $1.41 , $3.91 , $2.82
,5710012894,Hospital Chargemaster,Phenobarbital 60 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.35 , $0.74 , $1.08 , See APC Packaged Rates , $0.95 , $0.53 , $1.30 , $1.31 , $0.70 , See APC Packaged Rates , See APC Packaged Rates , $0.91 , $0.91 , See APC Packaged Rates , See APC Packaged Rates , $1.26 , $1.26 , $1.26 , $1.26 , See APC Packaged Rates , $0.47 , $0.81 , $0.47 , $1.31 , $0.95
,5710012901,Hospital Chargemaster,Bromocriptine 2.5 mg tab,Outpatient,Outpatient Default Percent / Case Rate,259, $8.44 , $4.64 , $6.75 , See APC Packaged Rates , $5.91 , $3.29 , $8.14 , $8.18 , $4.35 , See APC Packaged Rates , See APC Packaged Rates , $5.66 , $5.66 , See APC Packaged Rates , See APC Packaged Rates , $7.85 , $7.85 , $7.85 , $7.85 , See APC Packaged Rates , $2.95 , $5.06 , $2.95 , $8.18 , $5.91
,67401879,Hospital Chargemaster,Biotene Moisturizing,Outpatient,Outpatient Default Percent / Case Rate,259, $7.49 , $4.12 , $5.99 , See APC Packaged Rates , $5.24 , $2.92 , $7.23 , $7.26 , $3.86 , See APC Packaged Rates , See APC Packaged Rates , $5.03 , $5.03 , See APC Packaged Rates , See APC Packaged Rates , $6.97 , $6.97 , $6.97 , $6.97 , See APC Packaged Rates , $2.62 , $4.49 , $2.62 , $7.26 , $5.24
,67404816,Hospital Chargemaster,Micro-K 10 Meq Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $1.06 , $0.58 , $0.85 , See APC Packaged Rates , $0.74 , $0.41 , $1.02 , $1.03 , $0.55 , See APC Packaged Rates , See APC Packaged Rates , $0.71 , $0.71 , See APC Packaged Rates , See APC Packaged Rates , $0.99 , $0.99 , $0.99 , $0.99 , See APC Packaged Rates , $0.37 , $0.64 , $0.37 , $1.03 , $0.74
,67406087,Hospital Chargemaster,Lacri-Lube Opth Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $4.71 , $2.59 , $3.77 , See APC Packaged Rates , $3.30 , $1.84 , $4.54 , $4.56 , $2.43 , See APC Packaged Rates , See APC Packaged Rates , $3.16 , $3.16 , See APC Packaged Rates , See APC Packaged Rates , $4.38 , $4.38 , $4.38 , $4.38 , See APC Packaged Rates , $1.65 , $2.83 , $1.65 , $4.56 , $3.30
,67409199,Hospital Chargemaster,Acetaminophen Elix DF 160 MG,Outpatient,Outpatient Default Percent / Case Rate,259, $2.92 , $1.61 , $2.34 , See APC Packaged Rates , $2.04 , $1.14 , $2.82 , $2.83 , $1.50 , See APC Packaged Rates , See APC Packaged Rates , $1.96 , $1.96 , See APC Packaged Rates , See APC Packaged Rates , $2.72 , $2.72 , $2.72 , $2.72 , See APC Packaged Rates , $1.02 , $1.75 , $1.02 , $2.83 , $2.04
C8957,5720010022,Hospital Chargemaster,"Prolonged iv inf, req pump",Outpatient,Outpatient Default Percent / Case Rate,260, $584.00 , $321.20 , $481.22 , $381.19 , $408.80 , $227.76 , $708.04 , $553.37 , $606.14 , $381.19 , $381.19 , $391.86 , $391.86 , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $204.40 , $- , $- , $708.04 , $408.80
96365,5720010010,Hospital Chargemaster,Ther/proph/diag iv inf init,Outpatient,Outpatient Default Percent / Case Rate,260, $418.00 , $229.90 , $344.43 , $244.57 , $292.60 , $163.02 , $459.57 , $359.18 , $393.42 , $244.57 , $244.57 , $183.25 , $177.69 , $256.80 , $249.46 , $300.73 , $300.73 , $308.47 , $308.47 , $244.57 , $511.48 , $- , $- , $511.48 , $292.60
96360,5720010008,Hospital Chargemaster,Hydration iv infusion init,Outpatient,Outpatient Default Percent / Case Rate,260, $253.00 , $139.15 , $208.47 , $244.57 , $177.10 , $98.67 , $459.57 , $359.18 , $393.42 , $244.57 , $244.57 , $150.27 , $145.72 , $256.80 , $249.46 , $253.00 , $253.00 , $253.00 , $253.00 , $244.57 , $511.48 , $- , $- , $511.48 , $177.10
96374,5720010015,Hospital Chargemaster,Ther/proph/diag inj iv push,Outpatient,Outpatient Default Percent / Case Rate,260, $245.00 , $134.75 , $201.88 , $244.57 , $171.50 , $95.55 , $459.57 , $359.18 , $393.42 , $244.57 , $244.57 , $145.22 , $140.81 , $256.80 , $249.46 , $245.00 , $245.00 , $245.00 , $245.00 , $244.57 , $511.48 , $- , $- , $511.48 , $171.50
96367,5720010012,Hospital Chargemaster,Tx/proph/dg addl seq iv inf,Outpatient,Outpatient Default Percent / Case Rate,260, $125.00 , $68.75 , $103.00 , $74.12 , $87.50 , $48.75 , $146.70 , $114.66 , $125.59 , $74.12 , $74.12 , $91.21 , $88.45 , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $155.76 , $- , $- , $155.76 , $87.50
96361,5720010009,Hospital Chargemaster,Hydrate iv infusion add-on,Outpatient,Outpatient Default Percent / Case Rate,260, $253.00 , $139.15 , $208.47 , $47.84 , $177.10 , $98.67 , $93.01 , $72.69 , $79.62 , $47.84 , $47.84 , $43.08 , $41.77 , $50.23 , $48.80 , $61.50 , $61.50 , $63.08 , $63.08 , $47.84 , $100.54 , $- , $- , $208.47 , $177.10
96366,5720010011,Hospital Chargemaster,Ther/proph/diag iv inf addon,Outpatient,Outpatient Default Percent / Case Rate,260, $253.00 , $139.15 , $208.47 , $47.84 , $177.10 , $98.67 , $93.01 , $72.69 , $79.62 , $47.84 , $47.84 , $57.00 , $55.27 , $50.23 , $48.80 , $61.50 , $61.50 , $63.08 , $63.08 , $47.84 , $100.54 , $- , $- , $208.47 , $177.10
96375,5720010016,Hospital Chargemaster,Tx/pro/dx inj new drug addon,Outpatient,Outpatient Default Percent / Case Rate,260, $99.00 , $54.45 , $81.58 , $47.84 , $69.30 , $38.61 , $93.01 , $72.69 , $79.62 , $47.84 , $47.84 , $62.60 , $60.70 , $50.23 , $48.80 , $61.50 , $61.50 , $63.08 , $63.08 , $47.84 , $100.54 , $- , $- , $100.54 , $69.30
96376,5720010017,Hospital Chargemaster,Tx/pro/dx inj same drug adon,Outpatient,Outpatient Default Percent / Case Rate,260, $253.00 , $139.15 , $208.47 , See APC Packaged Rates , $177.10 , $98.67 , $34.18 , $26.71 , $29.26 , See APC Packaged Rates , See APC Packaged Rates , $62.60 , $60.70 , See APC Packaged Rates , See APC Packaged Rates , $235.29 , $235.29 , $235.29 , $235.29 , See APC Packaged Rates , $88.55 , $- , $- , $235.29 , $177.10
96368,5720010013,Hospital Chargemaster,Ther/diag concurrent inf,Outpatient,Outpatient Default Percent / Case Rate,260, $169.00 , $92.95 , $139.26 , See APC Packaged Rates , $118.30 , $65.91 , $78.28 , $61.18 , $67.01 , See APC Packaged Rates , See APC Packaged Rates , $53.16 , $51.55 , See APC Packaged Rates , See APC Packaged Rates , $157.17 , $157.17 , $157.17 , $157.17 , See APC Packaged Rates , $59.15 , $- , $- , $157.17 , $118.30
,5310010051,Hospital Chargemaster,Incentive Spirometry Initial,Outpatient,Outpatient Default Percent / Case Rate,270, $18.00 , $9.90 , $14.40 , See APC Packaged Rates , $12.60 , $7.02 , $17.37 , $17.44 , $9.27 , See APC Packaged Rates , See APC Packaged Rates , $12.08 , $12.08 , See APC Packaged Rates , See APC Packaged Rates , $16.74 , $16.74 , $16.74 , $16.74 , See APC Packaged Rates , $6.30 , $10.80 , $6.30 , $17.44 , $12.60
,5310010052,Hospital Chargemaster,Incentive Spirometry,Outpatient,Outpatient Default Percent / Case Rate,270, $9.00 , $4.95 , $7.20 , See APC Packaged Rates , $6.30 , $3.51 , $8.68 , $8.72 , $4.64 , See APC Packaged Rates , See APC Packaged Rates , $6.04 , $6.04 , See APC Packaged Rates , See APC Packaged Rates , $8.37 , $8.37 , $8.37 , $8.37 , See APC Packaged Rates , $3.15 , $5.40 , $3.15 , $8.72 , $6.30
A4570,6500074570,Hospital Chargemaster,Splint,Outpatient,Outpatient Default Percent / Case Rate,270, $148.00 , $81.40 , $121.95 , See APC Packaged Rates , $103.60 , $57.72 , $142.81 , $143.43 , $76.22 , See APC Packaged Rates , See APC Packaged Rates , $99.31 , $99.31 , See APC Packaged Rates , See APC Packaged Rates , $16.39 , $16.39 , $16.81 , $16.81 , See APC Packaged Rates , $51.80 , $- , $- , $143.43 , $103.60
A6449,6500076449,Hospital Chargemaster,"Ace bandage, Elastic 3""-5""",Outpatient,Outpatient Default Percent / Case Rate,270, $8.00 , $4.40 , $6.59 , See APC Packaged Rates , $5.60 , $3.12 , $7.72 , $7.75 , $4.12 , See APC Packaged Rates , See APC Packaged Rates , $5.37 , $5.37 , See APC Packaged Rates , See APC Packaged Rates , $7.44 , $7.44 , $7.44 , $7.44 , See APC Packaged Rates , $2.80 , $- , $- , $7.75 , $5.60
Q4006,8004030001,Hospital Chargemaster,"Long Arm Cast, Adult, FBRG",Outpatient,Outpatient Default Percent / Case Rate,270, $46.00 , $25.30 , $37.90 , See APC Packaged Rates , $32.20 , $17.94 , $44.39 , $44.58 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $30.87 , $30.87 , See APC Packaged Rates , See APC Packaged Rates , $31.22 , $31.22 , $32.03 , $32.03 , See APC Packaged Rates , $16.10 , $- , $- , $44.58 , $32.20
Q4018,8004030002,Hospital Chargemaster,"Long Arm Splint, Adult, FBRG",Outpatient,Outpatient Default Percent / Case Rate,270, $22.00 , $12.10 , $18.13 , See APC Packaged Rates , $15.40 , $8.58 , $21.23 , $21.32 , $11.33 , See APC Packaged Rates , See APC Packaged Rates , $14.76 , $14.76 , See APC Packaged Rates , See APC Packaged Rates , $15.51 , $15.51 , $15.91 , $15.91 , See APC Packaged Rates , $7.70 , $- , $- , $21.32 , $15.40
Q4030,8004030003,Hospital Chargemaster,"Long Leg Cast, Adult, FBRG",Outpatient,Outpatient Default Percent / Case Rate,270, $120.00 , $66.00 , $98.88 , See APC Packaged Rates , $84.00 , $46.80 , $115.79 , $116.29 , $61.80 , See APC Packaged Rates , See APC Packaged Rates , $80.52 , $80.52 , See APC Packaged Rates , See APC Packaged Rates , $81.31 , $81.31 , $83.41 , $83.41 , See APC Packaged Rates , $42.00 , $- , $- , $116.29 , $84.00
Q4042,8004030004,Hospital Chargemaster,"Long Leg Splint, Adult, FBRG",Outpatient,Outpatient Default Percent / Case Rate,270, $53.00 , $29.15 , $43.67 , See APC Packaged Rates , $37.10 , $20.67 , $51.14 , $51.36 , $27.30 , See APC Packaged Rates , See APC Packaged Rates , $35.56 , $35.56 , See APC Packaged Rates , See APC Packaged Rates , $36.49 , $36.49 , $37.43 , $37.43 , See APC Packaged Rates , $18.55 , $- , $- , $51.36 , $37.10
Q4010,8004030005,Hospital Chargemaster,"Short Arm Cast, Adult, FBRG",Outpatient,Outpatient Default Percent / Case Rate,270, $30.00 , $16.50 , $24.72 , See APC Packaged Rates , $21.00 , $11.70 , $28.95 , $29.07 , $15.45 , See APC Packaged Rates , See APC Packaged Rates , $20.13 , $20.13 , See APC Packaged Rates , See APC Packaged Rates , $20.81 , $20.81 , $21.35 , $21.35 , See APC Packaged Rates , $10.50 , $- , $- , $29.07 , $21.00
Q4022,8004030006,Hospital Chargemaster,"Short Arm Splint, Adult,FBRG",Outpatient,Outpatient Default Percent / Case Rate,270, $18.00 , $9.90 , $14.83 , See APC Packaged Rates , $12.60 , $7.02 , $17.37 , $17.44 , $9.27 , See APC Packaged Rates , See APC Packaged Rates , $12.08 , $12.08 , See APC Packaged Rates , See APC Packaged Rates , $12.99 , $12.99 , $13.33 , $13.33 , See APC Packaged Rates , $6.30 , $- , $- , $17.44 , $12.60
Q4038,8004030007,Hospital Chargemaster,"Short Leg Cast, Adult, FBRG",Outpatient,Outpatient Default Percent / Case Rate,270, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $52.14 , $26.15 , $23.61 , See APC Packaged Rates , See APC Packaged Rates , $43.62 , $43.62 , See APC Packaged Rates , See APC Packaged Rates , $44.02 , $44.02 , $45.16 , $45.16 , See APC Packaged Rates , $22.75 , $- , $- , $53.56 , $45.50
Q4046,8004030008,Hospital Chargemaster,"Short Leg Splint, Adult,FBRG",Outpatient,Outpatient Default Percent / Case Rate,270, $28.00 , $15.40 , $23.07 , See APC Packaged Rates , $19.60 , $10.92 , $27.02 , $27.13 , $14.42 , See APC Packaged Rates , See APC Packaged Rates , $18.79 , $18.79 , See APC Packaged Rates , See APC Packaged Rates , $19.95 , $19.95 , $20.46 , $20.46 , See APC Packaged Rates , $9.80 , $- , $- , $27.13 , $19.60
A4590,8004030009,Hospital Chargemaster,Special Casting Materials,Outpatient,Outpatient Default Percent / Case Rate,270, $57.00 , $31.35 , $46.97 , See APC Packaged Rates , $39.90 , $22.23 , $55.00 , $55.24 , $29.36 , See APC Packaged Rates , See APC Packaged Rates , $38.25 , $38.25 , See APC Packaged Rates , See APC Packaged Rates , $53.01 , $53.01 , $53.01 , $53.01 , See APC Packaged Rates , $19.95 , $- , $- , $55.24 , $39.90
Q4032,8004030011,Hospital Chargemaster,Cast sup lng leg ped fbrgls,Outpatient,Outpatient Default Percent / Case Rate,270, $60.00 , $33.00 , $49.44 , See APC Packaged Rates , $42.00 , $23.40 , $57.89 , $58.15 , $30.90 , See APC Packaged Rates , See APC Packaged Rates , $40.26 , $40.26 , See APC Packaged Rates , See APC Packaged Rates , $40.66 , $40.66 , $41.71 , $41.71 , See APC Packaged Rates , $21.00 , $- , $- , $58.15 , $42.00
Q4012,8004030012,Hospital Chargemaster,Cast Sup Shrt Arm Ped FBRG,Outpatient,Outpatient Default Percent / Case Rate,270, $15.00 , $8.25 , $12.36 , See APC Packaged Rates , $10.50 , $5.85 , $14.47 , $14.54 , $7.73 , See APC Packaged Rates , See APC Packaged Rates , $10.07 , $10.07 , See APC Packaged Rates , See APC Packaged Rates , $10.43 , $10.43 , $10.70 , $10.70 , See APC Packaged Rates , $5.25 , $- , $- , $14.54 , $10.50
A4562,8004030013,Hospital Chargemaster,"Pessary, Non Rubber,Any Type",Outpatient,Outpatient Default Percent / Case Rate,270, $36.00 , $19.80 , $29.66 , See APC Packaged Rates , $25.20 , $14.04 , $34.74 , $34.89 , $18.54 , See APC Packaged Rates , See APC Packaged Rates , $24.16 , $24.16 , See APC Packaged Rates , See APC Packaged Rates , $33.48 , $33.48 , $33.48 , $33.48 , See APC Packaged Rates , $12.60 , $- , $- , $34.89 , $25.20
A4561,8014034561,Hospital Chargemaster,"Pessary, Rubber any type",Outpatient,Outpatient Default Percent / Case Rate,270, $36.00 , $19.80 , $29.66 , See APC Packaged Rates , $25.20 , $14.04 , $28.25 , $14.17 , $12.79 , See APC Packaged Rates , See APC Packaged Rates , $24.16 , $24.16 , See APC Packaged Rates , See APC Packaged Rates , $33.48 , $33.48 , $33.48 , $33.48 , See APC Packaged Rates , $12.60 , $- , $- , $33.48 , $25.20
,5310010050,Hospital Chargemaster,O2 Per Day,Outpatient,Outpatient Default Percent / Case Rate,271, $56.00 , $30.80 , $44.80 , See APC Packaged Rates , $39.20 , $21.84 , $54.03 , $54.27 , $28.84 , See APC Packaged Rates , See APC Packaged Rates , $37.58 , $37.58 , See APC Packaged Rates , See APC Packaged Rates , $52.08 , $52.08 , $52.08 , $52.08 , See APC Packaged Rates , $19.60 , $33.60 , $19.60 , $54.27 , $39.20
V5241,5420140017,Hospital Chargemaster,"Hearing Aid Disp Fee, Mon Lt",Outpatient,Outpatient Default Percent / Case Rate,271," $1,300.00 ", $715.00 ," $1,071.20 ", See APC Packaged Rates , $910.00 , $507.00 ," $1,254.37 "," $1,259.83 ", $669.53 , See APC Packaged Rates , See APC Packaged Rates , $872.30 , $872.30 , See APC Packaged Rates , See APC Packaged Rates ," $1,209.00 "," $1,209.00 "," $1,209.00 "," $1,209.00 ", See APC Packaged Rates , $455.00 , $- , $- ," $1,259.83 ", $910.00
V5160,5430110005,Hospital Chargemaster,Hearing Aid Disp Fee Binaunal,Outpatient,Outpatient Default Percent / Case Rate,271," $1,600.00 ", $880.00 ," $1,318.40 ", See APC Packaged Rates ," $1,120.00 ", $624.00 ," $1,543.84 "," $1,550.56 ", $824.03 , See APC Packaged Rates , See APC Packaged Rates ," $1,073.60 "," $1,073.60 ", See APC Packaged Rates , See APC Packaged Rates ," $1,488.00 "," $1,488.00 "," $1,488.00 "," $1,488.00 ", See APC Packaged Rates , $560.00 , $- , $- ," $1,550.56 "," $1,120.00 "
V5181,5430110008,Hospital Chargemaster,Hearing Aid Monaural Bte,Outpatient,Outpatient Default Percent / Case Rate,271, $450.00 , $247.50 , $370.80 , See APC Packaged Rates , $315.00 , $175.50 , $434.21 , $436.10 , $231.76 , See APC Packaged Rates , See APC Packaged Rates , $301.95 , $301.95 , See APC Packaged Rates , See APC Packaged Rates , $418.50 , $418.50 , $418.50 , $418.50 , See APC Packaged Rates , $157.50 , $- , $- , $436.10 , $315.00
V5240,5430110016,Hospital Chargemaster,Hearing Aid Disp Fee Cros Bina,Outpatient,Outpatient Default Percent / Case Rate,271," $1,600.00 ", $880.00 ," $1,318.40 ", See APC Packaged Rates ," $1,120.00 ", $624.00 ," $1,543.84 "," $1,550.56 ", $824.03 , See APC Packaged Rates , See APC Packaged Rates ," $1,073.60 "," $1,073.60 ", See APC Packaged Rates , See APC Packaged Rates ," $1,488.00 "," $1,488.00 "," $1,488.00 "," $1,488.00 ", See APC Packaged Rates , $560.00 , $- , $- ," $1,550.56 "," $1,120.00 "
V5241,5430110017,Hospital Chargemaster,"Hearing Aid Disp Fee, Monaural",Outpatient,Outpatient Default Percent / Case Rate,271," $1,300.00 ", $715.00 ," $1,071.20 ", See APC Packaged Rates , $910.00 , $507.00 ," $1,254.37 "," $1,259.83 ", $669.53 , See APC Packaged Rates , See APC Packaged Rates , $872.30 , $872.30 , See APC Packaged Rates , See APC Packaged Rates ," $1,209.00 "," $1,209.00 "," $1,209.00 "," $1,209.00 ", See APC Packaged Rates , $455.00 , $- , $- ," $1,259.83 ", $910.00
V5264,5430110022,Hospital Chargemaster,Earmold,Outpatient,Outpatient Default Percent / Case Rate,271, $60.00 , $33.00 , $49.44 , See APC Packaged Rates , $42.00 , $23.40 , $57.89 , $58.15 , $30.90 , See APC Packaged Rates , See APC Packaged Rates , $40.26 , $40.26 , See APC Packaged Rates , See APC Packaged Rates , $60.00 , $- , $- , $- , See APC Packaged Rates , $21.00 , $- , $- , $60.00 , $42.00
V5266,5430110023,Hospital Chargemaster,Batteries,Outpatient,Outpatient Default Percent / Case Rate,271, $1.54 , $0.85 , $1.27 , See APC Packaged Rates , $1.08 , $0.60 , $1.49 , $1.49 , $0.79 , See APC Packaged Rates , See APC Packaged Rates , $1.03 , $1.03 , See APC Packaged Rates , See APC Packaged Rates , $1.43 , $1.43 , $1.43 , $1.43 , See APC Packaged Rates , $0.54 , $- , $- , $1.49 , $1.08
V5267,5430110024,Hospital Chargemaster,Hearing Aid Acces,Outpatient,Outpatient Default Percent / Case Rate,271, $13.24 , $7.28 , $10.91 , See APC Packaged Rates , $9.27 , $5.16 , $12.78 , $12.83 , $6.82 , See APC Packaged Rates , See APC Packaged Rates , $8.88 , $8.88 , See APC Packaged Rates , See APC Packaged Rates , $12.26 , $- , $- , $- , See APC Packaged Rates , $4.63 , $- , $- , $12.83 , $9.27
V5256,5430120001,Hospital Chargemaster,Hearing Aide DIG Monaural ITE,Outpatient,Outpatient Default Percent / Case Rate,271," $1,372.00 ", $754.60 ," $1,130.53 ", See APC Packaged Rates , $960.40 , $535.08 ," $1,323.84 "," $1,329.61 ", $706.61 , See APC Packaged Rates , See APC Packaged Rates , $920.61 , $920.61 , See APC Packaged Rates , See APC Packaged Rates , $931.93 , $- , $- , $- , See APC Packaged Rates , $480.20 , $- , $- ," $1,329.61 ", $960.40
V5257,5430120002,Hospital Chargemaster,Hearing Aid DIG Monaural BTE,Outpatient,Outpatient Default Percent / Case Rate,271, $826.04 , $454.32 , $680.66 , See APC Packaged Rates , $578.23 , $322.16 , $797.05 , $800.52 , $425.43 , See APC Packaged Rates , See APC Packaged Rates , $554.27 , $554.27 , See APC Packaged Rates , See APC Packaged Rates , $768.22 , $768.22 , $768.22 , $768.22 , See APC Packaged Rates , $289.11 , $- , $- , $800.52 , $578.23
V5259,5430120003,Hospital Chargemaster,Hearing Aid DIG Binaural ITC,Outpatient,Outpatient Default Percent / Case Rate,271," $2,066.86 "," $1,136.77 "," $1,703.09 ", See APC Packaged Rates ," $1,446.80 ", $806.08 ," $1,994.31 "," $2,002.99 "," $1,064.47 ", See APC Packaged Rates , See APC Packaged Rates ," $1,386.86 "," $1,386.86 ", See APC Packaged Rates , See APC Packaged Rates ," $1,922.18 "," $1,922.18 "," $1,922.18 "," $1,922.18 ", See APC Packaged Rates , $723.40 , $- , $- ," $2,002.99 "," $1,446.80 "
V5260,5430120004,Hospital Chargemaster,Hearing Aid DIG Binaural ITE,Outpatient,Outpatient Default Percent / Case Rate,271, $998.00 , $548.90 , $822.35 , See APC Packaged Rates , $698.60 , $389.22 , $962.97 , $967.16 , $513.99 , See APC Packaged Rates , See APC Packaged Rates , $669.66 , $669.66 , See APC Packaged Rates , See APC Packaged Rates , $998.00 , $- , $- , $- , See APC Packaged Rates , $349.30 , $- , $- , $998.00 , $698.60
V5261,5430120005,Hospital Chargemaster,Hearing Aid DIG Binaural BTE,Outpatient,Outpatient Default Percent / Case Rate,271," $1,921.77 "," $1,056.97 "," $1,583.54 ", See APC Packaged Rates ," $1,345.24 ", $749.49 ," $1,854.32 "," $1,862.39 ", $989.75 , See APC Packaged Rates , See APC Packaged Rates ," $1,289.51 "," $1,289.51 ", See APC Packaged Rates , See APC Packaged Rates ," $1,486.81 ", $- , $- , $- , See APC Packaged Rates , $672.62 , $- , $- ," $1,862.39 "," $1,345.24 "
V5255,5430140031,Hospital Chargemaster,Hearing Aid Digt Mon ITC Lv3LT,Outpatient,Outpatient Default Percent / Case Rate,271," $1,995.00 "," $1,097.25 "," $1,643.88 ", See APC Packaged Rates ," $1,396.50 ", $778.05 ," $1,924.98 "," $1,933.35 "," $1,027.46 ", See APC Packaged Rates , See APC Packaged Rates ," $1,338.65 "," $1,338.65 ", See APC Packaged Rates , See APC Packaged Rates ," $1,855.35 "," $1,855.35 "," $1,855.35 "," $1,855.35 ", See APC Packaged Rates , $698.25 , $- , $- ," $1,933.35 "," $1,396.50 "
V5255,5430150030,Hospital Chargemaster,Hearing Aid Digt Mon ITC Lv2RT,Outpatient,Outpatient Default Percent / Case Rate,271, $249.50 , $137.23 , $205.59 , See APC Packaged Rates , $174.65 , $97.31 , $240.74 , $241.79 , $128.50 , See APC Packaged Rates , See APC Packaged Rates , $167.41 , $167.41 , See APC Packaged Rates , See APC Packaged Rates , $232.04 , $232.04 , $232.04 , $232.04 , See APC Packaged Rates , $87.33 , $- , $- , $241.79 , $174.65
,61514482,Hospital Chargemaster,Sonicision 13 Cm Cordless,Outpatient,Outpatient Default Percent / Case Rate,271," $1,023.75 ", $563.06 , $819.00 , See APC Packaged Rates , $716.63 , $399.26 , $987.82 , $992.12 , $527.25 , See APC Packaged Rates , See APC Packaged Rates , $686.94 , $686.94 , See APC Packaged Rates , See APC Packaged Rates , $952.09 , $952.09 , $952.09 , $952.09 , See APC Packaged Rates , $358.31 , $614.25 , $358.31 , $992.12 , $716.63
,61533024,Hospital Chargemaster,Snare Polyp Roth-Net Disp,Outpatient,Outpatient Default Percent / Case Rate,271, $296.10 , $162.86 , $236.88 , See APC Packaged Rates , $207.27 , $115.48 , $285.71 , $286.95 , $152.50 , See APC Packaged Rates , See APC Packaged Rates , $198.68 , $198.68 , See APC Packaged Rates , See APC Packaged Rates , $275.37 , $275.37 , $275.37 , $275.37 , See APC Packaged Rates , $103.64 , $177.66 , $103.64 , $286.95 , $207.27
,65909606,Hospital Chargemaster,"Blade,Epf Endotral",Outpatient,Outpatient Default Percent / Case Rate,271, $646.88 , $355.78 , $517.50 , See APC Packaged Rates , $452.82 , $252.28 , $624.17 , $626.89 , $333.16 , See APC Packaged Rates , See APC Packaged Rates , $434.06 , $434.06 , See APC Packaged Rates , See APC Packaged Rates , $601.60 , $601.60 , $601.60 , $601.60 , See APC Packaged Rates , $226.41 , $388.13 , $226.41 , $626.89 , $452.82
,5150080001,Hospital Chargemaster,Eviva Probe,Outpatient,Outpatient Default Percent / Case Rate,272, $265.00 , $145.75 , $212.00 , See APC Packaged Rates , $185.50 , $103.35 , $255.70 , $256.81 , $136.48 , See APC Packaged Rates , See APC Packaged Rates , $177.82 , $177.82 , See APC Packaged Rates , See APC Packaged Rates , $246.45 , $246.45 , $246.45 , $246.45 , See APC Packaged Rates , $92.75 , $159.00 , $92.75 , $256.81 , $185.50
,5150080002,Hospital Chargemaster,Eviva Disposable Guide,Outpatient,Outpatient Default Percent / Case Rate,272, $10.00 , $5.50 , $8.00 , See APC Packaged Rates , $7.00 , $3.90 , $9.65 , $9.69 , $5.15 , See APC Packaged Rates , See APC Packaged Rates , $6.71 , $6.71 , See APC Packaged Rates , See APC Packaged Rates , $9.30 , $9.30 , $9.30 , $9.30 , See APC Packaged Rates , $3.50 , $6.00 , $3.50 , $9.69 , $7.00
,5150080003,Hospital Chargemaster,Evina Canister,Outpatient,Outpatient Default Percent / Case Rate,272, $5.00 , $2.75 , $4.00 , See APC Packaged Rates , $3.50 , $1.95 , $4.82 , $4.85 , $2.58 , See APC Packaged Rates , See APC Packaged Rates , $3.36 , $3.36 , See APC Packaged Rates , See APC Packaged Rates , $4.65 , $4.65 , $4.65 , $4.65 , See APC Packaged Rates , $1.75 , $3.00 , $1.75 , $4.85 , $3.50
,5150080004,Hospital Chargemaster,Evina S-Mark Clip,Outpatient,Outpatient Default Percent / Case Rate,272, $82.00 , $45.10 , $65.60 , See APC Packaged Rates , $57.40 , $31.98 , $79.12 , $79.47 , $42.23 , See APC Packaged Rates , See APC Packaged Rates , $55.02 , $55.02 , See APC Packaged Rates , See APC Packaged Rates , $76.26 , $76.26 , $76.26 , $76.26 , See APC Packaged Rates , $28.70 , $49.20 , $28.70 , $79.47 , $57.40
,5310010049,Hospital Chargemaster,Oxygen Setup,Outpatient,Outpatient Default Percent / Case Rate,272, $41.00 , $22.55 , $32.80 , See APC Packaged Rates , $28.70 , $15.99 , $39.56 , $39.73 , $21.12 , See APC Packaged Rates , See APC Packaged Rates , $27.51 , $27.51 , See APC Packaged Rates , See APC Packaged Rates , $38.13 , $38.13 , $38.13 , $38.13 , See APC Packaged Rates , $14.35 , $24.60 , $14.35 , $39.73 , $28.70
,61500009,Hospital Chargemaster,Extrator RX Balloon 12-15,Outpatient,Outpatient Default Percent / Case Rate,272, $456.75 , $251.21 , $365.40 , See APC Packaged Rates , $319.73 , $178.13 , $440.72 , $442.64 , $235.24 , See APC Packaged Rates , See APC Packaged Rates , $306.48 , $306.48 , See APC Packaged Rates , See APC Packaged Rates , $424.78 , $424.78 , $424.78 , $424.78 , See APC Packaged Rates , $159.86 , $274.05 , $159.86 , $442.64 , $319.73
,61500030,Hospital Chargemaster,Resure Rat Tooth GL Forcepts,Outpatient,Outpatient Default Percent / Case Rate,272, $236.25 , $129.94 , $189.00 , See APC Packaged Rates , $165.38 , $92.14 , $227.96 , $228.95 , $121.67 , See APC Packaged Rates , See APC Packaged Rates , $158.52 , $158.52 , See APC Packaged Rates , See APC Packaged Rates , $219.71 , $219.71 , $219.71 , $219.71 , See APC Packaged Rates , $82.69 , $141.75 , $82.69 , $228.95 , $165.38
,61500056,Hospital Chargemaster,Laser Fiber Greenlight Moxy,Outpatient,Outpatient Default Percent / Case Rate,272," $3,465.00 "," $1,905.75 "," $2,772.00 ", See APC Packaged Rates ," $2,425.50 "," $1,351.35 "," $3,343.38 "," $3,357.93 "," $1,784.54 ", See APC Packaged Rates , See APC Packaged Rates ," $2,325.02 "," $2,325.02 ", See APC Packaged Rates , See APC Packaged Rates ," $3,222.45 "," $3,222.45 "," $3,222.45 "," $3,222.45 ", See APC Packaged Rates ," $1,212.75 "," $2,079.00 "," $1,212.75 "," $3,357.93 "," $2,425.50 "
,61500071,Hospital Chargemaster,Fixator Frame Dia 3mm AO Fit,Outpatient,Outpatient Default Percent / Case Rate,272," $1,088.64 ", $598.75 , $870.91 , See APC Packaged Rates , $762.05 , $424.57 ," $1,050.43 "," $1,055.00 ", $560.67 , See APC Packaged Rates , See APC Packaged Rates , $730.48 , $730.48 , See APC Packaged Rates , See APC Packaged Rates ," $1,012.44 "," $1,012.44 "," $1,012.44 "," $1,012.44 ", See APC Packaged Rates , $381.02 , $653.18 , $381.02 ," $1,055.00 ", $762.05
,61500072,Hospital Chargemaster,Drill Bit Cal 3.1mmx285mm,Outpatient,Outpatient Default Percent / Case Rate,272, $381.78 , $209.98 , $305.42 , See APC Packaged Rates , $267.25 , $148.89 , $368.38 , $369.98 , $196.62 , See APC Packaged Rates , See APC Packaged Rates , $256.17 , $256.17 , See APC Packaged Rates , See APC Packaged Rates , $355.06 , $355.06 , $355.06 , $355.06 , See APC Packaged Rates , $133.62 , $229.07 , $133.62 , $369.98 , $267.25
,61500073,Hospital Chargemaster,Drill Bit Cal 2.5mmx285mm,Outpatient,Outpatient Default Percent / Case Rate,272, $381.78 , $209.98 , $305.42 , See APC Packaged Rates , $267.25 , $148.89 , $368.38 , $369.98 , $196.62 , See APC Packaged Rates , See APC Packaged Rates , $256.17 , $256.17 , See APC Packaged Rates , See APC Packaged Rates , $355.06 , $355.06 , $355.06 , $355.06 , See APC Packaged Rates , $133.62 , $229.07 , $133.62 , $369.98 , $267.25
,61500099,Hospital Chargemaster,Inlay stent 8FRx Multi Length,Outpatient,Outpatient Default Percent / Case Rate,272, $171.96 , $94.58 , $137.57 , See APC Packaged Rates , $120.37 , $67.06 , $165.92 , $166.65 , $88.56 , See APC Packaged Rates , See APC Packaged Rates , $115.39 , $115.39 , See APC Packaged Rates , See APC Packaged Rates , $159.92 , $159.92 , $159.92 , $159.92 , See APC Packaged Rates , $60.19 , $103.18 , $60.19 , $166.65 , $120.37
,61500100,Hospital Chargemaster,Inlay Stent 8x24,Outpatient,Outpatient Default Percent / Case Rate,272, $171.96 , $94.58 , $137.57 , See APC Packaged Rates , $120.37 , $67.06 , $165.92 , $166.65 , $88.56 , See APC Packaged Rates , See APC Packaged Rates , $115.39 , $115.39 , See APC Packaged Rates , See APC Packaged Rates , $159.92 , $159.92 , $159.92 , $159.92 , See APC Packaged Rates , $60.19 , $103.18 , $60.19 , $166.65 , $120.37
,61500101,Hospital Chargemaster,Inlay Stent 8x26,Outpatient,Outpatient Default Percent / Case Rate,272, $171.96 , $94.58 , $137.57 , See APC Packaged Rates , $120.37 , $67.06 , $165.92 , $166.65 , $88.56 , See APC Packaged Rates , See APC Packaged Rates , $115.39 , $115.39 , See APC Packaged Rates , See APC Packaged Rates , $159.92 , $159.92 , $159.92 , $159.92 , See APC Packaged Rates , $60.19 , $103.18 , $60.19 , $166.65 , $120.37
,61500102,Hospital Chargemaster,Inlay Stent 8x28,Outpatient,Outpatient Default Percent / Case Rate,272, $171.96 , $94.58 , $137.57 , See APC Packaged Rates , $120.37 , $67.06 , $165.92 , $166.65 , $88.56 , See APC Packaged Rates , See APC Packaged Rates , $115.39 , $115.39 , See APC Packaged Rates , See APC Packaged Rates , $159.92 , $159.92 , $159.92 , $159.92 , See APC Packaged Rates , $60.19 , $103.18 , $60.19 , $166.65 , $120.37
,61500103,Hospital Chargemaster,Skylight 1.9 Tipless Nitinol,Outpatient,Outpatient Default Percent / Case Rate,272, $567.00 , $311.85 , $453.60 , See APC Packaged Rates , $396.90 , $221.13 , $547.10 , $549.48 , $292.02 , See APC Packaged Rates , See APC Packaged Rates , $380.46 , $380.46 , See APC Packaged Rates , See APC Packaged Rates , $527.31 , $527.31 , $527.31 , $527.31 , See APC Packaged Rates , $198.45 , $340.20 , $198.45 , $549.48 , $396.90
,61500146,Hospital Chargemaster,Insertion Needle 5 In,Outpatient,Outpatient Default Percent / Case Rate,272, $315.00 , $173.25 , $252.00 , See APC Packaged Rates , $220.50 , $122.85 , $303.94 , $305.27 , $162.23 , See APC Packaged Rates , See APC Packaged Rates , $211.37 , $211.37 , See APC Packaged Rates , See APC Packaged Rates , $292.95 , $292.95 , $292.95 , $292.95 , See APC Packaged Rates , $110.25 , $189.00 , $110.25 , $305.27 , $220.50
,61500184,Hospital Chargemaster,Optimus Patient Trial Kit-CM,Outpatient,Outpatient Default Percent / Case Rate,272, $157.50 , $86.63 , $126.00 , See APC Packaged Rates , $110.25 , $61.43 , $151.97 , $152.63 , $81.12 , See APC Packaged Rates , See APC Packaged Rates , $105.68 , $105.68 , See APC Packaged Rates , See APC Packaged Rates , $146.48 , $146.48 , $146.48 , $146.48 , See APC Packaged Rates , $55.13 , $94.50 , $55.13 , $152.63 , $110.25
,61500210,Hospital Chargemaster,Rhinaer Stylus Ablation Device,Outpatient,Outpatient Default Percent / Case Rate,272," $2,992.50 "," $1,645.88 "," $2,394.00 ", See APC Packaged Rates ," $2,094.75 "," $1,167.08 "," $2,887.46 "," $2,900.03 "," $1,541.20 ", See APC Packaged Rates , See APC Packaged Rates ," $2,007.97 "," $2,007.97 ", See APC Packaged Rates , See APC Packaged Rates ," $2,783.03 "," $2,783.03 "," $2,783.03 "," $2,783.03 ", See APC Packaged Rates ," $1,047.38 "," $1,795.50 "," $1,047.38 "," $2,900.03 "," $2,094.75 "
,61500211,Hospital Chargemaster,Balloon XForce 6mmx4cmx6F,Outpatient,Outpatient Default Percent / Case Rate,272, $595.35 , $327.44 , $476.28 , See APC Packaged Rates , $416.75 , $232.19 , $574.45 , $576.95 , $306.62 , See APC Packaged Rates , See APC Packaged Rates , $399.48 , $399.48 , See APC Packaged Rates , See APC Packaged Rates , $553.68 , $553.68 , $553.68 , $553.68 , See APC Packaged Rates , $208.37 , $357.21 , $208.37 , $576.95 , $416.75
,61500212,Hospital Chargemaster,Balloon XForce 4mmx6cm 6F,Outpatient,Outpatient Default Percent / Case Rate,272, $595.35 , $327.44 , $476.28 , See APC Packaged Rates , $416.75 , $232.19 , $574.45 , $576.95 , $306.62 , See APC Packaged Rates , See APC Packaged Rates , $399.48 , $399.48 , See APC Packaged Rates , See APC Packaged Rates , $553.68 , $553.68 , $553.68 , $553.68 , See APC Packaged Rates , $208.37 , $357.21 , $208.37 , $576.95 , $416.75
,61500228,Hospital Chargemaster,Digitex Suture Delivery Device,Outpatient,Outpatient Default Percent / Case Rate,272," $1,237.16 ", $680.44 , $989.73 , See APC Packaged Rates , $866.01 , $482.49 ," $1,193.74 "," $1,198.93 ", $637.16 , See APC Packaged Rates , See APC Packaged Rates , $830.13 , $830.13 , See APC Packaged Rates , See APC Packaged Rates ," $1,150.56 "," $1,150.56 "," $1,150.56 "," $1,150.56 ", See APC Packaged Rates , $433.01 , $742.30 , $433.01 ," $1,198.93 ", $866.01
,61500244,Hospital Chargemaster,Thunderbeat Lap 25cm,Outpatient,Outpatient Default Percent / Case Rate,272," $1,417.50 ", $779.63 ," $1,134.00 ", See APC Packaged Rates , $992.25 , $552.83 ," $1,367.75 "," $1,373.70 ", $730.04 , See APC Packaged Rates , See APC Packaged Rates , $951.14 , $951.14 , See APC Packaged Rates , See APC Packaged Rates ," $1,318.28 "," $1,318.28 "," $1,318.28 "," $1,318.28 ", See APC Packaged Rates , $496.13 , $850.50 , $496.13 ," $1,373.70 ", $992.25
,61500245,Hospital Chargemaster,Sonicbeat Lap 35cm,Outpatient,Outpatient Default Percent / Case Rate,272, $882.00 , $485.10 , $705.60 , See APC Packaged Rates , $617.40 , $343.98 , $851.04 , $854.75 , $454.25 , See APC Packaged Rates , See APC Packaged Rates , $591.82 , $591.82 , See APC Packaged Rates , See APC Packaged Rates , $820.26 , $820.26 , $820.26 , $820.26 , See APC Packaged Rates , $308.70 , $529.20 , $308.70 , $854.75 , $617.40
,61500246,Hospital Chargemaster,Thuderbeat Open Extended,Outpatient,Outpatient Default Percent / Case Rate,272," $1,527.75 ", $840.26 ," $1,222.20 ", See APC Packaged Rates ," $1,069.43 ", $595.82 ," $1,474.13 "," $1,480.54 ", $786.82 , See APC Packaged Rates , See APC Packaged Rates ," $1,025.12 "," $1,025.12 ", See APC Packaged Rates , See APC Packaged Rates ," $1,420.81 "," $1,420.81 "," $1,420.81 "," $1,420.81 ", See APC Packaged Rates , $534.71 , $916.65 , $534.71 ," $1,480.54 "," $1,069.43 "
,61500249,Hospital Chargemaster,Resolution Clip Ultra 360,Outpatient,Outpatient Default Percent / Case Rate,272, $752.85 , $414.07 , $602.28 , See APC Packaged Rates , $527.00 , $293.61 , $726.42 , $729.59 , $387.73 , See APC Packaged Rates , See APC Packaged Rates , $505.16 , $505.16 , See APC Packaged Rates , See APC Packaged Rates , $700.15 , $700.15 , $700.15 , $700.15 , See APC Packaged Rates , $263.50 , $451.71 , $263.50 , $729.59 , $527.00
,61500266,Hospital Chargemaster,Overdrill AO 2.0mm L12mm,Outpatient,Outpatient Default Percent / Case Rate,272, $661.50 , $363.83 , $529.20 , See APC Packaged Rates , $463.05 , $257.99 , $638.28 , $641.06 , $340.69 , See APC Packaged Rates , See APC Packaged Rates , $443.87 , $443.87 , See APC Packaged Rates , See APC Packaged Rates , $615.20 , $615.20 , $615.20 , $615.20 , See APC Packaged Rates , $231.53 , $396.90 , $231.53 , $641.06 , $463.05
,61500273,Hospital Chargemaster,Cryo Turnkey Service,Outpatient,Outpatient Default Percent / Case Rate,272," $1,500.00 ", $825.00 ," $1,200.00 ", See APC Packaged Rates ," $1,050.00 ", $585.00 ," $1,447.35 "," $1,453.65 ", $772.53 , See APC Packaged Rates , See APC Packaged Rates ," $1,006.50 "," $1,006.50 ", See APC Packaged Rates , See APC Packaged Rates ," $1,395.00 "," $1,395.00 "," $1,395.00 "," $1,395.00 ", See APC Packaged Rates , $525.00 , $900.00 , $525.00 ," $1,453.65 "," $1,050.00 "
C2618,61500274,Hospital Chargemaster,Prostate Cryo Kit,Outpatient,Outpatient Default Percent / Case Rate,272," $14,175.00 "," $7,796.25 "," $11,680.20 ", See APC Packaged Rates ," $9,922.50 "," $5,528.25 "," $13,677.46 "," $13,736.99 "," $7,300.41 ", See APC Packaged Rates , See APC Packaged Rates ," $9,511.43 "," $9,511.43 ", See APC Packaged Rates , See APC Packaged Rates ," $13,182.75 "," $13,182.75 "," $13,182.75 "," $13,182.75 ", See APC Packaged Rates ," $4,961.25 ", $- , $- ," $13,736.99 "," $9,922.50 "
,61500293,Hospital Chargemaster,Trocar Spacemaker Pro Oval,Outpatient,Outpatient Default Percent / Case Rate,272," $1,800.48 ", $990.26 ," $1,440.38 ", See APC Packaged Rates ," $1,260.34 ", $702.19 ," $1,737.28 "," $1,744.85 ", $927.28 , See APC Packaged Rates , See APC Packaged Rates ," $1,208.12 "," $1,208.12 ", See APC Packaged Rates , See APC Packaged Rates ," $1,674.45 "," $1,674.45 "," $1,674.45 "," $1,674.45 ", See APC Packaged Rates , $630.17 ," $1,080.29 ", $630.17 ," $1,744.85 "," $1,260.34 "
,61500307,Hospital Chargemaster,Calib drill bit DIA 3.2mmx315m,Outpatient,Outpatient Default Percent / Case Rate,272, $378.95 , $208.42 , $303.16 , See APC Packaged Rates , $265.27 , $147.79 , $365.65 , $367.24 , $195.17 , See APC Packaged Rates , See APC Packaged Rates , $254.28 , $254.28 , See APC Packaged Rates , See APC Packaged Rates , $352.42 , $352.42 , $352.42 , $352.42 , See APC Packaged Rates , $132.63 , $227.37 , $132.63 , $367.24 , $265.27
,61500308,Hospital Chargemaster,K-wire Drill tip DIA 2.0x315mm,Outpatient,Outpatient Default Percent / Case Rate,272, $40.80 , $22.44 , $32.64 , See APC Packaged Rates , $28.56 , $15.91 , $39.37 , $39.54 , $21.01 , See APC Packaged Rates , See APC Packaged Rates , $27.38 , $27.38 , See APC Packaged Rates , See APC Packaged Rates , $37.94 , $37.94 , $37.94 , $37.94 , See APC Packaged Rates , $14.28 , $24.48 , $14.28 , $39.54 , $28.56
,61500335,Hospital Chargemaster,Plasma Needle RT Angled,Outpatient,Outpatient Default Percent / Case Rate,272," $1,399.36 ", $769.65 ," $1,119.49 ", See APC Packaged Rates , $979.55 , $545.75 ," $1,350.24 "," $1,356.12 ", $720.70 , See APC Packaged Rates , See APC Packaged Rates , $938.97 , $938.97 , See APC Packaged Rates , See APC Packaged Rates ," $1,301.40 "," $1,301.40 "," $1,301.40 "," $1,301.40 ", See APC Packaged Rates , $489.78 , $839.62 , $489.78 ," $1,356.12 ", $979.55
,61500338,Hospital Chargemaster,Deep Scrotal Retraction System,Outpatient,Outpatient Default Percent / Case Rate,272," $1,464.75 ", $805.61 ," $1,171.80 ", See APC Packaged Rates ," $1,025.33 ", $571.25 ," $1,413.34 "," $1,419.49 ", $754.38 , See APC Packaged Rates , See APC Packaged Rates , $982.85 , $982.85 , See APC Packaged Rates , See APC Packaged Rates ," $1,362.22 "," $1,362.22 "," $1,362.22 "," $1,362.22 ", See APC Packaged Rates , $512.66 , $878.85 , $512.66 ," $1,419.49 "," $1,025.33 "
,61500339,Hospital Chargemaster,Disposable Dialator 9mm-16mm,Outpatient,Outpatient Default Percent / Case Rate,272," $1,102.50 ", $606.38 , $882.00 , See APC Packaged Rates , $771.75 , $429.98 ," $1,063.80 "," $1,068.43 ", $567.81 , See APC Packaged Rates , See APC Packaged Rates , $739.78 , $739.78 , See APC Packaged Rates , See APC Packaged Rates ," $1,025.33 "," $1,025.33 "," $1,025.33 "," $1,025.33 ", See APC Packaged Rates , $385.88 , $661.50 , $385.88 ," $1,068.43 ", $771.75
,61501255,Hospital Chargemaster,Surgiclip,Outpatient,Outpatient Default Percent / Case Rate,272, $177.33 , $97.53 , $141.86 , See APC Packaged Rates , $124.13 , $69.16 , $171.11 , $171.85 , $91.33 , See APC Packaged Rates , See APC Packaged Rates , $118.99 , $118.99 , See APC Packaged Rates , See APC Packaged Rates , $164.92 , $164.92 , $164.92 , $164.92 , See APC Packaged Rates , $62.07 , $106.40 , $62.07 , $171.85 , $124.13
,61501875,Hospital Chargemaster,Info Wound Vac,Outpatient,Outpatient Default Percent / Case Rate,272, $56.47 , $31.06 , $45.18 , See APC Packaged Rates , $39.53 , $22.02 , $54.49 , $54.73 , $29.08 , See APC Packaged Rates , See APC Packaged Rates , $37.89 , $37.89 , See APC Packaged Rates , See APC Packaged Rates , $52.52 , $52.52 , $52.52 , $52.52 , See APC Packaged Rates , $19.76 , $33.88 , $19.76 , $54.73 , $39.53
,61503485,Hospital Chargemaster,Retractor Retentus Pennus,Outpatient,Outpatient Default Percent / Case Rate,272, $188.84 , $103.86 , $151.07 , See APC Packaged Rates , $132.19 , $73.65 , $182.21 , $183.00 , $97.26 , See APC Packaged Rates , See APC Packaged Rates , $126.71 , $126.71 , See APC Packaged Rates , See APC Packaged Rates , $175.62 , $175.62 , $175.62 , $175.62 , See APC Packaged Rates , $66.09 , $113.30 , $66.09 , $183.00 , $132.19
,61507127,Hospital Chargemaster,"Cold Knife, Straight Blade",Outpatient,Outpatient Default Percent / Case Rate,272, $497.03 , $273.37 , $397.62 , See APC Packaged Rates , $347.92 , $193.84 , $479.58 , $481.67 , $255.98 , See APC Packaged Rates , See APC Packaged Rates , $333.51 , $333.51 , See APC Packaged Rates , See APC Packaged Rates , $462.24 , $462.24 , $462.24 , $462.24 , See APC Packaged Rates , $173.96 , $298.22 , $173.96 , $481.67 , $347.92
,61507174,Hospital Chargemaster,"Tube, Laser 5.0Mm",Outpatient,Outpatient Default Percent / Case Rate,272, $35.06 , $19.28 , $28.05 , See APC Packaged Rates , $24.54 , $13.67 , $33.83 , $33.98 , $18.06 , See APC Packaged Rates , See APC Packaged Rates , $23.53 , $23.53 , See APC Packaged Rates , See APC Packaged Rates , $32.61 , $32.61 , $32.61 , $32.61 , See APC Packaged Rates , $12.27 , $21.04 , $12.27 , $33.98 , $24.54
,61507224,Hospital Chargemaster,Uss Protack - 30 Tacks,Outpatient,Outpatient Default Percent / Case Rate,272, $630.00 , $346.50 , $504.00 , See APC Packaged Rates , $441.00 , $245.70 , $607.89 , $610.53 , $324.46 , See APC Packaged Rates , See APC Packaged Rates , $422.73 , $422.73 , See APC Packaged Rates , See APC Packaged Rates , $585.90 , $585.90 , $585.90 , $585.90 , See APC Packaged Rates , $220.50 , $378.00 , $220.50 , $610.53 , $441.00
,61507270,Hospital Chargemaster,Mobius Elastic Retractor,Outpatient,Outpatient Default Percent / Case Rate,272, $173.25 , $95.29 , $138.60 , See APC Packaged Rates , $121.28 , $67.57 , $167.17 , $167.90 , $89.23 , See APC Packaged Rates , See APC Packaged Rates , $116.25 , $116.25 , See APC Packaged Rates , See APC Packaged Rates , $161.12 , $161.12 , $161.12 , $161.12 , See APC Packaged Rates , $60.64 , $103.95 , $60.64 , $167.90 , $121.28
,61507828,Hospital Chargemaster,Drill Bit 1/16X4,Outpatient,Outpatient Default Percent / Case Rate,272, $223.97 , $123.18 , $179.18 , See APC Packaged Rates , $156.78 , $87.35 , $216.11 , $217.05 , $115.35 , See APC Packaged Rates , See APC Packaged Rates , $150.28 , $150.28 , See APC Packaged Rates , See APC Packaged Rates , $208.29 , $208.29 , $208.29 , $208.29 , See APC Packaged Rates , $78.39 , $134.38 , $78.39 , $217.05 , $156.78
,61507843,Hospital Chargemaster,"Drill Bit 3/32 X 4""",Outpatient,Outpatient Default Percent / Case Rate,272, $223.94 , $123.17 , $179.15 , See APC Packaged Rates , $156.76 , $87.34 , $216.08 , $217.02 , $115.33 , See APC Packaged Rates , See APC Packaged Rates , $150.26 , $150.26 , See APC Packaged Rates , See APC Packaged Rates , $208.26 , $208.26 , $208.26 , $208.26 , See APC Packaged Rates , $78.38 , $134.36 , $78.38 , $217.02 , $156.76
,61508309,Hospital Chargemaster,Staple Disposeable,Outpatient,Outpatient Default Percent / Case Rate,272, $275.01 , $151.26 , $220.01 , See APC Packaged Rates , $192.51 , $107.25 , $265.36 , $266.51 , $141.64 , See APC Packaged Rates , See APC Packaged Rates , $184.53 , $184.53 , See APC Packaged Rates , See APC Packaged Rates , $255.76 , $255.76 , $255.76 , $255.76 , See APC Packaged Rates , $96.25 , $165.01 , $96.25 , $266.51 , $192.51
,61508378,Hospital Chargemaster,"Surgicel 4"" X 8""",Outpatient,Outpatient Default Percent / Case Rate,272, $396.86 , $218.27 , $317.49 , See APC Packaged Rates , $277.80 , $154.78 , $382.93 , $384.60 , $204.39 , See APC Packaged Rates , See APC Packaged Rates , $266.29 , $266.29 , See APC Packaged Rates , See APC Packaged Rates , $369.08 , $369.08 , $369.08 , $369.08 , See APC Packaged Rates , $138.90 , $238.12 , $138.90 , $384.60 , $277.80
,61508383,Hospital Chargemaster,Surgicel 2 X 3,Outpatient,Outpatient Default Percent / Case Rate,272, $222.72 , $122.50 , $178.18 , See APC Packaged Rates , $155.90 , $86.86 , $214.90 , $215.84 , $114.71 , See APC Packaged Rates , See APC Packaged Rates , $149.45 , $149.45 , See APC Packaged Rates , See APC Packaged Rates , $207.13 , $207.13 , $207.13 , $207.13 , See APC Packaged Rates , $77.95 , $133.63 , $77.95 , $215.84 , $155.90
,61508384,Hospital Chargemaster,"Surgicel 2"" X 14""",Outpatient,Outpatient Default Percent / Case Rate,272, $379.42 , $208.68 , $303.54 , See APC Packaged Rates , $265.59 , $147.97 , $366.10 , $367.70 , $195.41 , See APC Packaged Rates , See APC Packaged Rates , $254.59 , $254.59 , See APC Packaged Rates , See APC Packaged Rates , $352.86 , $352.86 , $352.86 , $352.86 , See APC Packaged Rates , $132.80 , $227.65 , $132.80 , $367.70 , $265.59
,61508459,Hospital Chargemaster,Gia 60-3.8 Loading Unit Tcr55,Outpatient,Outpatient Default Percent / Case Rate,272, $121.00 , $66.55 , $96.80 , See APC Packaged Rates , $84.70 , $47.19 , $116.75 , $117.26 , $62.32 , See APC Packaged Rates , See APC Packaged Rates , $81.19 , $81.19 , See APC Packaged Rates , See APC Packaged Rates , $112.53 , $112.53 , $112.53 , $112.53 , See APC Packaged Rates , $42.35 , $72.60 , $42.35 , $117.26 , $84.70
,61508689,Hospital Chargemaster,Multifire TA 55 Stap,Outpatient,Outpatient Default Percent / Case Rate,272, $273.79 , $150.58 , $219.03 , See APC Packaged Rates , $191.65 , $106.78 , $264.18 , $265.33 , $141.01 , See APC Packaged Rates , See APC Packaged Rates , $183.71 , $183.71 , See APC Packaged Rates , See APC Packaged Rates , $254.62 , $254.62 , $254.62 , $254.62 , See APC Packaged Rates , $95.83 , $164.27 , $95.83 , $265.33 , $191.65
,61508690,Hospital Chargemaster,Stapler Ta 55 4.8 Tr60,Outpatient,Outpatient Default Percent / Case Rate,272, $137.17 , $75.44 , $109.74 , See APC Packaged Rates , $96.02 , $53.50 , $132.36 , $132.93 , $70.65 , See APC Packaged Rates , See APC Packaged Rates , $92.04 , $92.04 , See APC Packaged Rates , See APC Packaged Rates , $127.57 , $127.57 , $127.57 , $127.57 , See APC Packaged Rates , $48.01 , $82.30 , $48.01 , $132.93 , $96.02
,61508786,Hospital Chargemaster,Nasal Splint Doyle Ii,Outpatient,Outpatient Default Percent / Case Rate,272, $182.07 , $100.14 , $145.66 , See APC Packaged Rates , $127.45 , $71.01 , $175.68 , $176.44 , $93.77 , See APC Packaged Rates , See APC Packaged Rates , $122.17 , $122.17 , See APC Packaged Rates , See APC Packaged Rates , $169.33 , $169.33 , $169.33 , $169.33 , See APC Packaged Rates , $63.72 , $109.24 , $63.72 , $176.44 , $127.45
,61508815,Hospital Chargemaster,Clip Apply ER320,Outpatient,Outpatient Default Percent / Case Rate,272, $249.53 , $137.24 , $199.62 , See APC Packaged Rates , $174.67 , $97.32 , $240.77 , $241.82 , $128.51 , See APC Packaged Rates , See APC Packaged Rates , $167.43 , $167.43 , See APC Packaged Rates , See APC Packaged Rates , $232.06 , $232.06 , $232.06 , $232.06 , See APC Packaged Rates , $87.34 , $149.72 , $87.34 , $241.82 , $174.67
,61508846,Hospital Chargemaster,Cement Mixer Evac III,Outpatient,Outpatient Default Percent / Case Rate,272, $177.66 , $97.71 , $142.13 , See APC Packaged Rates , $124.36 , $69.29 , $171.42 , $172.17 , $91.50 , See APC Packaged Rates , See APC Packaged Rates , $119.21 , $119.21 , See APC Packaged Rates , See APC Packaged Rates , $165.22 , $165.22 , $165.22 , $165.22 , See APC Packaged Rates , $62.18 , $106.60 , $62.18 , $172.17 , $124.36
,61509614,Hospital Chargemaster,Cement Cartridge Kit,Outpatient,Outpatient Default Percent / Case Rate,272, $275.06 , $151.28 , $220.05 , See APC Packaged Rates , $192.54 , $107.27 , $265.41 , $266.56 , $141.66 , See APC Packaged Rates , See APC Packaged Rates , $184.57 , $184.57 , See APC Packaged Rates , See APC Packaged Rates , $255.81 , $255.81 , $255.81 , $255.81 , See APC Packaged Rates , $96.27 , $165.04 , $96.27 , $266.56 , $192.54
,61509618,Hospital Chargemaster,"Tube, Gastronomy 20FR",Outpatient,Outpatient Default Percent / Case Rate,272, $96.96 , $53.33 , $77.57 , See APC Packaged Rates , $67.87 , $37.81 , $93.56 , $93.96 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $65.06 , $65.06 , See APC Packaged Rates , See APC Packaged Rates , $90.17 , $90.17 , $90.17 , $90.17 , See APC Packaged Rates , $33.94 , $58.18 , $33.94 , $93.96 , $67.87
,61509624,Hospital Chargemaster,"Probe, Gold 7Fr",Outpatient,Outpatient Default Percent / Case Rate,272, $491.09 , $270.10 , $392.87 , See APC Packaged Rates , $343.76 , $191.53 , $473.85 , $475.92 , $252.92 , See APC Packaged Rates , See APC Packaged Rates , $329.52 , $329.52 , See APC Packaged Rates , See APC Packaged Rates , $456.71 , $456.71 , $456.71 , $456.71 , See APC Packaged Rates , $171.88 , $294.65 , $171.88 , $475.92 , $343.76
,61509846,Hospital Chargemaster,Falope-Ring Band,Outpatient,Outpatient Default Percent / Case Rate,272, $68.52 , $37.69 , $54.82 , See APC Packaged Rates , $47.96 , $26.72 , $66.11 , $66.40 , $35.29 , See APC Packaged Rates , See APC Packaged Rates , $45.98 , $45.98 , See APC Packaged Rates , See APC Packaged Rates , $63.72 , $63.72 , $63.72 , $63.72 , See APC Packaged Rates , $23.98 , $41.11 , $23.98 , $66.40 , $47.96
,61509855,Hospital Chargemaster,"Ligator, Saeed 6-Shooter",Outpatient,Outpatient Default Percent / Case Rate,272, $441.17 , $242.64 , $352.94 , See APC Packaged Rates , $308.82 , $172.06 , $425.68 , $427.54 , $227.21 , See APC Packaged Rates , See APC Packaged Rates , $296.03 , $296.03 , See APC Packaged Rates , See APC Packaged Rates , $410.29 , $410.29 , $410.29 , $410.29 , See APC Packaged Rates , $154.41 , $264.70 , $154.41 , $427.54 , $308.82
,61509872,Hospital Chargemaster,Falope Ring Band Applicator,Outpatient,Outpatient Default Percent / Case Rate,272, $708.75 , $389.81 , $567.00 , See APC Packaged Rates , $496.13 , $276.41 , $683.87 , $686.85 , $365.02 , See APC Packaged Rates , See APC Packaged Rates , $475.57 , $475.57 , See APC Packaged Rates , See APC Packaged Rates , $659.14 , $659.14 , $659.14 , $659.14 , See APC Packaged Rates , $248.06 , $425.25 , $248.06 , $686.85 , $496.13
,61509942,Hospital Chargemaster,"Cath, Cholangiogsam 18x4.5",Outpatient,Outpatient Default Percent / Case Rate,272, $173.25 , $95.29 , $138.60 , See APC Packaged Rates , $121.28 , $67.57 , $167.17 , $167.90 , $89.23 , See APC Packaged Rates , See APC Packaged Rates , $116.25 , $116.25 , See APC Packaged Rates , See APC Packaged Rates , $161.12 , $161.12 , $161.12 , $161.12 , See APC Packaged Rates , $60.64 , $103.95 , $60.64 , $167.90 , $121.28
,61510230,Hospital Chargemaster,Cement Spacer 12Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $415.80 , $228.69 , $332.64 , See APC Packaged Rates , $291.06 , $162.16 , $401.21 , $402.95 , $214.15 , See APC Packaged Rates , See APC Packaged Rates , $279.00 , $279.00 , See APC Packaged Rates , See APC Packaged Rates , $386.69 , $386.69 , $386.69 , $386.69 , See APC Packaged Rates , $145.53 , $249.48 , $145.53 , $402.95 , $291.06
,61510264,Hospital Chargemaster,Guide Wire Nitinol,Outpatient,Outpatient Default Percent / Case Rate,272, $204.75 , $112.61 , $163.80 , See APC Packaged Rates , $143.33 , $79.85 , $197.56 , $198.42 , $105.45 , See APC Packaged Rates , See APC Packaged Rates , $137.39 , $137.39 , See APC Packaged Rates , See APC Packaged Rates , $190.42 , $190.42 , $190.42 , $190.42 , See APC Packaged Rates , $71.66 , $122.85 , $71.66 , $198.42 , $143.33
,61510404,Hospital Chargemaster,Guidewire Ball Tip 3.2X800Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $352.49 , $193.87 , $281.99 , See APC Packaged Rates , $246.74 , $137.47 , $340.12 , $341.60 , $181.54 , See APC Packaged Rates , See APC Packaged Rates , $236.52 , $236.52 , See APC Packaged Rates , See APC Packaged Rates , $327.82 , $327.82 , $327.82 , $327.82 , See APC Packaged Rates , $123.37 , $211.49 , $123.37 , $341.60 , $246.74
,61510405,Hospital Chargemaster,Wire Kirschner 3.2X450Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $240.03 , $132.02 , $192.02 , See APC Packaged Rates , $168.02 , $93.61 , $231.60 , $232.61 , $123.62 , See APC Packaged Rates , See APC Packaged Rates , $161.06 , $161.06 , See APC Packaged Rates , See APC Packaged Rates , $223.23 , $223.23 , $223.23 , $223.23 , See APC Packaged Rates , $84.01 , $144.02 , $84.01 , $232.61 , $168.02
,61510424,Hospital Chargemaster,Universal Head,Outpatient,Outpatient Default Percent / Case Rate,272," $1,732.50 ", $952.88 ," $1,386.00 ", See APC Packaged Rates ," $1,212.75 ", $675.68 ," $1,671.69 "," $1,678.97 ", $892.27 , See APC Packaged Rates , See APC Packaged Rates ," $1,162.51 "," $1,162.51 ", See APC Packaged Rates , See APC Packaged Rates ," $1,611.23 "," $1,611.23 "," $1,611.23 "," $1,611.23 ", See APC Packaged Rates , $606.38 ," $1,039.50 ", $606.38 ," $1,678.97 "," $1,212.75 "
,61510494,Hospital Chargemaster,Guide Wire Ball Tipped,Outpatient,Outpatient Default Percent / Case Rate,272, $323.19 , $177.75 , $258.55 , See APC Packaged Rates , $226.23 , $126.04 , $311.85 , $313.20 , $166.45 , See APC Packaged Rates , See APC Packaged Rates , $216.86 , $216.86 , See APC Packaged Rates , See APC Packaged Rates , $300.57 , $300.57 , $300.57 , $300.57 , See APC Packaged Rates , $113.12 , $193.91 , $113.12 , $313.20 , $226.23
,61510854,Hospital Chargemaster,Isogard Blade,Outpatient,Outpatient Default Percent / Case Rate,272," $1,134.00 ", $623.70 , $907.20 , See APC Packaged Rates , $793.80 , $442.26 ," $1,094.20 "," $1,098.96 ", $584.03 , See APC Packaged Rates , See APC Packaged Rates , $760.91 , $760.91 , See APC Packaged Rates , See APC Packaged Rates ," $1,054.62 "," $1,054.62 "," $1,054.62 "," $1,054.62 ", See APC Packaged Rates , $396.90 , $680.40 , $396.90 ," $1,098.96 ", $793.80
C1713,61510866,Hospital Chargemaster,Button Nasal Septal,Outpatient,Outpatient Default Percent / Case Rate,272, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61510940,Hospital Chargemaster,Blade Radius 4.5 Cvd,Outpatient,Outpatient Default Percent / Case Rate,272, $263.55 , $144.95 , $210.84 , See APC Packaged Rates , $184.49 , $102.78 , $254.30 , $255.41 , $135.73 , See APC Packaged Rates , See APC Packaged Rates , $176.84 , $176.84 , See APC Packaged Rates , See APC Packaged Rates , $245.10 , $245.10 , $245.10 , $245.10 , See APC Packaged Rates , $92.24 , $158.13 , $92.24 , $255.41 , $184.49
,61510993,Hospital Chargemaster,Domestic Sterile Device,Outpatient,Outpatient Default Percent / Case Rate,272," $2,835.00 "," $1,559.25 "," $2,268.00 ", See APC Packaged Rates ," $1,984.50 "," $1,105.65 "," $2,735.49 "," $2,747.40 "," $1,460.08 ", See APC Packaged Rates , See APC Packaged Rates ," $1,902.29 "," $1,902.29 ", See APC Packaged Rates , See APC Packaged Rates ," $2,636.55 "," $2,636.55 "," $2,636.55 "," $2,636.55 ", See APC Packaged Rates , $992.25 ," $1,701.00 ", $992.25 ," $2,747.40 "," $1,984.50 "
,61511058,Hospital Chargemaster,Trocar Structural Balloon,Outpatient,Outpatient Default Percent / Case Rate,272, $283.50 , $155.93 , $226.80 , See APC Packaged Rates , $198.45 , $110.57 , $273.55 , $274.74 , $146.01 , See APC Packaged Rates , See APC Packaged Rates , $190.23 , $190.23 , See APC Packaged Rates , See APC Packaged Rates , $263.66 , $263.66 , $263.66 , $263.66 , See APC Packaged Rates , $99.23 , $170.10 , $99.23 , $274.74 , $198.45
C1781,61511074,Hospital Chargemaster,Composix Ex Mesh 10 X 13,Outpatient,Outpatient Default Percent / Case Rate,272, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511148,Hospital Chargemaster,Stapler Contour Curved Green,Outpatient,Outpatient Default Percent / Case Rate,272," $1,611.29 ", $886.21 ," $1,289.03 ", See APC Packaged Rates ," $1,127.90 ", $628.40 ," $1,554.73 "," $1,561.50 ", $829.85 , See APC Packaged Rates , See APC Packaged Rates ," $1,081.18 "," $1,081.18 ", See APC Packaged Rates , See APC Packaged Rates ," $1,498.50 "," $1,498.50 "," $1,498.50 "," $1,498.50 ", See APC Packaged Rates , $563.95 , $966.77 , $563.95 ," $1,561.50 "," $1,127.90 "
,61511150,Hospital Chargemaster,Staples Contour Reload Green,Outpatient,Outpatient Default Percent / Case Rate,272, $905.38 , $497.96 , $724.30 , See APC Packaged Rates , $633.77 , $353.10 , $873.60 , $877.40 , $466.29 , See APC Packaged Rates , See APC Packaged Rates , $607.51 , $607.51 , See APC Packaged Rates , See APC Packaged Rates , $842.00 , $842.00 , $842.00 , $842.00 , See APC Packaged Rates , $316.88 , $543.23 , $316.88 , $877.40 , $633.77
,61511171,Hospital Chargemaster,Cutter Harmonic Ace,Outpatient,Outpatient Default Percent / Case Rate,272," $2,684.22 "," $1,476.32 "," $2,147.38 ", See APC Packaged Rates ," $1,878.95 "," $1,046.85 "," $2,590.00 "," $2,601.28 "," $1,382.43 ", See APC Packaged Rates , See APC Packaged Rates ," $1,801.11 "," $1,801.11 ", See APC Packaged Rates , See APC Packaged Rates ," $2,496.32 "," $2,496.32 "," $2,496.32 "," $2,496.32 ", See APC Packaged Rates , $939.48 ," $1,610.53 ", $939.48 ," $2,601.28 "," $1,878.95 "
,61511188,Hospital Chargemaster,Electroblade,Outpatient,Outpatient Default Percent / Case Rate,272, $567.00 , $311.85 , $453.60 , See APC Packaged Rates , $396.90 , $221.13 , $547.10 , $549.48 , $292.02 , See APC Packaged Rates , See APC Packaged Rates , $380.46 , $380.46 , See APC Packaged Rates , See APC Packaged Rates , $527.31 , $527.31 , $527.31 , $527.31 , See APC Packaged Rates , $198.45 , $340.20 , $198.45 , $549.48 , $396.90
,61511282,Hospital Chargemaster,Ao Drill Sterile 4.2 X 340Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $334.53 , $183.99 , $267.62 , See APC Packaged Rates , $234.17 , $130.47 , $322.79 , $324.19 , $172.29 , See APC Packaged Rates , See APC Packaged Rates , $224.47 , $224.47 , See APC Packaged Rates , See APC Packaged Rates , $311.11 , $311.11 , $311.11 , $311.11 , See APC Packaged Rates , $117.09 , $200.72 , $117.09 , $324.19 , $234.17
,61511310,Hospital Chargemaster,Acl Saw Blade W/Stop,Outpatient,Outpatient Default Percent / Case Rate,272, $256.32 , $140.98 , $205.06 , See APC Packaged Rates , $179.42 , $99.96 , $247.32 , $248.40 , $132.01 , See APC Packaged Rates , See APC Packaged Rates , $171.99 , $171.99 , See APC Packaged Rates , See APC Packaged Rates , $238.38 , $238.38 , $238.38 , $238.38 , See APC Packaged Rates , $89.71 , $153.79 , $89.71 , $248.40 , $179.42
,61511663,Hospital Chargemaster,A/O Drill Sterile 4.2 X 180Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $358.16 , $196.99 , $286.53 , See APC Packaged Rates , $250.71 , $139.68 , $345.59 , $347.09 , $184.46 , See APC Packaged Rates , See APC Packaged Rates , $240.33 , $240.33 , See APC Packaged Rates , See APC Packaged Rates , $333.09 , $333.09 , $333.09 , $333.09 , See APC Packaged Rates , $125.36 , $214.90 , $125.36 , $347.09 , $250.71
,61511688,Hospital Chargemaster,"Thyroplasty Kit, Male",Outpatient,Outpatient Default Percent / Case Rate,272," $2,189.25 "," $1,204.09 "," $1,751.40 ", See APC Packaged Rates ," $1,532.48 ", $853.81 ," $2,112.41 "," $2,121.60 "," $1,127.51 ", See APC Packaged Rates , See APC Packaged Rates ," $1,468.99 "," $1,468.99 ", See APC Packaged Rates , See APC Packaged Rates ," $2,036.00 "," $2,036.00 "," $2,036.00 "," $2,036.00 ", See APC Packaged Rates , $766.24 ," $1,313.55 ", $766.24 ," $2,121.60 "," $1,532.48 "
,61511703,Hospital Chargemaster,Flex 60 Reload Staple Cart Wh,Outpatient,Outpatient Default Percent / Case Rate,272, $619.50 , $340.73 , $495.60 , See APC Packaged Rates , $433.65 , $241.61 , $597.76 , $600.36 , $319.05 , See APC Packaged Rates , See APC Packaged Rates , $415.68 , $415.68 , See APC Packaged Rates , See APC Packaged Rates , $576.14 , $576.14 , $576.14 , $576.14 , See APC Packaged Rates , $216.83 , $371.70 , $216.83 , $600.36 , $433.65
,61511704,Hospital Chargemaster,Lex 60 Reload Staple Cart Bl,Outpatient,Outpatient Default Percent / Case Rate,272, $615.73 , $338.65 , $492.58 , See APC Packaged Rates , $431.01 , $240.13 , $594.12 , $596.70 , $317.11 , See APC Packaged Rates , See APC Packaged Rates , $413.15 , $413.15 , See APC Packaged Rates , See APC Packaged Rates , $572.63 , $572.63 , $572.63 , $572.63 , See APC Packaged Rates , $215.51 , $369.44 , $215.51 , $596.70 , $431.01
,61511705,Hospital Chargemaster,Flex 60 Reload Staple Cart Gr,Outpatient,Outpatient Default Percent / Case Rate,272, $619.50 , $340.73 , $495.60 , See APC Packaged Rates , $433.65 , $241.61 , $597.76 , $600.36 , $319.05 , See APC Packaged Rates , See APC Packaged Rates , $415.68 , $415.68 , See APC Packaged Rates , See APC Packaged Rates , $576.14 , $576.14 , $576.14 , $576.14 , See APC Packaged Rates , $216.83 , $371.70 , $216.83 , $600.36 , $433.65
,61512005,Hospital Chargemaster,Pillcam Sb Kit,Outpatient,Outpatient Default Percent / Case Rate,272," $1,709.19 ", $940.05 ," $1,367.35 ", See APC Packaged Rates ," $1,196.43 ", $666.58 ," $1,649.20 "," $1,656.38 ", $880.27 , See APC Packaged Rates , See APC Packaged Rates ," $1,146.87 "," $1,146.87 ", See APC Packaged Rates , See APC Packaged Rates ," $1,589.55 "," $1,589.55 "," $1,589.55 "," $1,589.55 ", See APC Packaged Rates , $598.22 ," $1,025.51 ", $598.22 ," $1,656.38 "," $1,196.43 "
,61512064,Hospital Chargemaster,Abs Fix Device 5Mm,Outpatient,Outpatient Default Percent / Case Rate,272," $1,275.75 ", $701.66 ," $1,020.60 ", See APC Packaged Rates , $893.03 , $497.54 ," $1,230.97 "," $1,236.33 ", $657.04 , See APC Packaged Rates , See APC Packaged Rates , $856.03 , $856.03 , See APC Packaged Rates , See APC Packaged Rates ," $1,186.45 "," $1,186.45 "," $1,186.45 "," $1,186.45 ", See APC Packaged Rates , $446.51 , $765.45 , $446.51 ," $1,236.33 ", $893.03
,61512148,Hospital Chargemaster,Echelon 45 Stapler Reload,Outpatient,Outpatient Default Percent / Case Rate,272, $556.93 , $306.31 , $445.54 , See APC Packaged Rates , $389.85 , $217.20 , $537.38 , $539.72 , $286.83 , See APC Packaged Rates , See APC Packaged Rates , $373.70 , $373.70 , See APC Packaged Rates , See APC Packaged Rates , $517.94 , $517.94 , $517.94 , $517.94 , See APC Packaged Rates , $194.93 , $334.16 , $194.93 , $539.72 , $389.85
,61512156,Hospital Chargemaster,Reload Echelon 45 Stapler Blu,Outpatient,Outpatient Default Percent / Case Rate,272, $541.61 , $297.89 , $433.29 , See APC Packaged Rates , $379.13 , $211.23 , $522.60 , $524.87 , $278.94 , See APC Packaged Rates , See APC Packaged Rates , $363.42 , $363.42 , See APC Packaged Rates , See APC Packaged Rates , $503.70 , $503.70 , $503.70 , $503.70 , See APC Packaged Rates , $189.56 , $324.97 , $189.56 , $524.87 , $379.13
,61512164,Hospital Chargemaster,Ligamax Clip Applier,Outpatient,Outpatient Default Percent / Case Rate,272, $437.26 , $240.49 , $349.81 , See APC Packaged Rates , $306.08 , $170.53 , $421.91 , $423.75 , $225.20 , See APC Packaged Rates , See APC Packaged Rates , $293.40 , $293.40 , See APC Packaged Rates , See APC Packaged Rates , $406.65 , $406.65 , $406.65 , $406.65 , See APC Packaged Rates , $153.04 , $262.36 , $153.04 , $423.75 , $306.08
,61512319,Hospital Chargemaster,Cutter Linear Reload Green75M,Outpatient,Outpatient Default Percent / Case Rate,272, $446.97 , $245.83 , $357.58 , See APC Packaged Rates , $312.88 , $174.32 , $431.28 , $433.16 , $230.20 , See APC Packaged Rates , See APC Packaged Rates , $299.92 , $299.92 , See APC Packaged Rates , See APC Packaged Rates , $415.68 , $415.68 , $415.68 , $415.68 , See APC Packaged Rates , $156.44 , $268.18 , $156.44 , $433.16 , $312.88
,61512340,Hospital Chargemaster,Drill Bit,Outpatient,Outpatient Default Percent / Case Rate,272, $400.05 , $220.03 , $320.04 , See APC Packaged Rates , $280.04 , $156.02 , $386.01 , $387.69 , $206.03 , See APC Packaged Rates , See APC Packaged Rates , $268.43 , $268.43 , See APC Packaged Rates , See APC Packaged Rates , $372.05 , $372.05 , $372.05 , $372.05 , See APC Packaged Rates , $140.02 , $240.03 , $140.02 , $387.69 , $280.04
,61512348,Hospital Chargemaster,Laser Fiber 270,Outpatient,Outpatient Default Percent / Case Rate,272, $842.66 , $463.46 , $674.13 , See APC Packaged Rates , $589.86 , $328.64 , $813.08 , $816.62 , $433.99 , See APC Packaged Rates , See APC Packaged Rates , $565.42 , $565.42 , See APC Packaged Rates , See APC Packaged Rates , $783.67 , $783.67 , $783.67 , $783.67 , See APC Packaged Rates , $294.93 , $505.60 , $294.93 , $816.62 , $589.86
,61512349,Hospital Chargemaster,Laser Fiber 400,Outpatient,Outpatient Default Percent / Case Rate,272, $811.13 , $446.12 , $648.90 , See APC Packaged Rates , $567.79 , $316.34 , $782.66 , $786.07 , $417.75 , See APC Packaged Rates , See APC Packaged Rates , $544.27 , $544.27 , See APC Packaged Rates , See APC Packaged Rates , $754.35 , $754.35 , $754.35 , $754.35 , See APC Packaged Rates , $283.90 , $486.68 , $283.90 , $786.07 , $567.79
,61512350,Hospital Chargemaster,Laser Fiber 600,Outpatient,Outpatient Default Percent / Case Rate,272," $1,083.39 ", $595.86 , $866.71 , See APC Packaged Rates , $758.37 , $422.52 ," $1,045.36 "," $1,049.91 ", $557.97 , See APC Packaged Rates , See APC Packaged Rates , $726.95 , $726.95 , See APC Packaged Rates , See APC Packaged Rates ," $1,007.55 "," $1,007.55 "," $1,007.55 "," $1,007.55 ", See APC Packaged Rates , $379.19 , $650.03 , $379.19 ," $1,049.91 ", $758.37
C1781,61512618,Hospital Chargemaster,"Mesh C-Qur Lite 5.7 X 4.1""",Outpatient,Outpatient Default Percent / Case Rate,272, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512676,Hospital Chargemaster,Spiral Blade For Humeral Nail,Outpatient,Outpatient Default Percent / Case Rate,272, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61512707,Hospital Chargemaster,Ureteral Balloon Dilator 10Cm,Outpatient,Outpatient Default Percent / Case Rate,272, $448.88 , $246.88 , $359.10 , See APC Packaged Rates , $314.22 , $175.06 , $433.12 , $435.01 , $231.18 , See APC Packaged Rates , See APC Packaged Rates , $301.20 , $301.20 , See APC Packaged Rates , See APC Packaged Rates , $417.46 , $417.46 , $417.46 , $417.46 , See APC Packaged Rates , $157.11 , $269.33 , $157.11 , $435.01 , $314.22
,61512708,Hospital Chargemaster,Ureteral Balloon Dilator 4 Cm,Outpatient,Outpatient Default Percent / Case Rate,272, $446.51 , $245.58 , $357.21 , See APC Packaged Rates , $312.56 , $174.14 , $430.84 , $432.71 , $229.96 , See APC Packaged Rates , See APC Packaged Rates , $299.61 , $299.61 , See APC Packaged Rates , See APC Packaged Rates , $415.25 , $415.25 , $415.25 , $415.25 , See APC Packaged Rates , $156.28 , $267.91 , $156.28 , $432.71 , $312.56
,61512728,Hospital Chargemaster,Lead Introducer 7Fr Medtronic,Outpatient,Outpatient Default Percent / Case Rate,272, $167.09 , $91.90 , $133.67 , See APC Packaged Rates , $116.96 , $65.17 , $161.23 , $161.93 , $86.05 , See APC Packaged Rates , See APC Packaged Rates , $112.12 , $112.12 , See APC Packaged Rates , See APC Packaged Rates , $155.39 , $155.39 , $155.39 , $155.39 , See APC Packaged Rates , $58.48 , $100.25 , $58.48 , $161.93 , $116.96
,61512729,Hospital Chargemaster,Lead Introducer 9Fr Medtronic,Outpatient,Outpatient Default Percent / Case Rate,272, $173.88 , $95.63 , $139.10 , See APC Packaged Rates , $121.72 , $67.81 , $167.78 , $168.51 , $89.55 , See APC Packaged Rates , See APC Packaged Rates , $116.67 , $116.67 , See APC Packaged Rates , See APC Packaged Rates , $161.71 , $161.71 , $161.71 , $161.71 , See APC Packaged Rates , $60.86 , $104.33 , $60.86 , $168.51 , $121.72
C1894,61512739,Hospital Chargemaster,Introducer Kit,Outpatient,Outpatient Default Percent / Case Rate,272, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1787,61512741,Hospital Chargemaster,Patient PrograMer Icon,Outpatient,Outpatient Default Percent / Case Rate,272, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
L5400,61513233,Hospital Chargemaster,Rigid Dressing For Bk Amputa,Outpatient,Outpatient Default Percent / Case Rate,272, $- , $- , $- , See APC Packaged Rates , $- , $- ," $1,464.18 ", $734.47 , $663.05 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- ," $1,464.18 ", $-
,61513263,Hospital Chargemaster,Hyster Procedure Kit W/Svc,Outpatient,Outpatient Default Percent / Case Rate,272," $1,108.80 ", $609.84 , $887.04 , See APC Packaged Rates , $776.16 , $432.43 ," $1,069.88 "," $1,074.54 ", $571.05 , See APC Packaged Rates , See APC Packaged Rates , $744.00 , $744.00 , See APC Packaged Rates , See APC Packaged Rates ," $1,031.18 "," $1,031.18 "," $1,031.18 "," $1,031.18 ", See APC Packaged Rates , $388.08 , $665.28 , $388.08 ," $1,074.54 ", $776.16
,61513264,Hospital Chargemaster,Blade Truclear Incisor+ 2.9,Outpatient,Outpatient Default Percent / Case Rate,272," $1,830.24 "," $1,006.63 "," $1,464.19 ", See APC Packaged Rates ," $1,281.17 ", $713.79 ," $1,766.00 "," $1,773.69 ", $942.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,228.09 "," $1,228.09 ", See APC Packaged Rates , See APC Packaged Rates ," $1,702.12 "," $1,702.12 "," $1,702.12 "," $1,702.12 ", See APC Packaged Rates , $640.58 ," $1,098.14 ", $640.58 ," $1,773.69 "," $1,281.17 "
,61513342,Hospital Chargemaster,2.8Mm Drill - #121.00,Outpatient,Outpatient Default Percent / Case Rate,272, $431.55 , $237.35 , $345.24 , See APC Packaged Rates , $302.09 , $168.30 , $416.40 , $418.22 , $222.26 , See APC Packaged Rates , See APC Packaged Rates , $289.57 , $289.57 , See APC Packaged Rates , See APC Packaged Rates , $401.34 , $401.34 , $401.34 , $401.34 , See APC Packaged Rates , $151.04 , $258.93 , $151.04 , $418.22 , $302.09
,61513393,Hospital Chargemaster,Flexible Osteotome 8X80Mm,Outpatient,Outpatient Default Percent / Case Rate,272," $1,286.65 ", $707.66 ," $1,029.32 ", See APC Packaged Rates , $900.66 , $501.79 ," $1,241.49 "," $1,246.89 ", $662.65 , See APC Packaged Rates , See APC Packaged Rates , $863.34 , $863.34 , See APC Packaged Rates , See APC Packaged Rates ," $1,196.58 "," $1,196.58 "," $1,196.58 "," $1,196.58 ", See APC Packaged Rates , $450.33 , $771.99 , $450.33 ," $1,246.89 ", $900.66
,61513426,Hospital Chargemaster,Forcep Backloading Bigospy,Outpatient,Outpatient Default Percent / Case Rate,272," $1,197.00 ", $658.35 , $957.60 , See APC Packaged Rates , $837.90 , $466.83 ," $1,154.99 "," $1,160.01 ", $616.48 , See APC Packaged Rates , See APC Packaged Rates , $803.19 , $803.19 , See APC Packaged Rates , See APC Packaged Rates ," $1,113.21 "," $1,113.21 "," $1,113.21 "," $1,113.21 ", See APC Packaged Rates , $418.95 , $718.20 , $418.95 ," $1,160.01 ", $837.90
,61513461,Hospital Chargemaster,Tubing In-Flow Truclear,Outpatient,Outpatient Default Percent / Case Rate,272, $449.19 , $247.05 , $359.35 , See APC Packaged Rates , $314.43 , $175.18 , $433.42 , $435.31 , $231.34 , See APC Packaged Rates , See APC Packaged Rates , $301.41 , $301.41 , See APC Packaged Rates , See APC Packaged Rates , $417.75 , $417.75 , $417.75 , $417.75 , See APC Packaged Rates , $157.22 , $269.51 , $157.22 , $435.31 , $314.43
,61513463,Hospital Chargemaster,Blade Rotary Truclear,Outpatient,Outpatient Default Percent / Case Rate,272," $1,445.25 ", $794.89 ," $1,156.20 ", See APC Packaged Rates ," $1,011.68 ", $563.65 ," $1,394.52 "," $1,400.59 ", $744.33 , See APC Packaged Rates , See APC Packaged Rates , $969.76 , $969.76 , See APC Packaged Rates , See APC Packaged Rates ," $1,344.08 "," $1,344.08 "," $1,344.08 "," $1,344.08 ", See APC Packaged Rates , $505.84 , $867.15 , $505.84 ," $1,400.59 "," $1,011.68 "
,61513524,Hospital Chargemaster,Juggerknot Drill 2.9Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $219.36 , $120.65 , $175.49 , See APC Packaged Rates , $153.55 , $85.55 , $211.66 , $212.58 , $112.97 , See APC Packaged Rates , See APC Packaged Rates , $147.19 , $147.19 , See APC Packaged Rates , See APC Packaged Rates , $204.00 , $204.00 , $204.00 , $204.00 , See APC Packaged Rates , $76.78 , $131.62 , $76.78 , $212.58 , $153.55
,61513555,Hospital Chargemaster,Ngage Nm Stone Extractor,Outpatient,Outpatient Default Percent / Case Rate,272, $742.49 , $408.37 , $593.99 , See APC Packaged Rates , $519.74 , $289.57 , $716.43 , $719.55 , $382.40 , See APC Packaged Rates , See APC Packaged Rates , $498.21 , $498.21 , See APC Packaged Rates , See APC Packaged Rates , $690.52 , $690.52 , $690.52 , $690.52 , See APC Packaged Rates , $259.87 , $445.49 , $259.87 , $719.55 , $519.74
,61513582,Hospital Chargemaster,Xpress Path Assist 6Mm,Outpatient,Outpatient Default Percent / Case Rate,272," $4,725.00 "," $2,598.75 "," $3,780.00 ", See APC Packaged Rates ," $3,307.50 "," $1,842.75 "," $4,559.15 "," $4,579.00 "," $2,433.47 ", See APC Packaged Rates , See APC Packaged Rates ," $3,170.48 "," $3,170.48 ", See APC Packaged Rates , See APC Packaged Rates ," $4,394.25 "," $4,394.25 "," $4,394.25 "," $4,394.25 ", See APC Packaged Rates ," $1,653.75 "," $2,835.00 "," $1,653.75 "," $4,579.00 "," $3,307.50 "
C1713,61513603,Hospital Chargemaster,Torque Square Drive Screw Kit,Outpatient,Outpatient Default Percent / Case Rate,272, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513714,Hospital Chargemaster,Entceps,Outpatient,Outpatient Default Percent / Case Rate,272, $614.25 , $337.84 , $491.40 , See APC Packaged Rates , $429.98 , $239.56 , $592.69 , $595.27 , $316.35 , See APC Packaged Rates , See APC Packaged Rates , $412.16 , $412.16 , See APC Packaged Rates , See APC Packaged Rates , $571.25 , $571.25 , $571.25 , $571.25 , See APC Packaged Rates , $214.99 , $368.55 , $214.99 , $595.27 , $429.98
A4649,61513773,Hospital Chargemaster,Sinergy Kit 75M,Outpatient,Outpatient Default Percent / Case Rate,272," $2,027.81 "," $1,115.30 "," $1,670.92 ", See APC Packaged Rates ," $1,419.47 ", $790.85 ," $1,956.63 "," $1,965.15 "," $1,044.36 ", See APC Packaged Rates , See APC Packaged Rates ," $1,360.66 "," $1,360.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,885.86 "," $1,885.86 "," $1,885.86 "," $1,885.86 ", See APC Packaged Rates , $709.73 , $- , $- ," $1,965.15 "," $1,419.47 "
A4649,61513774,Hospital Chargemaster,Lumbarcool Kit 100M,Outpatient,Outpatient Default Percent / Case Rate,272," $2,027.81 "," $1,115.30 "," $1,670.92 ", See APC Packaged Rates ," $1,419.47 ", $790.85 ," $1,956.63 "," $1,965.15 "," $1,044.36 ", See APC Packaged Rates , See APC Packaged Rates ," $1,360.66 "," $1,360.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,885.86 "," $1,885.86 "," $1,885.86 "," $1,885.86 ", See APC Packaged Rates , $709.73 , $- , $- ," $1,965.15 "," $1,419.47 "
,61513819,Hospital Chargemaster,Cervical Kit,Outpatient,Outpatient Default Percent / Case Rate,272," $2,027.81 "," $1,115.30 "," $1,622.25 ", See APC Packaged Rates ," $1,419.47 ", $790.85 ," $1,956.63 "," $1,965.15 "," $1,044.36 ", See APC Packaged Rates , See APC Packaged Rates ," $1,360.66 "," $1,360.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,885.86 "," $1,885.86 "," $1,885.86 "," $1,885.86 ", See APC Packaged Rates , $709.73 ," $1,216.69 ", $709.73 ," $1,965.15 "," $1,419.47 "
,61513820,Hospital Chargemaster,Suture Passing Wire,Outpatient,Outpatient Default Percent / Case Rate,272, $236.25 , $129.94 , $189.00 , See APC Packaged Rates , $165.38 , $92.14 , $227.96 , $228.95 , $121.67 , See APC Packaged Rates , See APC Packaged Rates , $158.52 , $158.52 , See APC Packaged Rates , See APC Packaged Rates , $219.71 , $219.71 , $219.71 , $219.71 , See APC Packaged Rates , $82.69 , $141.75 , $82.69 , $228.95 , $165.38
,61513821,Hospital Chargemaster,Implant Delivery System,Outpatient,Outpatient Default Percent / Case Rate,272," $2,677.50 "," $1,472.63 "," $2,142.00 ", See APC Packaged Rates ," $1,874.25 "," $1,044.23 "," $2,583.52 "," $2,594.77 "," $1,378.97 ", See APC Packaged Rates , See APC Packaged Rates ," $1,796.60 "," $1,796.60 ", See APC Packaged Rates , See APC Packaged Rates ," $2,490.08 "," $2,490.08 "," $2,490.08 "," $2,490.08 ", See APC Packaged Rates , $937.13 ," $1,606.50 ", $937.13 ," $2,594.77 "," $1,874.25 "
,61513853,Hospital Chargemaster,Fiber Link,Outpatient,Outpatient Default Percent / Case Rate,272, $173.25 , $95.29 , $138.60 , See APC Packaged Rates , $121.28 , $67.57 , $167.17 , $167.90 , $89.23 , See APC Packaged Rates , See APC Packaged Rates , $116.25 , $116.25 , See APC Packaged Rates , See APC Packaged Rates , $161.12 , $161.12 , $161.12 , $161.12 , See APC Packaged Rates , $60.64 , $103.95 , $60.64 , $167.90 , $121.28
,61513950,Hospital Chargemaster,Acl Disposable Kit,Outpatient,Outpatient Default Percent / Case Rate,272, $456.75 , $251.21 , $365.40 , See APC Packaged Rates , $319.73 , $178.13 , $440.72 , $442.64 , $235.24 , See APC Packaged Rates , See APC Packaged Rates , $306.48 , $306.48 , See APC Packaged Rates , See APC Packaged Rates , $424.78 , $424.78 , $424.78 , $424.78 , See APC Packaged Rates , $159.86 , $274.05 , $159.86 , $442.64 , $319.73
,61514034,Hospital Chargemaster,Staple Reload 75,Outpatient,Outpatient Default Percent / Case Rate,272, $269.84 , $148.41 , $215.87 , See APC Packaged Rates , $188.89 , $105.24 , $260.37 , $261.50 , $138.97 , See APC Packaged Rates , See APC Packaged Rates , $181.06 , $181.06 , See APC Packaged Rates , See APC Packaged Rates , $250.95 , $250.95 , $250.95 , $250.95 , See APC Packaged Rates , $94.44 , $161.90 , $94.44 , $261.50 , $188.89
C1897,61514059,Hospital Chargemaster,Linear St 8 Contact TrialLead,Outpatient,Outpatient Default Percent / Case Rate,272, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514071,Hospital Chargemaster,"Blade Saw 0.050"" X 1.27Mm",Outpatient,Outpatient Default Percent / Case Rate,272, $166.98 , $91.84 , $133.58 , See APC Packaged Rates , $116.89 , $65.12 , $161.12 , $161.82 , $86.00 , See APC Packaged Rates , See APC Packaged Rates , $112.04 , $112.04 , See APC Packaged Rates , See APC Packaged Rates , $155.29 , $155.29 , $155.29 , $155.29 , See APC Packaged Rates , $58.44 , $100.19 , $58.44 , $161.82 , $116.89
,61514141,Hospital Chargemaster,Sonicision 39Cm,Outpatient,Outpatient Default Percent / Case Rate,272," $1,071.00 ", $589.05 , $856.80 , See APC Packaged Rates , $749.70 , $417.69 ," $1,033.41 "," $1,037.91 ", $551.59 , See APC Packaged Rates , See APC Packaged Rates , $718.64 , $718.64 , See APC Packaged Rates , See APC Packaged Rates , $996.03 , $996.03 , $996.03 , $996.03 , See APC Packaged Rates , $374.85 , $642.60 , $374.85 ," $1,037.91 ", $749.70
,61514180,Hospital Chargemaster,Loop Large 30 Degree Bipolar,Outpatient,Outpatient Default Percent / Case Rate,272," $1,383.63 ", $761.00 ," $1,106.90 ", See APC Packaged Rates , $968.54 , $539.62 ," $1,335.06 "," $1,340.88 ", $712.60 , See APC Packaged Rates , See APC Packaged Rates , $928.42 , $928.42 , See APC Packaged Rates , See APC Packaged Rates ," $1,286.78 "," $1,286.78 "," $1,286.78 "," $1,286.78 ", See APC Packaged Rates , $484.27 , $830.18 , $484.27 ," $1,340.88 ", $968.54
,61514181,Hospital Chargemaster,Loop Hf Resection 30Deg Mono,Outpatient,Outpatient Default Percent / Case Rate,272, $272.25 , $149.74 , $217.80 , See APC Packaged Rates , $190.58 , $106.18 , $262.69 , $263.84 , $140.21 , See APC Packaged Rates , See APC Packaged Rates , $182.68 , $182.68 , See APC Packaged Rates , See APC Packaged Rates , $253.19 , $253.19 , $253.19 , $253.19 , See APC Packaged Rates , $95.29 , $163.35 , $95.29 , $263.84 , $190.58
,61514182,Hospital Chargemaster,Roller Ball Monopolr,Outpatient,Outpatient Default Percent / Case Rate,272, $270.15 , $148.58 , $216.12 , See APC Packaged Rates , $189.11 , $105.36 , $260.67 , $261.80 , $139.13 , See APC Packaged Rates , See APC Packaged Rates , $181.27 , $181.27 , See APC Packaged Rates , See APC Packaged Rates , $251.24 , $251.24 , $251.24 , $251.24 , See APC Packaged Rates , $94.55 , $162.09 , $94.55 , $261.80 , $189.11
,61514183,Hospital Chargemaster,Loop Hf Resection 28F Mono 30,Outpatient,Outpatient Default Percent / Case Rate,272, $272.25 , $149.74 , $217.80 , See APC Packaged Rates , $190.58 , $106.18 , $262.69 , $263.84 , $140.21 , See APC Packaged Rates , See APC Packaged Rates , $182.68 , $182.68 , See APC Packaged Rates , See APC Packaged Rates , $253.19 , $253.19 , $253.19 , $253.19 , See APC Packaged Rates , $95.29 , $163.35 , $95.29 , $263.84 , $190.58
,61514305,Hospital Chargemaster,Cutter Linear Reload 45Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $387.19 , $212.95 , $309.75 , See APC Packaged Rates , $271.03 , $151.00 , $373.60 , $375.23 , $199.41 , See APC Packaged Rates , See APC Packaged Rates , $259.80 , $259.80 , See APC Packaged Rates , See APC Packaged Rates , $360.09 , $360.09 , $360.09 , $360.09 , See APC Packaged Rates , $135.52 , $232.31 , $135.52 , $375.23 , $271.03
,61514306,Hospital Chargemaster,Cutter Linear Reload Flex 45M,Outpatient,Outpatient Default Percent / Case Rate,272, $387.19 , $212.95 , $309.75 , See APC Packaged Rates , $271.03 , $151.00 , $373.60 , $375.23 , $199.41 , See APC Packaged Rates , See APC Packaged Rates , $259.80 , $259.80 , See APC Packaged Rates , See APC Packaged Rates , $360.09 , $360.09 , $360.09 , $360.09 , See APC Packaged Rates , $135.52 , $232.31 , $135.52 , $375.23 , $271.03
,61514319,Hospital Chargemaster,Precision Spectra OrCable1X16,Outpatient,Outpatient Default Percent / Case Rate,272, $315.00 , $173.25 , $252.00 , See APC Packaged Rates , $220.50 , $122.85 , $303.94 , $305.27 , $162.23 , See APC Packaged Rates , See APC Packaged Rates , $211.37 , $211.37 , See APC Packaged Rates , See APC Packaged Rates , $292.95 , $292.95 , $292.95 , $292.95 , See APC Packaged Rates , $110.25 , $189.00 , $110.25 , $305.27 , $220.50
,61514324,Hospital Chargemaster,Gelport Laparoscopic System,Outpatient,Outpatient Default Percent / Case Rate,272," $2,047.50 "," $1,126.13 "," $1,638.00 ", See APC Packaged Rates ," $1,433.25 ", $798.53 ," $1,975.63 "," $1,984.23 "," $1,054.50 ", See APC Packaged Rates , See APC Packaged Rates ," $1,373.87 "," $1,373.87 ", See APC Packaged Rates , See APC Packaged Rates ," $1,904.18 "," $1,904.18 "," $1,904.18 "," $1,904.18 ", See APC Packaged Rates , $716.63 ," $1,228.50 ", $716.63 ," $1,984.23 "," $1,433.25 "
,61514333,Hospital Chargemaster,Retractor Ring Rigid Large,Outpatient,Outpatient Default Percent / Case Rate,272, $173.25 , $95.29 , $138.60 , See APC Packaged Rates , $121.28 , $67.57 , $167.17 , $167.90 , $89.23 , See APC Packaged Rates , See APC Packaged Rates , $116.25 , $116.25 , See APC Packaged Rates , See APC Packaged Rates , $161.12 , $161.12 , $161.12 , $161.12 , See APC Packaged Rates , $60.64 , $103.95 , $60.64 , $167.90 , $121.28
,61514334,Hospital Chargemaster,Retractor Ring Rigid Xlarge,Outpatient,Outpatient Default Percent / Case Rate,272, $217.35 , $119.54 , $173.88 , See APC Packaged Rates , $152.15 , $84.77 , $209.72 , $210.63 , $111.94 , See APC Packaged Rates , See APC Packaged Rates , $145.84 , $145.84 , See APC Packaged Rates , See APC Packaged Rates , $202.14 , $202.14 , $202.14 , $202.14 , See APC Packaged Rates , $76.07 , $130.41 , $76.07 , $210.63 , $152.15
,61514336,Hospital Chargemaster,Retractor Ring Flexible Med,Outpatient,Outpatient Default Percent / Case Rate,272, $36.00 , $19.80 , $28.80 , See APC Packaged Rates , $25.20 , $14.04 , $34.74 , $34.89 , $18.54 , See APC Packaged Rates , See APC Packaged Rates , $24.16 , $24.16 , See APC Packaged Rates , See APC Packaged Rates , $33.48 , $33.48 , $33.48 , $33.48 , See APC Packaged Rates , $12.60 , $21.60 , $12.60 , $34.89 , $25.20
C1788,61514339,Hospital Chargemaster,Power Port 8.0Fr Isp,Outpatient,Outpatient Default Percent / Case Rate,272, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514346,Hospital Chargemaster,Ethicon Securestrap Absorbabl,Outpatient,Outpatient Default Percent / Case Rate,272," $1,740.05 ", $957.03 ," $1,392.04 ", See APC Packaged Rates ," $1,218.04 ", $678.62 ," $1,678.97 "," $1,686.28 ", $896.16 , See APC Packaged Rates , See APC Packaged Rates ," $1,167.57 "," $1,167.57 ", See APC Packaged Rates , See APC Packaged Rates ," $1,618.25 "," $1,618.25 "," $1,618.25 "," $1,618.25 ", See APC Packaged Rates , $609.02 ," $1,044.03 ", $609.02 ," $1,686.28 "," $1,218.04 "
,61514348,Hospital Chargemaster,Stapler Echelon Flex Powered,Outpatient,Outpatient Default Percent / Case Rate,272," $1,075.09 ", $591.30 , $860.07 , See APC Packaged Rates , $752.56 , $419.29 ," $1,037.35 "," $1,041.87 ", $553.69 , See APC Packaged Rates , See APC Packaged Rates , $721.39 , $721.39 , See APC Packaged Rates , See APC Packaged Rates , $999.83 , $999.83 , $999.83 , $999.83 , See APC Packaged Rates , $376.28 , $645.05 , $376.28 ," $1,041.87 ", $752.56
,61514392,Hospital Chargemaster,Echelon 45Mm Reload Grey,Outpatient,Outpatient Default Percent / Case Rate,272, $480.11 , $264.06 , $384.09 , See APC Packaged Rates , $336.08 , $187.24 , $463.26 , $465.27 , $247.27 , See APC Packaged Rates , See APC Packaged Rates , $322.15 , $322.15 , See APC Packaged Rates , See APC Packaged Rates , $446.50 , $446.50 , $446.50 , $446.50 , See APC Packaged Rates , $168.04 , $288.07 , $168.04 , $465.27 , $336.08
,61514393,Hospital Chargemaster,Echelon 45Mm Reload Gold,Outpatient,Outpatient Default Percent / Case Rate,272, $556.93 , $306.31 , $445.54 , See APC Packaged Rates , $389.85 , $217.20 , $537.38 , $539.72 , $286.83 , See APC Packaged Rates , See APC Packaged Rates , $373.70 , $373.70 , See APC Packaged Rates , See APC Packaged Rates , $517.94 , $517.94 , $517.94 , $517.94 , See APC Packaged Rates , $194.93 , $334.16 , $194.93 , $539.72 , $389.85
,61514407,Hospital Chargemaster,Echelon Flex Power 60Mm 440M,Outpatient,Outpatient Default Percent / Case Rate,272," $1,294.55 ", $712.00 ," $1,035.64 ", See APC Packaged Rates , $906.19 , $504.87 ," $1,249.11 "," $1,254.55 ", $666.72 , See APC Packaged Rates , See APC Packaged Rates , $868.64 , $868.64 , See APC Packaged Rates , See APC Packaged Rates ," $1,203.93 "," $1,203.93 "," $1,203.93 "," $1,203.93 ", See APC Packaged Rates , $453.09 , $776.73 , $453.09 ," $1,254.55 ", $906.19
,61514409,Hospital Chargemaster,Reload 60Mm Gold,Outpatient,Outpatient Default Percent / Case Rate,272, $618.16 , $339.99 , $494.53 , See APC Packaged Rates , $432.71 , $241.08 , $596.46 , $599.06 , $318.36 , See APC Packaged Rates , See APC Packaged Rates , $414.79 , $414.79 , See APC Packaged Rates , See APC Packaged Rates , $574.89 , $574.89 , $574.89 , $574.89 , See APC Packaged Rates , $216.36 , $370.90 , $216.36 , $599.06 , $432.71
,61514412,Hospital Chargemaster,Cath Taut 7.5 Fr 2.5 Cm,Outpatient,Outpatient Default Percent / Case Rate,272," $1,575.00 ", $866.25 ," $1,260.00 ", See APC Packaged Rates ," $1,102.50 ", $614.25 ," $1,519.72 "," $1,526.33 ", $811.16 , See APC Packaged Rates , See APC Packaged Rates ," $1,056.83 "," $1,056.83 ", See APC Packaged Rates , See APC Packaged Rates ," $1,464.75 "," $1,464.75 "," $1,464.75 "," $1,464.75 ", See APC Packaged Rates , $551.25 , $945.00 , $551.25 ," $1,526.33 "," $1,102.50 "
,61514418,Hospital Chargemaster,Purstring 65,Outpatient,Outpatient Default Percent / Case Rate,272, $507.31 , $279.02 , $405.85 , See APC Packaged Rates , $355.12 , $197.85 , $489.50 , $491.63 , $261.27 , See APC Packaged Rates , See APC Packaged Rates , $340.41 , $340.41 , See APC Packaged Rates , See APC Packaged Rates , $471.80 , $471.80 , $471.80 , $471.80 , See APC Packaged Rates , $177.56 , $304.39 , $177.56 , $491.63 , $355.12
,61514419,Hospital Chargemaster,Echelon 60 Reloads,Outpatient,Outpatient Default Percent / Case Rate,272, $619.50 , $340.73 , $495.60 , See APC Packaged Rates , $433.65 , $241.61 , $597.76 , $600.36 , $319.05 , See APC Packaged Rates , See APC Packaged Rates , $415.68 , $415.68 , See APC Packaged Rates , See APC Packaged Rates , $576.14 , $576.14 , $576.14 , $576.14 , See APC Packaged Rates , $216.83 , $371.70 , $216.83 , $600.36 , $433.65
,61514424,Hospital Chargemaster,Proximate 75 Reload,Outpatient,Outpatient Default Percent / Case Rate,272, $218.85 , $120.37 , $175.08 , See APC Packaged Rates , $153.20 , $85.35 , $211.17 , $212.09 , $112.71 , See APC Packaged Rates , See APC Packaged Rates , $146.85 , $146.85 , See APC Packaged Rates , See APC Packaged Rates , $203.53 , $203.53 , $203.53 , $203.53 , See APC Packaged Rates , $76.60 , $131.31 , $76.60 , $212.09 , $153.20
,61514428,Hospital Chargemaster,Seamguard Synthetic Graft,Outpatient,Outpatient Default Percent / Case Rate,272, $552.04 , $303.62 , $441.63 , See APC Packaged Rates , $386.43 , $215.30 , $532.66 , $534.98 , $284.31 , See APC Packaged Rates , See APC Packaged Rates , $370.42 , $370.42 , See APC Packaged Rates , See APC Packaged Rates , $513.40 , $513.40 , $513.40 , $513.40 , See APC Packaged Rates , $193.21 , $331.22 , $193.21 , $534.98 , $386.43
,61514465,Hospital Chargemaster,Bariatric Harmonic,Outpatient,Outpatient Default Percent / Case Rate,272," $2,975.98 "," $1,636.79 "," $2,380.78 ", See APC Packaged Rates ," $2,083.19 "," $1,160.63 "," $2,871.52 "," $2,884.02 "," $1,532.69 ", See APC Packaged Rates , See APC Packaged Rates ," $1,996.88 "," $1,996.88 ", See APC Packaged Rates , See APC Packaged Rates ," $2,767.66 "," $2,767.66 "," $2,767.66 "," $2,767.66 ", See APC Packaged Rates ," $1,041.59 "," $1,785.59 "," $1,041.59 "," $2,884.02 "," $2,083.19 "
,61514483,Hospital Chargemaster,Gelpoint Adv Access Platform,Outpatient,Outpatient Default Percent / Case Rate,272," $2,126.25 "," $1,169.44 "," $1,701.00 ", See APC Packaged Rates ," $1,488.38 ", $829.24 ," $2,051.62 "," $2,060.55 "," $1,095.06 ", See APC Packaged Rates , See APC Packaged Rates ," $1,426.71 "," $1,426.71 ", See APC Packaged Rates , See APC Packaged Rates ," $1,977.41 "," $1,977.41 "," $1,977.41 "," $1,977.41 ", See APC Packaged Rates , $744.19 ," $1,275.75 ", $744.19 ," $2,060.55 "," $1,488.38 "
,61514500,Hospital Chargemaster,Polaris Stent 7 X 24,Outpatient,Outpatient Default Percent / Case Rate,272, $169.96 , $93.48 , $135.97 , See APC Packaged Rates , $118.97 , $66.28 , $163.99 , $164.71 , $87.53 , See APC Packaged Rates , See APC Packaged Rates , $114.04 , $114.04 , See APC Packaged Rates , See APC Packaged Rates , $158.06 , $158.06 , $158.06 , $158.06 , See APC Packaged Rates , $59.49 , $101.98 , $59.49 , $164.71 , $118.97
,61514501,Hospital Chargemaster,Polaris Stent 7 X 26,Outpatient,Outpatient Default Percent / Case Rate,272, $171.96 , $94.58 , $137.57 , See APC Packaged Rates , $120.37 , $67.06 , $165.92 , $166.65 , $88.56 , See APC Packaged Rates , See APC Packaged Rates , $115.39 , $115.39 , See APC Packaged Rates , See APC Packaged Rates , $159.92 , $159.92 , $159.92 , $159.92 , See APC Packaged Rates , $60.19 , $103.18 , $60.19 , $166.65 , $120.37
,61514502,Hospital Chargemaster,Polarix Stent 7 X 28,Outpatient,Outpatient Default Percent / Case Rate,272, $170.29 , $93.66 , $136.23 , See APC Packaged Rates , $119.20 , $66.41 , $164.31 , $165.03 , $87.70 , See APC Packaged Rates , See APC Packaged Rates , $114.26 , $114.26 , See APC Packaged Rates , See APC Packaged Rates , $158.37 , $158.37 , $158.37 , $158.37 , See APC Packaged Rates , $59.60 , $102.17 , $59.60 , $165.03 , $119.20
,61514506,Hospital Chargemaster,Ligasure,Outpatient,Outpatient Default Percent / Case Rate,272," $1,563.60 ", $859.98 ," $1,250.88 ", See APC Packaged Rates ," $1,094.52 ", $609.80 ," $1,508.72 "," $1,515.28 ", $805.29 , See APC Packaged Rates , See APC Packaged Rates ," $1,049.18 "," $1,049.18 ", See APC Packaged Rates , See APC Packaged Rates ," $1,454.15 "," $1,454.15 "," $1,454.15 "," $1,454.15 ", See APC Packaged Rates , $547.26 , $938.16 , $547.26 ," $1,515.28 "," $1,094.52 "
,61514538,Hospital Chargemaster,Kugasyre L-Hook Inst?,Outpatient,Outpatient Default Percent / Case Rate,272," $2,004.98 "," $1,102.74 "," $1,603.98 ", See APC Packaged Rates ," $1,403.49 ", $781.94 ," $1,934.61 "," $1,943.03 "," $1,032.60 ", See APC Packaged Rates , See APC Packaged Rates ," $1,345.34 "," $1,345.34 ", See APC Packaged Rates , See APC Packaged Rates ," $1,864.63 "," $1,864.63 "," $1,864.63 "," $1,864.63 ", See APC Packaged Rates , $701.74 ," $1,202.99 ", $701.74 ," $1,943.03 "," $1,403.49 "
,61514539,Hospital Chargemaster,Ligasure Impact,Outpatient,Outpatient Default Percent / Case Rate,272," $1,945.13 "," $1,069.82 "," $1,556.10 ", See APC Packaged Rates ," $1,361.59 ", $758.60 ," $1,876.86 "," $1,885.03 "," $1,001.78 ", See APC Packaged Rates , See APC Packaged Rates ," $1,305.18 "," $1,305.18 ", See APC Packaged Rates , See APC Packaged Rates ," $1,808.97 "," $1,808.97 "," $1,808.97 "," $1,808.97 ", See APC Packaged Rates , $680.80 ," $1,167.08 ", $680.80 ," $1,885.03 "," $1,361.59 "
,61514578,Hospital Chargemaster,Needle Insert 17 Cm,Outpatient,Outpatient Default Percent / Case Rate,272, $315.00 , $173.25 , $252.00 , See APC Packaged Rates , $220.50 , $122.85 , $303.94 , $305.27 , $162.23 , See APC Packaged Rates , See APC Packaged Rates , $211.37 , $211.37 , See APC Packaged Rates , See APC Packaged Rates , $292.95 , $292.95 , $292.95 , $292.95 , See APC Packaged Rates , $110.25 , $189.00 , $110.25 , $305.27 , $220.50
,61514585,Hospital Chargemaster,K-Wire .054 Length 9,Outpatient,Outpatient Default Percent / Case Rate,272, $13.80 , $7.59 , $11.04 , See APC Packaged Rates , $9.66 , $5.38 , $13.32 , $13.37 , $7.11 , See APC Packaged Rates , See APC Packaged Rates , $9.26 , $9.26 , See APC Packaged Rates , See APC Packaged Rates , $12.83 , $12.83 , $12.83 , $12.83 , See APC Packaged Rates , $4.83 , $8.28 , $4.83 , $13.37 , $9.66
,61514590,Hospital Chargemaster,Vapor Coolpulse 90,Outpatient,Outpatient Default Percent / Case Rate,272, $472.50 , $259.88 , $378.00 , See APC Packaged Rates , $330.75 , $184.28 , $455.92 , $457.90 , $243.35 , See APC Packaged Rates , See APC Packaged Rates , $317.05 , $317.05 , See APC Packaged Rates , See APC Packaged Rates , $439.43 , $439.43 , $439.43 , $439.43 , See APC Packaged Rates , $165.38 , $283.50 , $165.38 , $457.90 , $330.75
,61514601,Hospital Chargemaster,Speedtrap White,Outpatient,Outpatient Default Percent / Case Rate,272, $236.25 , $129.94 , $189.00 , See APC Packaged Rates , $165.38 , $92.14 , $227.96 , $228.95 , $121.67 , See APC Packaged Rates , See APC Packaged Rates , $158.52 , $158.52 , See APC Packaged Rates , See APC Packaged Rates , $219.71 , $219.71 , $219.71 , $219.71 , See APC Packaged Rates , $82.69 , $141.75 , $82.69 , $228.95 , $165.38
C1713,61514615,Hospital Chargemaster,Drill Bit Peripheral Screw,Outpatient,Outpatient Default Percent / Case Rate,272, $308.07 , $169.44 , $253.85 , See APC Packaged Rates , $215.65 , $120.15 , $297.26 , $298.55 , $158.66 , See APC Packaged Rates , See APC Packaged Rates , $206.71 , $206.71 , See APC Packaged Rates , See APC Packaged Rates , $286.51 , $286.51 , $286.51 , $286.51 , See APC Packaged Rates , $107.82 , $- , $- , $298.55 , $215.65
,61514624,Hospital Chargemaster,Trimano Beach Kit,Outpatient,Outpatient Default Percent / Case Rate,272, $230.58 , $126.82 , $184.46 , See APC Packaged Rates , $161.41 , $89.93 , $222.49 , $223.46 , $118.75 , See APC Packaged Rates , See APC Packaged Rates , $154.72 , $154.72 , See APC Packaged Rates , See APC Packaged Rates , $214.44 , $214.44 , $214.44 , $214.44 , See APC Packaged Rates , $80.70 , $138.35 , $80.70 , $223.46 , $161.41
,61514651,Hospital Chargemaster,Rigidloop Disposable,Outpatient,Outpatient Default Percent / Case Rate,272, $787.50 , $433.13 , $630.00 , See APC Packaged Rates , $551.25 , $307.13 , $759.86 , $763.17 , $405.58 , See APC Packaged Rates , See APC Packaged Rates , $528.41 , $528.41 , See APC Packaged Rates , See APC Packaged Rates , $732.38 , $732.38 , $732.38 , $732.38 , See APC Packaged Rates , $275.63 , $472.50 , $275.63 , $763.17 , $551.25
,61514727,Hospital Chargemaster,Sheath Prosis Ureteral Access,Outpatient,Outpatient Default Percent / Case Rate,272, $291.06 , $160.08 , $232.85 , See APC Packaged Rates , $203.74 , $113.51 , $280.84 , $282.07 , $149.90 , See APC Packaged Rates , See APC Packaged Rates , $195.30 , $195.30 , See APC Packaged Rates , See APC Packaged Rates , $270.69 , $270.69 , $270.69 , $270.69 , See APC Packaged Rates , $101.87 , $174.64 , $101.87 , $282.07 , $203.74
,61514737,Hospital Chargemaster,Sheath Proxis Ureteral Access,Outpatient,Outpatient Default Percent / Case Rate,272, $363.83 , $200.11 , $291.06 , See APC Packaged Rates , $254.68 , $141.89 , $351.06 , $352.59 , $187.38 , See APC Packaged Rates , See APC Packaged Rates , $244.13 , $244.13 , See APC Packaged Rates , See APC Packaged Rates , $338.36 , $338.36 , $338.36 , $338.36 , See APC Packaged Rates , $127.34 , $218.30 , $127.34 , $352.59 , $254.68
,61514738,Hospital Chargemaster,Sheath Proxis Ureteral Access,Outpatient,Outpatient Default Percent / Case Rate,272, $363.83 , $200.11 , $291.06 , See APC Packaged Rates , $254.68 , $141.89 , $351.06 , $352.59 , $187.38 , See APC Packaged Rates , See APC Packaged Rates , $244.13 , $244.13 , See APC Packaged Rates , See APC Packaged Rates , $338.36 , $338.36 , $338.36 , $338.36 , See APC Packaged Rates , $127.34 , $218.30 , $127.34 , $352.59 , $254.68
,61514769,Hospital Chargemaster,Wavewriter Patient Trial Kit,Outpatient,Outpatient Default Percent / Case Rate,272, $157.50 , $86.63 , $126.00 , See APC Packaged Rates , $110.25 , $61.43 , $151.97 , $152.63 , $81.12 , See APC Packaged Rates , See APC Packaged Rates , $105.68 , $105.68 , See APC Packaged Rates , See APC Packaged Rates , $146.48 , $146.48 , $146.48 , $146.48 , See APC Packaged Rates , $55.13 , $94.50 , $55.13 , $152.63 , $110.25
,61514836,Hospital Chargemaster,Perfix Plug Sml,Outpatient,Outpatient Default Percent / Case Rate,272, $427.93 , $235.36 , $342.34 , See APC Packaged Rates , $299.55 , $166.89 , $412.91 , $414.71 , $220.39 , See APC Packaged Rates , See APC Packaged Rates , $287.14 , $287.14 , See APC Packaged Rates , See APC Packaged Rates , $397.97 , $397.97 , $397.97 , $397.97 , See APC Packaged Rates , $149.78 , $256.76 , $149.78 , $414.71 , $299.55
,61514850,Hospital Chargemaster,Ideal Suture Shuttle 90 Degre,Outpatient,Outpatient Default Percent / Case Rate,272, $441.00 , $242.55 , $352.80 , See APC Packaged Rates , $308.70 , $171.99 , $425.52 , $427.37 , $227.12 , See APC Packaged Rates , See APC Packaged Rates , $295.91 , $295.91 , See APC Packaged Rates , See APC Packaged Rates , $410.13 , $410.13 , $410.13 , $410.13 , See APC Packaged Rates , $154.35 , $264.60 , $154.35 , $427.37 , $308.70
,61514852,Hospital Chargemaster,Wire Chia For Suture Shuttle,Outpatient,Outpatient Default Percent / Case Rate,272, $315.00 , $173.25 , $252.00 , See APC Packaged Rates , $220.50 , $122.85 , $303.94 , $305.27 , $162.23 , See APC Packaged Rates , See APC Packaged Rates , $211.37 , $211.37 , See APC Packaged Rates , See APC Packaged Rates , $292.95 , $292.95 , $292.95 , $292.95 , See APC Packaged Rates , $110.25 , $189.00 , $110.25 , $305.27 , $220.50
,61514853,Hospital Chargemaster,Alexis 0 C-Section Retractor,Outpatient,Outpatient Default Percent / Case Rate,272, $217.35 , $119.54 , $173.88 , See APC Packaged Rates , $152.15 , $84.77 , $209.72 , $210.63 , $111.94 , See APC Packaged Rates , See APC Packaged Rates , $145.84 , $145.84 , See APC Packaged Rates , See APC Packaged Rates , $202.14 , $202.14 , $202.14 , $202.14 , See APC Packaged Rates , $76.07 , $130.41 , $76.07 , $210.63 , $152.15
,61514854,Hospital Chargemaster,Specimen Pouch 1500Ml,Outpatient,Outpatient Default Percent / Case Rate,272, $170.10 , $93.56 , $136.08 , See APC Packaged Rates , $119.07 , $66.34 , $164.13 , $164.84 , $87.60 , See APC Packaged Rates , See APC Packaged Rates , $114.14 , $114.14 , See APC Packaged Rates , See APC Packaged Rates , $158.19 , $158.19 , $158.19 , $158.19 , See APC Packaged Rates , $59.54 , $102.06 , $59.54 , $164.84 , $119.07
,61514906,Hospital Chargemaster,Multifire Scorpion Needle,Outpatient,Outpatient Default Percent / Case Rate,272, $220.50 , $121.28 , $176.40 , See APC Packaged Rates , $154.35 , $86.00 , $212.76 , $213.69 , $113.56 , See APC Packaged Rates , See APC Packaged Rates , $147.96 , $147.96 , See APC Packaged Rates , See APC Packaged Rates , $205.07 , $205.07 , $205.07 , $205.07 , See APC Packaged Rates , $77.18 , $132.30 , $77.18 , $213.69 , $154.35
C1713,61514951,Hospital Chargemaster,"Epimed Rx Coude Needle 6""",Outpatient,Outpatient Default Percent / Case Rate,272, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61515067,Hospital Chargemaster,Roth Net Food Bolus Retriver,Outpatient,Outpatient Default Percent / Case Rate,272, $330.75 , $181.91 , $264.60 , See APC Packaged Rates , $231.53 , $128.99 , $319.14 , $320.53 , $170.34 , See APC Packaged Rates , See APC Packaged Rates , $221.93 , $221.93 , See APC Packaged Rates , See APC Packaged Rates , $307.60 , $307.60 , $307.60 , $307.60 , See APC Packaged Rates , $115.76 , $198.45 , $115.76 , $320.53 , $231.53
,61515114,Hospital Chargemaster,Resolution Clip 360,Outpatient,Outpatient Default Percent / Case Rate,272, $626.85 , $344.77 , $501.48 , See APC Packaged Rates , $438.80 , $244.47 , $604.85 , $607.48 , $322.84 , See APC Packaged Rates , See APC Packaged Rates , $420.62 , $420.62 , See APC Packaged Rates , See APC Packaged Rates , $582.97 , $582.97 , $582.97 , $582.97 , See APC Packaged Rates , $219.40 , $376.11 , $219.40 , $607.48 , $438.80
,61515145,Hospital Chargemaster,Drill Bit Ao 2.0Mmx165M Scale,Outpatient,Outpatient Default Percent / Case Rate,272, $290.12 , $159.57 , $232.10 , See APC Packaged Rates , $203.08 , $113.15 , $279.94 , $281.16 , $149.42 , See APC Packaged Rates , See APC Packaged Rates , $194.67 , $194.67 , See APC Packaged Rates , See APC Packaged Rates , $269.81 , $269.81 , $269.81 , $269.81 , See APC Packaged Rates , $101.54 , $174.07 , $101.54 , $281.16 , $203.08
,61515146,Hospital Chargemaster,Drill Bit Ao 2.6Mx135M Scaled,Outpatient,Outpatient Default Percent / Case Rate,272, $290.12 , $159.57 , $232.10 , See APC Packaged Rates , $203.08 , $113.15 , $279.94 , $281.16 , $149.42 , See APC Packaged Rates , See APC Packaged Rates , $194.67 , $194.67 , See APC Packaged Rates , See APC Packaged Rates , $269.81 , $269.81 , $269.81 , $269.81 , See APC Packaged Rates , $101.54 , $174.07 , $101.54 , $281.16 , $203.08
,61515178,Hospital Chargemaster,Drill Twist W/Ao F Cann 2.7Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $571.73 , $314.45 , $457.38 , See APC Packaged Rates , $400.21 , $222.97 , $551.66 , $554.06 , $294.45 , See APC Packaged Rates , See APC Packaged Rates , $383.63 , $383.63 , See APC Packaged Rates , See APC Packaged Rates , $531.71 , $531.71 , $531.71 , $531.71 , See APC Packaged Rates , $200.11 , $343.04 , $200.11 , $554.06 , $400.21
,61515206,Hospital Chargemaster,Drill Bit NonLock A 2.5X216M,Outpatient,Outpatient Default Percent / Case Rate,272, $472.50 , $259.88 , $378.00 , See APC Packaged Rates , $330.75 , $184.28 , $455.92 , $457.90 , $243.35 , See APC Packaged Rates , See APC Packaged Rates , $317.05 , $317.05 , See APC Packaged Rates , See APC Packaged Rates , $439.43 , $439.43 , $439.43 , $439.43 , See APC Packaged Rates , $165.38 , $283.50 , $165.38 , $457.90 , $330.75
,61515221,Hospital Chargemaster,Drill Bit Locking Short,Outpatient,Outpatient Default Percent / Case Rate,272, $465.89 , $256.24 , $372.71 , See APC Packaged Rates , $326.12 , $181.70 , $449.54 , $451.49 , $239.94 , See APC Packaged Rates , See APC Packaged Rates , $312.61 , $312.61 , See APC Packaged Rates , See APC Packaged Rates , $433.28 , $433.28 , $433.28 , $433.28 , See APC Packaged Rates , $163.06 , $279.53 , $163.06 , $451.49 , $326.12
,61515230,Hospital Chargemaster,"Overdrill Ao, Dia 2.7Mmx122M",Outpatient,Outpatient Default Percent / Case Rate,272, $290.12 , $159.57 , $232.10 , See APC Packaged Rates , $203.08 , $113.15 , $279.94 , $281.16 , $149.42 , See APC Packaged Rates , See APC Packaged Rates , $194.67 , $194.67 , See APC Packaged Rates , See APC Packaged Rates , $269.81 , $269.81 , $269.81 , $269.81 , See APC Packaged Rates , $101.54 , $174.07 , $101.54 , $281.16 , $203.08
,61515234,Hospital Chargemaster,KWire Non-Threaded 2.5mm,Outpatient,Outpatient Default Percent / Case Rate,272, $66.15 , $36.38 , $52.92 , See APC Packaged Rates , $46.31 , $25.80 , $63.83 , $64.11 , $34.07 , See APC Packaged Rates , See APC Packaged Rates , $44.39 , $44.39 , See APC Packaged Rates , See APC Packaged Rates , $61.52 , $61.52 , $61.52 , $61.52 , See APC Packaged Rates , $23.15 , $39.69 , $23.15 , $64.11 , $46.31
,61515241,Hospital Chargemaster,Guide Wire Threaded 3.2 X300M,Outpatient,Outpatient Default Percent / Case Rate,272, $249.48 , $137.21 , $199.58 , See APC Packaged Rates , $174.64 , $97.30 , $240.72 , $241.77 , $128.49 , See APC Packaged Rates , See APC Packaged Rates , $167.40 , $167.40 , See APC Packaged Rates , See APC Packaged Rates , $232.02 , $232.02 , $232.02 , $232.02 , See APC Packaged Rates , $87.32 , $149.69 , $87.32 , $241.77 , $174.64
,61515242,Hospital Chargemaster,Drill Twist Cannulated 6.5Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $832.55 , $457.90 , $666.04 , See APC Packaged Rates , $582.79 , $324.69 , $803.33 , $806.82 , $428.78 , See APC Packaged Rates , See APC Packaged Rates , $558.64 , $558.64 , See APC Packaged Rates , See APC Packaged Rates , $774.27 , $774.27 , $774.27 , $774.27 , See APC Packaged Rates , $291.39 , $499.53 , $291.39 , $806.82 , $582.79
,61515243,Hospital Chargemaster,Drill Cannulated 5.6Mm Lg Ao,Outpatient,Outpatient Default Percent / Case Rate,272, $832.55 , $457.90 , $666.04 , See APC Packaged Rates , $582.79 , $324.69 , $803.33 , $806.82 , $428.78 , See APC Packaged Rates , See APC Packaged Rates , $558.64 , $558.64 , See APC Packaged Rates , See APC Packaged Rates , $774.27 , $774.27 , $774.27 , $774.27 , See APC Packaged Rates , $291.39 , $499.53 , $291.39 , $806.82 , $582.79
,61515250,Hospital Chargemaster,Unthreaded Guide Wire A 1.4Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $285.39 , $156.96 , $228.31 , See APC Packaged Rates , $199.77 , $111.30 , $275.37 , $276.57 , $146.98 , See APC Packaged Rates , See APC Packaged Rates , $191.50 , $191.50 , See APC Packaged Rates , See APC Packaged Rates , $265.41 , $265.41 , $265.41 , $265.41 , See APC Packaged Rates , $99.89 , $171.23 , $99.89 , $276.57 , $199.77
,61515255,Hospital Chargemaster,Colon Decompression Tube 14Fr,Outpatient,Outpatient Default Percent / Case Rate,272, $459.90 , $252.95 , $367.92 , See APC Packaged Rates , $321.93 , $179.36 , $443.76 , $445.69 , $236.86 , See APC Packaged Rates , See APC Packaged Rates , $308.59 , $308.59 , See APC Packaged Rates , See APC Packaged Rates , $427.71 , $427.71 , $427.71 , $427.71 , See APC Packaged Rates , $160.97 , $275.94 , $160.97 , $445.69 , $321.93
,61515262,Hospital Chargemaster,Drill Bit 3.2Mm/L145Mm Ao,Outpatient,Outpatient Default Percent / Case Rate,272, $337.37 , $185.55 , $269.90 , See APC Packaged Rates , $236.16 , $131.57 , $325.53 , $326.95 , $173.75 , See APC Packaged Rates , See APC Packaged Rates , $226.38 , $226.38 , See APC Packaged Rates , See APC Packaged Rates , $313.75 , $313.75 , $313.75 , $313.75 , See APC Packaged Rates , $118.08 , $202.42 , $118.08 , $326.95 , $236.16
,61515277,Hospital Chargemaster,Coolief Probe Kit 17G 50Mm,Outpatient,Outpatient Default Percent / Case Rate,272," $2,027.81 "," $1,115.30 "," $1,622.25 ", See APC Packaged Rates ," $1,419.47 ", $790.85 ," $1,956.63 "," $1,965.15 "," $1,044.36 ", See APC Packaged Rates , See APC Packaged Rates ," $1,360.66 "," $1,360.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,885.86 "," $1,885.86 "," $1,885.86 "," $1,885.86 ", See APC Packaged Rates , $709.73 ," $1,216.69 ", $709.73 ," $1,965.15 "," $1,419.47 "
,61515300,Hospital Chargemaster,Drill Bit Non Locking Short,Outpatient,Outpatient Default Percent / Case Rate,272, $472.50 , $259.88 , $378.00 , See APC Packaged Rates , $330.75 , $184.28 , $455.92 , $457.90 , $243.35 , See APC Packaged Rates , See APC Packaged Rates , $317.05 , $317.05 , See APC Packaged Rates , See APC Packaged Rates , $439.43 , $439.43 , $439.43 , $439.43 , See APC Packaged Rates , $165.38 , $283.50 , $165.38 , $457.90 , $330.75
,61515301,Hospital Chargemaster,Drill Bit Locking Short,Outpatient,Outpatient Default Percent / Case Rate,272, $465.89 , $256.24 , $372.71 , See APC Packaged Rates , $326.12 , $181.70 , $449.54 , $451.49 , $239.94 , See APC Packaged Rates , See APC Packaged Rates , $312.61 , $312.61 , See APC Packaged Rates , See APC Packaged Rates , $433.28 , $433.28 , $433.28 , $433.28 , See APC Packaged Rates , $163.06 , $279.53 , $163.06 , $451.49 , $326.12
,61515312,Hospital Chargemaster,Drill Bit Cannulated 2.6Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $509.36 , $280.15 , $407.49 , See APC Packaged Rates , $356.55 , $198.65 , $491.48 , $493.62 , $262.33 , See APC Packaged Rates , See APC Packaged Rates , $341.78 , $341.78 , See APC Packaged Rates , See APC Packaged Rates , $473.70 , $473.70 , $473.70 , $473.70 , See APC Packaged Rates , $178.28 , $305.62 , $178.28 , $493.62 , $356.55
,61515327,Hospital Chargemaster,Overdrill Ao Dia 3.5Mm X122M,Outpatient,Outpatient Default Percent / Case Rate,272, $290.12 , $159.57 , $232.10 , See APC Packaged Rates , $203.08 , $113.15 , $279.94 , $281.16 , $149.42 , See APC Packaged Rates , See APC Packaged Rates , $194.67 , $194.67 , See APC Packaged Rates , See APC Packaged Rates , $269.81 , $269.81 , $269.81 , $269.81 , See APC Packaged Rates , $101.54 , $174.07 , $101.54 , $281.16 , $203.08
,61515336,Hospital Chargemaster,Trocar 5Mm X 100Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $391.16 , $215.14 , $312.93 , See APC Packaged Rates , $273.81 , $152.55 , $377.43 , $379.07 , $201.46 , See APC Packaged Rates , See APC Packaged Rates , $262.47 , $262.47 , See APC Packaged Rates , See APC Packaged Rates , $363.78 , $363.78 , $363.78 , $363.78 , See APC Packaged Rates , $136.91 , $234.70 , $136.91 , $379.07 , $273.81
,61515337,Hospital Chargemaster,Trocar 12Mm X 100Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $517.71 , $284.74 , $414.17 , See APC Packaged Rates , $362.40 , $201.91 , $499.54 , $501.71 , $266.63 , See APC Packaged Rates , See APC Packaged Rates , $347.38 , $347.38 , See APC Packaged Rates , See APC Packaged Rates , $481.47 , $481.47 , $481.47 , $481.47 , See APC Packaged Rates , $181.20 , $310.63 , $181.20 , $501.71 , $362.40
,61515361,Hospital Chargemaster,Washer T8 & T10 Screws 2.4Mm/,Outpatient,Outpatient Default Percent / Case Rate,272, $24.14 , $13.28 , $19.31 , See APC Packaged Rates , $16.90 , $9.41 , $23.29 , $23.39 , $12.43 , See APC Packaged Rates , See APC Packaged Rates , $16.20 , $16.20 , See APC Packaged Rates , See APC Packaged Rates , $22.45 , $22.45 , $22.45 , $22.45 , See APC Packaged Rates , $8.45 , $14.48 , $8.45 , $23.39 , $16.90
,61515365,Hospital Chargemaster,Asnis Iii Guide Wire,Outpatient,Outpatient Default Percent / Case Rate,272, $253.26 , $139.29 , $202.61 , See APC Packaged Rates , $177.28 , $98.77 , $244.37 , $245.43 , $130.43 , See APC Packaged Rates , See APC Packaged Rates , $169.94 , $169.94 , See APC Packaged Rates , See APC Packaged Rates , $235.53 , $235.53 , $235.53 , $235.53 , See APC Packaged Rates , $88.64 , $151.96 , $88.64 , $245.43 , $177.28
,61515387,Hospital Chargemaster,Tenkhoff Catheter 47Cm,Outpatient,Outpatient Default Percent / Case Rate,272, $258.96 , $142.43 , $207.17 , See APC Packaged Rates , $181.27 , $100.99 , $249.87 , $250.96 , $133.37 , See APC Packaged Rates , See APC Packaged Rates , $173.76 , $173.76 , See APC Packaged Rates , See APC Packaged Rates , $240.83 , $240.83 , $240.83 , $240.83 , See APC Packaged Rates , $90.64 , $155.38 , $90.64 , $250.96 , $181.27
,61515393,Hospital Chargemaster,Rigiflex Ii Single Use Abd,Outpatient,Outpatient Default Percent / Case Rate,272," $1,937.25 "," $1,065.49 "," $1,549.80 ", See APC Packaged Rates ," $1,356.08 ", $755.53 ," $1,869.25 "," $1,877.39 ", $997.72 , See APC Packaged Rates , See APC Packaged Rates ," $1,299.89 "," $1,299.89 ", See APC Packaged Rates , See APC Packaged Rates ," $1,801.64 "," $1,801.64 "," $1,801.64 "," $1,801.64 ", See APC Packaged Rates , $678.04 ," $1,162.35 ", $678.04 ," $1,877.39 "," $1,356.08 "
,61515418,Hospital Chargemaster,Retriever Uni 230Cm L X 2.5M,Outpatient,Outpatient Default Percent / Case Rate,272, $330.75 , $181.91 , $264.60 , See APC Packaged Rates , $231.53 , $128.99 , $319.14 , $320.53 , $170.34 , See APC Packaged Rates , See APC Packaged Rates , $221.93 , $221.93 , See APC Packaged Rates , See APC Packaged Rates , $307.60 , $307.60 , $307.60 , $307.60 , See APC Packaged Rates , $115.76 , $198.45 , $115.76 , $320.53 , $231.53
,61515425,Hospital Chargemaster,Harmonic Hd 10001 Shears,Outpatient,Outpatient Default Percent / Case Rate,272," $3,667.88 "," $2,017.33 "," $2,934.30 ", See APC Packaged Rates ," $2,567.52 "," $1,430.47 "," $3,539.14 "," $3,554.54 "," $1,889.03 ", See APC Packaged Rates , See APC Packaged Rates ," $2,461.15 "," $2,461.15 ", See APC Packaged Rates , See APC Packaged Rates ," $3,411.13 "," $3,411.13 "," $3,411.13 "," $3,411.13 ", See APC Packaged Rates ," $1,283.76 "," $2,200.73 "," $1,283.76 "," $3,554.54 "," $2,567.52 "
,61515435,Hospital Chargemaster,Trocar Sleeve 12Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $294.24 , $161.83 , $235.39 , See APC Packaged Rates , $205.97 , $114.75 , $283.91 , $285.15 , $151.54 , See APC Packaged Rates , See APC Packaged Rates , $197.44 , $197.44 , See APC Packaged Rates , See APC Packaged Rates , $273.64 , $273.64 , $273.64 , $273.64 , See APC Packaged Rates , $102.98 , $176.54 , $102.98 , $285.15 , $205.97
,61515436,Hospital Chargemaster,Trocar Sleeve 5Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $227.32 , $125.03 , $181.86 , See APC Packaged Rates , $159.12 , $88.65 , $219.34 , $220.30 , $117.07 , See APC Packaged Rates , See APC Packaged Rates , $152.53 , $152.53 , See APC Packaged Rates , See APC Packaged Rates , $211.41 , $211.41 , $211.41 , $211.41 , See APC Packaged Rates , $79.56 , $136.39 , $79.56 , $220.30 , $159.12
,61516040,Hospital Chargemaster,2.1mm Cannulated Drill Bit,Outpatient,Outpatient Default Percent / Case Rate,272, $480.88 , $264.48 , $384.70 , See APC Packaged Rates , $336.62 , $187.54 , $464.00 , $466.02 , $247.66 , See APC Packaged Rates , See APC Packaged Rates , $322.67 , $322.67 , See APC Packaged Rates , See APC Packaged Rates , $447.22 , $447.22 , $447.22 , $447.22 , See APC Packaged Rates , $168.31 , $288.53 , $168.31 , $466.02 , $336.62
,61516094,Hospital Chargemaster,Botox Injetak Adjustable,Outpatient,Outpatient Default Percent / Case Rate,272, $186.12 , $102.37 , $148.90 , See APC Packaged Rates , $130.28 , $72.59 , $179.59 , $180.37 , $95.86 , See APC Packaged Rates , See APC Packaged Rates , $124.89 , $124.89 , See APC Packaged Rates , See APC Packaged Rates , $173.09 , $173.09 , $173.09 , $173.09 , See APC Packaged Rates , $65.14 , $111.67 , $65.14 , $180.37 , $130.28
,61516115,Hospital Chargemaster,Tome Preloaded Clever Cut W/V,Outpatient,Outpatient Default Percent / Case Rate,272," $1,259.50 ", $692.73 ," $1,007.60 ", See APC Packaged Rates , $881.65 , $491.21 ," $1,215.29 "," $1,220.58 ", $648.67 , See APC Packaged Rates , See APC Packaged Rates , $845.12 , $845.12 , See APC Packaged Rates , See APC Packaged Rates ," $1,171.34 "," $1,171.34 "," $1,171.34 "," $1,171.34 ", See APC Packaged Rates , $440.83 , $755.70 , $440.83 ," $1,220.58 ", $881.65
,61516116,Hospital Chargemaster,Jagtome With .025 X 260Cm Wir,Outpatient,Outpatient Default Percent / Case Rate,272, $953.35 , $524.34 , $762.68 , See APC Packaged Rates , $667.35 , $371.81 , $919.89 , $923.89 , $490.99 , See APC Packaged Rates , See APC Packaged Rates , $639.70 , $639.70 , See APC Packaged Rates , See APC Packaged Rates , $886.62 , $886.62 , $886.62 , $886.62 , See APC Packaged Rates , $333.67 , $572.01 , $333.67 , $923.89 , $667.35
,61516117,Hospital Chargemaster,Biopsy Cap Rx,Outpatient,Outpatient Default Percent / Case Rate,272, $9.23 , $5.08 , $7.38 , See APC Packaged Rates , $6.46 , $3.60 , $8.91 , $8.94 , $4.75 , See APC Packaged Rates , See APC Packaged Rates , $6.19 , $6.19 , See APC Packaged Rates , See APC Packaged Rates , $8.58 , $8.58 , $8.58 , $8.58 , See APC Packaged Rates , $3.23 , $5.54 , $3.23 , $8.94 , $6.46
,61516124,Hospital Chargemaster,Cytology Brush Rx,Outpatient,Outpatient Default Percent / Case Rate,272, $329.74 , $181.36 , $263.79 , See APC Packaged Rates , $230.82 , $128.60 , $318.17 , $319.55 , $169.82 , See APC Packaged Rates , See APC Packaged Rates , $221.26 , $221.26 , See APC Packaged Rates , See APC Packaged Rates , $306.66 , $306.66 , $306.66 , $306.66 , See APC Packaged Rates , $115.41 , $197.84 , $115.41 , $319.55 , $230.82
,61516125,Hospital Chargemaster,Glidewire Stf/ Shaft .035X260,Outpatient,Outpatient Default Percent / Case Rate,272, $177.35 , $97.54 , $141.88 , See APC Packaged Rates , $124.15 , $69.17 , $171.13 , $171.87 , $91.34 , See APC Packaged Rates , See APC Packaged Rates , $119.00 , $119.00 , See APC Packaged Rates , See APC Packaged Rates , $164.94 , $164.94 , $164.94 , $164.94 , See APC Packaged Rates , $62.07 , $106.41 , $62.07 , $171.87 , $124.15
,61516126,Hospital Chargemaster,Glidewire Stf/ Shaft .035X260,Outpatient,Outpatient Default Percent / Case Rate,272, $177.35 , $97.54 , $141.88 , See APC Packaged Rates , $124.15 , $69.17 , $171.13 , $171.87 , $91.34 , See APC Packaged Rates , See APC Packaged Rates , $119.00 , $119.00 , See APC Packaged Rates , See APC Packaged Rates , $164.94 , $164.94 , $164.94 , $164.94 , See APC Packaged Rates , $62.07 , $106.41 , $62.07 , $171.87 , $124.15
,61516131,Hospital Chargemaster,Cre Pro Balloon 6-8Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $672.43 , $369.84 , $537.94 , See APC Packaged Rates , $470.70 , $262.25 , $648.83 , $651.65 , $346.31 , See APC Packaged Rates , See APC Packaged Rates , $451.20 , $451.20 , See APC Packaged Rates , See APC Packaged Rates , $625.36 , $625.36 , $625.36 , $625.36 , See APC Packaged Rates , $235.35 , $403.46 , $235.35 , $651.65 , $470.70
,61516133,Hospital Chargemaster,Cre Pro Balloon 8-10Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $672.43 , $369.84 , $537.94 , See APC Packaged Rates , $470.70 , $262.25 , $648.83 , $651.65 , $346.31 , See APC Packaged Rates , See APC Packaged Rates , $451.20 , $451.20 , See APC Packaged Rates , See APC Packaged Rates , $625.36 , $625.36 , $625.36 , $625.36 , See APC Packaged Rates , $235.35 , $403.46 , $235.35 , $651.65 , $470.70
,61516139,Hospital Chargemaster,Hurricane Balloon 6Mm X 4Cm,Outpatient,Outpatient Default Percent / Case Rate,272, $754.17 , $414.79 , $603.34 , See APC Packaged Rates , $527.92 , $294.13 , $727.70 , $730.87 , $388.41 , See APC Packaged Rates , See APC Packaged Rates , $506.05 , $506.05 , See APC Packaged Rates , See APC Packaged Rates , $701.38 , $701.38 , $701.38 , $701.38 , See APC Packaged Rates , $263.96 , $452.50 , $263.96 , $730.87 , $527.92
,61516141,Hospital Chargemaster,Stent Retrieval Balloon,Outpatient,Outpatient Default Percent / Case Rate,272, $394.09 , $216.75 , $315.27 , See APC Packaged Rates , $275.86 , $153.70 , $380.26 , $381.91 , $202.96 , See APC Packaged Rates , See APC Packaged Rates , $264.43 , $264.43 , See APC Packaged Rates , See APC Packaged Rates , $366.50 , $366.50 , $366.50 , $366.50 , See APC Packaged Rates , $137.93 , $236.45 , $137.93 , $381.91 , $275.86
,61516142,Hospital Chargemaster,Truclear Ultra Mini Shaver,Outpatient,Outpatient Default Percent / Case Rate,272," $2,978.45 "," $1,638.15 "," $2,382.76 ", See APC Packaged Rates ," $2,084.92 "," $1,161.60 "," $2,873.91 "," $2,886.42 "," $1,533.96 ", See APC Packaged Rates , See APC Packaged Rates ," $1,998.54 "," $1,998.54 ", See APC Packaged Rates , See APC Packaged Rates ," $2,769.96 "," $2,769.96 "," $2,769.96 "," $2,769.96 ", See APC Packaged Rates ," $1,042.46 "," $1,787.07 "," $1,042.46 "," $2,886.42 "," $2,084.92 "
,61516151,Hospital Chargemaster,Savory Gillard Wire Guide,Outpatient,Outpatient Default Percent / Case Rate,272, $362.25 , $199.24 , $289.80 , See APC Packaged Rates , $253.58 , $141.28 , $349.54 , $351.06 , $186.57 , See APC Packaged Rates , See APC Packaged Rates , $243.07 , $243.07 , See APC Packaged Rates , See APC Packaged Rates , $336.89 , $336.89 , $336.89 , $336.89 , See APC Packaged Rates , $126.79 , $217.35 , $126.79 , $351.06 , $253.58
,61516161,Hospital Chargemaster,Reamer Shaft Modified Trinkle,Outpatient,Outpatient Default Percent / Case Rate,272, $915.71 , $503.64 , $732.57 , See APC Packaged Rates , $641.00 , $357.13 , $883.57 , $887.41 , $471.61 , See APC Packaged Rates , See APC Packaged Rates , $614.44 , $614.44 , See APC Packaged Rates , See APC Packaged Rates , $851.61 , $851.61 , $851.61 , $851.61 , See APC Packaged Rates , $320.50 , $549.43 , $320.50 , $887.41 , $641.00
C1713,61516162,Hospital Chargemaster,Elastic Nail Insertion Sleeve,Outpatient,Outpatient Default Percent / Case Rate,272, $259.18 , $142.55 , $213.56 , See APC Packaged Rates , $181.43 , $101.08 , $250.08 , $251.17 , $133.48 , See APC Packaged Rates , See APC Packaged Rates , $173.91 , $173.91 , See APC Packaged Rates , See APC Packaged Rates , $241.04 , $241.04 , $241.04 , $241.04 , See APC Packaged Rates , $90.71 , $- , $- , $251.17 , $181.43
C1713,61516172,Hospital Chargemaster,Cancellous T1 Screw,Outpatient,Outpatient Default Percent / Case Rate,272, $81.40 , $44.77 , $67.07 , See APC Packaged Rates , $56.98 , $31.75 , $78.54 , $78.88 , $41.92 , See APC Packaged Rates , See APC Packaged Rates , $54.62 , $54.62 , See APC Packaged Rates , See APC Packaged Rates , $75.70 , $75.70 , $75.70 , $75.70 , See APC Packaged Rates , $28.49 , $- , $- , $78.88 , $56.98
,61516176,Hospital Chargemaster,Laser Fiber 1000 Micron,Outpatient,Outpatient Default Percent / Case Rate,272," $2,000.25 "," $1,100.14 "," $1,600.20 ", See APC Packaged Rates ," $1,400.18 ", $780.10 ," $1,930.04 "," $1,938.44 "," $1,030.17 ", See APC Packaged Rates , See APC Packaged Rates ," $1,342.17 "," $1,342.17 ", See APC Packaged Rates , See APC Packaged Rates ," $1,860.23 "," $1,860.23 "," $1,860.23 "," $1,860.23 ", See APC Packaged Rates , $700.09 ," $1,200.15 ", $700.09 ," $1,938.44 "," $1,400.18 "
,61516207,Hospital Chargemaster,K-Wire 3X285Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $232.47 , $127.86 , $185.98 , See APC Packaged Rates , $162.73 , $90.66 , $224.31 , $225.29 , $119.73 , See APC Packaged Rates , See APC Packaged Rates , $155.99 , $155.99 , See APC Packaged Rates , See APC Packaged Rates , $216.20 , $216.20 , $216.20 , $216.20 , See APC Packaged Rates , $81.36 , $139.48 , $81.36 , $225.29 , $162.73
,61516208,Hospital Chargemaster,Threaded Recon K-Wires,Outpatient,Outpatient Default Percent / Case Rate,272, $299.57 , $164.76 , $239.66 , See APC Packaged Rates , $209.70 , $116.83 , $289.06 , $290.31 , $154.28 , See APC Packaged Rates , See APC Packaged Rates , $201.01 , $201.01 , See APC Packaged Rates , See APC Packaged Rates , $278.60 , $278.60 , $278.60 , $278.60 , See APC Packaged Rates , $104.85 , $179.74 , $104.85 , $290.31 , $209.70
,61516209,Hospital Chargemaster,Freehand Drill 4.2 X 185Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $383.67 , $211.02 , $306.94 , See APC Packaged Rates , $268.57 , $149.63 , $370.20 , $371.81 , $197.60 , See APC Packaged Rates , See APC Packaged Rates , $257.44 , $257.44 , See APC Packaged Rates , See APC Packaged Rates , $356.81 , $356.81 , $356.81 , $356.81 , See APC Packaged Rates , $134.28 , $230.20 , $134.28 , $371.81 , $268.57
,61516210,Hospital Chargemaster,Locking Drill 4.2X 360Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $383.67 , $211.02 , $306.94 , See APC Packaged Rates , $268.57 , $149.63 , $370.20 , $371.81 , $197.60 , See APC Packaged Rates , See APC Packaged Rates , $257.44 , $257.44 , See APC Packaged Rates , See APC Packaged Rates , $356.81 , $356.81 , $356.81 , $356.81 , See APC Packaged Rates , $134.28 , $230.20 , $134.28 , $371.81 , $268.57
,61516217,Hospital Chargemaster,Suprapubic Introducer Kit,Outpatient,Outpatient Default Percent / Case Rate,272," $1,008.85 ", $554.87 , $807.08 , See APC Packaged Rates , $706.20 , $393.45 , $973.44 , $977.68 , $519.58 , See APC Packaged Rates , See APC Packaged Rates , $676.94 , $676.94 , See APC Packaged Rates , See APC Packaged Rates , $938.23 , $938.23 , $938.23 , $938.23 , See APC Packaged Rates , $353.10 , $605.31 , $353.10 , $977.68 , $706.20
,61516231,Hospital Chargemaster,Arista Hemostat Powder 3Gm,Outpatient,Outpatient Default Percent / Case Rate,272, $560.70 , $308.39 , $448.56 , See APC Packaged Rates , $392.49 , $218.67 , $541.02 , $543.37 , $288.77 , See APC Packaged Rates , See APC Packaged Rates , $376.23 , $376.23 , See APC Packaged Rates , See APC Packaged Rates , $521.45 , $521.45 , $521.45 , $521.45 , See APC Packaged Rates , $196.25 , $336.42 , $196.25 , $543.37 , $392.49
,61516241,Hospital Chargemaster,K-Wire 3.2 X 450 Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $240.03 , $132.02 , $192.02 , See APC Packaged Rates , $168.02 , $93.61 , $231.60 , $232.61 , $123.62 , See APC Packaged Rates , See APC Packaged Rates , $161.06 , $161.06 , See APC Packaged Rates , See APC Packaged Rates , $223.23 , $223.23 , $223.23 , $223.23 , See APC Packaged Rates , $84.01 , $144.02 , $84.01 , $232.61 , $168.02
,61516251,Hospital Chargemaster,Drill Ao Scaled 1.6Mm L96Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $741.83 , $408.01 , $593.46 , See APC Packaged Rates , $519.28 , $289.31 , $715.79 , $718.91 , $382.06 , See APC Packaged Rates , See APC Packaged Rates , $497.77 , $497.77 , See APC Packaged Rates , See APC Packaged Rates , $689.90 , $689.90 , $689.90 , $689.90 , See APC Packaged Rates , $259.64 , $445.10 , $259.64 , $718.91 , $519.28
,61516289,Hospital Chargemaster,100 Watt Laser Rental Agiliti,Outpatient,Outpatient Default Percent / Case Rate,272," $2,047.50 "," $1,126.13 "," $1,638.00 ", See APC Packaged Rates ," $1,433.25 ", $798.53 ," $1,975.63 "," $1,984.23 "," $1,054.50 ", See APC Packaged Rates , See APC Packaged Rates ," $1,373.87 "," $1,373.87 ", See APC Packaged Rates , See APC Packaged Rates ," $1,904.18 "," $1,904.18 "," $1,904.18 "," $1,904.18 ", See APC Packaged Rates , $716.63 ," $1,228.50 ", $716.63 ," $1,984.23 "," $1,433.25 "
,61516338,Hospital Chargemaster,Bflex Scope 3.8,Outpatient,Outpatient Default Percent / Case Rate,272, $929.25 , $511.09 , $743.40 , See APC Packaged Rates , $650.48 , $362.41 , $896.63 , $900.54 , $478.58 , See APC Packaged Rates , See APC Packaged Rates , $623.53 , $623.53 , See APC Packaged Rates , See APC Packaged Rates , $864.20 , $864.20 , $864.20 , $864.20 , See APC Packaged Rates , $325.24 , $557.55 , $325.24 , $900.54 , $650.48
,61516339,Hospital Chargemaster,Bflex Scope 5.0,Outpatient,Outpatient Default Percent / Case Rate,272, $929.25 , $511.09 , $743.40 , See APC Packaged Rates , $650.48 , $362.41 , $896.63 , $900.54 , $478.58 , See APC Packaged Rates , See APC Packaged Rates , $623.53 , $623.53 , See APC Packaged Rates , See APC Packaged Rates , $864.20 , $864.20 , $864.20 , $864.20 , See APC Packaged Rates , $325.24 , $557.55 , $325.24 , $900.54 , $650.48
,61516344,Hospital Chargemaster,Drill Freehand 4.2X130Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $383.67 , $211.02 , $306.94 , See APC Packaged Rates , $268.57 , $149.63 , $370.20 , $371.81 , $197.60 , See APC Packaged Rates , See APC Packaged Rates , $257.44 , $257.44 , See APC Packaged Rates , See APC Packaged Rates , $356.81 , $356.81 , $356.81 , $356.81 , See APC Packaged Rates , $134.28 , $230.20 , $134.28 , $371.81 , $268.57
,61516363,Hospital Chargemaster,Hool 2mmx300mm,Outpatient,Outpatient Default Percent / Case Rate,272," $1,263.69 ", $695.03 ," $1,010.95 ", See APC Packaged Rates , $884.58 , $492.84 ," $1,219.33 "," $1,224.64 ", $650.83 , See APC Packaged Rates , See APC Packaged Rates , $847.94 , $847.94 , See APC Packaged Rates , See APC Packaged Rates ," $1,175.23 "," $1,175.23 "," $1,175.23 "," $1,175.23 ", See APC Packaged Rates , $442.29 , $758.21 , $442.29 ," $1,224.64 ", $884.58
,61530104,Hospital Chargemaster,Dilator Balloon 8-10Mm 3 Stag,Outpatient,Outpatient Default Percent / Case Rate,272, $590.12 , $324.57 , $472.10 , See APC Packaged Rates , $413.08 , $230.15 , $569.41 , $571.89 , $303.92 , See APC Packaged Rates , See APC Packaged Rates , $395.97 , $395.97 , See APC Packaged Rates , See APC Packaged Rates , $548.81 , $548.81 , $548.81 , $548.81 , See APC Packaged Rates , $206.54 , $354.07 , $206.54 , $571.89 , $413.08
,61530105,Hospital Chargemaster,Dilator Balloon 10-1Mm 3,Outpatient,Outpatient Default Percent / Case Rate,272, $590.12 , $324.57 , $472.10 , See APC Packaged Rates , $413.08 , $230.15 , $569.41 , $571.89 , $303.92 , See APC Packaged Rates , See APC Packaged Rates , $395.97 , $395.97 , See APC Packaged Rates , See APC Packaged Rates , $548.81 , $548.81 , $548.81 , $548.81 , See APC Packaged Rates , $206.54 , $354.07 , $206.54 , $571.89 , $413.08
,61530111,Hospital Chargemaster,Talon Grasping Device,Outpatient,Outpatient Default Percent / Case Rate,272, $446.78 , $245.73 , $357.42 , See APC Packaged Rates , $312.75 , $174.24 , $431.10 , $432.97 , $230.10 , See APC Packaged Rates , See APC Packaged Rates , $299.79 , $299.79 , See APC Packaged Rates , See APC Packaged Rates , $415.51 , $415.51 , $415.51 , $415.51 , See APC Packaged Rates , $156.37 , $268.07 , $156.37 , $432.97 , $312.75
,61531047,Hospital Chargemaster,Sphincterotome Jagtome,Outpatient,Outpatient Default Percent / Case Rate,272," $1,269.14 ", $698.03 ," $1,015.31 ", See APC Packaged Rates , $888.40 , $494.96 ," $1,224.59 "," $1,229.92 ", $653.63 , See APC Packaged Rates , See APC Packaged Rates , $851.59 , $851.59 , See APC Packaged Rates , See APC Packaged Rates ," $1,180.30 "," $1,180.30 "," $1,180.30 "," $1,180.30 ", See APC Packaged Rates , $444.20 , $761.48 , $444.20 ," $1,229.92 ", $888.40
,61532064,Hospital Chargemaster,Sphinterotome Biliary Wire,Outpatient,Outpatient Default Percent / Case Rate,272, $752.85 , $414.07 , $602.28 , See APC Packaged Rates , $527.00 , $293.61 , $726.42 , $729.59 , $387.73 , See APC Packaged Rates , See APC Packaged Rates , $505.16 , $505.16 , See APC Packaged Rates , See APC Packaged Rates , $700.15 , $700.15 , $700.15 , $700.15 , See APC Packaged Rates , $263.50 , $451.71 , $263.50 , $729.59 , $527.00
,61532065,Hospital Chargemaster,Sphincterotome Biliary Wire,Outpatient,Outpatient Default Percent / Case Rate,272, $752.85 , $414.07 , $602.28 , See APC Packaged Rates , $527.00 , $293.61 , $726.42 , $729.59 , $387.73 , See APC Packaged Rates , See APC Packaged Rates , $505.16 , $505.16 , See APC Packaged Rates , See APC Packaged Rates , $700.15 , $700.15 , $700.15 , $700.15 , See APC Packaged Rates , $263.50 , $451.71 , $263.50 , $729.59 , $527.00
,61532066,Hospital Chargemaster,Knife Needle Catheter,Outpatient,Outpatient Default Percent / Case Rate,272, $604.80 , $332.64 , $483.84 , See APC Packaged Rates , $423.36 , $235.87 , $583.57 , $586.11 , $311.48 , See APC Packaged Rates , See APC Packaged Rates , $405.82 , $405.82 , See APC Packaged Rates , See APC Packaged Rates , $562.46 , $562.46 , $562.46 , $562.46 , See APC Packaged Rates , $211.68 , $362.88 , $211.68 , $586.11 , $423.36
,61532069,Hospital Chargemaster,Basket Biliary 220Cm 7Fr,Outpatient,Outpatient Default Percent / Case Rate,272, $535.50 , $294.53 , $428.40 , See APC Packaged Rates , $374.85 , $208.85 , $516.70 , $518.95 , $275.79 , See APC Packaged Rates , See APC Packaged Rates , $359.32 , $359.32 , See APC Packaged Rates , See APC Packaged Rates , $498.02 , $498.02 , $498.02 , $498.02 , See APC Packaged Rates , $187.43 , $321.30 , $187.43 , $518.95 , $374.85
,61532070,Hospital Chargemaster,Cytology Brush Biliary,Outpatient,Outpatient Default Percent / Case Rate,272, $318.15 , $174.98 , $254.52 , See APC Packaged Rates , $222.71 , $124.08 , $306.98 , $308.32 , $163.85 , See APC Packaged Rates , See APC Packaged Rates , $213.48 , $213.48 , See APC Packaged Rates , See APC Packaged Rates , $295.88 , $295.88 , $295.88 , $295.88 , See APC Packaged Rates , $111.35 , $190.89 , $111.35 , $308.32 , $222.71
,61532071,Hospital Chargemaster,Jagwire .O25 X 450 Cm,Outpatient,Outpatient Default Percent / Case Rate,272, $535.50 , $294.53 , $428.40 , See APC Packaged Rates , $374.85 , $208.85 , $516.70 , $518.95 , $275.79 , See APC Packaged Rates , See APC Packaged Rates , $359.32 , $359.32 , See APC Packaged Rates , See APC Packaged Rates , $498.02 , $498.02 , $498.02 , $498.02 , See APC Packaged Rates , $187.43 , $321.30 , $187.43 , $518.95 , $374.85
,61532072,Hospital Chargemaster,Cre Wire Guided Balloon 6-8Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $672.43 , $369.84 , $537.94 , See APC Packaged Rates , $470.70 , $262.25 , $648.83 , $651.65 , $346.31 , See APC Packaged Rates , See APC Packaged Rates , $451.20 , $451.20 , See APC Packaged Rates , See APC Packaged Rates , $625.36 , $625.36 , $625.36 , $625.36 , See APC Packaged Rates , $235.35 , $403.46 , $235.35 , $651.65 , $470.70
,61532073,Hospital Chargemaster,Cre Wire Guided Balloon 8-10M,Outpatient,Outpatient Default Percent / Case Rate,272, $672.43 , $369.84 , $537.94 , See APC Packaged Rates , $470.70 , $262.25 , $648.83 , $651.65 , $346.31 , See APC Packaged Rates , See APC Packaged Rates , $451.20 , $451.20 , See APC Packaged Rates , See APC Packaged Rates , $625.36 , $625.36 , $625.36 , $625.36 , See APC Packaged Rates , $235.35 , $403.46 , $235.35 , $651.65 , $470.70
,61532074,Hospital Chargemaster,Cre Wire Guided Balloon,Outpatient,Outpatient Default Percent / Case Rate,272, $672.43 , $369.84 , $537.94 , See APC Packaged Rates , $470.70 , $262.25 , $648.83 , $651.65 , $346.31 , See APC Packaged Rates , See APC Packaged Rates , $451.20 , $451.20 , See APC Packaged Rates , See APC Packaged Rates , $625.36 , $625.36 , $625.36 , $625.36 , See APC Packaged Rates , $235.35 , $403.46 , $235.35 , $651.65 , $470.70
,61532076,Hospital Chargemaster,Trapezoid Lithotriptor Basket,Outpatient,Outpatient Default Percent / Case Rate,272, $830.59 , $456.82 , $664.47 , See APC Packaged Rates , $581.41 , $323.93 , $801.44 , $804.92 , $427.77 , See APC Packaged Rates , See APC Packaged Rates , $557.33 , $557.33 , See APC Packaged Rates , See APC Packaged Rates , $772.45 , $772.45 , $772.45 , $772.45 , See APC Packaged Rates , $290.71 , $498.35 , $290.71 , $804.92 , $581.41
,61532077,Hospital Chargemaster,Ercp Balloon Catheter,Outpatient,Outpatient Default Percent / Case Rate,272, $358.19 , $197.00 , $286.55 , See APC Packaged Rates , $250.73 , $139.69 , $345.62 , $347.12 , $184.48 , See APC Packaged Rates , See APC Packaged Rates , $240.35 , $240.35 , See APC Packaged Rates , See APC Packaged Rates , $333.12 , $333.12 , $333.12 , $333.12 , See APC Packaged Rates , $125.37 , $214.91 , $125.37 , $347.12 , $250.73
,61532078,Hospital Chargemaster,Visiglide Guidewire,Outpatient,Outpatient Default Percent / Case Rate,272, $518.62 , $285.24 , $414.90 , See APC Packaged Rates , $363.03 , $202.26 , $500.42 , $502.59 , $267.10 , See APC Packaged Rates , See APC Packaged Rates , $347.99 , $347.99 , See APC Packaged Rates , See APC Packaged Rates , $482.32 , $482.32 , $482.32 , $482.32 , See APC Packaged Rates , $181.52 , $311.17 , $181.52 , $502.59 , $363.03
,61532079,Hospital Chargemaster,Visiglide Guidewire,Outpatient,Outpatient Default Percent / Case Rate,272, $806.40 , $443.52 , $645.12 , See APC Packaged Rates , $564.48 , $314.50 , $778.10 , $781.48 , $415.31 , See APC Packaged Rates , See APC Packaged Rates , $541.09 , $541.09 , See APC Packaged Rates , See APC Packaged Rates , $749.95 , $749.95 , $749.95 , $749.95 , See APC Packaged Rates , $282.24 , $483.84 , $282.24 , $781.48 , $564.48
,61533025,Hospital Chargemaster,Esophageal Overtube 250Cm,Outpatient,Outpatient Default Percent / Case Rate,272, $614.25 , $337.84 , $491.40 , See APC Packaged Rates , $429.98 , $239.56 , $592.69 , $595.27 , $316.35 , See APC Packaged Rates , See APC Packaged Rates , $412.16 , $412.16 , See APC Packaged Rates , See APC Packaged Rates , $571.25 , $571.25 , $571.25 , $571.25 , See APC Packaged Rates , $214.99 , $368.55 , $214.99 , $595.27 , $429.98
,61533026,Hospital Chargemaster,Gastric Overtube 50Cm,Outpatient,Outpatient Default Percent / Case Rate,272, $708.75 , $389.81 , $567.00 , See APC Packaged Rates , $496.13 , $276.41 , $683.87 , $686.85 , $365.02 , See APC Packaged Rates , See APC Packaged Rates , $475.57 , $475.57 , See APC Packaged Rates , See APC Packaged Rates , $659.14 , $659.14 , $659.14 , $659.14 , See APC Packaged Rates , $248.06 , $425.25 , $248.06 , $686.85 , $496.13
,61533031,Hospital Chargemaster,Roth Net Retrieval Device,Outpatient,Outpatient Default Percent / Case Rate,272, $267.75 , $147.26 , $214.20 , See APC Packaged Rates , $187.43 , $104.42 , $258.35 , $259.48 , $137.90 , See APC Packaged Rates , See APC Packaged Rates , $179.66 , $179.66 , See APC Packaged Rates , See APC Packaged Rates , $249.01 , $249.01 , $249.01 , $249.01 , See APC Packaged Rates , $93.71 , $160.65 , $93.71 , $259.48 , $187.43
,61533051,Hospital Chargemaster,Biopsy Forcep Cold,Outpatient,Outpatient Default Percent / Case Rate,272, $204.75 , $112.61 , $163.80 , See APC Packaged Rates , $143.33 , $79.85 , $197.56 , $198.42 , $105.45 , See APC Packaged Rates , See APC Packaged Rates , $137.39 , $137.39 , See APC Packaged Rates , See APC Packaged Rates , $190.42 , $190.42 , $190.42 , $190.42 , See APC Packaged Rates , $71.66 , $122.85 , $71.66 , $198.42 , $143.33
,61533055,Hospital Chargemaster,Probe Straight Fire 2.3Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $689.69 , $379.33 , $551.75 , See APC Packaged Rates , $482.78 , $268.98 , $665.48 , $668.38 , $355.20 , See APC Packaged Rates , See APC Packaged Rates , $462.78 , $462.78 , See APC Packaged Rates , See APC Packaged Rates , $641.41 , $641.41 , $641.41 , $641.41 , See APC Packaged Rates , $241.39 , $413.81 , $241.39 , $668.38 , $482.78
,61533068,Hospital Chargemaster,Dilator Balloon 15Mm 3 Stage,Outpatient,Outpatient Default Percent / Case Rate,272, $590.12 , $324.57 , $472.10 , See APC Packaged Rates , $413.08 , $230.15 , $569.41 , $571.89 , $303.92 , See APC Packaged Rates , See APC Packaged Rates , $395.97 , $395.97 , See APC Packaged Rates , See APC Packaged Rates , $548.81 , $548.81 , $548.81 , $548.81 , See APC Packaged Rates , $206.54 , $354.07 , $206.54 , $571.89 , $413.08
,61533069,Hospital Chargemaster,Dilator Balloon 18Mm 3 Stage,Outpatient,Outpatient Default Percent / Case Rate,272, $590.12 , $324.57 , $472.10 , See APC Packaged Rates , $413.08 , $230.15 , $569.41 , $571.89 , $303.92 , See APC Packaged Rates , See APC Packaged Rates , $395.97 , $395.97 , See APC Packaged Rates , See APC Packaged Rates , $548.81 , $548.81 , $548.81 , $548.81 , See APC Packaged Rates , $206.54 , $354.07 , $206.54 , $571.89 , $413.08
,61533070,Hospital Chargemaster,Dilator Balloon 20Mm 3 Stage,Outpatient,Outpatient Default Percent / Case Rate,272, $590.12 , $324.57 , $472.10 , See APC Packaged Rates , $413.08 , $230.15 , $569.41 , $571.89 , $303.92 , See APC Packaged Rates , See APC Packaged Rates , $395.97 , $395.97 , See APC Packaged Rates , See APC Packaged Rates , $548.81 , $548.81 , $548.81 , $548.81 , See APC Packaged Rates , $206.54 , $354.07 , $206.54 , $571.89 , $413.08
,61533076,Hospital Chargemaster,Advance Capsule Deliver Devic,Outpatient,Outpatient Default Percent / Case Rate,272, $519.75 , $285.86 , $415.80 , See APC Packaged Rates , $363.83 , $202.70 , $501.51 , $503.69 , $267.68 , See APC Packaged Rates , See APC Packaged Rates , $348.75 , $348.75 , See APC Packaged Rates , See APC Packaged Rates , $483.37 , $483.37 , $483.37 , $483.37 , See APC Packaged Rates , $181.91 , $311.85 , $181.91 , $503.69 , $363.83
,61533088,Hospital Chargemaster,Talon Grasping Device,Outpatient,Outpatient Default Percent / Case Rate,272, $267.75 , $147.26 , $214.20 , See APC Packaged Rates , $187.43 , $104.42 , $258.35 , $259.48 , $137.90 , See APC Packaged Rates , See APC Packaged Rates , $179.66 , $179.66 , See APC Packaged Rates , See APC Packaged Rates , $249.01 , $249.01 , $249.01 , $249.01 , See APC Packaged Rates , $93.71 , $160.65 , $93.71 , $259.48 , $187.43
,61533090,Hospital Chargemaster,Urethral Dilator Set,Outpatient,Outpatient Default Percent / Case Rate,272, $705.50 , $388.03 , $564.40 , See APC Packaged Rates , $493.85 , $275.15 , $680.74 , $683.70 , $363.35 , See APC Packaged Rates , See APC Packaged Rates , $473.39 , $473.39 , See APC Packaged Rates , See APC Packaged Rates , $656.12 , $656.12 , $656.12 , $656.12 , See APC Packaged Rates , $246.93 , $423.30 , $246.93 , $683.70 , $493.85
,61533093,Hospital Chargemaster,Clip Device,Outpatient,Outpatient Default Percent / Case Rate,272, $482.15 , $265.18 , $385.72 , See APC Packaged Rates , $337.51 , $188.04 , $465.23 , $467.25 , $248.32 , See APC Packaged Rates , See APC Packaged Rates , $323.52 , $323.52 , See APC Packaged Rates , See APC Packaged Rates , $448.40 , $448.40 , $448.40 , $448.40 , See APC Packaged Rates , $168.75 , $289.29 , $168.75 , $467.25 , $337.51
,61533120,Hospital Chargemaster,Sidefire Probe 2.3Mm X 6.9Fr,Outpatient,Outpatient Default Percent / Case Rate,272, $692.84 , $381.06 , $554.27 , See APC Packaged Rates , $484.99 , $270.21 , $668.52 , $671.43 , $356.83 , See APC Packaged Rates , See APC Packaged Rates , $464.90 , $464.90 , See APC Packaged Rates , See APC Packaged Rates , $644.34 , $644.34 , $644.34 , $644.34 , See APC Packaged Rates , $242.49 , $415.70 , $242.49 , $671.43 , $484.99
C1713,61533128,Hospital Chargemaster,Fecal Transplant Lower Deliv,Outpatient,Outpatient Default Percent / Case Rate,272, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61533130,Hospital Chargemaster,Glo 5-4-3 Cannula 018 Wire,Outpatient,Outpatient Default Percent / Case Rate,272, $195.30 , $107.42 , $156.24 , See APC Packaged Rates , $136.71 , $76.17 , $188.44 , $189.27 , $100.58 , See APC Packaged Rates , See APC Packaged Rates , $131.05 , $131.05 , See APC Packaged Rates , See APC Packaged Rates , $181.63 , $181.63 , $181.63 , $181.63 , See APC Packaged Rates , $68.36 , $117.18 , $68.36 , $189.27 , $136.71
,61533134,Hospital Chargemaster,Balloon Billary 4Mm X 3Cm,Outpatient,Outpatient Default Percent / Case Rate,272, $683.55 , $375.95 , $546.84 , See APC Packaged Rates , $478.49 , $266.58 , $659.56 , $662.43 , $352.04 , See APC Packaged Rates , See APC Packaged Rates , $458.66 , $458.66 , See APC Packaged Rates , See APC Packaged Rates , $635.70 , $635.70 , $635.70 , $635.70 , See APC Packaged Rates , $239.24 , $410.13 , $239.24 , $662.43 , $478.49
,61533138,Hospital Chargemaster,Novagold High Performance,Outpatient,Outpatient Default Percent / Case Rate,272, $614.25 , $337.84 , $491.40 , See APC Packaged Rates , $429.98 , $239.56 , $592.69 , $595.27 , $316.35 , See APC Packaged Rates , See APC Packaged Rates , $412.16 , $412.16 , See APC Packaged Rates , See APC Packaged Rates , $571.25 , $571.25 , $571.25 , $571.25 , See APC Packaged Rates , $214.99 , $368.55 , $214.99 , $595.27 , $429.98
,61533143,Hospital Chargemaster,Tome Clever Cut 3.9 Fr,Outpatient,Outpatient Default Percent / Case Rate,272," $1,259.50 ", $692.73 ," $1,007.60 ", See APC Packaged Rates , $881.65 , $491.21 ," $1,215.29 "," $1,220.58 ", $648.67 , See APC Packaged Rates , See APC Packaged Rates , $845.12 , $845.12 , See APC Packaged Rates , See APC Packaged Rates ," $1,171.34 "," $1,171.34 "," $1,171.34 "," $1,171.34 ", See APC Packaged Rates , $440.83 , $755.70 , $440.83 ," $1,220.58 ", $881.65
,61535059,Hospital Chargemaster,"Central Line KT, 7FR 16cm",Outpatient,Outpatient Default Percent / Case Rate,272, $355.89 , $195.74 , $284.71 , See APC Packaged Rates , $249.12 , $138.80 , $343.40 , $344.89 , $183.29 , See APC Packaged Rates , See APC Packaged Rates , $238.80 , $238.80 , See APC Packaged Rates , See APC Packaged Rates , $330.98 , $330.98 , $330.98 , $330.98 , See APC Packaged Rates , $124.56 , $213.53 , $124.56 , $344.89 , $249.12
,61585521,Hospital Chargemaster,Endo Linear Cutter Vascular,Outpatient,Outpatient Default Percent / Case Rate,272, $774.37 , $425.90 , $619.50 , See APC Packaged Rates , $542.06 , $302.00 , $747.19 , $750.44 , $398.82 , See APC Packaged Rates , See APC Packaged Rates , $519.60 , $519.60 , See APC Packaged Rates , See APC Packaged Rates , $720.16 , $720.16 , $720.16 , $720.16 , See APC Packaged Rates , $271.03 , $464.62 , $271.03 , $750.44 , $542.06
,65202912,Hospital Chargemaster,Oxygen Setup,Outpatient,Outpatient Default Percent / Case Rate,272, $40.00 , $22.00 , $32.00 , See APC Packaged Rates , $28.00 , $15.60 , $38.60 , $38.76 , $20.60 , See APC Packaged Rates , See APC Packaged Rates , $26.84 , $26.84 , See APC Packaged Rates , See APC Packaged Rates , $37.20 , $37.20 , $37.20 , $37.20 , See APC Packaged Rates , $14.00 , $24.00 , $14.00 , $38.76 , $28.00
L3900,5450010077,Hospital Chargemaster,Dynamic Splint,Outpatient,Outpatient Default Percent / Case Rate,274, $200.00 , $110.00 , $164.80 , See APC Packaged Rates , $140.00 , $78.00 ," $1,453.75 ", $729.24 , $658.32 , See APC Packaged Rates , See APC Packaged Rates , $66.60 , $66.60 , See APC Packaged Rates , See APC Packaged Rates , $200.00 , $200.00 , $200.00 , $200.00 , See APC Packaged Rates , $70.00 , $- , $- ," $1,453.75 ", $140.00
L3808,5450010075,Hospital Chargemaster,Resting Splint,Outpatient,Outpatient Default Percent / Case Rate,274, $160.00 , $88.00 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $458.29 , $229.89 , $207.53 , See APC Packaged Rates , See APC Packaged Rates , $53.28 , $53.28 , See APC Packaged Rates , See APC Packaged Rates , $160.00 , $160.00 , $160.00 , $160.00 , See APC Packaged Rates , $56.00 , $- , $- , $458.29 , $112.00
L3808,5450010076,Hospital Chargemaster,Hand Based Splint,Outpatient,Outpatient Default Percent / Case Rate,274, $160.00 , $88.00 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $458.29 , $229.89 , $207.53 , See APC Packaged Rates , See APC Packaged Rates , $53.28 , $53.28 , See APC Packaged Rates , See APC Packaged Rates , $160.00 , $160.00 , $160.00 , $160.00 , See APC Packaged Rates , $56.00 , $- , $- , $458.29 , $112.00
L3906,5450010078,Hospital Chargemaster,Wrist based Splint,Outpatient,Outpatient Default Percent / Case Rate,274, $160.00 , $88.00 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $524.19 , $262.95 , $237.38 , See APC Packaged Rates , See APC Packaged Rates , $53.28 , $53.28 , See APC Packaged Rates , See APC Packaged Rates , $160.00 , $160.00 , $160.00 , $160.00 , See APC Packaged Rates , $56.00 , $- , $- , $524.19 , $112.00
L3763,5450010074,Hospital Chargemaster,Elbow Splint,Outpatient,Outpatient Default Percent / Case Rate,274, $160.00 , $88.00 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $789.32 , $395.94 , $357.44 , See APC Packaged Rates , See APC Packaged Rates , $53.28 , $53.28 , See APC Packaged Rates , See APC Packaged Rates , $160.00 , $160.00 , $160.00 , $160.00 , See APC Packaged Rates , $56.00 , $- , $- , $789.32 , $112.00
L3929,5450010080,Hospital Chargemaster,LMB Splint,Outpatient,Outpatient Default Percent / Case Rate,274, $91.00 , $50.05 , $74.98 , See APC Packaged Rates , $63.70 , $35.49 , $87.81 , $88.19 , $46.87 , See APC Packaged Rates , See APC Packaged Rates , $30.30 , $30.30 , See APC Packaged Rates , See APC Packaged Rates , $73.76 , $73.76 , $75.66 , $75.66 , See APC Packaged Rates , $31.85 , $- , $- , $88.19 , $63.70
L3931,5450010081,Hospital Chargemaster,Phoenix Outrigger Slpint,Outpatient,Outpatient Default Percent / Case Rate,274, $60.00 , $33.00 , $49.44 , See APC Packaged Rates , $42.00 , $23.40 , $57.89 , $58.15 , $30.90 , See APC Packaged Rates , See APC Packaged Rates , $19.98 , $19.98 , See APC Packaged Rates , See APC Packaged Rates , $60.00 , $60.00 , $60.00 , $60.00 , See APC Packaged Rates , $21.00 , $- , $- , $60.00 , $42.00
L3925,5450010079,Hospital Chargemaster,Finger Based Splint,Outpatient,Outpatient Default Percent / Case Rate,274, $96.00 , $52.80 , $79.10 , See APC Packaged Rates , $67.20 , $37.44 , $58.31 , $29.25 , $26.41 , See APC Packaged Rates , See APC Packaged Rates , $31.97 , $31.97 , See APC Packaged Rates , See APC Packaged Rates , $49.24 , $49.24 , $50.51 , $50.51 , See APC Packaged Rates , $33.60 , $- , $- , $79.10 , $67.20
,61510577,Hospital Chargemaster,Cement Spacer Omnifit,Outpatient,Outpatient Default Percent / Case Rate,274, $415.80 , $228.69 , $332.64 , See APC Packaged Rates , $291.06 , $162.16 , $401.21 , $402.95 , $214.15 , See APC Packaged Rates , See APC Packaged Rates , $138.46 , $138.46 , See APC Packaged Rates , See APC Packaged Rates , $386.69 , $386.69 , $386.69 , $386.69 , See APC Packaged Rates , $145.53 , $249.48 , $138.46 , $402.95 , $291.06
C1713,61510703,Hospital Chargemaster,Locking Screw 5 X 55M,Outpatient,Outpatient Default Percent / Case Rate,274, $347.76 , $191.27 , $286.55 , See APC Packaged Rates , $243.43 , $135.63 , $335.55 , $337.01 , $179.10 , See APC Packaged Rates , See APC Packaged Rates , $115.80 , $115.80 , See APC Packaged Rates , See APC Packaged Rates , $323.42 , $323.42 , $323.42 , $323.42 , See APC Packaged Rates , $121.72 , $- , $- , $337.01 , $243.43
C1713,61510704,Hospital Chargemaster,Tibial Nail T2 9 X 330M,Outpatient,Outpatient Default Percent / Case Rate,274, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510709,Hospital Chargemaster,Omega Plus 140 Deg Slot Plate,Outpatient,Outpatient Default Percent / Case Rate,274, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61510722,Hospital Chargemaster,Bixcut Reamer Shaft 8.0X450Mm,Outpatient,Outpatient Default Percent / Case Rate,274, $555.66 , $305.61 , $444.53 , See APC Packaged Rates , $388.96 , $216.71 , $536.16 , $538.49 , $286.18 , See APC Packaged Rates , See APC Packaged Rates , $185.03 , $185.03 , See APC Packaged Rates , See APC Packaged Rates , $516.76 , $516.76 , $516.76 , $516.76 , See APC Packaged Rates , $194.48 , $333.40 , $185.03 , $538.49 , $388.96
C1713,61510769,Hospital Chargemaster,Tibial Nail T2 10 X 345,Outpatient,Outpatient Default Percent / Case Rate,274, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1776,61510774,Hospital Chargemaster,Acetabular Shell,Outpatient,Outpatient Default Percent / Case Rate,274," $2,362.50 "," $1,299.38 "," $1,946.70 ", See APC Packaged Rates ," $1,653.75 ", $921.38 ," $2,279.58 "," $2,289.50 "," $1,216.73 ", See APC Packaged Rates , See APC Packaged Rates , $786.71 , $786.71 , See APC Packaged Rates , See APC Packaged Rates ," $2,197.13 "," $2,197.13 "," $2,197.13 "," $2,197.13 ", See APC Packaged Rates , $826.88 , $- , $- ," $2,289.50 "," $1,653.75 "
,61510778,Hospital Chargemaster,Teflon Tube Sterile,Outpatient,Outpatient Default Percent / Case Rate,274, $445.10 , $244.81 , $356.08 , See APC Packaged Rates , $311.57 , $173.59 , $429.48 , $431.35 , $229.24 , See APC Packaged Rates , See APC Packaged Rates , $148.22 , $148.22 , See APC Packaged Rates , See APC Packaged Rates , $413.94 , $413.94 , $413.94 , $413.94 , See APC Packaged Rates , $155.79 , $267.06 , $148.22 , $431.35 , $311.57
C1713,61510784,Hospital Chargemaster,T2 Humeral Lock Nail 9X270M,Outpatient,Outpatient Default Percent / Case Rate,274, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510924,Hospital Chargemaster,Tibial Bearing Insert 12M #9,Outpatient,Outpatient Default Percent / Case Rate,274, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510933,Hospital Chargemaster,Mini Nail Lengthener 32 X 5M,Outpatient,Outpatient Default Percent / Case Rate,274, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510939,Hospital Chargemaster,Insert Tibial Bearing 10M #7,Outpatient,Outpatient Default Percent / Case Rate,274, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61510944,Hospital Chargemaster,Guide Wire,Outpatient,Outpatient Default Percent / Case Rate,274, $368.55 , $202.70 , $294.84 , See APC Packaged Rates , $257.99 , $143.73 , $355.61 , $357.16 , $189.81 , See APC Packaged Rates , See APC Packaged Rates , $122.73 , $122.73 , See APC Packaged Rates , See APC Packaged Rates , $342.75 , $342.75 , $342.75 , $342.75 , See APC Packaged Rates , $128.99 , $221.13 , $122.73 , $357.16 , $257.99
C1713,61510945,Hospital Chargemaster,Nail Kit Long GaMa 11/340M,Outpatient,Outpatient Default Percent / Case Rate,274, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61510947,Hospital Chargemaster,Acetabular Shell Psl,Outpatient,Outpatient Default Percent / Case Rate,274," $2,362.50 "," $1,299.38 "," $1,890.00 ", See APC Packaged Rates ," $1,653.75 ", $921.38 ," $2,279.58 "," $2,289.50 "," $1,216.73 ", See APC Packaged Rates , See APC Packaged Rates , $786.71 , $786.71 , See APC Packaged Rates , See APC Packaged Rates ," $2,197.13 "," $2,197.13 "," $2,197.13 "," $2,197.13 ", See APC Packaged Rates , $826.88 ," $1,417.50 ", $786.71 ," $2,289.50 "," $1,653.75 "
L1940,61520207,Hospital Chargemaster,Brace Cust Molded Plastic Afo,Outpatient,Outpatient Default Percent / Case Rate,274, $- , $- , $- , See APC Packaged Rates , $- , $- , $752.97 , $377.71 , $340.98 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $752.97 , $-
L0630,61520208,Hospital Chargemaster,Brace Cust Mold Lso WPost Pan,Outpatient,Outpatient Default Percent / Case Rate,274, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1721,61500032,Hospital Chargemaster,BIV ICD Defibrillator CRTD,Outpatient,Outpatient Default Percent / Case Rate,275," $43,520.40 "," $23,936.22 "," $35,860.81 ", See APC Packaged Rates ," $30,464.28 "," $16,972.96 "," $41,992.83 "," $42,175.62 "," $22,413.88 ", See APC Packaged Rates , See APC Packaged Rates ," $16,320.15 "," $16,320.15 ", See APC Packaged Rates , See APC Packaged Rates ," $40,473.97 "," $40,473.97 "," $40,473.97 "," $40,473.97 ", See APC Packaged Rates ," $15,232.14 ", $- , $- ," $42,175.62 "," $30,464.28 "
C1882,61500053,Hospital Chargemaster,CRTD DTM1D1 Claria,Outpatient,Outpatient Default Percent / Case Rate,275," $43,520.40 "," $23,936.22 "," $35,860.81 ", See APC Packaged Rates ," $30,464.28 "," $16,972.96 "," $41,992.83 "," $42,175.62 "," $22,413.88 ", See APC Packaged Rates , See APC Packaged Rates ," $16,320.15 "," $16,320.15 ", See APC Packaged Rates , See APC Packaged Rates ," $40,473.97 "," $40,473.97 "," $40,473.97 "," $40,473.97 ", See APC Packaged Rates ," $15,232.14 ", $- , $- ," $42,175.62 "," $30,464.28 "
C1892,61508816,Hospital Chargemaster,Lead Introducer 9Fr,Outpatient,Outpatient Default Percent / Case Rate,275, $166.95 , $91.82 , $137.57 , See APC Packaged Rates , $116.87 , $65.11 , $161.09 , $161.79 , $85.98 , See APC Packaged Rates , See APC Packaged Rates , $62.61 , $62.61 , See APC Packaged Rates , See APC Packaged Rates , $155.26 , $155.26 , $155.26 , $155.26 , See APC Packaged Rates , $58.43 , $- , $- , $161.79 , $116.87
C1785,61510023,Hospital Chargemaster,Pacemaker Kappa 400 Dr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61510078,Hospital Chargemaster,Pacemaker Lead 4092-58,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1779,61510173,Hospital Chargemaster,Pacing Lead #5076-58,Outpatient,Outpatient Default Percent / Case Rate,275," $1,176.00 ", $646.80 , $969.02 , See APC Packaged Rates , $823.20 , $458.64 ," $1,134.72 "," $1,139.66 ", $605.66 , See APC Packaged Rates , See APC Packaged Rates , $441.00 , $441.00 , See APC Packaged Rates , See APC Packaged Rates ," $1,093.68 "," $1,093.68 "," $1,093.68 "," $1,093.68 ", See APC Packaged Rates , $411.60 , $- , $- ," $1,139.66 ", $823.20
C1898,61510412,Hospital Chargemaster,Pacing Lead #5092,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1779,61510756,Hospital Chargemaster,Pacemaker Lead,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61510796,Hospital Chargemaster,Pacing Lead Fineline Ii,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61510928,Hospital Chargemaster,Pacing Lead,Outpatient,Outpatient Default Percent / Case Rate,275," $1,097.60 ", $603.68 , $904.42 , See APC Packaged Rates , $768.32 , $428.06 ," $1,059.07 "," $1,063.68 ", $565.29 , See APC Packaged Rates , See APC Packaged Rates , $411.60 , $411.60 , See APC Packaged Rates , See APC Packaged Rates ," $1,020.77 "," $1,020.77 "," $1,020.77 "," $1,020.77 ", See APC Packaged Rates , $384.16 , $- , $- ," $1,063.68 ", $768.32
C1785,61510989,Hospital Chargemaster,Pacemaker Enpulse,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61511032,Hospital Chargemaster,Pacing Lead 45Cm,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61511075,Hospital Chargemaster,Pacemaker Insignia 1 Plus Dr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61511157,Hospital Chargemaster,Pacemaker Enryhthm,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61511356,Hospital Chargemaster,Adapata Pacemaker,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61511500,Hospital Chargemaster,"Pacemaker, Sensia",Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61511659,Hospital Chargemaster,Versa Dual Chamber Pacemaker,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61511795,Hospital Chargemaster,Indignia I Plus Dr Pacemaker,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61511796,Hospital Chargemaster,Pacemaker Adsr01,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61512110,Hospital Chargemaster,Pacemaker Adapta Addr03,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61512136,Hospital Chargemaster,Pacemaker Pm-System Cylos Vr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61512204,Hospital Chargemaster,Pacemaker Victory Xldr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61512227,Hospital Chargemaster,Pacemaker Adapta Adsr03,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61512242,Hospital Chargemaster,Altura Pacemaker S202,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61512243,Hospital Chargemaster,Adapta Pacemaker Adsr06,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61512289,Hospital Chargemaster,Pacemaker Sensia,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61512327,Hospital Chargemaster,Pacemaker Cylos Vr/349811,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61512356,Hospital Chargemaster,Pacemaker Cylos Dr-T,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61512404,Hospital Chargemaster,Pacemaker Cylos Dr System,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61512454,Hospital Chargemaster,Pacemaker Altrua S203Dr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61512508,Hospital Chargemaster,Zepher Pacemaker System,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61512525,Hospital Chargemaster,Altrua Pacemaker #S403,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61512571,Hospital Chargemaster,Pacemaker Victory Sr #5610,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61512688,Hospital Chargemaster,Evia Pacemaker And Lead Set,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61512722,Hospital Chargemaster,Pacemaker Evia Sr-T,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61512723,Hospital Chargemaster,Pacemaker Lead Setrox S 53,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61512743,Hospital Chargemaster,Pacemaker Altrua 20 Dddr Is-1,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1878,61512744,Hospital Chargemaster,Pacemaker Lead Dextrus 53Cm,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61512745,Hospital Chargemaster,Pacemaker Lead Dextrus 60Cm,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61512771,Hospital Chargemaster,Evia Dr-T Pacemaker,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61512784,Hospital Chargemaster,Pacing Lead Setrox S 60,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1722,61512798,Hospital Chargemaster,Virtuoso Implant Defrib Ii Vr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1895,61512800,Hospital Chargemaster,PacemakerDefib Impl Lead 65Cm,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61512826,Hospital Chargemaster,Pacemaker Apapta L,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1722,61512860,Hospital Chargemaster,Pacemaker Maximo Ii Vr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1882,61512877,Hospital Chargemaster,Pacer/Defib Concerto Ii Crt-D,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61512927,Hospital Chargemaster,Altrua Pacemaker 80,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61512979,Hospital Chargemaster,Pacing Lead Ventricle,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1722,61513038,Hospital Chargemaster,Pacemaker Single Chamber Icd,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1882,61513099,Hospital Chargemaster,Pacemaker/Defibrillator,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1722,61513103,Hospital Chargemaster,Pacemaker/Defibrillator,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1895,61513126,Hospital Chargemaster,Pacing Lead Quattro 6947-65,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1721,61513201,Hospital Chargemaster,Pacemaker Secura Dr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1722,61513202,Hospital Chargemaster,Defibrillator Icd-Vr E140,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1895,61513203,Hospital Chargemaster,Defib Lead Endotak 59Cm,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1882,61513249,Hospital Chargemaster,Pacemaker Consulta Crt-D,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1722,61513250,Hospital Chargemaster,Pacemaker Secura Vr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1721,61513281,Hospital Chargemaster,Pacemaker Energen Icd-Dr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61513301,Hospital Chargemaster,Pacemaker Advantio,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61513330,Hospital Chargemaster,Pacemaker Accent Dr Rf,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61513380,Hospital Chargemaster,Pacemaker System Revo,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61513384,Hospital Chargemaster,Pacemaker Advantio,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61513401,Hospital Chargemaster,Pacemaker/Lead System,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1722,61513412,Hospital Chargemaster,Pacemaker D204Vrm,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1721,61513436,Hospital Chargemaster,Pacemaker Cd2231-40,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1882,61513517,Hospital Chargemaster,Pacemaker Viva S Crt-D,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1721,61513519,Hospital Chargemaster,Pacemaker Evera Xt Dr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1722,61513537,Hospital Chargemaster,Pacemaker,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61513608,Hospital Chargemaster,Pacemaker Ingenio K172 Sr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1721,61513609,Hospital Chargemaster,Pacemaker Incepta Icd E163,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1882,61513627,Hospital Chargemaster,Pacemaker Protecta Crt,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61513653,Hospital Chargemaster,Pacemaker Lead 45Cm,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1882,61513685,Hospital Chargemaster,Pacemaker Incepta Crt-D,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C2621,61513710,Hospital Chargemaster,Pacemaker,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1882,61513749,Hospital Chargemaster,Pacemaker Engergen Crt-D,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1721,61513876,Hospital Chargemaster,Pacemaker Unify Assura Crt,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61513936,Hospital Chargemaster,Pacemaker Accolate Dr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61513960,Hospital Chargemaster,Pacemake Essentio Dr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61514044,Hospital Chargemaster,Pacemaker Essentio Sr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1721,61514143,Hospital Chargemaster,Pacemaker Inogen El Icd Vr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61514148,Hospital Chargemaster,Pacemaker Accolade Sr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1721,61514191,Hospital Chargemaster,Pacemaker Evera S Dr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1777,61514222,Hospital Chargemaster,Pacing Lead 64Cm Reliance Sg,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1722,61514223,Hospital Chargemaster,Pacemaker Inogen El Icd Vr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1722,61514224,Hospital Chargemaster,Pacemaker Evera Svr Dvb3D1,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61514267,Hospital Chargemaster,Pacing Lead 59Cm,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61514268,Hospital Chargemaster,Pacing Lead 52Cm,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61514269,Hospital Chargemaster,Pacemaker Essentio Mri Dr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61514270,Hospital Chargemaster,Pacing Lead 52Cm,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61514271,Hospital Chargemaster,Pacing Lead 45Cm,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1721,61514304,Hospital Chargemaster,Pacemaker Unify Assura,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61514308,Hospital Chargemaster,Pacemaker Unify Assura,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C2621,61514316,Hospital Chargemaster,Pacemaker Valitude Crt-P,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61514327,Hospital Chargemaster,Pacemaker Etrinsas Sr-T,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61514385,Hospital Chargemaster,Lv Lead Tendril Sts,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61514386,Hospital Chargemaster,Lv Generator Assurity,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61514430,Hospital Chargemaster,Pacemaker Essentio L110,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61514431,Hospital Chargemaster,Lead Ingevity 7742,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61514470,Hospital Chargemaster,Pacemaker Etrinsa 8Dr-T,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1722,61514495,Hospital Chargemaster,Pacemaker Dynagen El Icd Dr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1882,61514524,Hospital Chargemaster,Dynagen Crt-D,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1898,61514540,Hospital Chargemaster,V-Lead 4074-58Cm,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514545,Hospital Chargemaster,Pacing Lead A-Lead,Outpatient,Outpatient Default Percent / Case Rate,275," $1,176.00 ", $646.80 , $940.80 , See APC Packaged Rates , $823.20 , $458.64 ," $1,134.72 "," $1,139.66 ", $605.66 , See APC Packaged Rates , See APC Packaged Rates , $441.00 , $441.00 , See APC Packaged Rates , See APC Packaged Rates ," $1,093.68 "," $1,093.68 "," $1,093.68 "," $1,093.68 ", See APC Packaged Rates , $411.60 , $705.60 , $411.60 ," $1,139.66 ", $823.20
C1721,61514566,Hospital Chargemaster,Inogen El Icd Dr D142,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1882,61514569,Hospital Chargemaster,Generator Change Crtd,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61514643,Hospital Chargemaster,Pacemaker A3Sr01,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1722,61514734,Hospital Chargemaster,Pacemaker Dynagen El Icd Vr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1722,61514808,Hospital Chargemaster,Momemtun El Vr,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1882,61514809,Hospital Chargemaster,Momentum Crt-D,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61514865,Hospital Chargemaster,Eluna 8 Drt Promri,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1785,61514878,Hospital Chargemaster,Pacemaker Azure Xt Dr Mri,Outpatient,Outpatient Default Percent / Case Rate,275," $9,912.00 "," $5,451.60 "," $8,167.49 ", See APC Packaged Rates ," $6,938.40 "," $3,865.68 "," $9,564.09 "," $9,605.72 "," $5,104.88 ", See APC Packaged Rates , See APC Packaged Rates ," $3,717.00 "," $3,717.00 ", See APC Packaged Rates , See APC Packaged Rates ," $9,218.16 "," $9,218.16 "," $9,218.16 "," $9,218.16 ", See APC Packaged Rates ," $3,469.20 ", $- , $- ," $9,605.72 "," $6,938.40 "
C1721,61514885,Hospital Chargemaster,Pacemaker D121,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1722,61514986,Hospital Chargemaster,Icd-Vr Dvfb1D1 Visia Af Mri,Outpatient,Outpatient Default Percent / Case Rate,275," $28,837.20 "," $15,860.46 "," $23,761.85 ", See APC Packaged Rates ," $20,186.04 "," $11,246.51 "," $27,825.01 "," $27,946.13 "," $14,851.73 ", See APC Packaged Rates , See APC Packaged Rates ," $10,813.95 "," $10,813.95 ", See APC Packaged Rates , See APC Packaged Rates ," $26,818.60 "," $26,818.60 "," $26,818.60 "," $26,818.60 ", See APC Packaged Rates ," $10,093.02 ", $- , $- ," $27,946.13 "," $20,186.04 "
C2621,61515014,Hospital Chargemaster,Solara Mri Crtp Device,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1882,61515049,Hospital Chargemaster,Momentum Crt-D Isi Dfi Isi,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1722,61515111,Hospital Chargemaster,Pacemaker Vigilant El Vr Df4,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1786,61515231,Hospital Chargemaster,Azure Xt Sr Mri Device,Outpatient,Outpatient Default Percent / Case Rate,275," $7,316.40 "," $4,024.02 "," $6,028.71 ", See APC Packaged Rates ," $5,121.48 "," $2,853.40 "," $7,059.59 "," $7,090.32 "," $3,768.09 ", See APC Packaged Rates , See APC Packaged Rates ," $2,743.65 "," $2,743.65 ", See APC Packaged Rates , See APC Packaged Rates ," $6,804.25 "," $6,804.25 "," $6,804.25 "," $6,804.25 ", See APC Packaged Rates ," $2,560.74 ", $- , $- ," $7,090.32 "," $5,121.48 "
C1722,61515319,Hospital Chargemaster,IcdVr Dvfb1D4 Visia Mri Af Us,Outpatient,Outpatient Default Percent / Case Rate,275," $28,837.20 "," $15,860.46 "," $23,761.85 ", See APC Packaged Rates ," $20,186.04 "," $11,246.51 "," $27,825.01 "," $27,946.13 "," $14,851.73 ", See APC Packaged Rates , See APC Packaged Rates ," $10,813.95 "," $10,813.95 ", See APC Packaged Rates , See APC Packaged Rates ," $26,818.60 "," $26,818.60 "," $26,818.60 "," $26,818.60 ", See APC Packaged Rates ," $10,093.02 ", $- , $- ," $27,946.13 "," $20,186.04 "
C1767,61516157,Hospital Chargemaster,Crtp W1Tro3 Solara Crtp,Outpatient,Outpatient Default Percent / Case Rate,275," $14,910.00 "," $8,200.50 "," $12,285.84 ", See APC Packaged Rates ," $10,437.00 "," $5,814.90 "," $14,386.66 "," $14,449.28 "," $7,678.95 ", See APC Packaged Rates , See APC Packaged Rates ," $5,591.25 "," $5,591.25 ", See APC Packaged Rates , See APC Packaged Rates ," $13,866.30 "," $13,866.30 "," $13,866.30 "," $13,866.30 ", See APC Packaged Rates ," $5,218.50 ", $- , $- ," $14,449.28 "," $10,437.00 "
C1898,61516202,Hospital Chargemaster,Lead 407645 Pkg Assy,Outpatient,Outpatient Default Percent / Case Rate,275," $1,166.20 ", $641.41 , $960.95 , See APC Packaged Rates , $816.34 , $454.82 ," $1,125.27 "," $1,130.16 ", $600.62 , See APC Packaged Rates , See APC Packaged Rates , $437.33 , $437.33 , See APC Packaged Rates , See APC Packaged Rates ," $1,084.57 "," $1,084.57 "," $1,084.57 "," $1,084.57 ", See APC Packaged Rates , $408.17 , $- , $- ," $1,130.16 ", $816.34
C1898,61516203,Hospital Chargemaster,Lead 407658 Pkg Assy,Outpatient,Outpatient Default Percent / Case Rate,275, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1721,61516215,Hospital Chargemaster,Defibrillator Dual Chamber,Outpatient,Outpatient Default Percent / Case Rate,275," $31,976.00 "," $17,586.80 "," $26,348.22 ", See APC Packaged Rates ," $22,383.20 "," $12,470.64 "," $30,853.64 "," $30,987.94 "," $16,468.28 ", See APC Packaged Rates , See APC Packaged Rates ," $11,991.00 "," $11,991.00 ", See APC Packaged Rates , See APC Packaged Rates ," $29,737.68 "," $29,737.68 "," $29,737.68 "," $29,737.68 ", See APC Packaged Rates ," $11,191.60 ", $- , $- ," $30,987.94 "," $22,383.20 "
V2630,61501008,Hospital Chargemaster,Intraocular Lens 8191B,Outpatient,Outpatient Default Percent / Case Rate,276, $- , $- , $- , See APC Packaged Rates , $- , $- , $144.81 , $72.64 , $65.58 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $144.81 , $-
V2632,61501009,Hospital Chargemaster,Intraocular Lens Model EZE-55,Outpatient,Outpatient Default Percent / Case Rate,276, $- , $- , $- , See APC Packaged Rates , $- , $- , $144.81 , $72.64 , $65.58 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $144.81 , $-
V2630,61501015,Hospital Chargemaster,Intraocular Lens Model L141U,Outpatient,Outpatient Default Percent / Case Rate,276, $- , $- , $- , See APC Packaged Rates , $- , $- , $144.81 , $72.64 , $65.58 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $144.81 , $-
V2630,61501050,Hospital Chargemaster,Intraocular lens model L122UV,Outpatient,Outpatient Default Percent / Case Rate,276, $- , $- , $- , See APC Packaged Rates , $- , $- , $144.81 , $72.64 , $65.58 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $144.81 , $-
V2630,61585559,Hospital Chargemaster,Lens I.O.L. 23.0 Diopter,Outpatient,Outpatient Default Percent / Case Rate,276, $- , $- , $- , See APC Packaged Rates , $- , $- , $144.81 , $72.64 , $65.58 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $144.81 , $-
V2630,61585561,Hospital Chargemaster,Lens I.O.L. 22.0 Diopter,Outpatient,Outpatient Default Percent / Case Rate,276, $- , $- , $- , See APC Packaged Rates , $- , $- , $144.81 , $72.64 , $65.58 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $144.81 , $-
C1713,61500016,Hospital Chargemaster,No 2 Triathlo TS Plus Tibial,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61500021,Hospital Chargemaster,Guide Wire Acrobat 2,Outpatient,Outpatient Default Percent / Case Rate,278, $658.35 , $362.09 , $542.48 , See APC Packaged Rates , $460.85 , $256.76 , $635.24 , $638.01 , $339.06 , See APC Packaged Rates , See APC Packaged Rates , $219.23 , $219.23 , See APC Packaged Rates , See APC Packaged Rates , $612.27 , $612.27 , $612.27 , $612.27 , See APC Packaged Rates , $230.42 , $- , $- , $638.01 , $460.85
C1713,61500031,Hospital Chargemaster,Humeral Nail T2 7MMX240MM,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61500033,Hospital Chargemaster,Screw Cortex Ti 3.5Mm/L16Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61500034,Hospital Chargemaster,Screw Cortex Ti 3.5Mm/L18Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61500035,Hospital Chargemaster,Screw Cortex TI 4.5mm/l48mm,Outpatient,Outpatient Default Percent / Case Rate,278, $84.99 , $46.74 , $70.03 , See APC Packaged Rates , $59.49 , $33.15 , $82.01 , $82.36 , $43.77 , See APC Packaged Rates , See APC Packaged Rates , $28.30 , $28.30 , See APC Packaged Rates , See APC Packaged Rates , $79.04 , $79.04 , $79.04 , $79.04 , See APC Packaged Rates , $29.75 , $- , $- , $82.36 , $59.49
C1713,61500036,Hospital Chargemaster,Screw Cortex TI 4.5mm/L75mm,Outpatient,Outpatient Default Percent / Case Rate,278, $84.99 , $46.74 , $70.03 , See APC Packaged Rates , $59.49 , $33.15 , $82.01 , $82.36 , $43.77 , See APC Packaged Rates , See APC Packaged Rates , $28.30 , $28.30 , See APC Packaged Rates , See APC Packaged Rates , $79.04 , $79.04 , $79.04 , $79.04 , See APC Packaged Rates , $29.75 , $- , $- , $82.36 , $59.49
,61500049,Hospital Chargemaster,Ansis Ii Ss Cann Scr 4X34Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $347.76 , $191.27 , $278.21 , See APC Packaged Rates , $243.43 , $135.63 , $335.55 , $337.01 , $179.10 , See APC Packaged Rates , See APC Packaged Rates , $115.80 , $115.80 , See APC Packaged Rates , See APC Packaged Rates , $323.42 , $323.42 , $323.42 , $323.42 , See APC Packaged Rates , $121.72 , $208.66 , $115.80 , $337.01 , $243.43
,61500051,Hospital Chargemaster,Ansis Ii Ss Cann Scr 4X46Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $347.76 , $191.27 , $278.21 , See APC Packaged Rates , $243.43 , $135.63 , $335.55 , $337.01 , $179.10 , See APC Packaged Rates , See APC Packaged Rates , $115.80 , $115.80 , See APC Packaged Rates , See APC Packaged Rates , $323.42 , $323.42 , $323.42 , $323.42 , See APC Packaged Rates , $121.72 , $208.66 , $115.80 , $337.01 , $243.43
C1713,61500052,Hospital Chargemaster,Screw Lock T2 F/T mmx70mm,Outpatient,Outpatient Default Percent / Case Rate,278, $347.76 , $191.27 , $286.55 , See APC Packaged Rates , $243.43 , $135.63 , $335.55 , $337.01 , $179.10 , See APC Packaged Rates , See APC Packaged Rates , $115.80 , $115.80 , See APC Packaged Rates , See APC Packaged Rates , $323.42 , $323.42 , $323.42 , $323.42 , See APC Packaged Rates , $121.72 , $- , $- , $337.01 , $243.43
C1713,61500054,Hospital Chargemaster,Triathlon sym cone Augment,Outpatient,Outpatient Default Percent / Case Rate,278," $14,333.76 "," $7,883.57 "," $11,811.02 ", See APC Packaged Rates ," $10,033.63 "," $5,590.17 "," $13,830.65 "," $13,890.85 "," $7,382.17 ", See APC Packaged Rates , See APC Packaged Rates ," $4,773.14 "," $4,773.14 ", See APC Packaged Rates , See APC Packaged Rates ," $13,330.40 "," $13,330.40 "," $13,330.40 "," $13,330.40 ", See APC Packaged Rates ," $5,016.82 ", $- , $- ," $13,890.85 "," $10,033.63 "
C1713,61500055,Hospital Chargemaster,Reunion RFX - Humeral,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61500068,Hospital Chargemaster,Rest Mod Prox Cone Body 19mm,Outpatient,Outpatient Default Percent / Case Rate,278," $14,759.01 "," $8,117.46 "," $12,161.42 ", See APC Packaged Rates ," $10,331.31 "," $5,756.01 "," $14,240.97 "," $14,302.96 "," $7,601.19 ", See APC Packaged Rates , See APC Packaged Rates ," $4,914.75 "," $4,914.75 ", See APC Packaged Rates , See APC Packaged Rates ," $13,725.88 "," $13,725.88 "," $13,725.88 "," $13,725.88 ", See APC Packaged Rates ," $5,165.65 ", $- , $- ," $14,302.96 "," $10,331.31 "
C1713,61500075,Hospital Chargemaster,Screw 6.5 mm Low Profile,Outpatient,Outpatient Default Percent / Case Rate,278, $393.12 , $216.22 , $323.93 , See APC Packaged Rates , $275.18 , $153.32 , $379.32 , $380.97 , $202.46 , See APC Packaged Rates , See APC Packaged Rates , $130.91 , $130.91 , See APC Packaged Rates , See APC Packaged Rates , $365.60 , $365.60 , $365.60 , $365.60 , See APC Packaged Rates , $137.59 , $- , $- , $380.97 , $275.18
C1713,61500087,Hospital Chargemaster,Tibial Insert No 5 Triathlon,Outpatient,Outpatient Default Percent / Case Rate,278," $8,213.94 "," $4,517.67 "," $6,768.29 ", See APC Packaged Rates ," $5,749.76 "," $3,203.44 "," $7,925.63 "," $7,960.13 "," $4,230.34 ", See APC Packaged Rates , See APC Packaged Rates ," $2,735.24 "," $2,735.24 ", See APC Packaged Rates , See APC Packaged Rates ," $7,638.96 "," $7,638.96 "," $7,638.96 "," $7,638.96 ", See APC Packaged Rates ," $2,874.88 ", $- , $- ," $7,960.13 "," $5,749.76 "
C1713,61500092,Hospital Chargemaster,Tibial Insert Triathalon PS X3,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,984.94 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 ", $- , $- ," $3,510.56 "," $2,535.75 "
C1713,61500093,Hospital Chargemaster,Tri TS Femur SZ2 Right,Outpatient,Outpatient Default Percent / Case Rate,278," $22,462.65 "," $12,354.46 "," $18,509.22 ", See APC Packaged Rates ," $15,723.86 "," $8,760.43 "," $21,674.21 "," $21,768.55 "," $11,568.71 ", See APC Packaged Rates , See APC Packaged Rates ," $7,480.06 "," $7,480.06 ", See APC Packaged Rates , See APC Packaged Rates ," $20,890.26 "," $20,890.26 "," $20,890.26 "," $20,890.26 ", See APC Packaged Rates ," $7,861.93 ", $- , $- ," $21,768.55 "," $15,723.86 "
C1713,61500094,Hospital Chargemaster,Tibial Insert NO 2 Triathlon T,Outpatient,Outpatient Default Percent / Case Rate,278," $8,213.94 "," $4,517.67 "," $6,768.29 ", See APC Packaged Rates ," $5,749.76 "," $3,203.44 "," $7,925.63 "," $7,960.13 "," $4,230.34 ", See APC Packaged Rates , See APC Packaged Rates ," $2,735.24 "," $2,735.24 ", See APC Packaged Rates , See APC Packaged Rates ," $7,638.96 "," $7,638.96 "," $7,638.96 "," $7,638.96 ", See APC Packaged Rates ," $2,874.88 ", $- , $- ," $7,960.13 "," $5,749.76 "
C1713,61500095,Hospital Chargemaster,Femoral Distal Tri 10mm SZ2 R,Outpatient,Outpatient Default Percent / Case Rate,278," $4,057.83 "," $2,231.81 "," $3,343.65 ", See APC Packaged Rates ," $2,840.48 "," $1,582.55 "," $3,915.40 "," $3,932.44 "," $2,089.86 ", See APC Packaged Rates , See APC Packaged Rates ," $1,351.26 "," $1,351.26 ", See APC Packaged Rates , See APC Packaged Rates ," $3,773.78 "," $3,773.78 "," $3,773.78 "," $3,773.78 ", See APC Packaged Rates ," $1,420.24 ", $- , $- ," $3,932.44 "," $2,840.48 "
C1713,61500096,Hospital Chargemaster,Tri Post Augment SZ 2 5mm,Outpatient,Outpatient Default Percent / Case Rate,278," $4,057.83 "," $2,231.81 "," $3,343.65 ", See APC Packaged Rates ," $2,840.48 "," $1,582.55 "," $3,915.40 "," $3,932.44 "," $2,089.86 ", See APC Packaged Rates , See APC Packaged Rates ," $1,351.26 "," $1,351.26 ", See APC Packaged Rates , See APC Packaged Rates ," $3,773.78 "," $3,773.78 "," $3,773.78 "," $3,773.78 ", See APC Packaged Rates ," $1,420.24 ", $- , $- ," $3,932.44 "," $2,840.48 "
C1713,61500112,Hospital Chargemaster,Triathlon PS x3 Tibial Insert,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,984.94 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 ", $- , $- ," $3,510.56 "," $2,535.75 "
C1713,61500113,Hospital Chargemaster,Distal Lateral Femur Plate,Outpatient,Outpatient Default Percent / Case Rate,278," $4,814.33 "," $2,647.88 "," $3,967.01 ", See APC Packaged Rates ," $3,370.03 "," $1,877.59 "," $4,645.35 "," $4,665.57 "," $2,479.48 ", See APC Packaged Rates , See APC Packaged Rates ," $1,603.17 "," $1,603.17 ", See APC Packaged Rates , See APC Packaged Rates ," $4,477.33 "," $4,477.33 "," $4,477.33 "," $4,477.33 ", See APC Packaged Rates ," $1,685.02 ", $- , $- ," $4,665.57 "," $3,370.03 "
C1713,61500114,Hospital Chargemaster,4.5mm Cortex T1 Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $84.99 , $46.74 , $70.03 , See APC Packaged Rates , $59.49 , $33.15 , $82.01 , $82.36 , $43.77 , See APC Packaged Rates , See APC Packaged Rates , $28.30 , $28.30 , See APC Packaged Rates , See APC Packaged Rates , $79.04 , $79.04 , $79.04 , $79.04 , See APC Packaged Rates , $29.75 , $- , $- , $82.36 , $59.49
C1713,61500147,Hospital Chargemaster,Trident II Tritanium Multihole,Outpatient,Outpatient Default Percent / Case Rate,278," $9,996.05 "," $5,497.83 "," $8,236.75 ", See APC Packaged Rates ," $6,997.24 "," $3,898.46 "," $9,645.19 "," $9,687.17 "," $5,148.17 ", See APC Packaged Rates , See APC Packaged Rates ," $3,328.68 "," $3,328.68 ", See APC Packaged Rates , See APC Packaged Rates ," $9,296.33 "," $9,296.33 "," $9,296.33 "," $9,296.33 ", See APC Packaged Rates ," $3,498.62 ", $- , $- ," $9,687.17 "," $6,997.24 "
C1713,61500152,Hospital Chargemaster,Tri RM/LL Tib AugS25 5mm,Outpatient,Outpatient Default Percent / Case Rate,278," $3,702.51 "," $2,036.38 "," $3,050.87 ", See APC Packaged Rates ," $2,591.76 "," $1,443.98 "," $3,572.55 "," $3,588.10 "," $1,906.87 ", See APC Packaged Rates , See APC Packaged Rates ," $1,232.94 "," $1,232.94 ", See APC Packaged Rates , See APC Packaged Rates ," $3,443.33 "," $3,443.33 "," $3,443.33 "," $3,443.33 ", See APC Packaged Rates ," $1,295.88 ", $- , $- ," $3,588.10 "," $2,591.76 "
C1713,61500153,Hospital Chargemaster,Stimulan Rapid Cure 5cc,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1788,61500154,Hospital Chargemaster,PowerPort 8 FR ISP,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61500156,Hospital Chargemaster,Stimulan Rapid Cure 10cc,Outpatient,Outpatient Default Percent / Case Rate,278," $4,725.00 "," $2,598.75 "," $3,893.40 ", See APC Packaged Rates ," $3,307.50 "," $1,842.75 "," $4,559.15 "," $4,579.00 "," $2,433.47 ", See APC Packaged Rates , See APC Packaged Rates ," $1,573.43 "," $1,573.43 ", See APC Packaged Rates , See APC Packaged Rates ," $4,394.25 "," $4,394.25 "," $4,394.25 "," $4,394.25 ", See APC Packaged Rates ," $1,653.75 ", $- , $- ," $4,579.00 "," $3,307.50 "
C1713,61500162,Hospital Chargemaster,T2 Recon 3.2mm X 400mm K Wire,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61500163,Hospital Chargemaster,T2 recon lag screw 6.5mmx85mm,Outpatient,Outpatient Default Percent / Case Rate,278, $447.93 , $246.36 , $369.09 , See APC Packaged Rates , $313.55 , $174.69 , $432.21 , $434.09 , $230.69 , See APC Packaged Rates , See APC Packaged Rates , $149.16 , $149.16 , See APC Packaged Rates , See APC Packaged Rates , $416.57 , $416.57 , $416.57 , $416.57 , See APC Packaged Rates , $156.78 , $- , $- , $434.09 , $313.55
C1713,61500164,Hospital Chargemaster,Femoral nail GT LT 11x360mm,Outpatient,Outpatient Default Percent / Case Rate,278," $4,446.98 "," $2,445.84 "," $3,664.31 ", See APC Packaged Rates ," $3,112.89 "," $1,734.32 "," $4,290.89 "," $4,309.57 "," $2,290.28 ", See APC Packaged Rates , See APC Packaged Rates ," $1,480.84 "," $1,480.84 ", See APC Packaged Rates , See APC Packaged Rates ," $4,135.69 "," $4,135.69 "," $4,135.69 "," $4,135.69 ", See APC Packaged Rates ," $1,556.44 ", $- , $- ," $4,309.57 "," $3,112.89 "
C1713,61500165,Hospital Chargemaster,Advanced locking screw 5x40mm,Outpatient,Outpatient Default Percent / Case Rate,278, $496.88 , $273.28 , $409.43 , See APC Packaged Rates , $347.82 , $193.78 , $479.44 , $481.53 , $255.90 , See APC Packaged Rates , See APC Packaged Rates , $165.46 , $165.46 , See APC Packaged Rates , See APC Packaged Rates , $462.10 , $462.10 , $462.10 , $462.10 , See APC Packaged Rates , $173.91 , $- , $- , $481.53 , $347.82
C1713,61500166,Hospital Chargemaster,Advanced locking screw 5x40mm,Outpatient,Outpatient Default Percent / Case Rate,278, $496.88 , $273.28 , $409.43 , See APC Packaged Rates , $347.82 , $193.78 , $479.44 , $481.53 , $255.90 , See APC Packaged Rates , See APC Packaged Rates , $165.46 , $165.46 , See APC Packaged Rates , See APC Packaged Rates , $462.10 , $462.10 , $462.10 , $462.10 , See APC Packaged Rates , $173.91 , $- , $- , $481.53 , $347.82
C1771,61500179,Hospital Chargemaster,Altis Single Incision Sling,Outpatient,Outpatient Default Percent / Case Rate,278," $4,759.65 "," $2,617.81 "," $3,921.95 ", See APC Packaged Rates ," $3,331.76 "," $1,856.26 "," $4,592.59 "," $4,612.58 "," $2,451.31 ", See APC Packaged Rates , See APC Packaged Rates ," $1,584.96 "," $1,584.96 ", See APC Packaged Rates , See APC Packaged Rates ," $4,426.47 "," $4,426.47 "," $4,426.47 "," $4,426.47 ", See APC Packaged Rates ," $1,665.88 ", $- , $- ," $4,612.58 "," $3,331.76 "
C1713,61500185,Hospital Chargemaster,Universal C-Taper +omm Adapter,Outpatient,Outpatient Default Percent / Case Rate,278, $672.84 , $370.06 , $554.42 , See APC Packaged Rates , $470.99 , $262.41 , $649.22 , $652.05 , $346.53 , See APC Packaged Rates , See APC Packaged Rates , $224.06 , $224.06 , See APC Packaged Rates , See APC Packaged Rates , $625.74 , $625.74 , $625.74 , $625.74 , See APC Packaged Rates , $235.49 , $- , $- , $652.05 , $470.99
C1713,61500186,Hospital Chargemaster,Bio Univ Taper Head 32 +0mm,Outpatient,Outpatient Default Percent / Case Rate,278," $2,913.75 "," $1,602.56 "," $2,400.93 ", See APC Packaged Rates ," $2,039.63 "," $1,136.36 "," $2,811.48 "," $2,823.72 "," $1,500.64 ", See APC Packaged Rates , See APC Packaged Rates , $970.28 , $970.28 , See APC Packaged Rates , See APC Packaged Rates ," $2,709.79 "," $2,709.79 "," $2,709.79 "," $2,709.79 ", See APC Packaged Rates ," $1,019.81 ", $- , $- ," $2,823.72 "," $2,039.63 "
C1713,61500187,Hospital Chargemaster,Crossfire Eccentric Insert 10,Outpatient,Outpatient Default Percent / Case Rate,278," $4,864.86 "," $2,675.67 "," $4,008.64 ", See APC Packaged Rates ," $3,405.40 "," $1,897.30 "," $4,694.10 "," $4,714.54 "," $2,505.50 ", See APC Packaged Rates , See APC Packaged Rates ," $1,620.00 "," $1,620.00 ", See APC Packaged Rates , See APC Packaged Rates ," $4,524.32 "," $4,524.32 "," $4,524.32 "," $4,524.32 ", See APC Packaged Rates ," $1,702.70 ", $- , $- ," $4,714.54 "," $3,405.40 "
C1713,61500188,Hospital Chargemaster,Rest Mod Prox Cone 25mm +30,Outpatient,Outpatient Default Percent / Case Rate,278," $14,759.01 "," $8,117.46 "," $12,161.42 ", See APC Packaged Rates ," $10,331.31 "," $5,756.01 "," $14,240.97 "," $14,302.96 "," $7,601.19 ", See APC Packaged Rates , See APC Packaged Rates ," $4,914.75 "," $4,914.75 ", See APC Packaged Rates , See APC Packaged Rates ," $13,725.88 "," $13,725.88 "," $13,725.88 "," $13,725.88 ", See APC Packaged Rates ," $5,165.65 ", $- , $- ," $14,302.96 "," $10,331.31 "
C1713,61500189,Hospital Chargemaster,Trident X3 Eccentric 10 36mm,Outpatient,Outpatient Default Percent / Case Rate,278," $2,898.00 "," $1,593.90 "," $2,387.95 ", See APC Packaged Rates ," $2,028.60 "," $1,130.22 "," $2,796.28 "," $2,808.45 "," $1,492.53 ", See APC Packaged Rates , See APC Packaged Rates , $965.03 , $965.03 , See APC Packaged Rates , See APC Packaged Rates ," $2,695.14 "," $2,695.14 "," $2,695.14 "," $2,695.14 ", See APC Packaged Rates ," $1,014.30 ", $- , $- ," $2,808.45 "," $2,028.60 "
C1713,61500190,Hospital Chargemaster,Trident II Tritanium Multihole,Outpatient,Outpatient Default Percent / Case Rate,278," $7,996.84 "," $4,398.26 "," $6,589.40 ", See APC Packaged Rates ," $5,597.79 "," $3,118.77 "," $7,716.15 "," $7,749.74 "," $4,118.53 ", See APC Packaged Rates , See APC Packaged Rates ," $2,662.95 "," $2,662.95 ", See APC Packaged Rates , See APC Packaged Rates ," $7,437.06 "," $7,437.06 "," $7,437.06 "," $7,437.06 ", See APC Packaged Rates ," $2,798.89 ", $- , $- ," $7,749.74 "," $5,597.79 "
C1713,61500191,Hospital Chargemaster,Tri II Tritanium Multihole 62G,Outpatient,Outpatient Default Percent / Case Rate,278," $7,996.84 "," $4,398.26 "," $6,589.40 ", See APC Packaged Rates ," $5,597.79 "," $3,118.77 "," $7,716.15 "," $7,749.74 "," $4,118.53 ", See APC Packaged Rates , See APC Packaged Rates ," $2,662.95 "," $2,662.95 ", See APC Packaged Rates , See APC Packaged Rates ," $7,437.06 "," $7,437.06 "," $7,437.06 "," $7,437.06 ", See APC Packaged Rates ," $2,798.89 ", $- , $- ," $7,749.74 "," $5,597.79 "
C1713,61500193,Hospital Chargemaster,Canellous TI Screw 6.0mm/L35,Outpatient,Outpatient Default Percent / Case Rate,278, $95.76 , $52.67 , $78.91 , See APC Packaged Rates , $67.03 , $37.35 , $92.40 , $92.80 , $49.32 , See APC Packaged Rates , See APC Packaged Rates , $31.89 , $31.89 , See APC Packaged Rates , See APC Packaged Rates , $89.06 , $89.06 , $89.06 , $89.06 , See APC Packaged Rates , $33.52 , $- , $- , $92.80 , $67.03
C1713,61500194,Hospital Chargemaster,Cancellous TI Screw 6.0mm,Outpatient,Outpatient Default Percent / Case Rate,278, $95.76 , $52.67 , $78.91 , See APC Packaged Rates , $67.03 , $37.35 , $92.40 , $92.80 , $49.32 , See APC Packaged Rates , See APC Packaged Rates , $31.89 , $31.89 , See APC Packaged Rates , See APC Packaged Rates , $89.06 , $89.06 , $89.06 , $89.06 , See APC Packaged Rates , $33.52 , $- , $- , $92.80 , $67.03
C1713,61500195,Hospital Chargemaster,Cancellous TI Screw 6.0mm,Outpatient,Outpatient Default Percent / Case Rate,278, $95.76 , $52.67 , $78.91 , See APC Packaged Rates , $67.03 , $37.35 , $92.40 , $92.80 , $49.32 , See APC Packaged Rates , See APC Packaged Rates , $31.89 , $31.89 , See APC Packaged Rates , See APC Packaged Rates , $89.06 , $89.06 , $89.06 , $89.06 , See APC Packaged Rates , $33.52 , $- , $- , $92.80 , $67.03
C1713,61500196,Hospital Chargemaster,Cancelleous T1 Screw 6.0mm,Outpatient,Outpatient Default Percent / Case Rate,278, $95.76 , $52.67 , $78.91 , See APC Packaged Rates , $67.03 , $37.35 , $92.40 , $92.80 , $49.32 , See APC Packaged Rates , See APC Packaged Rates , $31.89 , $31.89 , See APC Packaged Rates , See APC Packaged Rates , $89.06 , $89.06 , $89.06 , $89.06 , See APC Packaged Rates , $33.52 , $- , $- , $92.80 , $67.03
C1713,61500197,Hospital Chargemaster,Canellous Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $95.76 , $52.67 , $78.91 , See APC Packaged Rates , $67.03 , $37.35 , $92.40 , $92.80 , $49.32 , See APC Packaged Rates , See APC Packaged Rates , $31.89 , $31.89 , See APC Packaged Rates , See APC Packaged Rates , $89.06 , $89.06 , $89.06 , $89.06 , See APC Packaged Rates , $33.52 , $- , $- , $92.80 , $67.03
C1713,61500198,Hospital Chargemaster,Distal lateral Place,Outpatient,Outpatient Default Percent / Case Rate,278," $4,606.06 "," $2,533.33 "," $3,795.39 ", See APC Packaged Rates ," $3,224.24 "," $1,796.36 "," $4,444.39 "," $4,463.73 "," $2,372.21 ", See APC Packaged Rates , See APC Packaged Rates ," $1,533.82 "," $1,533.82 ", See APC Packaged Rates , See APC Packaged Rates ," $4,283.64 "," $4,283.64 "," $4,283.64 "," $4,283.64 ", See APC Packaged Rates ," $1,612.12 ", $- , $- ," $4,463.73 "," $3,224.24 "
C1713,61500199,Hospital Chargemaster,Cortex TI Screw 4.5mm,Outpatient,Outpatient Default Percent / Case Rate,278, $84.99 , $46.74 , $70.03 , See APC Packaged Rates , $59.49 , $33.15 , $82.01 , $82.36 , $43.77 , See APC Packaged Rates , See APC Packaged Rates , $28.30 , $28.30 , See APC Packaged Rates , See APC Packaged Rates , $79.04 , $79.04 , $79.04 , $79.04 , See APC Packaged Rates , $29.75 , $- , $- , $82.36 , $59.49
C1713,61500200,Hospital Chargemaster,6mm Cancellous TI Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $95.76 , $52.67 , $78.91 , See APC Packaged Rates , $67.03 , $37.35 , $92.40 , $92.80 , $49.32 , See APC Packaged Rates , See APC Packaged Rates , $31.89 , $31.89 , See APC Packaged Rates , See APC Packaged Rates , $89.06 , $89.06 , $89.06 , $89.06 , See APC Packaged Rates , $33.52 , $- , $- , $92.80 , $67.03
C1713,61500201,Hospital Chargemaster,Cancellous TI screw 6.0mm/L50m,Outpatient,Outpatient Default Percent / Case Rate,278, $95.76 , $52.67 , $78.91 , See APC Packaged Rates , $67.03 , $37.35 , $92.40 , $92.80 , $49.32 , See APC Packaged Rates , See APC Packaged Rates , $31.89 , $31.89 , See APC Packaged Rates , See APC Packaged Rates , $89.06 , $89.06 , $89.06 , $89.06 , See APC Packaged Rates , $33.52 , $- , $- , $92.80 , $67.03
C1713,61500202,Hospital Chargemaster,Cortex TI screw 4.5mm/L50,Outpatient,Outpatient Default Percent / Case Rate,278, $84.99 , $46.74 , $70.03 , See APC Packaged Rates , $59.49 , $33.15 , $82.01 , $82.36 , $43.77 , See APC Packaged Rates , See APC Packaged Rates , $28.30 , $28.30 , See APC Packaged Rates , See APC Packaged Rates , $79.04 , $79.04 , $79.04 , $79.04 , See APC Packaged Rates , $29.75 , $- , $- , $82.36 , $59.49
C1713,61500203,Hospital Chargemaster,Cortex TI Screw 4.5mm/L65mm,Outpatient,Outpatient Default Percent / Case Rate,278, $84.99 , $46.74 , $70.03 , See APC Packaged Rates , $59.49 , $33.15 , $82.01 , $82.36 , $43.77 , See APC Packaged Rates , See APC Packaged Rates , $28.30 , $28.30 , See APC Packaged Rates , See APC Packaged Rates , $79.04 , $79.04 , $79.04 , $79.04 , See APC Packaged Rates , $29.75 , $- , $- , $82.36 , $59.49
C1781,61500226,Hospital Chargemaster,Graft Axis Tutoplst Dermis,Outpatient,Outpatient Default Percent / Case Rate,278," $9,535.05 "," $5,244.28 "," $7,856.88 ", See APC Packaged Rates ," $6,674.54 "," $3,718.67 "," $9,200.37 "," $9,240.42 "," $4,910.74 ", See APC Packaged Rates , See APC Packaged Rates ," $3,175.17 "," $3,175.17 ", See APC Packaged Rates , See APC Packaged Rates ," $8,867.60 "," $8,867.60 "," $8,867.60 "," $8,867.60 ", See APC Packaged Rates ," $3,337.27 ", $- , $- ," $9,240.42 "," $6,674.54 "
L8699,61500231,Hospital Chargemaster,Urolift System,Outpatient,Outpatient Default Percent / Case Rate,278," $3,071.25 "," $1,689.19 "," $2,530.71 ", See APC Packaged Rates ," $2,149.88 "," $1,197.79 "," $2,963.45 "," $2,976.35 "," $1,581.76 ", See APC Packaged Rates , See APC Packaged Rates ," $1,022.73 "," $1,022.73 ", See APC Packaged Rates , See APC Packaged Rates ," $2,856.26 "," $2,856.26 "," $2,856.26 "," $2,856.26 ", See APC Packaged Rates ," $1,074.94 ", $- , $- ," $2,976.35 "," $2,149.88 "
C1713,61500232,Hospital Chargemaster,Kwire Non-threaded 3.0mm,Outpatient,Outpatient Default Percent / Case Rate,278, $66.15 , $36.38 , $54.51 , See APC Packaged Rates , $46.31 , $25.80 , $63.83 , $64.11 , $34.07 , See APC Packaged Rates , See APC Packaged Rates , $22.03 , $22.03 , See APC Packaged Rates , See APC Packaged Rates , $61.52 , $61.52 , $61.52 , $61.52 , See APC Packaged Rates , $23.15 , $- , $- , $64.11 , $46.31
C2622,61500257,Hospital Chargemaster,Penile Implant 9.5mm x 14-23cm,Outpatient,Outpatient Default Percent / Case Rate,278," $38,382.75 "," $21,110.51 "," $31,627.39 ", See APC Packaged Rates ," $26,867.93 "," $14,969.27 "," $37,035.52 "," $37,196.72 "," $19,767.88 ", See APC Packaged Rates , See APC Packaged Rates ," $12,781.46 "," $12,781.46 ", See APC Packaged Rates , See APC Packaged Rates ," $35,695.96 "," $35,695.96 "," $35,695.96 "," $35,695.96 ", See APC Packaged Rates ," $13,433.96 ", $- , $- ," $37,196.72 "," $26,867.93 "
C1713,61500258,Hospital Chargemaster,Screw 4mm Cancellous T1,Outpatient,Outpatient Default Percent / Case Rate,278, $81.40 , $44.77 , $67.07 , See APC Packaged Rates , $56.98 , $31.75 , $78.54 , $78.88 , $41.92 , See APC Packaged Rates , See APC Packaged Rates , $27.11 , $27.11 , See APC Packaged Rates , See APC Packaged Rates , $75.70 , $75.70 , $75.70 , $75.70 , See APC Packaged Rates , $28.49 , $- , $- , $78.88 , $56.98
C1713,61500259,Hospital Chargemaster,Screw 3.5mm Cortex T1,Outpatient,Outpatient Default Percent / Case Rate,278, $75.41 , $41.48 , $62.14 , See APC Packaged Rates , $52.79 , $29.41 , $72.76 , $73.08 , $38.84 , See APC Packaged Rates , See APC Packaged Rates , $25.11 , $25.11 , See APC Packaged Rates , See APC Packaged Rates , $70.13 , $70.13 , $70.13 , $70.13 , See APC Packaged Rates , $26.39 , $- , $- , $73.08 , $52.79
C1713,61500261,Hospital Chargemaster,Bone Screw T6 2.0mm L14mm,Outpatient,Outpatient Default Percent / Case Rate,278, $437.06 , $240.38 , $360.14 , See APC Packaged Rates , $305.94 , $170.45 , $421.72 , $423.55 , $225.09 , See APC Packaged Rates , See APC Packaged Rates , $145.54 , $145.54 , See APC Packaged Rates , See APC Packaged Rates , $406.47 , $406.47 , $406.47 , $406.47 , See APC Packaged Rates , $152.97 , $- , $- , $423.55 , $305.94
C1713,61500262,Hospital Chargemaster,Bone Screw T6 2.0mm L16mm,Outpatient,Outpatient Default Percent / Case Rate,278, $437.06 , $240.38 , $360.14 , See APC Packaged Rates , $305.94 , $170.45 , $421.72 , $423.55 , $225.09 , See APC Packaged Rates , See APC Packaged Rates , $145.54 , $145.54 , See APC Packaged Rates , See APC Packaged Rates , $406.47 , $406.47 , $406.47 , $406.47 , See APC Packaged Rates , $152.97 , $- , $- , $423.55 , $305.94
C1713,61500263,Hospital Chargemaster,Bone Screw T6 2.0mm L18mm,Outpatient,Outpatient Default Percent / Case Rate,278, $437.06 , $240.38 , $360.14 , See APC Packaged Rates , $305.94 , $170.45 , $421.72 , $423.55 , $225.09 , See APC Packaged Rates , See APC Packaged Rates , $145.54 , $145.54 , See APC Packaged Rates , See APC Packaged Rates , $406.47 , $406.47 , $406.47 , $406.47 , See APC Packaged Rates , $152.97 , $- , $- , $423.55 , $305.94
C1713,61500264,Hospital Chargemaster,Bone Screw T6 2.0mm L20mm,Outpatient,Outpatient Default Percent / Case Rate,278, $437.06 , $240.38 , $360.14 , See APC Packaged Rates , $305.94 , $170.45 , $421.72 , $423.55 , $225.09 , See APC Packaged Rates , See APC Packaged Rates , $145.54 , $145.54 , See APC Packaged Rates , See APC Packaged Rates , $406.47 , $406.47 , $406.47 , $406.47 , See APC Packaged Rates , $152.97 , $- , $- , $423.55 , $305.94
C1713,61500265,Hospital Chargemaster,Bone Screw T6 2.0mm L22mm,Outpatient,Outpatient Default Percent / Case Rate,278, $437.06 , $240.38 , $360.14 , See APC Packaged Rates , $305.94 , $170.45 , $421.72 , $423.55 , $225.09 , See APC Packaged Rates , See APC Packaged Rates , $145.54 , $145.54 , See APC Packaged Rates , See APC Packaged Rates , $406.47 , $406.47 , $406.47 , $406.47 , See APC Packaged Rates , $152.97 , $- , $- , $423.55 , $305.94
C1713,61500268,Hospital Chargemaster,Proximal Medial Tibial Plate,Outpatient,Outpatient Default Percent / Case Rate,278," $3,562.27 "," $1,959.25 "," $2,935.31 ", See APC Packaged Rates ," $2,493.59 "," $1,389.29 "," $3,437.23 "," $3,452.20 "," $1,834.64 ", See APC Packaged Rates , See APC Packaged Rates ," $1,186.24 "," $1,186.24 ", See APC Packaged Rates , See APC Packaged Rates ," $3,312.91 "," $3,312.91 "," $3,312.91 "," $3,312.91 ", See APC Packaged Rates ," $1,246.79 ", $- , $- ," $3,452.20 "," $2,493.59 "
C1713,61500270,Hospital Chargemaster,Bone Cancellour Crushed 30cc,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61500281,Hospital Chargemaster,Proximal Medial Plate Rt,Outpatient,Outpatient Default Percent / Case Rate,278," $3,353.99 "," $1,844.69 "," $2,763.69 ", See APC Packaged Rates ," $2,347.79 "," $1,308.06 "," $3,236.26 "," $3,250.35 "," $1,727.37 ", See APC Packaged Rates , See APC Packaged Rates ," $1,116.88 "," $1,116.88 ", See APC Packaged Rates , See APC Packaged Rates ," $3,119.21 "," $3,119.21 "," $3,119.21 "," $3,119.21 ", See APC Packaged Rates ," $1,173.90 ", $- , $- ," $3,250.35 "," $2,347.79 "
C1713,61500282,Hospital Chargemaster,K-Wire Wdrill Tip,Outpatient,Outpatient Default Percent / Case Rate,278, $30.60 , $16.83 , $25.21 , See APC Packaged Rates , $21.42 , $11.93 , $29.53 , $29.65 , $15.76 , See APC Packaged Rates , See APC Packaged Rates , $10.19 , $10.19 , See APC Packaged Rates , See APC Packaged Rates , $28.46 , $28.46 , $28.46 , $28.46 , See APC Packaged Rates , $10.71 , $- , $- , $29.65 , $21.42
C1713,61500287,Hospital Chargemaster,Bone Screw T6 2.0mm L16mm,Outpatient,Outpatient Default Percent / Case Rate,278, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.00 , $0.00 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $- , $- , $0.01 , $0.01
C1781,61500294,Hospital Chargemaster,Mesh Progrip 10cmx15cm,Outpatient,Outpatient Default Percent / Case Rate,278," $1,181.88 ", $650.03 , $973.87 , See APC Packaged Rates , $827.32 , $460.93 ," $1,140.40 "," $1,145.36 ", $608.69 , See APC Packaged Rates , See APC Packaged Rates , $393.57 , $393.57 , See APC Packaged Rates , See APC Packaged Rates ," $1,099.15 "," $1,099.15 "," $1,099.15 "," $1,099.15 ", See APC Packaged Rates , $413.66 , $- , $- ," $1,145.36 ", $827.32
C1875,61500296,Hospital Chargemaster,Stent inlay optima 7FRx22cm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1875,61500297,Hospital Chargemaster,Stent inlay optima 7FRx26cm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1875,61500298,Hospital Chargemaster,Stent inlay optima 7FRx26cm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1875,61500299,Hospital Chargemaster,Stent inlay optima 7FRx28cm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61500300,Hospital Chargemaster,Locking screw T6 2.0mm L8mm,Outpatient,Outpatient Default Percent / Case Rate,278, $748.91 , $411.90 , $617.10 , See APC Packaged Rates , $524.24 , $292.07 , $722.62 , $725.77 , $385.70 , See APC Packaged Rates , See APC Packaged Rates , $249.39 , $249.39 , See APC Packaged Rates , See APC Packaged Rates , $696.49 , $696.49 , $696.49 , $696.49 , See APC Packaged Rates , $262.12 , $- , $- , $725.77 , $524.24
C1713,61500301,Hospital Chargemaster,Locking screw T6 2.0mm L12mm,Outpatient,Outpatient Default Percent / Case Rate,278, $748.91 , $411.90 , $617.10 , See APC Packaged Rates , $524.24 , $292.07 , $722.62 , $725.77 , $385.70 , See APC Packaged Rates , See APC Packaged Rates , $249.39 , $249.39 , See APC Packaged Rates , See APC Packaged Rates , $696.49 , $696.49 , $696.49 , $696.49 , See APC Packaged Rates , $262.12 , $- , $- , $725.77 , $524.24
C1713,61500302,Hospital Chargemaster,Bone Screw T6 2.0mm L12mm,Outpatient,Outpatient Default Percent / Case Rate,278, $437.06 , $240.38 , $360.14 , See APC Packaged Rates , $305.94 , $170.45 , $421.72 , $423.55 , $225.09 , See APC Packaged Rates , See APC Packaged Rates , $145.54 , $145.54 , See APC Packaged Rates , See APC Packaged Rates , $406.47 , $406.47 , $406.47 , $406.47 , See APC Packaged Rates , $152.97 , $- , $- , $423.55 , $305.94
C1713,61500304,Hospital Chargemaster,Distal lateral femur plate,Outpatient,Outpatient Default Percent / Case Rate,278," $5,129.15 "," $2,821.03 "," $4,226.42 ", See APC Packaged Rates ," $3,590.41 "," $2,000.37 "," $4,949.12 "," $4,970.66 "," $2,641.61 ", See APC Packaged Rates , See APC Packaged Rates ," $1,708.01 "," $1,708.01 ", See APC Packaged Rates , See APC Packaged Rates ," $4,770.11 "," $4,770.11 "," $4,770.11 "," $4,770.11 ", See APC Packaged Rates ," $1,795.20 ", $- , $- ," $4,970.66 "," $3,590.41 "
C1713,61500305,Hospital Chargemaster,Cortex screw T1 4.5mm L55mm,Outpatient,Outpatient Default Percent / Case Rate,278, $84.99 , $46.74 , $70.03 , See APC Packaged Rates , $59.49 , $33.15 , $82.01 , $82.36 , $43.77 , See APC Packaged Rates , See APC Packaged Rates , $28.30 , $28.30 , See APC Packaged Rates , See APC Packaged Rates , $79.04 , $79.04 , $79.04 , $79.04 , See APC Packaged Rates , $29.75 , $- , $- , $82.36 , $59.49
,61500306,Hospital Chargemaster,TENDON PATELLAR PRESHAPED,Outpatient,Outpatient Default Percent / Case Rate,278," $10,395.00 "," $5,717.25 "," $8,316.00 ", See APC Packaged Rates ," $7,276.50 "," $4,054.05 "," $10,030.14 "," $10,073.79 "," $5,353.63 ", See APC Packaged Rates , See APC Packaged Rates ," $3,461.54 "," $3,461.54 ", See APC Packaged Rates , See APC Packaged Rates ," $9,667.35 "," $9,667.35 "," $9,667.35 "," $9,667.35 ", See APC Packaged Rates ," $3,638.25 "," $6,237.00 "," $3,461.54 "," $10,073.79 "," $7,276.50 "
C1713,61500316,Hospital Chargemaster,Grip plate 200mm Vitallium,Outpatient,Outpatient Default Percent / Case Rate,278," $6,605.55 "," $3,633.05 "," $5,442.97 ", See APC Packaged Rates ," $4,623.89 "," $2,576.16 "," $6,373.70 "," $6,401.44 "," $3,401.99 ", See APC Packaged Rates , See APC Packaged Rates ," $2,199.65 "," $2,199.65 ", See APC Packaged Rates , See APC Packaged Rates ," $6,143.16 "," $6,143.16 "," $6,143.16 "," $6,143.16 ", See APC Packaged Rates ," $2,311.94 ", $- , $- ," $6,401.44 "," $4,623.89 "
C1713,61500317,Hospital Chargemaster,Screw Cortex T1 4.5mm L26mm,Outpatient,Outpatient Default Percent / Case Rate,278, $84.99 , $46.74 , $70.03 , See APC Packaged Rates , $59.49 , $33.15 , $82.01 , $82.36 , $43.77 , See APC Packaged Rates , See APC Packaged Rates , $28.30 , $28.30 , See APC Packaged Rates , See APC Packaged Rates , $79.04 , $79.04 , $79.04 , $79.04 , See APC Packaged Rates , $29.75 , $- , $- , $82.36 , $59.49
C1713,61500318,Hospital Chargemaster,Screw self tap 4.5X38mm,Outpatient,Outpatient Default Percent / Case Rate,278, $64.26 , $35.34 , $52.95 , See APC Packaged Rates , $44.98 , $25.06 , $62.00 , $62.27 , $33.10 , See APC Packaged Rates , See APC Packaged Rates , $21.40 , $21.40 , See APC Packaged Rates , See APC Packaged Rates , $59.76 , $59.76 , $59.76 , $59.76 , See APC Packaged Rates , $22.49 , $- , $- , $62.27 , $44.98
C1713,61500319,Hospital Chargemaster,Screw self tap 4.5 x 42mm,Outpatient,Outpatient Default Percent / Case Rate,278, $64.26 , $35.34 , $52.95 , See APC Packaged Rates , $44.98 , $25.06 , $62.00 , $62.27 , $33.10 , See APC Packaged Rates , See APC Packaged Rates , $21.40 , $21.40 , See APC Packaged Rates , See APC Packaged Rates , $59.76 , $59.76 , $59.76 , $59.76 , See APC Packaged Rates , $22.49 , $- , $- , $62.27 , $44.98
C1813,61500331,Hospital Chargemaster,Testicular Prosthesis Small,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1813,61500332,Hospital Chargemaster,Testicular Prosthesis Medium,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1813,61500333,Hospital Chargemaster,Testicular Prosthesis Large,Outpatient,Outpatient Default Percent / Case Rate,278," $7,566.30 "," $4,161.47 "," $6,234.63 ", See APC Packaged Rates ," $5,296.41 "," $2,950.86 "," $7,300.72 "," $7,332.50 "," $3,896.80 ", See APC Packaged Rates , See APC Packaged Rates ," $2,519.58 "," $2,519.58 ", See APC Packaged Rates , See APC Packaged Rates ," $7,036.66 "," $7,036.66 "," $7,036.66 "," $7,036.66 ", See APC Packaged Rates ," $2,648.21 ", $- , $- ," $7,332.50 "," $5,296.41 "
C1713,61500334,Hospital Chargemaster,Exeter V40 Stem 44mm No2,Outpatient,Outpatient Default Percent / Case Rate,278," $5,197.50 "," $2,858.63 "," $4,282.74 ", See APC Packaged Rates ," $3,638.25 "," $2,027.03 "," $5,015.07 "," $5,036.90 "," $2,676.82 ", See APC Packaged Rates , See APC Packaged Rates ," $1,730.77 "," $1,730.77 ", See APC Packaged Rates , See APC Packaged Rates ," $4,833.68 "," $4,833.68 "," $4,833.68 "," $4,833.68 ", See APC Packaged Rates ," $1,819.13 ", $- , $- ," $5,036.90 "," $3,638.25 "
C1713,61500336,Hospital Chargemaster,Locking Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $421.00 , $231.55 , $346.90 , See APC Packaged Rates , $294.70 , $164.19 , $406.22 , $407.99 , $216.82 , See APC Packaged Rates , See APC Packaged Rates , $140.19 , $140.19 , See APC Packaged Rates , See APC Packaged Rates , $391.53 , $391.53 , $391.53 , $391.53 , See APC Packaged Rates , $147.35 , $- , $- , $407.99 , $294.70
C1713,61500337,Hospital Chargemaster,Locking Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $421.00 , $231.55 , $346.90 , See APC Packaged Rates , $294.70 , $164.19 , $406.22 , $407.99 , $216.82 , See APC Packaged Rates , See APC Packaged Rates , $140.19 , $140.19 , See APC Packaged Rates , See APC Packaged Rates , $391.53 , $391.53 , $391.53 , $391.53 , See APC Packaged Rates , $147.35 , $- , $- , $407.99 , $294.70
C1813,61500340,Hospital Chargemaster,Ambicor Penile Prothesis,Outpatient,Outpatient Default Percent / Case Rate,278," $50,699.25 "," $27,884.59 "," $41,776.18 ", See APC Packaged Rates ," $35,489.48 "," $19,772.71 "," $48,919.71 "," $49,132.64 "," $26,111.13 ", See APC Packaged Rates , See APC Packaged Rates ," $16,882.85 "," $16,882.85 ", See APC Packaged Rates , See APC Packaged Rates ," $47,150.30 "," $47,150.30 "," $47,150.30 "," $47,150.30 ", See APC Packaged Rates ," $17,744.74 ", $- , $- ," $49,132.64 "," $35,489.48 "
C1713,61500346,Hospital Chargemaster,Nail Tibial 9x31 5mm,Outpatient,Outpatient Default Percent / Case Rate,278," $3,396.05 "," $1,867.83 "," $2,798.35 ", See APC Packaged Rates ," $2,377.24 "," $1,324.46 "," $3,276.85 "," $3,291.11 "," $1,749.03 ", See APC Packaged Rates , See APC Packaged Rates ," $1,130.88 "," $1,130.88 ", See APC Packaged Rates , See APC Packaged Rates ," $3,158.33 "," $3,158.33 "," $3,158.33 "," $3,158.33 ", See APC Packaged Rates ," $1,188.62 ", $- , $- ," $3,291.11 "," $2,377.24 "
C1713,61500347,Hospital Chargemaster,Screw Locking,Outpatient,Outpatient Default Percent / Case Rate,278, $421.00 , $231.55 , $346.90 , See APC Packaged Rates , $294.70 , $164.19 , $406.22 , $407.99 , $216.82 , See APC Packaged Rates , See APC Packaged Rates , $140.19 , $140.19 , See APC Packaged Rates , See APC Packaged Rates , $391.53 , $391.53 , $391.53 , $391.53 , See APC Packaged Rates , $147.35 , $- , $- , $407.99 , $294.70
C1713,61500348,Hospital Chargemaster,Screw Locking,Outpatient,Outpatient Default Percent / Case Rate,278, $421.00 , $231.55 , $346.90 , See APC Packaged Rates , $294.70 , $164.19 , $406.22 , $407.99 , $216.82 , See APC Packaged Rates , See APC Packaged Rates , $140.19 , $140.19 , See APC Packaged Rates , See APC Packaged Rates , $391.53 , $391.53 , $391.53 , $391.53 , See APC Packaged Rates , $147.35 , $- , $- , $407.99 , $294.70
C1713,61501108,Hospital Chargemaster,K-Wire .062 9 Strile,Outpatient,Outpatient Default Percent / Case Rate,278, $13.80 , $7.59 , $11.37 , See APC Packaged Rates , $9.66 , $5.38 , $13.32 , $13.37 , $7.11 , See APC Packaged Rates , See APC Packaged Rates , $4.60 , $4.60 , See APC Packaged Rates , See APC Packaged Rates , $12.83 , $12.83 , $12.83 , $12.83 , See APC Packaged Rates , $4.83 , $- , $- , $13.37 , $9.66
C1713,61507018,Hospital Chargemaster,Tissue Marker Twist Shape 8G,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61507019,Hospital Chargemaster,Tissue Marker Bowtie Shape 8G,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61507023,Hospital Chargemaster,Mammomar Tissue Mark Twist10G,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61507024,Hospital Chargemaster,Tissue Marke Bowtie Shape 10G,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61507106,Hospital Chargemaster,Filshie Clip,Outpatient,Outpatient Default Percent / Case Rate,278, $346.50 , $190.58 , $277.20 , See APC Packaged Rates , $242.55 , $135.14 , $334.34 , $335.79 , $178.45 , See APC Packaged Rates , See APC Packaged Rates , $115.38 , $115.38 , See APC Packaged Rates , See APC Packaged Rates , $322.25 , $322.25 , $322.25 , $322.25 , See APC Packaged Rates , $121.28 , $207.90 , $115.38 , $335.79 , $242.55
C1713,61507208,Hospital Chargemaster,"Pin, Rigidfix Btb 2.7M Cross",Outpatient,Outpatient Default Percent / Case Rate,278," $1,102.50 ", $606.38 , $908.46 , See APC Packaged Rates , $771.75 , $429.98 ," $1,063.80 "," $1,068.43 ", $567.81 , See APC Packaged Rates , See APC Packaged Rates , $367.13 , $367.13 , See APC Packaged Rates , See APC Packaged Rates ," $1,025.33 "," $1,025.33 "," $1,025.33 "," $1,025.33 ", See APC Packaged Rates , $385.88 , $- , $- ," $1,068.43 ", $771.75
C1713,61507226,Hospital Chargemaster,"Pin, Threaded Guide 2.8mm",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
A4649,61508483,Hospital Chargemaster,Goode T-Tubes,Outpatient,Outpatient Default Percent / Case Rate,278, $131.73 , $72.45 , $108.55 , See APC Packaged Rates , $92.21 , $51.37 , $127.11 , $127.66 , $67.84 , See APC Packaged Rates , See APC Packaged Rates , $43.87 , $43.87 , See APC Packaged Rates , See APC Packaged Rates , $122.51 , $122.51 , $122.51 , $122.51 , See APC Packaged Rates , $46.11 , $- , $- , $127.66 , $92.21
,61508610,Hospital Chargemaster,Gastrostomy Introduce,Outpatient,Outpatient Default Percent / Case Rate,278," $1,329.30 ", $731.12 ," $1,063.44 ", See APC Packaged Rates , $930.51 , $518.43 ," $1,282.64 "," $1,288.22 ", $684.62 , See APC Packaged Rates , See APC Packaged Rates , $442.66 , $442.66 , See APC Packaged Rates , See APC Packaged Rates ," $1,236.25 "," $1,236.25 "," $1,236.25 "," $1,236.25 ", See APC Packaged Rates , $465.26 , $797.58 , $442.66 ," $1,288.22 ", $930.51
C1781,61509253,Hospital Chargemaster,"Mesh,Marlex 3x6",Outpatient,Outpatient Default Percent / Case Rate,278, $104.78 , $57.63 , $86.34 , See APC Packaged Rates , $73.35 , $40.86 , $101.10 , $101.54 , $53.96 , See APC Packaged Rates , See APC Packaged Rates , $34.89 , $34.89 , See APC Packaged Rates , See APC Packaged Rates , $97.45 , $97.45 , $97.45 , $97.45 , See APC Packaged Rates , $36.67 , $- , $- , $101.54 , $73.35
C1781,61509256,Hospital Chargemaster,"Mesh, Marlex 1x4",Outpatient,Outpatient Default Percent / Case Rate,278, $76.75 , $42.21 , $63.24 , See APC Packaged Rates , $53.73 , $29.93 , $74.06 , $74.38 , $39.53 , See APC Packaged Rates , See APC Packaged Rates , $25.56 , $25.56 , See APC Packaged Rates , See APC Packaged Rates , $71.38 , $71.38 , $71.38 , $71.38 , See APC Packaged Rates , $26.86 , $- , $- , $74.38 , $53.73
C1713,61509314,Hospital Chargemaster,Circular Stapler Curved,Outpatient,Outpatient Default Percent / Case Rate,278, $926.79 , $509.73 , $763.67 , See APC Packaged Rates , $648.75 , $361.45 , $894.26 , $898.15 , $477.32 , See APC Packaged Rates , See APC Packaged Rates , $308.62 , $308.62 , See APC Packaged Rates , See APC Packaged Rates , $861.91 , $861.91 , $861.91 , $861.91 , See APC Packaged Rates , $324.38 , $- , $- , $898.15 , $648.75
C1713,61509558,Hospital Chargemaster,Circular Stapler Curved 25mm,Outpatient,Outpatient Default Percent / Case Rate,278, $926.79 , $509.73 , $763.67 , See APC Packaged Rates , $648.75 , $361.45 , $894.26 , $898.15 , $477.32 , See APC Packaged Rates , See APC Packaged Rates , $308.62 , $308.62 , See APC Packaged Rates , See APC Packaged Rates , $861.91 , $861.91 , $861.91 , $861.91 , See APC Packaged Rates , $324.38 , $- , $- , $898.15 , $648.75
C1781,61509559,Hospital Chargemaster,Plug Prefix Med,Outpatient,Outpatient Default Percent / Case Rate,278, $436.91 , $240.30 , $360.01 , See APC Packaged Rates , $305.84 , $170.39 , $421.57 , $423.41 , $225.02 , See APC Packaged Rates , See APC Packaged Rates , $145.49 , $145.49 , See APC Packaged Rates , See APC Packaged Rates , $406.33 , $406.33 , $406.33 , $406.33 , See APC Packaged Rates , $152.92 , $- , $- , $423.41 , $305.84
C1781,61509560,Hospital Chargemaster,Prefix Plug LRG,Outpatient,Outpatient Default Percent / Case Rate,278, $445.88 , $245.23 , $367.41 , See APC Packaged Rates , $312.12 , $173.89 , $430.23 , $432.10 , $229.64 , See APC Packaged Rates , See APC Packaged Rates , $148.48 , $148.48 , See APC Packaged Rates , See APC Packaged Rates , $414.67 , $414.67 , $414.67 , $414.67 , See APC Packaged Rates , $156.06 , $- , $- , $432.10 , $312.12
C1713,61509658,Hospital Chargemaster,Screw Cancellous 6.5 16/40mm,Outpatient,Outpatient Default Percent / Case Rate,278, $85.18 , $46.85 , $70.19 , See APC Packaged Rates , $59.63 , $33.22 , $82.19 , $82.55 , $43.87 , See APC Packaged Rates , See APC Packaged Rates , $28.36 , $28.36 , See APC Packaged Rates , See APC Packaged Rates , $79.22 , $79.22 , $79.22 , $79.22 , See APC Packaged Rates , $29.81 , $- , $- , $82.55 , $59.63
C1713,61509687,Hospital Chargemaster,Washer 13.0mm,Outpatient,Outpatient Default Percent / Case Rate,278, $72.89 , $40.09 , $60.06 , See APC Packaged Rates , $51.02 , $28.43 , $70.33 , $70.64 , $37.54 , See APC Packaged Rates , See APC Packaged Rates , $24.27 , $24.27 , See APC Packaged Rates , See APC Packaged Rates , $67.79 , $67.79 , $67.79 , $67.79 , See APC Packaged Rates , $25.51 , $- , $- , $70.64 , $51.02
C1713,61509738,Hospital Chargemaster,Stapler 90 Linear,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61509741,Hospital Chargemaster,Tube Paprella Vent,Outpatient,Outpatient Default Percent / Case Rate,278, $46.49 , $25.57 , $37.19 , See APC Packaged Rates , $32.54 , $18.13 , $44.86 , $45.05 , $23.94 , See APC Packaged Rates , See APC Packaged Rates , $15.48 , $15.48 , See APC Packaged Rates , See APC Packaged Rates , $43.24 , $43.24 , $43.24 , $43.24 , See APC Packaged Rates , $16.27 , $27.89 , $15.48 , $45.05 , $32.54
,61509912,Hospital Chargemaster,Femoral Guide Pin Xlong,Outpatient,Outpatient Default Percent / Case Rate,278, $214.20 , $117.81 , $171.36 , See APC Packaged Rates , $149.94 , $83.54 , $206.68 , $207.58 , $110.32 , See APC Packaged Rates , See APC Packaged Rates , $71.33 , $71.33 , See APC Packaged Rates , See APC Packaged Rates , $199.21 , $199.21 , $199.21 , $199.21 , See APC Packaged Rates , $74.97 , $128.52 , $71.33 , $207.58 , $149.94
C1713,61510006,Hospital Chargemaster,Screw Lag 85M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61510015,Hospital Chargemaster,Universal Cement Restrictor,Outpatient,Outpatient Default Percent / Case Rate,278, $403.92 , $222.16 , $323.14 , See APC Packaged Rates , $282.74 , $157.53 , $389.74 , $391.44 , $208.03 , See APC Packaged Rates , See APC Packaged Rates , $134.51 , $134.51 , See APC Packaged Rates , See APC Packaged Rates , $375.65 , $375.65 , $375.65 , $375.65 , See APC Packaged Rates , $141.37 , $242.35 , $134.51 , $391.44 , $282.74
C1713,61510056,Hospital Chargemaster,Screw Cancellous Bone,Outpatient,Outpatient Default Percent / Case Rate,278, $393.12 , $216.22 , $323.93 , See APC Packaged Rates , $275.18 , $153.32 , $379.32 , $380.97 , $202.46 , See APC Packaged Rates , See APC Packaged Rates , $130.91 , $130.91 , See APC Packaged Rates , See APC Packaged Rates , $365.60 , $365.60 , $365.60 , $365.60 , See APC Packaged Rates , $137.59 , $- , $- , $380.97 , $275.18
C1713,61510057,Hospital Chargemaster,Screw Cancellous Bone,Outpatient,Outpatient Default Percent / Case Rate,278, $393.12 , $216.22 , $323.93 , See APC Packaged Rates , $275.18 , $153.32 , $379.32 , $380.97 , $202.46 , See APC Packaged Rates , See APC Packaged Rates , $130.91 , $130.91 , See APC Packaged Rates , See APC Packaged Rates , $365.60 , $365.60 , $365.60 , $365.60 , See APC Packaged Rates , $137.59 , $- , $- , $380.97 , $275.18
C1713,61510063,Hospital Chargemaster,Screw Cancellous Bone,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61510070,Hospital Chargemaster,Universal Head,Outpatient,Outpatient Default Percent / Case Rate,278," $1,732.50 ", $952.88 ," $1,386.00 ", See APC Packaged Rates ," $1,212.75 ", $675.68 ," $1,671.69 "," $1,678.97 ", $892.27 , See APC Packaged Rates , See APC Packaged Rates , $576.92 , $576.92 , See APC Packaged Rates , See APC Packaged Rates ," $1,611.23 "," $1,611.23 "," $1,611.23 "," $1,611.23 ", See APC Packaged Rates , $606.38 ," $1,039.50 ", $576.92 ," $1,678.97 "," $1,212.75 "
,61510103,Hospital Chargemaster,Universal Head Uh1-48-26,Outpatient,Outpatient Default Percent / Case Rate,278," $1,757.70 ", $966.74 ," $1,406.16 ", See APC Packaged Rates ," $1,230.39 ", $685.50 ," $1,696.00 "," $1,703.39 ", $905.25 , See APC Packaged Rates , See APC Packaged Rates , $585.31 , $585.31 , See APC Packaged Rates , See APC Packaged Rates ," $1,634.66 "," $1,634.66 "," $1,634.66 "," $1,634.66 ", See APC Packaged Rates , $615.20 ," $1,054.62 ", $585.31 ," $1,703.39 "," $1,230.39 "
C1713,61510104,Hospital Chargemaster,Cancellous Bone Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510109,Hospital Chargemaster,Cancellous Bone Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $393.12 , $216.22 , $323.93 , See APC Packaged Rates , $275.18 , $153.32 , $379.32 , $380.97 , $202.46 , See APC Packaged Rates , See APC Packaged Rates , $130.91 , $130.91 , See APC Packaged Rates , See APC Packaged Rates , $365.60 , $365.60 , $365.60 , $365.60 , See APC Packaged Rates , $137.59 , $- , $- , $380.97 , $275.18
,61510126,Hospital Chargemaster,Universal Head #Uh1-46-26,Outpatient,Outpatient Default Percent / Case Rate,278," $1,732.50 ", $952.88 ," $1,386.00 ", See APC Packaged Rates ," $1,212.75 ", $675.68 ," $1,671.69 "," $1,678.97 ", $892.27 , See APC Packaged Rates , See APC Packaged Rates , $576.92 , $576.92 , See APC Packaged Rates , See APC Packaged Rates ," $1,611.23 "," $1,611.23 "," $1,611.23 "," $1,611.23 ", See APC Packaged Rates , $606.38 ," $1,039.50 ", $576.92 ," $1,678.97 "," $1,212.75 "
C1713,61510152,Hospital Chargemaster,Screw Cannulated 3.0 X 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510184,Hospital Chargemaster,Screw Crotical 3.5 X 16,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61510231,Hospital Chargemaster,Universal Head Uhr,Outpatient,Outpatient Default Percent / Case Rate,278," $1,732.50 ", $952.88 ," $1,386.00 ", See APC Packaged Rates ," $1,212.75 ", $675.68 ," $1,671.69 "," $1,678.97 ", $892.27 , See APC Packaged Rates , See APC Packaged Rates , $576.92 , $576.92 , See APC Packaged Rates , See APC Packaged Rates ," $1,611.23 "," $1,611.23 "," $1,611.23 "," $1,611.23 ", See APC Packaged Rates , $606.38 ," $1,039.50 ", $576.92 ," $1,678.97 "," $1,212.75 "
,61510233,Hospital Chargemaster,Universal Head,Outpatient,Outpatient Default Percent / Case Rate,278," $1,559.25 ", $857.59 ," $1,247.40 ", See APC Packaged Rates ," $1,091.48 ", $608.11 ," $1,504.52 "," $1,511.07 ", $803.04 , See APC Packaged Rates , See APC Packaged Rates , $519.23 , $519.23 , See APC Packaged Rates , See APC Packaged Rates ," $1,450.10 "," $1,450.10 "," $1,450.10 "," $1,450.10 ", See APC Packaged Rates , $545.74 , $935.55 , $519.23 ," $1,511.07 "," $1,091.48 "
C1713,61510319,Hospital Chargemaster,Screw Cortical 3.5 X 12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61510329,Hospital Chargemaster,Cement Spacer,Outpatient,Outpatient Default Percent / Case Rate,278, $415.80 , $228.69 , $332.64 , See APC Packaged Rates , $291.06 , $162.16 , $401.21 , $402.95 , $214.15 , See APC Packaged Rates , See APC Packaged Rates , $138.46 , $138.46 , See APC Packaged Rates , See APC Packaged Rates , $386.69 , $386.69 , $386.69 , $386.69 , See APC Packaged Rates , $145.53 , $249.48 , $138.46 , $402.95 , $291.06
C1713,61510381,Hospital Chargemaster,Lag Screw 80M,Outpatient,Outpatient Default Percent / Case Rate,278, $624.39 , $343.41 , $514.50 , See APC Packaged Rates , $437.07 , $243.51 , $602.47 , $605.10 , $321.57 , See APC Packaged Rates , See APC Packaged Rates , $207.92 , $207.92 , See APC Packaged Rates , See APC Packaged Rates , $580.68 , $580.68 , $580.68 , $580.68 , See APC Packaged Rates , $218.54 , $- , $- , $605.10 , $437.07
C1713,61510390,Hospital Chargemaster,Screw Lag 90M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510500,Hospital Chargemaster,Locking Screw 4 X 40M,Outpatient,Outpatient Default Percent / Case Rate,278, $352.49 , $193.87 , $290.45 , See APC Packaged Rates , $246.74 , $137.47 , $340.12 , $341.60 , $181.54 , See APC Packaged Rates , See APC Packaged Rates , $117.38 , $117.38 , See APC Packaged Rates , See APC Packaged Rates , $327.82 , $327.82 , $327.82 , $327.82 , See APC Packaged Rates , $123.37 , $- , $- , $341.60 , $246.74
C1713,61510502,Hospital Chargemaster,Locking Screw 4 X 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61510542,Hospital Chargemaster,Universal Head Uhr,Outpatient,Outpatient Default Percent / Case Rate,278," $1,732.50 ", $952.88 ," $1,386.00 ", See APC Packaged Rates ," $1,212.75 ", $675.68 ," $1,671.69 "," $1,678.97 ", $892.27 , See APC Packaged Rates , See APC Packaged Rates , $576.92 , $576.92 , See APC Packaged Rates , See APC Packaged Rates ," $1,611.23 "," $1,611.23 "," $1,611.23 "," $1,611.23 ", See APC Packaged Rates , $606.38 ," $1,039.50 ", $576.92 ," $1,678.97 "," $1,212.75 "
C1713,61510570,Hospital Chargemaster,Locking Screw 5 X 45M,Outpatient,Outpatient Default Percent / Case Rate,278, $347.76 , $191.27 , $286.55 , See APC Packaged Rates , $243.43 , $135.63 , $335.55 , $337.01 , $179.10 , See APC Packaged Rates , See APC Packaged Rates , $115.80 , $115.80 , See APC Packaged Rates , See APC Packaged Rates , $323.42 , $323.42 , $323.42 , $323.42 , See APC Packaged Rates , $121.72 , $- , $- , $337.01 , $243.43
C1713,61510571,Hospital Chargemaster,Locking Screw 5 X 50M,Outpatient,Outpatient Default Percent / Case Rate,278, $347.76 , $191.27 , $286.55 , See APC Packaged Rates , $243.43 , $135.63 , $335.55 , $337.01 , $179.10 , See APC Packaged Rates , See APC Packaged Rates , $115.80 , $115.80 , See APC Packaged Rates , See APC Packaged Rates , $323.42 , $323.42 , $323.42 , $323.42 , See APC Packaged Rates , $121.72 , $- , $- , $337.01 , $243.43
C1713,61510572,Hospital Chargemaster,Locking Screw 4 X 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510574,Hospital Chargemaster,Nail Tibial T2 8 X 300M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510633,Hospital Chargemaster,Tibial Bearing Insert #5 12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510663,Hospital Chargemaster,Screw Lag 75M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510685,Hospital Chargemaster,Bone Cement W/Tobramycin,Outpatient,Outpatient Default Percent / Case Rate,278, $850.50 , $467.78 , $700.81 , See APC Packaged Rates , $595.35 , $331.70 , $820.65 , $824.22 , $438.02 , See APC Packaged Rates , See APC Packaged Rates , $283.22 , $283.22 , See APC Packaged Rates , See APC Packaged Rates , $790.97 , $790.97 , $790.97 , $790.97 , See APC Packaged Rates , $297.68 , $- , $- , $824.22 , $595.35
,61510687,Hospital Chargemaster,Universal Head Size 54,Outpatient,Outpatient Default Percent / Case Rate,278," $1,732.50 ", $952.88 ," $1,386.00 ", See APC Packaged Rates ," $1,212.75 ", $675.68 ," $1,671.69 "," $1,678.97 ", $892.27 , See APC Packaged Rates , See APC Packaged Rates , $576.92 , $576.92 , See APC Packaged Rates , See APC Packaged Rates ," $1,611.23 "," $1,611.23 "," $1,611.23 "," $1,611.23 ", See APC Packaged Rates , $606.38 ," $1,039.50 ", $576.92 ," $1,678.97 "," $1,212.75 "
C1713,61510767,Hospital Chargemaster,Screw Locking 5X35 M,Outpatient,Outpatient Default Percent / Case Rate,278, $347.76 , $191.27 , $286.55 , See APC Packaged Rates , $243.43 , $135.63 , $335.55 , $337.01 , $179.10 , See APC Packaged Rates , See APC Packaged Rates , $115.80 , $115.80 , See APC Packaged Rates , See APC Packaged Rates , $323.42 , $323.42 , $323.42 , $323.42 , See APC Packaged Rates , $121.72 , $- , $- , $337.01 , $243.43
C1713,61510770,Hospital Chargemaster,Screw Locking 5 X 40M,Outpatient,Outpatient Default Percent / Case Rate,278, $347.76 , $191.27 , $286.55 , See APC Packaged Rates , $243.43 , $135.63 , $335.55 , $337.01 , $179.10 , See APC Packaged Rates , See APC Packaged Rates , $115.80 , $115.80 , See APC Packaged Rates , See APC Packaged Rates , $323.42 , $323.42 , $323.42 , $323.42 , See APC Packaged Rates , $121.72 , $- , $- , $337.01 , $243.43
C1713,61510780,Hospital Chargemaster,Screw Locking 4 X 36M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510781,Hospital Chargemaster,Screw Locking 4 X 50M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510782,Hospital Chargemaster,Screw Locking 4 X 28M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510802,Hospital Chargemaster,Screw Bone 4 X 45M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510803,Hospital Chargemaster,Nail Locking 9 X 250 Tc,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510812,Hospital Chargemaster,Plate 5 Hole Mjp,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510821,Hospital Chargemaster,Insert Tibial Bearing 12M #5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510828,Hospital Chargemaster,"Pin, 3 Passport Headless",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510829,Hospital Chargemaster,"Pin, 2.5 Passport Headless",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510841,Hospital Chargemaster,Insert Tibial Bearing 8M #9,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510857,Hospital Chargemaster,Screw Super Lag 65M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510859,Hospital Chargemaster,Screw Standard Lag 115M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510860,Hospital Chargemaster,Plate Left Toe,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510861,Hospital Chargemaster,Screw Cortical 3.5 X 12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510862,Hospital Chargemaster,Screw Cortical 3.5 X 14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510863,Hospital Chargemaster,Screw Cortical 3.5 X 18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510864,Hospital Chargemaster,Screw Cortical 3.5 X 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510868,Hospital Chargemaster,Screw Lag 95M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510874,Hospital Chargemaster,"Screw, Cancelous 5.0 40M",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510875,Hospital Chargemaster,"Screw,Cancelous 5.0 X 35M",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510877,Hospital Chargemaster,"Screw,Cortical 3.5 X 25 M",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61510878,Hospital Chargemaster,"Head, Universal Uhr",Outpatient,Outpatient Default Percent / Case Rate,278," $1,732.50 ", $952.88 ," $1,386.00 ", See APC Packaged Rates ," $1,212.75 ", $675.68 ," $1,671.69 "," $1,678.97 ", $892.27 , See APC Packaged Rates , See APC Packaged Rates , $576.92 , $576.92 , See APC Packaged Rates , See APC Packaged Rates ," $1,611.23 "," $1,611.23 "," $1,611.23 "," $1,611.23 ", See APC Packaged Rates , $606.38 ," $1,039.50 ", $576.92 ," $1,678.97 "," $1,212.75 "
C1713,61510879,Hospital Chargemaster,"Screw,Cortical 3.5 X 22.5M",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61510888,Hospital Chargemaster,Thyroplasty Implant,Outpatient,Outpatient Default Percent / Case Rate,278," $1,023.75 ", $563.06 , $819.00 , See APC Packaged Rates , $716.63 , $399.26 , $987.82 , $992.12 , $527.25 , See APC Packaged Rates , See APC Packaged Rates , $340.91 , $340.91 , See APC Packaged Rates , See APC Packaged Rates , $952.09 , $952.09 , $952.09 , $952.09 , See APC Packaged Rates , $358.31 , $614.25 , $340.91 , $992.12 , $716.63
C1713,61510906,Hospital Chargemaster,Tibial Bearing Insert #7 8M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510908,Hospital Chargemaster,Tibial Bearing Insert #5 8M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510923,Hospital Chargemaster,Insert Tibial Bearing #9 15M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510930,Hospital Chargemaster,Screw Cortical 50 X 18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510931,Hospital Chargemaster,Screw Cortical 60 X 25M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510932,Hospital Chargemaster,Screw Cortical 45 X 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510946,Hospital Chargemaster,Screw Lag 12/90M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510949,Hospital Chargemaster,Insert Tibial Bearing 10M #9,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510951,Hospital Chargemaster,Tibial Nail Std T2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510961,Hospital Chargemaster,Insert Tibial Bearing 15M #7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510963,Hospital Chargemaster,Sideplate Std Barrel 120Deg4S,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510982,Hospital Chargemaster,Tibial Bearing Insert 18M #7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510983,Hospital Chargemaster,Nail GaMa Long 11X320X130 Deg,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61510984,Hospital Chargemaster,Plate Std Barrel Sideplate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61510985,Hospital Chargemaster,Mesh 3Dmax Med Left,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61510986,Hospital Chargemaster,Mesh 3Dmax Large Left,Outpatient,Outpatient Default Percent / Case Rate,278, $509.99 , $280.49 , $420.23 , See APC Packaged Rates , $356.99 , $198.90 , $492.09 , $494.23 , $262.66 , See APC Packaged Rates , See APC Packaged Rates , $169.83 , $169.83 , See APC Packaged Rates , See APC Packaged Rates , $474.29 , $474.29 , $474.29 , $474.29 , See APC Packaged Rates , $178.50 , $- , $- , $494.23 , $356.99
C1781,61510987,Hospital Chargemaster,Mesh 3Dmax Med Right,Outpatient,Outpatient Default Percent / Case Rate,278, $469.04 , $257.97 , $386.49 , See APC Packaged Rates , $328.33 , $182.93 , $452.58 , $454.55 , $241.56 , See APC Packaged Rates , See APC Packaged Rates , $156.19 , $156.19 , See APC Packaged Rates , See APC Packaged Rates , $436.21 , $436.21 , $436.21 , $436.21 , See APC Packaged Rates , $164.16 , $- , $- , $454.55 , $328.33
C1781,61510988,Hospital Chargemaster,Mesh 3Dmax Large Right,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61510992,Hospital Chargemaster,Universal Head Uhr,Outpatient,Outpatient Default Percent / Case Rate,278," $1,732.50 ", $952.88 ," $1,386.00 ", See APC Packaged Rates ," $1,212.75 ", $675.68 ," $1,671.69 "," $1,678.97 ", $892.27 , See APC Packaged Rates , See APC Packaged Rates , $576.92 , $576.92 , See APC Packaged Rates , See APC Packaged Rates ," $1,611.23 "," $1,611.23 "," $1,611.23 "," $1,611.23 ", See APC Packaged Rates , $606.38 ," $1,039.50 ", $576.92 ," $1,678.97 "," $1,212.75 "
C1713,61510994,Hospital Chargemaster,Plate Side Std 130 Deg 8 Slot,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511016,Hospital Chargemaster,Plate Barrel Side,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511045,Hospital Chargemaster,Nail Humeral Locking T2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511047,Hospital Chargemaster,Plate Std Right Green,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511048,Hospital Chargemaster,Screw Non Locking 2.3 X 22,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511049,Hospital Chargemaster,Screw Non Locking 2.3 X 20,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511050,Hospital Chargemaster,Screw Non Locking 2.3 X 14,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511051,Hospital Chargemaster,Screw Non Locking 2.3 X 18,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511052,Hospital Chargemaster,Screw Non Locking 2.3 X 22,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511053,Hospital Chargemaster,Screw Locking 3.5 X 14,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511054,Hospital Chargemaster,Peg Smooth 2.3 X 22,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511055,Hospital Chargemaster,Screw Locking 3.5 X 12,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511059,Hospital Chargemaster,"Anchor, Mini Quick Plus",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511081,Hospital Chargemaster,Plate Side Std Barrel 4 Slot,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511092,Hospital Chargemaster,Plate 14 Hole Straight Recon,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511093,Hospital Chargemaster,Screw 2.4 X 12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511094,Hospital Chargemaster,Screw 2.4 X 14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511097,Hospital Chargemaster,Screw Emergency 2.7 X 12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511099,Hospital Chargemaster,Barrel Sideplate 135 Deg 3Slo,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511106,Hospital Chargemaster,"Plate, Barrel side plate",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511107,Hospital Chargemaster,Tibial Bearing Insert 10M #5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511108,Hospital Chargemaster,Plate Distal Volar Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511109,Hospital Chargemaster,Screw Smooth 2.3 X 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511110,Hospital Chargemaster,Screw Locking 2.3 X 18M,Outpatient,Outpatient Default Percent / Case Rate,278, $283.50 , $155.93 , $233.60 , See APC Packaged Rates , $198.45 , $110.57 , $273.55 , $274.74 , $146.01 , See APC Packaged Rates , See APC Packaged Rates , $94.41 , $94.41 , See APC Packaged Rates , See APC Packaged Rates , $263.66 , $263.66 , $263.66 , $263.66 , See APC Packaged Rates , $99.23 , $- , $- , $274.74 , $198.45
C1713,61511111,Hospital Chargemaster,Screw Locking 2.3 X 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $283.50 , $155.93 , $233.60 , See APC Packaged Rates , $198.45 , $110.57 , $273.55 , $274.74 , $146.01 , See APC Packaged Rates , See APC Packaged Rates , $94.41 , $94.41 , See APC Packaged Rates , See APC Packaged Rates , $263.66 , $263.66 , $263.66 , $263.66 , See APC Packaged Rates , $99.23 , $- , $- , $274.74 , $198.45
C1713,61511112,Hospital Chargemaster,Screw Locking 2.3 X 22M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511113,Hospital Chargemaster,Screw Locking 2.3 X 24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511114,Hospital Chargemaster,Screw Locking 2.3 X 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511115,Hospital Chargemaster,Screw Locking 2.3 X 28M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511116,Hospital Chargemaster,Screw Locking 3.5 X 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511117,Hospital Chargemaster,Screw Locking 3.5 X 18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1769,61511121,Hospital Chargemaster,Guide Wire .054,Outpatient,Outpatient Default Percent / Case Rate,278, $16.00 , $8.80 , $13.18 , See APC Packaged Rates , $11.20 , $6.24 , $15.44 , $15.51 , $8.24 , See APC Packaged Rates , See APC Packaged Rates , $5.33 , $5.33 , See APC Packaged Rates , See APC Packaged Rates , $14.88 , $14.88 , $14.88 , $14.88 , See APC Packaged Rates , $5.60 , $- , $- , $15.51 , $11.20
C1713,61511124,Hospital Chargemaster,Apex Half Pin 5/150 50 Thr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511132,Hospital Chargemaster,Screw Locking 5 X 25M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511133,Hospital Chargemaster,Screw Locking 4 X 24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511134,Hospital Chargemaster,Humoral Nail Left 10 X 150M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511142,Hospital Chargemaster,Tibial Bearing Insert #5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511151,Hospital Chargemaster,Standard Lag Screw 70M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511152,Hospital Chargemaster,Sideplate 130 Degree 5 Hole,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511153,Hospital Chargemaster,Screw Lag 105M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511159,Hospital Chargemaster,Tibial Bearing Insert 10M #9,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511160,Hospital Chargemaster,Plate Side Barrel 4 Hole 130,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511161,Hospital Chargemaster,Screw Lag 65M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511167,Hospital Chargemaster,Insert Tibial Bearing #5 8M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511169,Hospital Chargemaster,Femoral Head Std 26Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $1,814.40 ", $997.92 ," $1,451.52 ", See APC Packaged Rates ," $1,270.08 ", $707.62 ," $1,750.71 "," $1,758.34 ", $934.45 , See APC Packaged Rates , See APC Packaged Rates , $604.20 , $604.20 , See APC Packaged Rates , See APC Packaged Rates ," $1,687.39 "," $1,687.39 "," $1,687.39 "," $1,687.39 ", See APC Packaged Rates , $635.04 ," $1,088.64 ", $604.20 ," $1,758.34 "," $1,270.08 "
C1713,61511175,Hospital Chargemaster,Cannulated Fixation Screw9X30,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511176,Hospital Chargemaster,Screw Softsilk 9 X 20,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511213,Hospital Chargemaster,Tibial Bearing Insert #3,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511232,Hospital Chargemaster,Tibial Bearing Insert 10M #5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511248,Hospital Chargemaster,Tibial Baseplate #6 Cemented,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511249,Hospital Chargemaster,Asymmetric Patella A38 X 11Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $2,243.78 "," $1,234.08 "," $1,795.02 ", See APC Packaged Rates ," $1,570.65 ", $875.07 ," $2,165.02 "," $2,174.45 "," $1,155.59 ", See APC Packaged Rates , See APC Packaged Rates , $747.18 , $747.18 , See APC Packaged Rates , See APC Packaged Rates ," $2,086.72 "," $2,086.72 "," $2,086.72 "," $2,086.72 ", See APC Packaged Rates , $785.32 ," $1,346.27 ", $747.18 ," $2,174.45 "," $1,570.65 "
C1713,61511259,Hospital Chargemaster,Tibial Bearing Insert #5 8M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511268,Hospital Chargemaster,Tibial Baseplate #7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511271,Hospital Chargemaster,Locking Screw 4 X 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511272,Hospital Chargemaster,Locking Screw 4 X 38M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511273,Hospital Chargemaster,T2 Humerus Nail,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511275,Hospital Chargemaster,Universal Head Uhr,Outpatient,Outpatient Default Percent / Case Rate,278," $1,732.50 ", $952.88 ," $1,386.00 ", See APC Packaged Rates ," $1,212.75 ", $675.68 ," $1,671.69 "," $1,678.97 ", $892.27 , See APC Packaged Rates , See APC Packaged Rates , $576.92 , $576.92 , See APC Packaged Rates , See APC Packaged Rates ," $1,611.23 "," $1,611.23 "," $1,611.23 "," $1,611.23 ", See APC Packaged Rates , $606.38 ," $1,039.50 ", $576.92 ," $1,678.97 "," $1,212.75 "
C1713,61511278,Hospital Chargemaster,Tibial Bearing Insert #9,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511280,Hospital Chargemaster,Tibial Nail Std T2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511301,Hospital Chargemaster,Poly Hip Insert 32Mm 10 Degre,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
C1713,61511304,Hospital Chargemaster,Poly Hip Insert 36Mm 10 Degre,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,984.94 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 ", $- , $- ," $3,510.56 "," $2,535.75 "
C1713,61511313,Hospital Chargemaster,Tibial Baseplate #4 Knee,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511314,Hospital Chargemaster,Femoral Component Cr #4 Left,Outpatient,Outpatient Default Percent / Case Rate,278," $4,488.75 "," $2,468.81 "," $3,591.00 ", See APC Packaged Rates ," $3,142.13 "," $1,750.61 "," $4,331.19 "," $4,350.05 "," $2,311.80 ", See APC Packaged Rates , See APC Packaged Rates ," $1,494.75 "," $1,494.75 ", See APC Packaged Rates , See APC Packaged Rates ," $4,174.54 "," $4,174.54 "," $4,174.54 "," $4,174.54 ", See APC Packaged Rates ," $1,571.06 "," $2,693.25 "," $1,494.75 "," $4,350.05 "," $3,142.13 "
C1713,61511327,Hospital Chargemaster,Tibial Bearing Insert #5 8M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1878,61511328,Hospital Chargemaster,Phonoform Silicone Block Left,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511342,Hospital Chargemaster,Femoral Component Cr Right #4,Outpatient,Outpatient Default Percent / Case Rate,278," $4,488.75 "," $2,468.81 "," $3,591.00 ", See APC Packaged Rates ," $3,142.13 "," $1,750.61 "," $4,331.19 "," $4,350.05 "," $2,311.80 ", See APC Packaged Rates , See APC Packaged Rates ," $1,494.75 "," $1,494.75 ", See APC Packaged Rates , See APC Packaged Rates ," $4,174.54 "," $4,174.54 "," $4,174.54 "," $4,174.54 ", See APC Packaged Rates ," $1,571.06 "," $2,693.25 "," $1,494.75 "," $4,350.05 "," $3,142.13 "
C1713,61511343,Hospital Chargemaster,Tibial Baseplate #3,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511348,Hospital Chargemaster,Hip Stem Conial Distal 17X155,Outpatient,Outpatient Default Percent / Case Rate,278," $12,434.00 "," $6,838.70 "," $9,947.20 ", See APC Packaged Rates ," $8,703.80 "," $4,849.26 "," $11,997.57 "," $12,049.79 "," $6,403.76 ", See APC Packaged Rates , See APC Packaged Rates ," $4,140.52 "," $4,140.52 ", See APC Packaged Rates , See APC Packaged Rates ," $11,563.62 "," $11,563.62 "," $11,563.62 "," $11,563.62 ", See APC Packaged Rates ," $4,351.90 "," $7,460.40 "," $4,140.52 "," $12,049.79 "," $8,703.80 "
C1713,61511355,Hospital Chargemaster,Sideplate 140 Degree 5 Slot,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511359,Hospital Chargemaster,Tibial Bearing Insert 12M #7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511374,Hospital Chargemaster,Tibial Bearing Insert 12M #7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511375,Hospital Chargemaster,Standard Barrel Sideplate 135,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511382,Hospital Chargemaster,Screw Calaxo 8 X 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511400,Hospital Chargemaster,Tibial Baseplate #5,Outpatient,Outpatient Default Percent / Case Rate,278," $3,228.75 "," $1,775.81 "," $2,660.49 ", See APC Packaged Rates ," $2,260.13 "," $1,259.21 "," $3,115.42 "," $3,128.98 "," $1,662.87 ", See APC Packaged Rates , See APC Packaged Rates ," $1,075.17 "," $1,075.17 ", See APC Packaged Rates , See APC Packaged Rates ," $3,002.74 "," $3,002.74 "," $3,002.74 "," $3,002.74 ", See APC Packaged Rates ," $1,130.06 ", $- , $- ," $3,128.98 "," $2,260.13 "
C1713,61511402,Hospital Chargemaster,Screw Calaxo 8 X 25M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511404,Hospital Chargemaster,Tibial Bearing Insert 8M #9,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511405,Hospital Chargemaster,Femoral Component,Outpatient,Outpatient Default Percent / Case Rate,278," $4,488.75 "," $2,468.81 "," $3,591.00 ", See APC Packaged Rates ," $3,142.13 "," $1,750.61 "," $4,331.19 "," $4,350.05 "," $2,311.80 ", See APC Packaged Rates , See APC Packaged Rates ," $1,494.75 "," $1,494.75 ", See APC Packaged Rates , See APC Packaged Rates ," $4,174.54 "," $4,174.54 "," $4,174.54 "," $4,174.54 ", See APC Packaged Rates ," $1,571.06 "," $2,693.25 "," $1,494.75 "," $4,350.05 "," $3,142.13 "
C1713,61511422,Hospital Chargemaster,Rci Screw 7 X 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511423,Hospital Chargemaster,Rci Screw 9 X 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511424,Hospital Chargemaster,Rci Screw 8 X 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511425,Hospital Chargemaster,Tibial Bearing Insert 10M #9,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511426,Hospital Chargemaster,Softsilk Screw 8 X 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511428,Hospital Chargemaster,Softsilk Interface Screw 7X30,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511429,Hospital Chargemaster,Softsilk Interface Screw 8X30,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511431,Hospital Chargemaster,Tibial Bearing Insert #5 12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511432,Hospital Chargemaster,Softsilk Interface Screw 9X30,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511433,Hospital Chargemaster,Softsilk Interference Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511446,Hospital Chargemaster,Locking Screw 4 X 32M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511447,Hospital Chargemaster,Humeral Nail Long Lt 8X260M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511454,Hospital Chargemaster,Tibial Bearing Insert #7 10M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511464,Hospital Chargemaster,"Nail Kit, Tronchanteric",Outpatient,Outpatient Default Percent / Case Rate,278," $2,687.58 "," $1,478.17 "," $2,214.57 ", See APC Packaged Rates ," $1,881.31 "," $1,048.16 "," $2,593.25 "," $2,604.53 "," $1,384.16 ", See APC Packaged Rates , See APC Packaged Rates , $894.96 , $894.96 , See APC Packaged Rates , See APC Packaged Rates ," $2,499.45 "," $2,499.45 "," $2,499.45 "," $2,499.45 ", See APC Packaged Rates , $940.65 , $- , $- ," $2,604.53 "," $1,881.31 "
C1713,61511465,Hospital Chargemaster,Lag Screw 10.5X100,Outpatient,Outpatient Default Percent / Case Rate,278," $1,017.77 ", $559.77 , $838.64 , See APC Packaged Rates , $712.44 , $396.93 , $982.05 , $986.32 , $524.17 , See APC Packaged Rates , See APC Packaged Rates , $338.92 , $338.92 , See APC Packaged Rates , See APC Packaged Rates , $946.53 , $946.53 , $946.53 , $946.53 , See APC Packaged Rates , $356.22 , $- , $- , $986.32 , $712.44
C1713,61511493,Hospital Chargemaster,Screw Set T1 8 X 17.5M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511494,Hospital Chargemaster,Long GaMa Nail Kit 11X130X125,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511495,Hospital Chargemaster,Lag Screw 10X5 X 110M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,017.77 ", $559.77 , $838.64 , See APC Packaged Rates , $712.44 , $396.93 , $982.05 , $986.32 , $524.17 , See APC Packaged Rates , See APC Packaged Rates , $338.92 , $338.92 , See APC Packaged Rates , See APC Packaged Rates , $946.53 , $946.53 , $946.53 , $946.53 , See APC Packaged Rates , $356.22 , $- , $- , $986.32 , $712.44
C1713,61511508,Hospital Chargemaster,Screw Calaxo 7 X 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511510,Hospital Chargemaster,C-Taper Neck Adj Sleeve,Outpatient,Outpatient Default Percent / Case Rate,278, $559.44 , $307.69 , $447.55 , See APC Packaged Rates , $391.61 , $218.18 , $539.80 , $542.15 , $288.12 , See APC Packaged Rates , See APC Packaged Rates , $186.29 , $186.29 , See APC Packaged Rates , See APC Packaged Rates , $520.28 , $520.28 , $520.28 , $520.28 , See APC Packaged Rates , $195.80 , $335.66 , $186.29 , $542.15 , $391.61
,61511511,Hospital Chargemaster,Endoprosthesis Head Co 49Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $1,417.50 ", $779.63 ," $1,134.00 ", See APC Packaged Rates , $992.25 , $552.83 ," $1,367.75 "," $1,373.70 ", $730.04 , See APC Packaged Rates , See APC Packaged Rates , $472.03 , $472.03 , See APC Packaged Rates , See APC Packaged Rates ," $1,318.28 "," $1,318.28 "," $1,318.28 "," $1,318.28 ", See APC Packaged Rates , $496.13 , $850.50 , $472.03 ," $1,373.70 ", $992.25
C1713,61511574,Hospital Chargemaster,Bone Cancellous Crushed 15Cc,Outpatient,Outpatient Default Percent / Case Rate,278," $1,102.50 ", $606.38 , $908.46 , See APC Packaged Rates , $771.75 , $429.98 ," $1,063.80 "," $1,068.43 ", $567.81 , See APC Packaged Rates , See APC Packaged Rates , $367.13 , $367.13 , See APC Packaged Rates , See APC Packaged Rates ," $1,025.33 "," $1,025.33 "," $1,025.33 "," $1,025.33 ", See APC Packaged Rates , $385.88 , $- , $- ," $1,068.43 ", $771.75
C1713,61511579,Hospital Chargemaster,Screw Calaxo 8 X 35M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511602,Hospital Chargemaster,T2 Tibial Nail Std 9 X 360M,Outpatient,Outpatient Default Percent / Case Rate,278," $3,827.25 "," $2,104.99 "," $3,153.65 ", See APC Packaged Rates ," $2,679.08 "," $1,492.63 "," $3,692.91 "," $3,708.99 "," $1,971.11 ", See APC Packaged Rates , See APC Packaged Rates ," $1,274.47 "," $1,274.47 ", See APC Packaged Rates , See APC Packaged Rates ," $3,559.34 "," $3,559.34 "," $3,559.34 "," $3,559.34 ", See APC Packaged Rates ," $1,339.54 ", $- , $- ," $3,708.99 "," $2,679.08 "
C1713,61511603,Hospital Chargemaster,Locking Screw 5 X 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511606,Hospital Chargemaster,Tibial Bearing Insert 10M #11,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511620,Hospital Chargemaster,Trident X3 10 Deg Poly Ins 36,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
C1713,61511622,Hospital Chargemaster,Tibial Bearing Insert 12M #9,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511623,Hospital Chargemaster,Polyethylene Insert 10 Deg36M,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
C1713,61511625,Hospital Chargemaster,Tibial Bearing Insert 12M #3,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511626,Hospital Chargemaster,Tibial Bearing Insert 10M #12,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511628,Hospital Chargemaster,Tibial Bearing Insert 15M #5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511655,Hospital Chargemaster,45 Degree Right Accu Pass,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511660,Hospital Chargemaster,Tibial Bearing Insert 12M #7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511661,Hospital Chargemaster,Tibial Bearing Insert 8M #11,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511662,Hospital Chargemaster,T2 Femoralnail A/R 11X360M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511669,Hospital Chargemaster,Tibial Bearing Insert #5 13M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511670,Hospital Chargemaster,Lag Screw 10.5 X 95M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,017.77 ", $559.77 , $838.64 , See APC Packaged Rates , $712.44 , $396.93 , $982.05 , $986.32 , $524.17 , See APC Packaged Rates , See APC Packaged Rates , $338.92 , $338.92 , See APC Packaged Rates , See APC Packaged Rates , $946.53 , $946.53 , $946.53 , $946.53 , See APC Packaged Rates , $356.22 , $- , $- , $986.32 , $712.44
,61511671,Hospital Chargemaster,Gamma Mail Lit 11X180Mmx125,Outpatient,Outpatient Default Percent / Case Rate,278," $2,687.58 "," $1,478.17 "," $2,150.06 ", See APC Packaged Rates ," $1,881.31 "," $1,048.16 "," $2,593.25 "," $2,604.53 "," $1,384.16 ", See APC Packaged Rates , See APC Packaged Rates , $894.96 , $894.96 , See APC Packaged Rates , See APC Packaged Rates ," $2,499.45 "," $2,499.45 "," $2,499.45 "," $2,499.45 ", See APC Packaged Rates , $940.65 ," $1,612.55 ", $894.96 ," $2,604.53 "," $1,881.31 "
,61511674,Hospital Chargemaster,Unitrax Head Component 42Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $1,417.50 ", $779.63 ," $1,134.00 ", See APC Packaged Rates , $992.25 , $552.83 ," $1,367.75 "," $1,373.70 ", $730.04 , See APC Packaged Rates , See APC Packaged Rates , $472.03 , $472.03 , See APC Packaged Rates , See APC Packaged Rates ," $1,318.28 "," $1,318.28 "," $1,318.28 "," $1,318.28 ", See APC Packaged Rates , $496.13 , $850.50 , $472.03 ," $1,373.70 ", $992.25
,61511682,Hospital Chargemaster,Femoral Component Left #5,Outpatient,Outpatient Default Percent / Case Rate,278," $4,488.75 "," $2,468.81 "," $3,591.00 ", See APC Packaged Rates ," $3,142.13 "," $1,750.61 "," $4,331.19 "," $4,350.05 "," $2,311.80 ", See APC Packaged Rates , See APC Packaged Rates ," $1,494.75 "," $1,494.75 ", See APC Packaged Rates , See APC Packaged Rates ," $4,174.54 "," $4,174.54 "," $4,174.54 "," $4,174.54 ", See APC Packaged Rates ," $1,571.06 "," $2,693.25 "," $1,494.75 "," $4,350.05 "," $3,142.13 "
,61511686,Hospital Chargemaster,C-Taper Adjustment Sleeve 5Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $559.44 , $307.69 , $447.55 , See APC Packaged Rates , $391.61 , $218.18 , $539.80 , $542.15 , $288.12 , See APC Packaged Rates , See APC Packaged Rates , $186.29 , $186.29 , See APC Packaged Rates , See APC Packaged Rates , $520.28 , $520.28 , $520.28 , $520.28 , See APC Packaged Rates , $195.80 , $335.66 , $186.29 , $542.15 , $391.61
C1713,61511695,Hospital Chargemaster,Femoral Component Cr #2 Left,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511710,Hospital Chargemaster,Tibial Bearing Insert 18M #7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511730,Hospital Chargemaster,Ps Femoral Component #5,Outpatient,Outpatient Default Percent / Case Rate,278," $4,488.75 "," $2,468.81 "," $3,591.00 ", See APC Packaged Rates ," $3,142.13 "," $1,750.61 "," $4,331.19 "," $4,350.05 "," $2,311.80 ", See APC Packaged Rates , See APC Packaged Rates ," $1,494.75 "," $1,494.75 ", See APC Packaged Rates , See APC Packaged Rates ," $4,174.54 "," $4,174.54 "," $4,174.54 "," $4,174.54 ", See APC Packaged Rates ," $1,571.06 "," $2,693.25 "," $1,494.75 "," $4,350.05 "," $3,142.13 "
,61511734,Hospital Chargemaster,Ps Femoral Component #6,Outpatient,Outpatient Default Percent / Case Rate,278," $4,488.75 "," $2,468.81 "," $3,591.00 ", See APC Packaged Rates ," $3,142.13 "," $1,750.61 "," $4,331.19 "," $4,350.05 "," $2,311.80 ", See APC Packaged Rates , See APC Packaged Rates ," $1,494.75 "," $1,494.75 ", See APC Packaged Rates , See APC Packaged Rates ," $4,174.54 "," $4,174.54 "," $4,174.54 "," $4,174.54 ", See APC Packaged Rates ," $1,571.06 "," $2,693.25 "," $1,494.75 "," $4,350.05 "," $3,142.13 "
,61511738,Hospital Chargemaster,Cr Femoral Component #3 Right,Outpatient,Outpatient Default Percent / Case Rate,278," $4,488.75 "," $2,468.81 "," $3,591.00 ", See APC Packaged Rates ," $3,142.13 "," $1,750.61 "," $4,331.19 "," $4,350.05 "," $2,311.80 ", See APC Packaged Rates , See APC Packaged Rates ," $1,494.75 "," $1,494.75 ", See APC Packaged Rates , See APC Packaged Rates ," $4,174.54 "," $4,174.54 "," $4,174.54 "," $4,174.54 ", See APC Packaged Rates ," $1,571.06 "," $2,693.25 "," $1,494.75 "," $4,350.05 "," $3,142.13 "
C1713,61511751,Hospital Chargemaster,"Plate, Right Clavicle",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511753,Hospital Chargemaster,Locking Cortical Screw 2.5X18,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511754,Hospital Chargemaster,Simplex Speedset Bone Cement,Outpatient,Outpatient Default Percent / Case Rate,278, $201.60 , $110.88 , $166.12 , See APC Packaged Rates , $141.12 , $78.62 , $194.52 , $195.37 , $103.83 , See APC Packaged Rates , See APC Packaged Rates , $67.13 , $67.13 , See APC Packaged Rates , See APC Packaged Rates , $187.49 , $187.49 , $187.49 , $187.49 , See APC Packaged Rates , $70.56 , $- , $- , $195.37 , $141.12
,61511805,Hospital Chargemaster,Endoprosthesis Head Comp 45Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $1,417.50 ", $779.63 ," $1,134.00 ", See APC Packaged Rates , $992.25 , $552.83 ," $1,367.75 "," $1,373.70 ", $730.04 , See APC Packaged Rates , See APC Packaged Rates , $472.03 , $472.03 , See APC Packaged Rates , See APC Packaged Rates ," $1,318.28 "," $1,318.28 "," $1,318.28 "," $1,318.28 ", See APC Packaged Rates , $496.13 , $850.50 , $472.03 ," $1,373.70 ", $992.25
,61511812,Hospital Chargemaster,Unitrax Endoprosthesis Head C,Outpatient,Outpatient Default Percent / Case Rate,278," $1,417.50 ", $779.63 ," $1,134.00 ", See APC Packaged Rates , $992.25 , $552.83 ," $1,367.75 "," $1,373.70 ", $730.04 , See APC Packaged Rates , See APC Packaged Rates , $472.03 , $472.03 , See APC Packaged Rates , See APC Packaged Rates ," $1,318.28 "," $1,318.28 "," $1,318.28 "," $1,318.28 ", See APC Packaged Rates , $496.13 , $850.50 , $472.03 ," $1,373.70 ", $992.25
C1713,61511860,Hospital Chargemaster,Screw Cannulated Lag 2.0X20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511861,Hospital Chargemaster,Screw Cannulated Lag 2.0X30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511862,Hospital Chargemaster,Screw Cannulated Lag 2.0X32M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511863,Hospital Chargemaster,Screw Cannulated Lag 2.0X36M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511864,Hospital Chargemaster,Screw Cannulated Lag 2.4X30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511865,Hospital Chargemaster,Screw Cannulated Lag 2.4X36M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511866,Hospital Chargemaster,Screw Cannulated Lag 2.4X42M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511867,Hospital Chargemaster,Guide Wire Double Trocar 6,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511874,Hospital Chargemaster,C-Taper Neck Sleeve 10Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $366.19 , $201.40 , $292.95 , See APC Packaged Rates , $256.33 , $142.81 , $353.34 , $354.87 , $188.60 , See APC Packaged Rates , See APC Packaged Rates , $121.94 , $121.94 , See APC Packaged Rates , See APC Packaged Rates , $340.56 , $340.56 , $340.56 , $340.56 , See APC Packaged Rates , $128.17 , $219.71 , $121.94 , $354.87 , $256.33
C1713,61511906,Hospital Chargemaster,Screw 22M Std Acutrak,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511914,Hospital Chargemaster,Tibial Bearing Insert 4 - 9 M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511915,Hospital Chargemaster,Asymmetric Patella A35 - 10 M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,575.00 ", $866.25 ," $1,260.00 ", See APC Packaged Rates ," $1,102.50 ", $614.25 ," $1,519.72 "," $1,526.33 ", $811.16 , See APC Packaged Rates , See APC Packaged Rates , $524.48 , $524.48 , See APC Packaged Rates , See APC Packaged Rates ," $1,464.75 "," $1,464.75 "," $1,464.75 "," $1,464.75 ", See APC Packaged Rates , $551.25 , $945.00 , $524.48 ," $1,526.33 "," $1,102.50 "
C1713,61511967,Hospital Chargemaster,Acutrak 2 Mini Bone Screw 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511976,Hospital Chargemaster,Bioabsorbable Screw 8 X 35M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61511980,Hospital Chargemaster,Hip Stem 132 Degree #6 Omnifi,Outpatient,Outpatient Default Percent / Case Rate,278," $3,701.25 "," $2,035.69 "," $2,961.00 ", See APC Packaged Rates ," $2,590.88 "," $1,443.49 "," $3,571.34 "," $3,586.88 "," $1,906.22 ", See APC Packaged Rates , See APC Packaged Rates ," $1,232.52 "," $1,232.52 ", See APC Packaged Rates , See APC Packaged Rates ," $3,442.16 "," $3,442.16 "," $3,442.16 "," $3,442.16 ", See APC Packaged Rates ," $1,295.44 "," $2,220.75 "," $1,232.52 "," $3,586.88 "," $2,590.88 "
C1713,61511988,Hospital Chargemaster,Screw Bioabsorbable 9 X 35M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61511999,Hospital Chargemaster,"Plate,Clavical Left",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512000,Hospital Chargemaster,Screw Cortical 3.5 X 22M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512001,Hospital Chargemaster,Screw Cortical 3.5 X 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512025,Hospital Chargemaster,"Screw, Softsilk 7 X 25Mm",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512026,Hospital Chargemaster,Tibial Baseplate Size 4 Pkr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512032,Hospital Chargemaster,Softsilk Screw 8 X 25M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512044,Hospital Chargemaster,Biorci Absorbable Screw 8X25,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512045,Hospital Chargemaster,Screw Biorci 9X25M Absorbable,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512051,Hospital Chargemaster,Tibial Baseplate Pkr Size 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512052,Hospital Chargemaster,Femoral Component Pkr Size 3,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512068,Hospital Chargemaster,Tibial Bearing Stabil 12M 9,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61512083,Hospital Chargemaster,Femoral Component #3 Lt,Outpatient,Outpatient Default Percent / Case Rate,278," $4,488.75 "," $2,468.81 "," $3,591.00 ", See APC Packaged Rates ," $3,142.13 "," $1,750.61 "," $4,331.19 "," $4,350.05 "," $2,311.80 ", See APC Packaged Rates , See APC Packaged Rates ," $1,494.75 "," $1,494.75 ", See APC Packaged Rates , See APC Packaged Rates ," $4,174.54 "," $4,174.54 "," $4,174.54 "," $4,174.54 ", See APC Packaged Rates ," $1,571.06 "," $2,693.25 "," $1,494.75 "," $4,350.05 "," $3,142.13 "
C1713,61512084,Hospital Chargemaster,Primary Tibial Baseplate #2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512092,Hospital Chargemaster,Tibial Bearing Insert #9 8M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61512093,Hospital Chargemaster,Asymmetric Patella Sz A32 10M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,575.00 ", $866.25 ," $1,260.00 ", See APC Packaged Rates ," $1,102.50 ", $614.25 ," $1,519.72 "," $1,526.33 ", $811.16 , See APC Packaged Rates , See APC Packaged Rates , $524.48 , $524.48 , See APC Packaged Rates , See APC Packaged Rates ," $1,464.75 "," $1,464.75 "," $1,464.75 "," $1,464.75 ", See APC Packaged Rates , $551.25 , $945.00 , $524.48 ," $1,526.33 "," $1,102.50 "
C1713,61512094,Hospital Chargemaster,Tibial Bearing Insert 4 11 M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512095,Hospital Chargemaster,Screw Softsilk 9 X 25,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512097,Hospital Chargemaster,Acutrak 2 Fixation Screw 18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512103,Hospital Chargemaster,Tibial Bearing Insert 10M #3,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512109,Hospital Chargemaster,Super Lag Screw 75M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512112,Hospital Chargemaster,Femoral Component #7 Lt,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61512117,Hospital Chargemaster,Triathlon X3 Tibial Ins 3 8Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $1,890.00 "," $1,039.50 "," $1,512.00 ", See APC Packaged Rates ," $1,323.00 ", $737.10 ," $1,823.66 "," $1,831.60 ", $973.39 , See APC Packaged Rates , See APC Packaged Rates , $629.37 , $629.37 , See APC Packaged Rates , See APC Packaged Rates ," $1,757.70 "," $1,757.70 "," $1,757.70 "," $1,757.70 ", See APC Packaged Rates , $661.50 ," $1,134.00 ", $629.37 ," $1,831.60 "," $1,323.00 "
C1713,61512118,Hospital Chargemaster,Triathlon Tibial Baseplate 3,Outpatient,Outpatient Default Percent / Case Rate,278," $3,150.00 "," $1,732.50 "," $2,595.60 ", See APC Packaged Rates ," $2,205.00 "," $1,228.50 "," $3,039.44 "," $3,052.67 "," $1,622.31 ", See APC Packaged Rates , See APC Packaged Rates ," $1,048.95 "," $1,048.95 ", See APC Packaged Rates , See APC Packaged Rates ," $2,929.50 "," $2,929.50 "," $2,929.50 "," $2,929.50 ", See APC Packaged Rates ," $1,102.50 ", $- , $- ," $3,052.67 "," $2,205.00 "
,61512119,Hospital Chargemaster,Triathlon Femoral Comp Size 3,Outpatient,Outpatient Default Percent / Case Rate,278," $4,410.00 "," $2,425.50 "," $3,528.00 ", See APC Packaged Rates ," $3,087.00 "," $1,719.90 "," $4,255.21 "," $4,273.73 "," $2,271.24 ", See APC Packaged Rates , See APC Packaged Rates ," $1,468.53 "," $1,468.53 ", See APC Packaged Rates , See APC Packaged Rates ," $4,101.30 "," $4,101.30 "," $4,101.30 "," $4,101.30 ", See APC Packaged Rates ," $1,543.50 "," $2,646.00 "," $1,468.53 "," $4,273.73 "," $3,087.00 "
C1713,61512129,Hospital Chargemaster,Tibial Baseplate Pkr Size #2,Outpatient,Outpatient Default Percent / Case Rate,278," $3,150.00 "," $1,732.50 "," $2,595.60 ", See APC Packaged Rates ," $2,205.00 "," $1,228.50 "," $3,039.44 "," $3,052.67 "," $1,622.31 ", See APC Packaged Rates , See APC Packaged Rates ," $1,048.95 "," $1,048.95 ", See APC Packaged Rates , See APC Packaged Rates ," $2,929.50 "," $2,929.50 "," $2,929.50 "," $2,929.50 ", See APC Packaged Rates ," $1,102.50 ", $- , $- ," $3,052.67 "," $2,205.00 "
,61512130,Hospital Chargemaster,Tibial Insert Prk X3 Size #2,Outpatient,Outpatient Default Percent / Case Rate,278," $1,890.00 "," $1,039.50 "," $1,512.00 ", See APC Packaged Rates ," $1,323.00 ", $737.10 ," $1,823.66 "," $1,831.60 ", $973.39 , See APC Packaged Rates , See APC Packaged Rates , $629.37 , $629.37 , See APC Packaged Rates , See APC Packaged Rates ," $1,757.70 "," $1,757.70 "," $1,757.70 "," $1,757.70 ", See APC Packaged Rates , $661.50 ," $1,134.00 ", $629.37 ," $1,831.60 "," $1,323.00 "
C1713,61512139,Hospital Chargemaster,Interface Screw BiorciHa10X25,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512158,Hospital Chargemaster,Tibial Bearing Insert 15M #3,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512163,Hospital Chargemaster,Screw Biosure-Ha 8 X 35M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512165,Hospital Chargemaster,Screw Biosure Ha 11 X 30,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512171,Hospital Chargemaster,Tibial Bearing Insert Ps 311M,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,984.94 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 ", $- , $- ," $3,510.56 "," $2,535.75 "
,61512199,Hospital Chargemaster,Triathlon Asymmetric Patella,Outpatient,Outpatient Default Percent / Case Rate,278," $1,575.00 ", $866.25 ," $1,260.00 ", See APC Packaged Rates ," $1,102.50 ", $614.25 ," $1,519.72 "," $1,526.33 ", $811.16 , See APC Packaged Rates , See APC Packaged Rates , $524.48 , $524.48 , See APC Packaged Rates , See APC Packaged Rates ," $1,464.75 "," $1,464.75 "," $1,464.75 "," $1,464.75 ", See APC Packaged Rates , $551.25 , $945.00 , $524.48 ," $1,526.33 "," $1,102.50 "
C1713,61512200,Hospital Chargemaster,Tibial Bearing Insert 3 11 M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512201,Hospital Chargemaster,Tibial Bearing Insert #7 15M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61512205,Hospital Chargemaster,Patella Triathlon Asymmetric,Outpatient,Outpatient Default Percent / Case Rate,278," $1,575.00 ", $866.25 ," $1,260.00 ", See APC Packaged Rates ," $1,102.50 ", $614.25 ," $1,519.72 "," $1,526.33 ", $811.16 , See APC Packaged Rates , See APC Packaged Rates , $524.48 , $524.48 , See APC Packaged Rates , See APC Packaged Rates ," $1,464.75 "," $1,464.75 "," $1,464.75 "," $1,464.75 ", See APC Packaged Rates , $551.25 , $945.00 , $524.48 ," $1,526.33 "," $1,102.50 "
C1713,61512206,Hospital Chargemaster,"Tibial Insert, Scorpio Cr",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512245,Hospital Chargemaster,Tibial Bearing Insert,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512265,Hospital Chargemaster,Nail Trochanteric Rt Long 400,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512266,Hospital Chargemaster,Lag Screw 120 X 10.5M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512271,Hospital Chargemaster,Trochanteric Nail 200 X 11M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512272,Hospital Chargemaster,Lag Screw 95 X 10.5M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61512284,Hospital Chargemaster,Plug Extra-Lg Perfix 1.6 X2.0,Outpatient,Outpatient Default Percent / Case Rate,278, $514.71 , $283.09 , $411.77 , See APC Packaged Rates , $360.30 , $200.74 , $496.64 , $498.81 , $265.09 , See APC Packaged Rates , See APC Packaged Rates , $171.40 , $171.40 , See APC Packaged Rates , See APC Packaged Rates , $478.68 , $478.68 , $478.68 , $478.68 , See APC Packaged Rates , $180.15 , $308.83 , $171.40 , $498.81 , $360.30
C1713,61512315,Hospital Chargemaster,Lag Screw 110M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512316,Hospital Chargemaster,Anti-Rotation Screw 4.5 X 38M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61512318,Hospital Chargemaster,Cutterlinear Reload Blue 75Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $410.40 , $225.72 , $328.32 , See APC Packaged Rates , $287.28 , $160.06 , $395.99 , $397.72 , $211.36 , See APC Packaged Rates , See APC Packaged Rates , $136.66 , $136.66 , See APC Packaged Rates , See APC Packaged Rates , $381.67 , $381.67 , $381.67 , $381.67 , See APC Packaged Rates , $143.64 , $246.24 , $136.66 , $397.72 , $287.28
C1713,61512339,Hospital Chargemaster,Radial Head Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512341,Hospital Chargemaster,Non-Locking Screw 2.3 X 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512342,Hospital Chargemaster,Locking Screw 2.3 X 24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512361,Hospital Chargemaster,Tibial Bearing Insert 15M #9,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512381,Hospital Chargemaster,Lock Clavicle Plate W/Exten 5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512461,Hospital Chargemaster,Tibial Bearing Insert Size #7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512469,Hospital Chargemaster,Screw Biosure 10X25M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512477,Hospital Chargemaster,Tibial Bearing Insert Stabili,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512483,Hospital Chargemaster,Biosure Screw 9X30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512496,Hospital Chargemaster,Tibial Insert Size 3 - 8M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512498,Hospital Chargemaster,Tibial Baseplate Size 3,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61512506,Hospital Chargemaster,Flexible Osteotome 6Mm X 67Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $1,286.65 ", $707.66 ," $1,029.32 ", See APC Packaged Rates , $900.66 , $501.79 ," $1,241.49 "," $1,246.89 ", $662.65 , See APC Packaged Rates , See APC Packaged Rates , $428.45 , $428.45 , See APC Packaged Rates , See APC Packaged Rates ," $1,196.58 "," $1,196.58 "," $1,196.58 "," $1,196.58 ", See APC Packaged Rates , $450.33 , $771.99 , $428.45 ," $1,246.89 ", $900.66
C1713,61512507,Hospital Chargemaster,Tibial Bearing Insert 18M #7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61512511,Hospital Chargemaster,Stent Loop 6 X 22,Outpatient,Outpatient Default Percent / Case Rate,278, $171.33 , $94.23 , $137.06 , See APC Packaged Rates , $119.93 , $66.82 , $165.32 , $166.04 , $88.24 , See APC Packaged Rates , See APC Packaged Rates , $57.05 , $57.05 , See APC Packaged Rates , See APC Packaged Rates , $159.34 , $159.34 , $159.34 , $159.34 , See APC Packaged Rates , $59.97 , $102.80 , $57.05 , $166.04 , $119.93
C2618,61512512,Hospital Chargemaster,Stent Loop 6 X 24,Outpatient,Outpatient Default Percent / Case Rate,278, $171.77 , $94.47 , $141.54 , See APC Packaged Rates , $120.24 , $66.99 , $165.74 , $166.46 , $88.46 , See APC Packaged Rates , See APC Packaged Rates , $57.20 , $57.20 , See APC Packaged Rates , See APC Packaged Rates , $159.75 , $159.75 , $159.75 , $159.75 , See APC Packaged Rates , $60.12 , $- , $- , $166.46 , $120.24
,61512513,Hospital Chargemaster,Stent Loop 6 X 26,Outpatient,Outpatient Default Percent / Case Rate,278, $171.79 , $94.48 , $137.43 , See APC Packaged Rates , $120.25 , $67.00 , $165.76 , $166.48 , $88.48 , See APC Packaged Rates , See APC Packaged Rates , $57.21 , $57.21 , See APC Packaged Rates , See APC Packaged Rates , $159.76 , $159.76 , $159.76 , $159.76 , See APC Packaged Rates , $60.13 , $103.07 , $57.21 , $166.48 , $120.25
,61512514,Hospital Chargemaster,Stent Loop 6 X 28,Outpatient,Outpatient Default Percent / Case Rate,278, $169.46 , $93.20 , $135.57 , See APC Packaged Rates , $118.62 , $66.09 , $163.51 , $164.22 , $87.28 , See APC Packaged Rates , See APC Packaged Rates , $56.43 , $56.43 , See APC Packaged Rates , See APC Packaged Rates , $157.60 , $157.60 , $157.60 , $157.60 , See APC Packaged Rates , $59.31 , $101.68 , $56.43 , $164.22 , $118.62
C1713,61512516,Hospital Chargemaster,K-wire .045 smooth 9 inch,Outpatient,Outpatient Default Percent / Case Rate,278, $13.80 , $7.59 , $11.37 , See APC Packaged Rates , $9.66 , $5.38 , $13.32 , $13.37 , $7.11 , See APC Packaged Rates , See APC Packaged Rates , $4.60 , $4.60 , See APC Packaged Rates , See APC Packaged Rates , $12.83 , $12.83 , $12.83 , $12.83 , See APC Packaged Rates , $4.83 , $- , $- , $13.37 , $9.66
C1713,61512526,Hospital Chargemaster,Tibial Baseplate Size 1,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512529,Hospital Chargemaster,Tibial Baseplate Size #1 Pkr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512531,Hospital Chargemaster,Femoral Component Sz 1 Pkr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512533,Hospital Chargemaster,Tibial Bearing Insert 8M #3,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512542,Hospital Chargemaster,Tibial Bearing Insert 10M #3,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512563,Hospital Chargemaster,Femoral Component Size 5 Pkr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512564,Hospital Chargemaster,Tibial Baseplate Size 4 Pkr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512570,Hospital Chargemaster,Screw Biosure Ha 6 X 25M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512578,Hospital Chargemaster,Plate Lcp 4.5M 4 Hole Medial,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512587,Hospital Chargemaster,Cannulated Lag Screw 2.4X12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512591,Hospital Chargemaster,Biosure Screw 11 X 35M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512592,Hospital Chargemaster,Screw Lock Self-Tap 2.7X26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512593,Hospital Chargemaster,Plate Lat Distal Fibula Rt,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61512613,Hospital Chargemaster,Hernia Meshc-Qur 6X8,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61512617,Hospital Chargemaster,"Mesh C-Qur Lite 3 X 6""",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512619,Hospital Chargemaster,Screw Biosure 8X30,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61512620,Hospital Chargemaster,Mesh C-Qur V-Patch 2.5 X 2.5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512650,Hospital Chargemaster,Screw Bioabsor Inter 11X30,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512656,Hospital Chargemaster,Tibial Bearing Insert Sz5 9M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512662,Hospital Chargemaster,Plate Side 3 Hole 130 Degree,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512677,Hospital Chargemaster,Humeral Nail End Cap OM T25,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512699,Hospital Chargemaster,Tibial Bearing Insert 5 11M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512700,Hospital Chargemaster,Screw Cannulated Ti 6.5X30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512701,Hospital Chargemaster,Screw Cann Asnis Iii 6.5X60M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512702,Hospital Chargemaster,Screw Cann Asnis Iii 6.5X65M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512703,Hospital Chargemaster,Screw Cannulated Ti 6.5X50M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512704,Hospital Chargemaster,Screw Cann Asnis Iii 6.5X80M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512705,Hospital Chargemaster,Screw Cann Asnis Iii 6.5X85M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512717,Hospital Chargemaster,Tibial Bearing Insert Sz4 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1897,61512737,Hospital Chargemaster,Pne Kit,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1778,61512738,Hospital Chargemaster,Interstim Lead,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1767,61512740,Hospital Chargemaster,Interstim Ii Neurostimulator,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512750,Hospital Chargemaster,Aculoc Vdr Plate Lft Narrow,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512752,Hospital Chargemaster,Mini At2 Screw 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512753,Hospital Chargemaster,Standard At2 Screw 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512759,Hospital Chargemaster,Thyroplasty Implant Male 9,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512760,Hospital Chargemaster,Tibial Insert Triathlon Cr 3X,Outpatient,Outpatient Default Percent / Case Rate,278," $1,575.00 ", $866.25 ," $1,297.80 ", See APC Packaged Rates ," $1,102.50 ", $614.25 ," $1,519.72 "," $1,526.33 ", $811.16 , See APC Packaged Rates , See APC Packaged Rates , $524.48 , $524.48 , See APC Packaged Rates , See APC Packaged Rates ," $1,464.75 "," $1,464.75 "," $1,464.75 "," $1,464.75 ", See APC Packaged Rates , $551.25 , $- , $- ," $1,526.33 "," $1,102.50 "
C1713,61512761,Hospital Chargemaster,Std Plate Left,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512765,Hospital Chargemaster,"Screw, Threaded 2.3 X 16",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512766,Hospital Chargemaster,"Screw, Locking 3.5 X 12",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512767,Hospital Chargemaster,"Screw, Locking 3.5 X 18",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512769,Hospital Chargemaster,"Std Right Plate, Long",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61512777,Hospital Chargemaster,Femoral Head Ceramic V40 32Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $2,913.75 "," $1,602.56 "," $2,331.00 ", See APC Packaged Rates ," $2,039.63 "," $1,136.36 "," $2,811.48 "," $2,823.72 "," $1,500.64 ", See APC Packaged Rates , See APC Packaged Rates , $970.28 , $970.28 , See APC Packaged Rates , See APC Packaged Rates ," $2,709.79 "," $2,709.79 "," $2,709.79 "," $2,709.79 ", See APC Packaged Rates ," $1,019.81 "," $1,748.25 ", $970.28 ," $2,823.72 "," $2,039.63 "
C1713,61512789,Hospital Chargemaster,Screw Non-Locking 2.3 X 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $283.50 , $155.93 , $233.60 , See APC Packaged Rates , $198.45 , $110.57 , $273.55 , $274.74 , $146.01 , See APC Packaged Rates , See APC Packaged Rates , $94.41 , $94.41 , See APC Packaged Rates , See APC Packaged Rates , $263.66 , $263.66 , $263.66 , $263.66 , See APC Packaged Rates , $99.23 , $- , $- , $274.74 , $198.45
C1713,61512817,Hospital Chargemaster,Screw Mini At2 24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512818,Hospital Chargemaster,Screw Std Acutrak 18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512825,Hospital Chargemaster,Screw Biosure Ha 10X30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512838,Hospital Chargemaster,Triathlon Tibial Baseplate Si,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512839,Hospital Chargemaster,Tibial Bearing Insert Siz 1 9,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512852,Hospital Chargemaster,Baseplate Size 4 Tri Ts,Outpatient,Outpatient Default Percent / Case Rate,278," $5,670.00 "," $3,118.50 "," $4,672.08 ", See APC Packaged Rates ," $3,969.00 "," $2,211.30 "," $5,470.98 "," $5,494.80 "," $2,920.16 ", See APC Packaged Rates , See APC Packaged Rates ," $1,888.11 "," $1,888.11 ", See APC Packaged Rates , See APC Packaged Rates ," $5,273.10 "," $5,273.10 "," $5,273.10 "," $5,273.10 ", See APC Packaged Rates ," $1,984.50 ", $- , $- ," $5,494.80 "," $3,969.00 "
C1713,61512863,Hospital Chargemaster,Femoral Head 36Mm Biolox,Outpatient,Outpatient Default Percent / Case Rate,278," $2,913.75 "," $1,602.56 "," $2,400.93 ", See APC Packaged Rates ," $2,039.63 "," $1,136.36 "," $2,811.48 "," $2,823.72 "," $1,500.64 ", See APC Packaged Rates , See APC Packaged Rates , $970.28 , $970.28 , See APC Packaged Rates , See APC Packaged Rates ," $2,709.79 "," $2,709.79 "," $2,709.79 "," $2,709.79 ", See APC Packaged Rates ," $1,019.81 ", $- , $- ," $2,823.72 "," $2,039.63 "
C1713,61512888,Hospital Chargemaster,Screw Biosure 7 X 25M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61512892,Hospital Chargemaster,Mesh Ventrio 11 X 14,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61512893,Hospital Chargemaster,Ventralex Hernia Patch Large,Outpatient,Outpatient Default Percent / Case Rate,278," $1,732.50 ", $952.88 ," $1,386.00 ", See APC Packaged Rates ," $1,212.75 ", $675.68 ," $1,671.69 "," $1,678.97 ", $892.27 , See APC Packaged Rates , See APC Packaged Rates , $576.92 , $576.92 , See APC Packaged Rates , See APC Packaged Rates ," $1,611.23 "," $1,611.23 "," $1,611.23 "," $1,611.23 ", See APC Packaged Rates , $606.38 ," $1,039.50 ", $576.92 ," $1,678.97 "," $1,212.75 "
C1781,61512894,Hospital Chargemaster,Mesh Ventrio 8 X 12,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61512897,Hospital Chargemaster,Mesh 3D Max Med Light Right,Outpatient,Outpatient Default Percent / Case Rate,278, $562.12 , $309.17 , $463.19 , See APC Packaged Rates , $393.48 , $219.23 , $542.39 , $544.75 , $289.50 , See APC Packaged Rates , See APC Packaged Rates , $187.19 , $187.19 , See APC Packaged Rates , See APC Packaged Rates , $522.77 , $522.77 , $522.77 , $522.77 , See APC Packaged Rates , $196.74 , $- , $- , $544.75 , $393.48
C1781,61512898,Hospital Chargemaster,Mesh 3D Maxmed Light Left,Outpatient,Outpatient Default Percent / Case Rate,278, $561.96 , $309.08 , $463.06 , See APC Packaged Rates , $393.37 , $219.16 , $542.24 , $544.60 , $289.42 , See APC Packaged Rates , See APC Packaged Rates , $187.13 , $187.13 , See APC Packaged Rates , See APC Packaged Rates , $522.62 , $522.62 , $522.62 , $522.62 , See APC Packaged Rates , $196.69 , $- , $- , $544.60 , $393.37
C1781,61512899,Hospital Chargemaster,Mesh 3D Max Large Light Left,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61512900,Hospital Chargemaster,Mesh 3D Max Large Light Right,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61512904,Hospital Chargemaster,Screw Interference 9 X 23M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61512920,Hospital Chargemaster,Head Femoral Biolox 36M X 2.5,Outpatient,Outpatient Default Percent / Case Rate,278," $2,913.75 "," $1,602.56 "," $2,331.00 ", See APC Packaged Rates ," $2,039.63 "," $1,136.36 "," $2,811.48 "," $2,823.72 "," $1,500.64 ", See APC Packaged Rates , See APC Packaged Rates , $970.28 , $970.28 , See APC Packaged Rates , See APC Packaged Rates ," $2,709.79 "," $2,709.79 "," $2,709.79 "," $2,709.79 ", See APC Packaged Rates ," $1,019.81 "," $1,748.25 ", $970.28 ," $2,823.72 "," $2,039.63 "
,61512922,Hospital Chargemaster,Femoral Head 36 X 2.5Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $2,913.75 "," $1,602.56 "," $2,331.00 ", See APC Packaged Rates ," $2,039.63 "," $1,136.36 "," $2,811.48 "," $2,823.72 "," $1,500.64 ", See APC Packaged Rates , See APC Packaged Rates , $970.28 , $970.28 , See APC Packaged Rates , See APC Packaged Rates ," $2,709.79 "," $2,709.79 "," $2,709.79 "," $2,709.79 ", See APC Packaged Rates ," $1,019.81 "," $1,748.25 ", $970.28 ," $2,823.72 "," $2,039.63 "
C1713,61512937,Hospital Chargemaster,Tibial Baseplate Sz Sm-2 Mrh,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61512954,Hospital Chargemaster,Mesh Plug Perfix Light Large,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61512955,Hospital Chargemaster,Mesh Preshaped 2.4X5.4 Soft,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61512956,Hospital Chargemaster,Mesh Max Light Left 4.1X6.2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61512957,Hospital Chargemaster,Mesh Max Light Right 4.1X6.2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61512960,Hospital Chargemaster,Mesh Ventralight 15X20Cm,Outpatient,Outpatient Default Percent / Case Rate,278," $2,094.75 "," $1,152.11 "," $1,726.07 ", See APC Packaged Rates ," $1,466.33 ", $816.95 ," $2,021.22 "," $2,030.02 "," $1,078.84 ", See APC Packaged Rates , See APC Packaged Rates , $697.55 , $697.55 , See APC Packaged Rates , See APC Packaged Rates ," $1,948.12 "," $1,948.12 "," $1,948.12 "," $1,948.12 ", See APC Packaged Rates , $733.16 , $- , $- ," $2,030.02 "," $1,466.33 "
C1713,61512966,Hospital Chargemaster,Screw Bone Acutrak 2 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61512967,Hospital Chargemaster,Acl Kit,Outpatient,Outpatient Default Percent / Case Rate,278, $787.50 , $433.13 , $630.00 , See APC Packaged Rates , $551.25 , $307.13 , $759.86 , $763.17 , $405.58 , See APC Packaged Rates , See APC Packaged Rates , $262.24 , $262.24 , See APC Packaged Rates , See APC Packaged Rates , $732.38 , $732.38 , $732.38 , $732.38 , See APC Packaged Rates , $275.63 , $472.50 , $262.24 , $763.17 , $551.25
C1713,61512976,Hospital Chargemaster,Tibial Baseplate Sz 2,Outpatient,Outpatient Default Percent / Case Rate,278," $5,670.00 "," $3,118.50 "," $4,672.08 ", See APC Packaged Rates ," $3,969.00 "," $2,211.30 "," $5,470.98 "," $5,494.80 "," $2,920.16 ", See APC Packaged Rates , See APC Packaged Rates ," $1,888.11 "," $1,888.11 ", See APC Packaged Rates , See APC Packaged Rates ," $5,273.10 "," $5,273.10 "," $5,273.10 "," $5,273.10 ", See APC Packaged Rates ," $1,984.50 ", $- , $- ," $5,494.80 "," $3,969.00 "
,61512978,Hospital Chargemaster,Tibial Stabilizer Sz 2 11Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $8,213.94 "," $4,517.67 "," $6,571.15 ", See APC Packaged Rates ," $5,749.76 "," $3,203.44 "," $7,925.63 "," $7,960.13 "," $4,230.34 ", See APC Packaged Rates , See APC Packaged Rates ," $2,735.24 "," $2,735.24 ", See APC Packaged Rates , See APC Packaged Rates ," $7,638.96 "," $7,638.96 "," $7,638.96 "," $7,638.96 ", See APC Packaged Rates ," $2,874.88 "," $4,928.36 "," $2,735.24 "," $7,960.13 "," $5,749.76 "
,61512981,Hospital Chargemaster,Ventralex St Hernia Patch Sma,Outpatient,Outpatient Default Percent / Case Rate,278," $1,118.25 ", $615.04 , $894.60 , See APC Packaged Rates , $782.78 , $436.12 ," $1,079.00 "," $1,083.70 ", $575.92 , See APC Packaged Rates , See APC Packaged Rates , $372.38 , $372.38 , See APC Packaged Rates , See APC Packaged Rates ," $1,039.97 "," $1,039.97 "," $1,039.97 "," $1,039.97 ", See APC Packaged Rates , $391.39 , $670.95 , $372.38 ," $1,083.70 ", $782.78
C1781,61512982,Hospital Chargemaster,Ventralex Hernia Patch Medium,Outpatient,Outpatient Default Percent / Case Rate,278," $1,354.50 ", $744.98 ," $1,116.11 ", See APC Packaged Rates , $948.15 , $528.26 ," $1,306.96 "," $1,312.65 ", $697.59 , See APC Packaged Rates , See APC Packaged Rates , $451.05 , $451.05 , See APC Packaged Rates , See APC Packaged Rates ," $1,259.69 "," $1,259.69 "," $1,259.69 "," $1,259.69 ", See APC Packaged Rates , $474.08 , $- , $- ," $1,312.65 ", $948.15
,61512996,Hospital Chargemaster,Delta Biolox Head 32Mm/+4,Outpatient,Outpatient Default Percent / Case Rate,278," $2,913.75 "," $1,602.56 "," $2,331.00 ", See APC Packaged Rates ," $2,039.63 "," $1,136.36 "," $2,811.48 "," $2,823.72 "," $1,500.64 ", See APC Packaged Rates , See APC Packaged Rates , $970.28 , $970.28 , See APC Packaged Rates , See APC Packaged Rates ," $2,709.79 "," $2,709.79 "," $2,709.79 "," $2,709.79 ", See APC Packaged Rates ," $1,019.81 "," $1,748.25 ", $970.28 ," $2,823.72 "," $2,039.63 "
,61512998,Hospital Chargemaster,V40 Biolox Delta Head 36Mm/+5,Outpatient,Outpatient Default Percent / Case Rate,278," $2,913.75 "," $1,602.56 "," $2,331.00 ", See APC Packaged Rates ," $2,039.63 "," $1,136.36 "," $2,811.48 "," $2,823.72 "," $1,500.64 ", See APC Packaged Rates , See APC Packaged Rates , $970.28 , $970.28 , See APC Packaged Rates , See APC Packaged Rates ," $2,709.79 "," $2,709.79 "," $2,709.79 "," $2,709.79 ", See APC Packaged Rates ," $1,019.81 "," $1,748.25 ", $970.28 ," $2,823.72 "," $2,039.63 "
C1713,61513030,Hospital Chargemaster,Screw Milagro 9 X 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513045,Hospital Chargemaster,Head Delta Biolox 36Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $2,913.75 "," $1,602.56 "," $2,331.00 ", See APC Packaged Rates ," $2,039.63 "," $1,136.36 "," $2,811.48 "," $2,823.72 "," $1,500.64 ", See APC Packaged Rates , See APC Packaged Rates , $970.28 , $970.28 , See APC Packaged Rates , See APC Packaged Rates ," $2,709.79 "," $2,709.79 "," $2,709.79 "," $2,709.79 ", See APC Packaged Rates ," $1,019.81 "," $1,748.25 ", $970.28 ," $2,823.72 "," $2,039.63 "
,61513046,Hospital Chargemaster,Stem Hip Omnifit Hfx Size 5,Outpatient,Outpatient Default Percent / Case Rate,278," $3,701.25 "," $2,035.69 "," $2,961.00 ", See APC Packaged Rates ," $2,590.88 "," $1,443.49 "," $3,571.34 "," $3,586.88 "," $1,906.22 ", See APC Packaged Rates , See APC Packaged Rates ," $1,232.52 "," $1,232.52 ", See APC Packaged Rates , See APC Packaged Rates ," $3,442.16 "," $3,442.16 "," $3,442.16 "," $3,442.16 ", See APC Packaged Rates ," $1,295.44 "," $2,220.75 "," $1,232.52 "," $3,586.88 "," $2,590.88 "
C1713,61513050,Hospital Chargemaster,Screw Biosure 8X25M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513079,Hospital Chargemaster,Nail Hip Fracture LT 13X380M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513080,Hospital Chargemaster,Screw Hip Fracturenail 10.5M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513081,Hospital Chargemaster,Screw Hip Fracture Nail 95M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513082,Hospital Chargemaster,Screw Cortical 5.0X45M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513083,Hospital Chargemaster,Threaded Guide Pin 3.2X444M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513090,Hospital Chargemaster,Screw Milagro Bio 7 X 23,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513101,Hospital Chargemaster,Tibial Bearing Insert 9X125M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513115,Hospital Chargemaster,Bearing Insert Size 6 11Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
C1713,61513122,Hospital Chargemaster,Screw Cancellous 6.5X40M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513123,Hospital Chargemaster,Screw Biosure 9X25M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513144,Hospital Chargemaster,Screw 16M Biotrak Mini,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513147,Hospital Chargemaster,Contour Vl Stent 6Fr X 22-30C,Outpatient,Outpatient Default Percent / Case Rate,278, $166.95 , $91.82 , $133.56 , See APC Packaged Rates , $116.87 , $65.11 , $161.09 , $161.79 , $85.98 , See APC Packaged Rates , See APC Packaged Rates , $55.59 , $55.59 , See APC Packaged Rates , See APC Packaged Rates , $155.26 , $155.26 , $155.26 , $155.26 , See APC Packaged Rates , $58.43 , $100.17 , $55.59 , $161.79 , $116.87
,61513181,Hospital Chargemaster,Patellar Tendon 10/10Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $10,395.00 "," $5,717.25 "," $8,316.00 ", See APC Packaged Rates ," $7,276.50 "," $4,054.05 "," $10,030.14 "," $10,073.79 "," $5,353.63 ", See APC Packaged Rates , See APC Packaged Rates ," $3,461.54 "," $3,461.54 ", See APC Packaged Rates , See APC Packaged Rates ," $9,667.35 "," $9,667.35 "," $9,667.35 "," $9,667.35 ", See APC Packaged Rates ," $3,638.25 "," $6,237.00 "," $3,461.54 "," $10,073.79 "," $7,276.50 "
,61513186,Hospital Chargemaster,Stent Contour Vl Ureteral,Outpatient,Outpatient Default Percent / Case Rate,278, $169.96 , $93.48 , $135.97 , See APC Packaged Rates , $118.97 , $66.28 , $163.99 , $164.71 , $87.53 , See APC Packaged Rates , See APC Packaged Rates , $56.60 , $56.60 , See APC Packaged Rates , See APC Packaged Rates , $158.06 , $158.06 , $158.06 , $158.06 , See APC Packaged Rates , $59.49 , $101.98 , $56.60 , $164.71 , $118.97
C1713,61513239,Hospital Chargemaster,Biosure Ha Screw 7 X 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513267,Hospital Chargemaster,Tibial Bearing Insert Sz5 13M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513274,Hospital Chargemaster,Stem Hip 132 Degree Sz230X90M,Outpatient,Outpatient Default Percent / Case Rate,278," $7,245.00 "," $3,984.75 "," $5,796.00 ", See APC Packaged Rates ," $5,071.50 "," $2,825.55 "," $6,990.70 "," $7,021.13 "," $3,731.32 ", See APC Packaged Rates , See APC Packaged Rates ," $2,412.59 "," $2,412.59 ", See APC Packaged Rates , See APC Packaged Rates ," $6,737.85 "," $6,737.85 "," $6,737.85 "," $6,737.85 ", See APC Packaged Rates ," $2,535.75 "," $4,347.00 "," $2,412.59 "," $7,021.13 "," $5,071.50 "
C1713,61513278,Hospital Chargemaster,Biosure Ha Screw 9X25M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513292,Hospital Chargemaster,Nail Tibial Std 12X360M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513293,Hospital Chargemaster,Screw Locking Threaded 5X60M,Outpatient,Outpatient Default Percent / Case Rate,278, $347.76 , $191.27 , $286.55 , See APC Packaged Rates , $243.43 , $135.63 , $335.55 , $337.01 , $179.10 , See APC Packaged Rates , See APC Packaged Rates , $115.80 , $115.80 , See APC Packaged Rates , See APC Packaged Rates , $323.42 , $323.42 , $323.42 , $323.42 , See APC Packaged Rates , $121.72 , $- , $- , $337.01 , $243.43
C1713,61513294,Hospital Chargemaster,Screw Lock Part Thrd 5X45M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513300,Hospital Chargemaster,Femoral Head Lfit V40 26Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $1,890.00 "," $1,039.50 "," $1,512.00 ", See APC Packaged Rates ," $1,323.00 ", $737.10 ," $1,823.66 "," $1,831.60 ", $973.39 , See APC Packaged Rates , See APC Packaged Rates , $629.37 , $629.37 , See APC Packaged Rates , See APC Packaged Rates ," $1,757.70 "," $1,757.70 "," $1,757.70 "," $1,757.70 ", See APC Packaged Rates , $661.50 ," $1,134.00 ", $629.37 ," $1,831.60 "," $1,323.00 "
,61513316,Hospital Chargemaster,Femoral Comp Size 1 Lft Cr,Outpatient,Outpatient Default Percent / Case Rate,278," $4,488.75 "," $2,468.81 "," $3,591.00 ", See APC Packaged Rates ," $3,142.13 "," $1,750.61 "," $4,331.19 "," $4,350.05 "," $2,311.80 ", See APC Packaged Rates , See APC Packaged Rates ," $1,494.75 "," $1,494.75 ", See APC Packaged Rates , See APC Packaged Rates ," $4,174.54 "," $4,174.54 "," $4,174.54 "," $4,174.54 ", See APC Packaged Rates ," $1,571.06 "," $2,693.25 "," $1,494.75 "," $4,350.05 "," $3,142.13 "
C1713,61513321,Hospital Chargemaster,Screw Self Tap Cort 4.5X34Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513324,Hospital Chargemaster,Accolade Ii 127 Deg Size 4,Outpatient,Outpatient Default Percent / Case Rate,278," $7,245.00 "," $3,984.75 "," $5,969.88 ", See APC Packaged Rates ," $5,071.50 "," $2,825.55 "," $6,990.70 "," $7,021.13 "," $3,731.32 ", See APC Packaged Rates , See APC Packaged Rates ," $2,412.59 "," $2,412.59 ", See APC Packaged Rates , See APC Packaged Rates ," $6,737.85 "," $6,737.85 "," $6,737.85 "," $6,737.85 ", See APC Packaged Rates ," $2,535.75 ", $- , $- ," $7,021.13 "," $5,071.50 "
C1713,61513326,Hospital Chargemaster,Nail Supracondylar 13X60M T2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513327,Hospital Chargemaster,Screwlocking F/T 5 X 37.5M,Outpatient,Outpatient Default Percent / Case Rate,278, $347.76 , $191.27 , $286.55 , See APC Packaged Rates , $243.43 , $135.63 , $335.55 , $337.01 , $179.10 , See APC Packaged Rates , See APC Packaged Rates , $115.80 , $115.80 , See APC Packaged Rates , See APC Packaged Rates , $323.42 , $323.42 , $323.42 , $323.42 , See APC Packaged Rates , $121.72 , $- , $- , $337.01 , $243.43
C1713,61513328,Hospital Chargemaster,Screw F/T Locking 5 X 75M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513329,Hospital Chargemaster,Screw F/T Locking 5 80M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513333,Hospital Chargemaster,Hip Stem 37X11 Mm Size 7,Outpatient,Outpatient Default Percent / Case Rate,278," $7,245.00 "," $3,984.75 "," $5,796.00 ", See APC Packaged Rates ," $5,071.50 "," $2,825.55 "," $6,990.70 "," $7,021.13 "," $3,731.32 ", See APC Packaged Rates , See APC Packaged Rates ," $2,412.59 "," $2,412.59 ", See APC Packaged Rates , See APC Packaged Rates ," $6,737.85 "," $6,737.85 "," $6,737.85 "," $6,737.85 ", See APC Packaged Rates ," $2,535.75 "," $4,347.00 "," $2,412.59 "," $7,021.13 "," $5,071.50 "
C1713,61513334,Hospital Chargemaster,Long Nail Kit Left 11X380M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513335,Hospital Chargemaster,Lag Screw 10.5X90M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,038.04 ", $570.92 , $855.34 , See APC Packaged Rates , $726.63 , $404.84 ," $1,001.60 "," $1,005.96 ", $534.61 , See APC Packaged Rates , See APC Packaged Rates , $345.67 , $345.67 , See APC Packaged Rates , See APC Packaged Rates , $965.38 , $965.38 , $965.38 , $965.38 , See APC Packaged Rates , $363.31 , $- , $- ," $1,005.96 ", $726.63
C1713,61513341,Hospital Chargemaster,Aculok 2Vdr Standard Left,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513343,Hospital Chargemaster,2.3 X 20M Cortical Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513344,Hospital Chargemaster,Cortical Screw 2.3 X 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513345,Hospital Chargemaster,Locking Screw 2.3 X 28M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513346,Hospital Chargemaster,Self Tab Cortical Screw3.5X30,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513348,Hospital Chargemaster,Locking Screw Axsos 4M/L34M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513349,Hospital Chargemaster,Locking Screw Axsos 4M/L36M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513350,Hospital Chargemaster,Locking Screw Axsos 4M/L42M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513351,Hospital Chargemaster,Locking Screw Axsos 4M/L46M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513352,Hospital Chargemaster,K-Wire Trocar Point,Outpatient,Outpatient Default Percent / Case Rate,278, $45.36 , $24.95 , $37.38 , See APC Packaged Rates , $31.75 , $17.69 , $43.77 , $43.96 , $23.36 , See APC Packaged Rates , See APC Packaged Rates , $15.10 , $15.10 , See APC Packaged Rates , See APC Packaged Rates , $42.18 , $42.18 , $42.18 , $42.18 , See APC Packaged Rates , $15.88 , $- , $- , $43.96 , $31.75
C1713,61513353,Hospital Chargemaster,Proximal Lat Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513361,Hospital Chargemaster,Interference Screw 8 X 23M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513376,Hospital Chargemaster,Tibial Nail 10X390M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513407,Hospital Chargemaster,Screw Ha Biosure 7 X 25M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513408,Hospital Chargemaster,Liner Insert 22.2Mm Size 38D,Outpatient,Outpatient Default Percent / Case Rate,278," $4,410.00 "," $2,425.50 "," $3,528.00 ", See APC Packaged Rates ," $3,087.00 "," $1,719.90 "," $4,255.21 "," $4,273.73 "," $2,271.24 ", See APC Packaged Rates , See APC Packaged Rates ," $1,468.53 "," $1,468.53 ", See APC Packaged Rates , See APC Packaged Rates ," $4,101.30 "," $4,101.30 "," $4,101.30 "," $4,101.30 ", See APC Packaged Rates ," $1,543.50 "," $2,646.00 "," $1,468.53 "," $4,273.73 "," $3,087.00 "
,61513410,Hospital Chargemaster,Liner Mdm Cocr 38Mmd,Outpatient,Outpatient Default Percent / Case Rate,278," $4,410.00 "," $2,425.50 "," $3,528.00 ", See APC Packaged Rates ," $3,087.00 "," $1,719.90 "," $4,255.21 "," $4,273.73 "," $2,271.24 ", See APC Packaged Rates , See APC Packaged Rates ," $1,468.53 "," $1,468.53 ", See APC Packaged Rates , See APC Packaged Rates ," $4,101.30 "," $4,101.30 "," $4,101.30 "," $4,101.30 ", See APC Packaged Rates ," $1,543.50 "," $2,646.00 "," $1,468.53 "," $4,273.73 "," $3,087.00 "
,61513429,Hospital Chargemaster,Femoral Head 22.2M Lv40,Outpatient,Outpatient Default Percent / Case Rate,278," $1,732.50 ", $952.88 ," $1,386.00 ", See APC Packaged Rates ," $1,212.75 ", $675.68 ," $1,671.69 "," $1,678.97 ", $892.27 , See APC Packaged Rates , See APC Packaged Rates , $576.92 , $576.92 , See APC Packaged Rates , See APC Packaged Rates ," $1,611.23 "," $1,611.23 "," $1,611.23 "," $1,611.23 ", See APC Packaged Rates , $606.38 ," $1,039.50 ", $576.92 ," $1,678.97 "," $1,212.75 "
,61513430,Hospital Chargemaster,Stem Hip 127 Deg 30X99Mm Sz2,Outpatient,Outpatient Default Percent / Case Rate,278," $7,245.00 "," $3,984.75 "," $5,796.00 ", See APC Packaged Rates ," $5,071.50 "," $2,825.55 "," $6,990.70 "," $7,021.13 "," $3,731.32 ", See APC Packaged Rates , See APC Packaged Rates ," $2,412.59 "," $2,412.59 ", See APC Packaged Rates , See APC Packaged Rates ," $6,737.85 "," $6,737.85 "," $6,737.85 "," $6,737.85 ", See APC Packaged Rates ," $2,535.75 "," $4,347.00 "," $2,412.59 "," $7,021.13 "," $5,071.50 "
,61513434,Hospital Chargemaster,Hip Stem 37X117Mm Sz 8 127Deg,Outpatient,Outpatient Default Percent / Case Rate,278," $7,245.00 "," $3,984.75 "," $5,796.00 ", See APC Packaged Rates ," $5,071.50 "," $2,825.55 "," $6,990.70 "," $7,021.13 "," $3,731.32 ", See APC Packaged Rates , See APC Packaged Rates ," $2,412.59 "," $2,412.59 ", See APC Packaged Rates , See APC Packaged Rates ," $6,737.85 "," $6,737.85 "," $6,737.85 "," $6,737.85 ", See APC Packaged Rates ," $2,535.75 "," $4,347.00 "," $2,412.59 "," $7,021.13 "," $5,071.50 "
,61513435,Hospital Chargemaster,Femoral Head 36Mm V40,Outpatient,Outpatient Default Percent / Case Rate,278," $1,764.00 ", $970.20 ," $1,411.20 ", See APC Packaged Rates ," $1,234.80 ", $687.96 ," $1,702.08 "," $1,709.49 ", $908.50 , See APC Packaged Rates , See APC Packaged Rates , $587.41 , $587.41 , See APC Packaged Rates , See APC Packaged Rates ," $1,640.52 "," $1,640.52 "," $1,640.52 "," $1,640.52 ", See APC Packaged Rates , $617.40 ," $1,058.40 ", $587.41 ," $1,709.49 "," $1,234.80 "
C1713,61513445,Hospital Chargemaster,Sideplate Omega+ 149X4 Slot,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513447,Hospital Chargemaster,Trident X3 Insert 36Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
,61513448,Hospital Chargemaster,Femoral Head Lfit 36Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $1,795.50 ", $987.53 ," $1,436.40 ", See APC Packaged Rates ," $1,256.85 ", $700.25 ," $1,732.48 "," $1,740.02 ", $924.72 , See APC Packaged Rates , See APC Packaged Rates , $597.90 , $597.90 , See APC Packaged Rates , See APC Packaged Rates ," $1,669.82 "," $1,669.82 "," $1,669.82 "," $1,669.82 ", See APC Packaged Rates , $628.43 ," $1,077.30 ", $597.90 ," $1,740.02 "," $1,256.85 "
C1713,61513467,Hospital Chargemaster,Tibial Bearing Insert Sz8 11M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513468,Hospital Chargemaster,Tibial Baseplate Size 8,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513471,Hospital Chargemaster,Screw Cancellous Bone 6.5X40M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513484,Hospital Chargemaster,Accolade Ii Sz5 127 Deg Stem,Outpatient,Outpatient Default Percent / Case Rate,278," $7,245.00 "," $3,984.75 "," $5,796.00 ", See APC Packaged Rates ," $5,071.50 "," $2,825.55 "," $6,990.70 "," $7,021.13 "," $3,731.32 ", See APC Packaged Rates , See APC Packaged Rates ," $2,412.59 "," $2,412.59 ", See APC Packaged Rates , See APC Packaged Rates ," $6,737.85 "," $6,737.85 "," $6,737.85 "," $6,737.85 ", See APC Packaged Rates ," $2,535.75 "," $4,347.00 "," $2,412.59 "," $7,021.13 "," $5,071.50 "
C1897,61513516,Hospital Chargemaster,Temporary Leads,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513525,Hospital Chargemaster,Juggerknot Anchor 2.9M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,102.50 ", $606.38 , $908.46 , See APC Packaged Rates , $771.75 , $429.98 ," $1,063.80 "," $1,068.43 ", $567.81 , See APC Packaged Rates , See APC Packaged Rates , $367.13 , $367.13 , See APC Packaged Rates , See APC Packaged Rates ," $1,025.33 "," $1,025.33 "," $1,025.33 "," $1,025.33 ", See APC Packaged Rates , $385.88 , $- , $- ," $1,068.43 ", $771.75
C1713,61513540,Hospital Chargemaster,Tibial Bearing Insert Size 89,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1778,61513542,Hospital Chargemaster,Spinal Cord Stimulator Leads,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1820,61513567,Hospital Chargemaster,Mri Battery,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513598,Hospital Chargemaster,Rest Mod Conical Distal Stem,Outpatient,Outpatient Default Percent / Case Rate,278," $10,574.55 "," $5,816.00 "," $8,459.64 ", See APC Packaged Rates ," $7,402.19 "," $4,124.07 "," $10,203.38 "," $10,247.80 "," $5,446.10 ", See APC Packaged Rates , See APC Packaged Rates ," $3,521.33 "," $3,521.33 ", See APC Packaged Rates , See APC Packaged Rates ," $9,834.33 "," $9,834.33 "," $9,834.33 "," $9,834.33 ", See APC Packaged Rates ," $3,701.09 "," $6,344.73 "," $3,521.33 "," $10,247.80 "," $7,402.19 "
C1713,61513604,Hospital Chargemaster,Replicator Plate 4.5M Offset,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513610,Hospital Chargemaster,Delta Head Biolox 36Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $2,913.75 "," $1,602.56 "," $2,331.00 ", See APC Packaged Rates ," $2,039.63 "," $1,136.36 "," $2,811.48 "," $2,823.72 "," $1,500.64 ", See APC Packaged Rates , See APC Packaged Rates , $970.28 , $970.28 , See APC Packaged Rates , See APC Packaged Rates ," $2,709.79 "," $2,709.79 "," $2,709.79 "," $2,709.79 ", See APC Packaged Rates ," $1,019.81 "," $1,748.25 ", $970.28 ," $2,823.72 "," $2,039.63 "
,61513641,Hospital Chargemaster,Cable/Sleeve Set 2.0 Beaded,Outpatient,Outpatient Default Percent / Case Rate,278," $1,188.81 ", $653.85 , $951.05 , See APC Packaged Rates , $832.17 , $463.64 ," $1,147.08 "," $1,152.08 ", $612.26 , See APC Packaged Rates , See APC Packaged Rates , $395.87 , $395.87 , See APC Packaged Rates , See APC Packaged Rates ," $1,105.59 "," $1,105.59 "," $1,105.59 "," $1,105.59 ", See APC Packaged Rates , $416.08 , $713.29 , $395.87 ," $1,152.08 ", $832.17
C1897,61513643,Hospital Chargemaster,Trial Lead,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513648,Hospital Chargemaster,Insert Trident 36Mm 0 Degree,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
,61513655,Hospital Chargemaster,Trident Insert 36Mmid,Outpatient,Outpatient Default Percent / Case Rate,278," $3,976.88 "," $2,187.28 "," $3,181.50 ", See APC Packaged Rates ," $2,783.82 "," $1,550.98 "," $3,837.29 "," $3,853.99 "," $2,048.17 ", See APC Packaged Rates , See APC Packaged Rates ," $1,324.30 "," $1,324.30 ", See APC Packaged Rates , See APC Packaged Rates ," $3,698.50 "," $3,698.50 "," $3,698.50 "," $3,698.50 ", See APC Packaged Rates ," $1,391.91 "," $2,386.13 "," $1,324.30 "," $3,853.99 "," $2,783.82 "
C1713,61513656,Hospital Chargemaster,Accolade 88 127 Deg Sz 6,Outpatient,Outpatient Default Percent / Case Rate,278," $7,245.00 "," $3,984.75 "," $5,969.88 ", See APC Packaged Rates ," $5,071.50 "," $2,825.55 "," $6,990.70 "," $7,021.13 "," $3,731.32 ", See APC Packaged Rates , See APC Packaged Rates ," $2,412.59 "," $2,412.59 ", See APC Packaged Rates , See APC Packaged Rates ," $6,737.85 "," $6,737.85 "," $6,737.85 "," $6,737.85 ", See APC Packaged Rates ," $2,535.75 ", $- , $- ," $7,021.13 "," $5,071.50 "
,61513677,Hospital Chargemaster,Delta Head Biolox V40 32Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $2,913.75 "," $1,602.56 "," $2,331.00 ", See APC Packaged Rates ," $2,039.63 "," $1,136.36 "," $2,811.48 "," $2,823.72 "," $1,500.64 ", See APC Packaged Rates , See APC Packaged Rates , $970.28 , $970.28 , See APC Packaged Rates , See APC Packaged Rates ," $2,709.79 "," $2,709.79 "," $2,709.79 "," $2,709.79 ", See APC Packaged Rates ," $1,019.81 "," $1,748.25 ", $970.28 ," $2,823.72 "," $2,039.63 "
C1713,61513681,Hospital Chargemaster,Cement Restrictor,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513682,Hospital Chargemaster,Screw Cancellous 6.5X50M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513686,Hospital Chargemaster,Femoral Head Lfit V40 25Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $1,890.00 "," $1,039.50 "," $1,512.00 ", See APC Packaged Rates ," $1,323.00 ", $737.10 ," $1,823.66 "," $1,831.60 ", $973.39 , See APC Packaged Rates , See APC Packaged Rates , $629.37 , $629.37 , See APC Packaged Rates , See APC Packaged Rates ," $1,757.70 "," $1,757.70 "," $1,757.70 "," $1,757.70 ", See APC Packaged Rates , $661.50 ," $1,134.00 ", $629.37 ," $1,831.60 "," $1,323.00 "
C1897,61513688,Hospital Chargemaster,Trial Lead Kit 60Cm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513692,Hospital Chargemaster,"Guide Wire 1.5 X 12""",Outpatient,Outpatient Default Percent / Case Rate,278, $431.55 , $237.35 , $345.24 , See APC Packaged Rates , $302.09 , $168.30 , $416.40 , $418.22 , $222.26 , See APC Packaged Rates , See APC Packaged Rates , $143.71 , $143.71 , See APC Packaged Rates , See APC Packaged Rates , $401.34 , $401.34 , $401.34 , $401.34 , See APC Packaged Rates , $151.04 , $258.93 , $143.71 , $418.22 , $302.09
C1778,61513696,Hospital Chargemaster,Lead Kit Patient PrograMer,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513701,Hospital Chargemaster,Baseplate Tri Ts Size 3,Outpatient,Outpatient Default Percent / Case Rate,278," $5,670.00 "," $3,118.50 "," $4,672.08 ", See APC Packaged Rates ," $3,969.00 "," $2,211.30 "," $5,470.98 "," $5,494.80 "," $2,920.16 ", See APC Packaged Rates , See APC Packaged Rates ," $1,888.11 "," $1,888.11 ", See APC Packaged Rates , See APC Packaged Rates ," $5,273.10 "," $5,273.10 "," $5,273.10 "," $5,273.10 ", See APC Packaged Rates ," $1,984.50 ", $- , $- ," $5,494.80 "," $3,969.00 "
C1776,61513711,Hospital Chargemaster,Humeral Stem Primary 11M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513716,Hospital Chargemaster,Screw Biosure 11 X 25M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1764,61513729,Hospital Chargemaster,Linq Implantable Eventrecorde,Outpatient,Outpatient Default Percent / Case Rate,278," $13,006.00 "," $7,153.30 "," $10,716.94 ", See APC Packaged Rates ," $9,104.20 "," $5,072.34 "," $12,549.49 "," $12,604.11 "," $6,698.35 ", See APC Packaged Rates , See APC Packaged Rates ," $4,331.00 "," $4,331.00 ", See APC Packaged Rates , See APC Packaged Rates ," $12,095.58 "," $12,095.58 "," $12,095.58 "," $12,095.58 ", See APC Packaged Rates ," $4,552.10 ", $- , $- ," $12,604.11 "," $9,104.20 "
,61513733,Hospital Chargemaster,Head V40 Cocr Lfit 36Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $1,890.00 "," $1,039.50 "," $1,512.00 ", See APC Packaged Rates ," $1,323.00 ", $737.10 ," $1,823.66 "," $1,831.60 ", $973.39 , See APC Packaged Rates , See APC Packaged Rates , $629.37 , $629.37 , See APC Packaged Rates , See APC Packaged Rates ," $1,757.70 "," $1,757.70 "," $1,757.70 "," $1,757.70 ", See APC Packaged Rates , $661.50 ," $1,134.00 ", $629.37 ," $1,831.60 "," $1,323.00 "
,61513736,Hospital Chargemaster,Rest Mod Prox Cone Body 19Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $14,759.01 "," $8,117.46 "," $11,807.21 ", See APC Packaged Rates ," $10,331.31 "," $5,756.01 "," $14,240.97 "," $14,302.96 "," $7,601.19 ", See APC Packaged Rates , See APC Packaged Rates ," $4,914.75 "," $4,914.75 ", See APC Packaged Rates , See APC Packaged Rates ," $13,725.88 "," $13,725.88 "," $13,725.88 "," $13,725.88 ", See APC Packaged Rates ," $5,165.65 "," $8,855.41 "," $4,914.75 "," $14,302.96 "," $10,331.31 "
,61513737,Hospital Chargemaster,Tibial Insert Rm/Ll #3 9Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $1,878.66 "," $1,033.26 "," $1,502.93 ", See APC Packaged Rates ," $1,315.06 ", $732.68 ," $1,812.72 "," $1,820.61 ", $967.55 , See APC Packaged Rates , See APC Packaged Rates , $625.59 , $625.59 , See APC Packaged Rates , See APC Packaged Rates ," $1,747.15 "," $1,747.15 "," $1,747.15 "," $1,747.15 ", See APC Packaged Rates , $657.53 ," $1,127.20 ", $625.59 ," $1,820.61 "," $1,315.06 "
C1713,61513757,Hospital Chargemaster,Screw Lag Cann 2.4 X 14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1897,61513760,Hospital Chargemaster,Accessory/Guide Wire Kit,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513761,Hospital Chargemaster,Tibial Bearing Insert Sz7 11M,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,984.94 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 ", $- , $- ," $3,510.56 "," $2,535.75 "
,61513786,Hospital Chargemaster,Accolade Ii 127 Deg Size 3,Outpatient,Outpatient Default Percent / Case Rate,278," $7,245.00 "," $3,984.75 "," $5,796.00 ", See APC Packaged Rates ," $5,071.50 "," $2,825.55 "," $6,990.70 "," $7,021.13 "," $3,731.32 ", See APC Packaged Rates , See APC Packaged Rates ," $2,412.59 "," $2,412.59 ", See APC Packaged Rates , See APC Packaged Rates ," $6,737.85 "," $6,737.85 "," $6,737.85 "," $6,737.85 ", See APC Packaged Rates ," $2,535.75 "," $4,347.00 "," $2,412.59 "," $7,021.13 "," $5,071.50 "
,61513788,Hospital Chargemaster,Insert Trident 32Mm 0 Degx3,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
C1713,61513814,Hospital Chargemaster,Tibial Bearing Insert Sz4 9M,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,984.94 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 ", $- , $- ," $3,510.56 "," $2,535.75 "
C1713,61513816,Hospital Chargemaster,Screw Vlp 3.5X22M Locking,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513830,Hospital Chargemaster,Insert Triathlon Cs Sz 6 9Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
C1713,61513838,Hospital Chargemaster,Tendon Gracilis,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513845,Hospital Chargemaster,Screw Interference 11X26Nn,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513849,Hospital Chargemaster,Femoral Component Beaded W/Pa,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,040.00 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 "," $3,780.00 "," $2,097.90 "," $6,105.33 "," $4,410.00 "
C1713,61513850,Hospital Chargemaster,Thiathlon Baseplate Size 6,Outpatient,Outpatient Default Percent / Case Rate,278," $4,646.25 "," $2,555.44 "," $3,828.51 ", See APC Packaged Rates ," $3,252.38 "," $1,812.04 "," $4,483.17 "," $4,502.68 "," $2,392.91 ", See APC Packaged Rates , See APC Packaged Rates ," $1,547.20 "," $1,547.20 ", See APC Packaged Rates , See APC Packaged Rates ," $4,321.01 "," $4,321.01 "," $4,321.01 "," $4,321.01 ", See APC Packaged Rates ," $1,626.19 ", $- , $- ," $4,502.68 "," $3,252.38 "
,61513870,Hospital Chargemaster,Stem Cemented Tri 12 X 50Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $4,106.97 "," $2,258.83 "," $3,285.58 ", See APC Packaged Rates ," $2,874.88 "," $1,601.72 "," $3,962.82 "," $3,980.06 "," $2,115.17 ", See APC Packaged Rates , See APC Packaged Rates ," $1,367.62 "," $1,367.62 ", See APC Packaged Rates , See APC Packaged Rates ," $3,819.48 "," $3,819.48 "," $3,819.48 "," $3,819.48 ", See APC Packaged Rates ," $1,437.44 "," $2,464.18 "," $1,367.62 "," $3,980.06 "," $2,874.88 "
C1713,61513885,Hospital Chargemaster,Baseplate Tri Ts Size 7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61513894,Hospital Chargemaster,Stem Hip Size 6 127Mm Omnifit,Outpatient,Outpatient Default Percent / Case Rate,278," $3,701.25 "," $2,035.69 "," $2,961.00 ", See APC Packaged Rates ," $2,590.88 "," $1,443.49 "," $3,571.34 "," $3,586.88 "," $1,906.22 ", See APC Packaged Rates , See APC Packaged Rates ," $1,232.52 "," $1,232.52 ", See APC Packaged Rates , See APC Packaged Rates ," $3,442.16 "," $3,442.16 "," $3,442.16 "," $3,442.16 ", See APC Packaged Rates ," $1,295.44 "," $2,220.75 "," $1,232.52 "," $3,586.88 "," $2,590.88 "
,61513895,Hospital Chargemaster,Thiathlon Cs Ins Sz 3 9Mm X3,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
C1713,61513918,Hospital Chargemaster,Screw Milagro Advance 8 X 23,Outpatient,Outpatient Default Percent / Case Rate,278," $1,181.25 ", $649.69 , $973.35 , See APC Packaged Rates , $826.88 , $460.69 ," $1,139.79 "," $1,144.75 ", $608.37 , See APC Packaged Rates , See APC Packaged Rates , $393.36 , $393.36 , See APC Packaged Rates , See APC Packaged Rates ," $1,098.56 "," $1,098.56 "," $1,098.56 "," $1,098.56 ", See APC Packaged Rates , $413.44 , $- , $- ," $1,144.75 ", $826.88
C1713,61513919,Hospital Chargemaster,Screw Milagro Advance 9 X 23,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513926,Hospital Chargemaster,Replicator Plate 1.5M Offset,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513927,Hospital Chargemaster,Humeral Head Short 41X16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1882,61513937,Hospital Chargemaster,Generator Inogen Crt-D,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513938,Hospital Chargemaster,Screw Milagro 9 X 30 M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513939,Hospital Chargemaster,ScrewGuidewire Biceptor 9X15M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513953,Hospital Chargemaster,Screw Interference 9 X 25M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513959,Hospital Chargemaster,Tri Ts Baseplate Size 6,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513961,Hospital Chargemaster,Screw Mulagro 10 C 30M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,181.25 ", $649.69 , $973.35 , See APC Packaged Rates , $826.88 , $460.69 ," $1,139.79 "," $1,144.75 ", $608.37 , See APC Packaged Rates , See APC Packaged Rates , $393.36 , $393.36 , See APC Packaged Rates , See APC Packaged Rates ," $1,098.56 "," $1,098.56 "," $1,098.56 "," $1,098.56 ", See APC Packaged Rates , $413.44 , $- , $- ," $1,144.75 ", $826.88
,61513978,Hospital Chargemaster,Insert Triathlon Sz3 11Mm X3,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
C1713,61513986,Hospital Chargemaster,Suture Anchor Corkscrew3.5X10,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61513987,Hospital Chargemaster,Screw Tenodesis 5.5 X 15M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514001,Hospital Chargemaster,Nail Long Kit 11 X 380 X 125M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514020,Hospital Chargemaster,Triathlon Insert Cs X3 Sz1 9M,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
C1713,61514031,Hospital Chargemaster,Insert Triathlon X3 Sz5 9M,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,984.94 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 ", $- , $- ," $3,510.56 "," $2,535.75 "
C1713,61514054,Hospital Chargemaster,Screw Biocomposite 10 X 28M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514055,Hospital Chargemaster,Screw Biocomposite 8 X 23M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514072,Hospital Chargemaster,Screw Milagro Advance 10X23M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,181.25 ", $649.69 , $973.35 , See APC Packaged Rates , $826.88 , $460.69 ," $1,139.79 "," $1,144.75 ", $608.37 , See APC Packaged Rates , See APC Packaged Rates , $393.36 , $393.36 , See APC Packaged Rates , See APC Packaged Rates ," $1,098.56 "," $1,098.56 "," $1,098.56 "," $1,098.56 ", See APC Packaged Rates , $413.44 , $- , $- ," $1,144.75 ", $826.88
C1897,61514076,Hospital Chargemaster,Lead Kit 70Cm Linear St,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1820,61514078,Hospital Chargemaster,Implantable Pulse Generator,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514084,Hospital Chargemaster,Screw Tenodesis 6.25X14 Pk,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514097,Hospital Chargemaster,Screw Milagro Advance 7X23,Outpatient,Outpatient Default Percent / Case Rate,278," $1,181.25 ", $649.69 , $973.35 , See APC Packaged Rates , $826.88 , $460.69 ," $1,139.79 "," $1,144.75 ", $608.37 , See APC Packaged Rates , See APC Packaged Rates , $393.36 , $393.36 , See APC Packaged Rates , See APC Packaged Rates ," $1,098.56 "," $1,098.56 "," $1,098.56 "," $1,098.56 ", See APC Packaged Rates , $413.44 , $- , $- ," $1,144.75 ", $826.88
Q4126,61514099,Hospital Chargemaster,Dermaspan 4 X 4 Cm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $92.63 , $92.63 , $92.63 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $92.70 , $- , $92.70 , $-
C1713,61514105,Hospital Chargemaster,Tri Ts Baseplate Size 5,Outpatient,Outpatient Default Percent / Case Rate,278," $5,670.00 "," $3,118.50 "," $4,672.08 ", See APC Packaged Rates ," $3,969.00 "," $2,211.30 "," $5,470.98 "," $5,494.80 "," $2,920.16 ", See APC Packaged Rates , See APC Packaged Rates ," $1,888.11 "," $1,888.11 ", See APC Packaged Rates , See APC Packaged Rates ," $5,273.10 "," $5,273.10 "," $5,273.10 "," $5,273.10 ", See APC Packaged Rates ," $1,984.50 ", $- , $- ," $5,494.80 "," $3,969.00 "
,61514111,Hospital Chargemaster,Tibial Insert Ps X3 Triathlon,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
,61514112,Hospital Chargemaster,Tri Ts Femur Sz 3 Left,Outpatient,Outpatient Default Percent / Case Rate,278," $22,462.65 "," $12,354.46 "," $17,970.12 ", See APC Packaged Rates ," $15,723.86 "," $8,760.43 "," $21,674.21 "," $21,768.55 "," $11,568.71 ", See APC Packaged Rates , See APC Packaged Rates ," $7,480.06 "," $7,480.06 ", See APC Packaged Rates , See APC Packaged Rates ," $20,890.26 "," $20,890.26 "," $20,890.26 "," $20,890.26 ", See APC Packaged Rates ," $7,861.93 "," $13,477.59 "," $7,480.06 "," $21,768.55 "," $15,723.86 "
,61514114,Hospital Chargemaster,Femoral Augment 5Mm Sz3 Left,Outpatient,Outpatient Default Percent / Case Rate,278," $3,863.16 "," $2,124.74 "," $3,090.53 ", See APC Packaged Rates ," $2,704.21 "," $1,506.63 "," $3,727.56 "," $3,743.79 "," $1,989.60 ", See APC Packaged Rates , See APC Packaged Rates ," $1,286.43 "," $1,286.43 ", See APC Packaged Rates , See APC Packaged Rates ," $3,592.74 "," $3,592.74 "," $3,592.74 "," $3,592.74 ", See APC Packaged Rates ," $1,352.11 "," $2,317.90 "," $1,286.43 "," $3,743.79 "," $2,704.21 "
C1713,61514120,Hospital Chargemaster,Triathlon Insert Cs X3 Sz2 9M,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,984.94 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 ", $- , $- ," $3,510.56 "," $2,535.75 "
C1713,61514125,Hospital Chargemaster,Plate Primary 1St Mtp 3.5M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514128,Hospital Chargemaster,Screw 4.0X28M Cann Headless,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514129,Hospital Chargemaster,Screw 3.5X18M Nonlock Double,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514130,Hospital Chargemaster,Screw 4.0X20M Nonlock Double,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514131,Hospital Chargemaster,Screw 3.5X18M Locking Double,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514132,Hospital Chargemaster,Screw 3.5X20M Locking Double,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514144,Hospital Chargemaster,Screw 2.4 X 20M Cannulated,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514146,Hospital Chargemaster,Screw 2.4 X 26M Cannulated,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514160,Hospital Chargemaster,Screw Milagro Interference30M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,181.25 ", $649.69 , $973.35 , See APC Packaged Rates , $826.88 , $460.69 ," $1,139.79 "," $1,144.75 ", $608.37 , See APC Packaged Rates , See APC Packaged Rates , $393.36 , $393.36 , See APC Packaged Rates , See APC Packaged Rates ," $1,098.56 "," $1,098.56 "," $1,098.56 "," $1,098.56 ", See APC Packaged Rates , $413.44 , $- , $- ," $1,144.75 ", $826.88
C1713,61514170,Hospital Chargemaster,Screw 2.5 X 22M Non Locking,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514171,Hospital Chargemaster,Screw 3.5 X 28M Non Locking,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514172,Hospital Chargemaster,Plate Fore Foot/Mid Foot,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514173,Hospital Chargemaster,Screw 3.5 X 20M Non Locking,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514174,Hospital Chargemaster,Screw 3.5 X 18M Non Locking,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514175,Hospital Chargemaster,Screw 3.5 X 10M Locking,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514176,Hospital Chargemaster,Screw Bio-Comp Interference,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61514189,Hospital Chargemaster,Mesh 3D X-Large 4.8X6.7 Left,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61514190,Hospital Chargemaster,Mesh 3D X-Large 4.8X6.7 Right,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514201,Hospital Chargemaster,K-Wire 1.25 X 150mm SS,Outpatient,Outpatient Default Percent / Case Rate,278, $8.82 , $4.85 , $7.06 , See APC Packaged Rates , $6.17 , $3.44 , $8.51 , $8.55 , $4.54 , See APC Packaged Rates , See APC Packaged Rates , $2.94 , $2.94 , See APC Packaged Rates , See APC Packaged Rates , $8.20 , $8.20 , $8.20 , $8.20 , See APC Packaged Rates , $3.09 , $5.29 , $2.94 , $8.55 , $6.17
,61514202,Hospital Chargemaster,K-Wire 1.6 X 150mm SS,Outpatient,Outpatient Default Percent / Case Rate,278, $17.01 , $9.36 , $13.61 , See APC Packaged Rates , $11.91 , $6.63 , $16.41 , $16.48 , $8.76 , See APC Packaged Rates , See APC Packaged Rates , $5.66 , $5.66 , See APC Packaged Rates , See APC Packaged Rates , $15.82 , $15.82 , $15.82 , $15.82 , See APC Packaged Rates , $5.95 , $10.21 , $5.66 , $16.48 , $11.91
C1713,61514203,Hospital Chargemaster,Plate Volar Dr 10H Left Short,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514204,Hospital Chargemaster,Screw Locking T8 2.7/L14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514206,Hospital Chargemaster,Screw Locking T8 2.7/L18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514207,Hospital Chargemaster,Screw Locking T8 2.7/L22M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514208,Hospital Chargemaster,Locking Screw T8 2.7/L24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514212,Hospital Chargemaster,Screw Headless 2.0 X 18M Cann,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514214,Hospital Chargemaster,Screw Headless 2.0 X 22M Cann,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514215,Hospital Chargemaster,Screw Headless 2.0 X 14M Cann,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514216,Hospital Chargemaster,Screw Headless 2.0 X 16M Cann,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514217,Hospital Chargemaster,Screw Headless 2.4 X 18M Cann,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514225,Hospital Chargemaster,Tibial Baseplate Size 7 9M,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,984.94 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 ", $- , $- ," $3,510.56 "," $2,535.75 "
C1776,61514234,Hospital Chargemaster,Humeral Head Short 47M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514235,Hospital Chargemaster,Femoral Component Beaded W/Pa,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,040.00 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 "," $3,780.00 "," $2,097.90 "," $6,105.33 "," $4,410.00 "
C1713,61514236,Hospital Chargemaster,Baseplate Tritanium Size 3,Outpatient,Outpatient Default Percent / Case Rate,278," $4,646.25 "," $2,555.44 "," $3,828.51 ", See APC Packaged Rates ," $3,252.38 "," $1,812.04 "," $4,483.17 "," $4,502.68 "," $2,392.91 ", See APC Packaged Rates , See APC Packaged Rates ," $1,547.20 "," $1,547.20 ", See APC Packaged Rates , See APC Packaged Rates ," $4,321.01 "," $4,321.01 "," $4,321.01 "," $4,321.01 ", See APC Packaged Rates ," $1,626.19 ", $- , $- ," $4,502.68 "," $3,252.38 "
C1713,61514237,Hospital Chargemaster,Patella AsyMetric Tritanium,Outpatient,Outpatient Default Percent / Case Rate,278," $2,205.00 "," $1,212.75 "," $1,816.92 ", See APC Packaged Rates ," $1,543.50 ", $859.95 ," $2,127.60 "," $2,136.87 "," $1,135.62 ", See APC Packaged Rates , See APC Packaged Rates , $734.27 , $734.27 , See APC Packaged Rates , See APC Packaged Rates ," $2,050.65 "," $2,050.65 "," $2,050.65 "," $2,050.65 ", See APC Packaged Rates , $771.75 , $- , $- ," $2,136.87 "," $1,543.50 "
Q4121,61514241,Hospital Chargemaster,Theraskin 13Cm Square,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $39.15 , $39.15 , $39.15 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $43.82 , $- , $43.82 , $-
C1713,61514246,Hospital Chargemaster,Screw 2.0 Cann Headless 34M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514247,Hospital Chargemaster,Screw 2.0 Cann Headless 32M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514248,Hospital Chargemaster,Screw 2.0 Cann Headless 12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514249,Hospital Chargemaster,Screw 2.0 Cannulated Lag 18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514250,Hospital Chargemaster,Screw 2.0 Cann Headless 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
Q4121,61514251,Hospital Chargemaster,"Theraskin 2 X 3""",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $39.15 , $39.15 , $39.15 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $43.82 , $- , $43.82 , $-
C1781,61514259,Hospital Chargemaster,"Mesh Soft 12"" X 12""",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514264,Hospital Chargemaster,Screw Headless 2.0 X 28M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61514265,Hospital Chargemaster,"Mesh Phasix 6 X 8""",Outpatient,Outpatient Default Percent / Case Rate,278," $12,253.50 "," $6,739.43 "," $10,096.88 ", See APC Packaged Rates ," $8,577.45 "," $4,778.87 "," $11,823.40 "," $11,874.87 "," $6,310.80 ", See APC Packaged Rates , See APC Packaged Rates ," $4,080.42 "," $4,080.42 ", See APC Packaged Rates , See APC Packaged Rates ," $11,395.76 "," $11,395.76 "," $11,395.76 "," $11,395.76 ", See APC Packaged Rates ," $4,288.73 ", $- , $- ," $11,874.87 "," $8,577.45 "
C1713,61514266,Hospital Chargemaster,Screw Headless 2.0MX10M Cann,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1778,61514274,Hospital Chargemaster,Linear 8 Contact Lead Kit 50C,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61514287,Hospital Chargemaster,"Mesh Ventralight St 4 X 6""",Outpatient,Outpatient Default Percent / Case Rate,278," $1,534.84 ", $844.16 ," $1,264.71 ", See APC Packaged Rates ," $1,074.39 ", $598.59 ," $1,480.97 "," $1,487.41 ", $790.47 , See APC Packaged Rates , See APC Packaged Rates , $511.10 , $511.10 , See APC Packaged Rates , See APC Packaged Rates ," $1,427.40 "," $1,427.40 "," $1,427.40 "," $1,427.40 ", See APC Packaged Rates , $537.19 , $- , $- ," $1,487.41 "," $1,074.39 "
C1781,61514288,Hospital Chargemaster,"Mesh Circle 4.5""",Outpatient,Outpatient Default Percent / Case Rate,278," $1,669.50 ", $918.23 ," $1,375.67 ", See APC Packaged Rates ," $1,168.65 ", $651.11 ," $1,610.90 "," $1,617.91 ", $859.83 , See APC Packaged Rates , See APC Packaged Rates , $555.94 , $555.94 , See APC Packaged Rates , See APC Packaged Rates ," $1,552.64 "," $1,552.64 "," $1,552.64 "," $1,552.64 ", See APC Packaged Rates , $584.33 , $- , $- ," $1,617.91 "," $1,168.65 "
C1781,61514289,Hospital Chargemaster,"Mesh Circle 6""",Outpatient,Outpatient Default Percent / Case Rate,278," $2,441.25 "," $1,342.69 "," $2,011.59 ", See APC Packaged Rates ," $1,708.88 ", $952.09 ," $2,355.56 "," $2,365.82 "," $1,257.29 ", See APC Packaged Rates , See APC Packaged Rates , $812.94 , $812.94 , See APC Packaged Rates , See APC Packaged Rates ," $2,270.36 "," $2,270.36 "," $2,270.36 "," $2,270.36 ", See APC Packaged Rates , $854.44 , $- , $- ," $2,365.82 "," $1,708.88 "
C1781,61514290,Hospital Chargemaster,Mesh Ventralight 6X8,Outpatient,Outpatient Default Percent / Case Rate,278," $2,724.75 "," $1,498.61 "," $2,245.19 ", See APC Packaged Rates ," $1,907.33 "," $1,062.65 "," $2,629.11 "," $2,640.56 "," $1,403.30 ", See APC Packaged Rates , See APC Packaged Rates , $907.34 , $907.34 , See APC Packaged Rates , See APC Packaged Rates ," $2,534.02 "," $2,534.02 "," $2,534.02 "," $2,534.02 ", See APC Packaged Rates , $953.66 , $- , $- ," $2,640.56 "," $1,907.33 "
C1781,61514291,Hospital Chargemaster,"Mesh Ventralight 7 X 9""",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61514300,Hospital Chargemaster,Mesh Ventralight 10X15Cm Oval,Outpatient,Outpatient Default Percent / Case Rate,278," $1,062.34 ", $584.29 , $875.37 , See APC Packaged Rates , $743.64 , $414.31 ," $1,025.05 "," $1,029.51 ", $547.13 , See APC Packaged Rates , See APC Packaged Rates , $353.76 , $353.76 , See APC Packaged Rates , See APC Packaged Rates , $987.98 , $987.98 , $987.98 , $987.98 , See APC Packaged Rates , $371.82 , $- , $- ," $1,029.51 ", $743.64
C1713,61514301,Hospital Chargemaster,Peek Swivel Lock 5.5 X 19.1M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514315,Hospital Chargemaster,Screw Cannulated 2.0 X 24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1897,61514318,Hospital Chargemaster,50Cm 16 Contact Trial Lead,Outpatient,Outpatient Default Percent / Case Rate,278," $3,780.00 "," $2,079.00 "," $3,114.72 ", See APC Packaged Rates ," $2,646.00 "," $1,474.20 "," $3,647.32 "," $3,663.20 "," $1,946.78 ", See APC Packaged Rates , See APC Packaged Rates ," $1,258.74 "," $1,258.74 ", See APC Packaged Rates , See APC Packaged Rates ," $3,515.40 "," $3,515.40 "," $3,515.40 "," $3,515.40 ", See APC Packaged Rates ," $1,323.00 ", $- , $- ," $3,663.20 "," $2,646.00 "
C1713,61514344,Hospital Chargemaster,Screw Low Profile Solid 5.5M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514349,Hospital Chargemaster,Screw Headless Cann 2.4 X 24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514350,Hospital Chargemaster,Screw Headless Cann 2.4 X 28M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514359,Hospital Chargemaster,Screw Lo-Pro Thd 4.5 X 40M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514360,Hospital Chargemaster,Screw Lo-Pro Thd 4.5 X 45M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514376,Hospital Chargemaster,Screw Headless Cann 2.4MX22M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514377,Hospital Chargemaster,Screw Headless Cann 3.0MX22M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514378,Hospital Chargemaster,Screw Headless Cann 3.0MX18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514381,Hospital Chargemaster,Screw Headless 2.4Mx12M Cann,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514387,Hospital Chargemaster,GaMa 3 Nail 11 X 300,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514388,Hospital Chargemaster,Screw Lag 10.5 X 80,Outpatient,Outpatient Default Percent / Case Rate,278," $1,017.77 ", $559.77 , $838.64 , See APC Packaged Rates , $712.44 , $396.93 , $982.05 , $986.32 , $524.17 , See APC Packaged Rates , See APC Packaged Rates , $338.92 , $338.92 , See APC Packaged Rates , See APC Packaged Rates , $946.53 , $946.53 , $946.53 , $946.53 , See APC Packaged Rates , $356.22 , $- , $- , $986.32 , $712.44
C1713,61514390,Hospital Chargemaster,Screw Periprosthetic 5.0X 14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514405,Hospital Chargemaster,Screw Headless Cannulated 2.0,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514417,Hospital Chargemaster,Screw Tenodesis 5.5M X 8,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514454,Hospital Chargemaster,Screw Locking Bone Rsp 5 X 18,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514455,Hospital Chargemaster,Screw Locking Bone Rsp 5X26,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514456,Hospital Chargemaster,Screw Locking Bone Rsp 5X34,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514457,Hospital Chargemaster,Glenoid Head W/Retain Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514458,Hospital Chargemaster,Rep Baseplate 30M W/P2 Coat,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514459,Hospital Chargemaster,Rep Humeral Socket Insert,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514472,Hospital Chargemaster,Cannulated Headless Screw 2.4,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514499,Hospital Chargemaster,Polaris Stent 7 X 22,Outpatient,Outpatient Default Percent / Case Rate,278, $170.71 , $93.89 , $136.57 , See APC Packaged Rates , $119.50 , $66.58 , $164.72 , $165.44 , $87.92 , See APC Packaged Rates , See APC Packaged Rates , $56.85 , $56.85 , See APC Packaged Rates , See APC Packaged Rates , $158.76 , $158.76 , $158.76 , $158.76 , See APC Packaged Rates , $59.75 , $102.43 , $56.85 , $165.44 , $119.50
C1713,61514505,Hospital Chargemaster,Triathlon Ps X3 Tibial Insert,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,984.94 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 ", $- , $- ," $3,510.56 "," $2,535.75 "
C1713,61514514,Hospital Chargemaster,Plate Right 10,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514516,Hospital Chargemaster,Screw 10M 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514517,Hospital Chargemaster,Screw 12M 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514518,Hospital Chargemaster,Screw 16M 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514519,Hospital Chargemaster,Screw 18M 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514520,Hospital Chargemaster,Screw 20M 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514521,Hospital Chargemaster,Screw 3.0M X 20,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514542,Hospital Chargemaster,Triathlon Pkr Baseplate #5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514547,Hospital Chargemaster,Tri Ts Baseplate Size 1,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1788,61514550,Hospital Chargemaster,Picc Line WO Sherloc 5Fr Dual,Outpatient,Outpatient Default Percent / Case Rate,278, $554.40 , $304.92 , $456.83 , See APC Packaged Rates , $388.08 , $216.22 , $534.94 , $537.27 , $285.53 , See APC Packaged Rates , See APC Packaged Rates , $184.62 , $184.62 , See APC Packaged Rates , See APC Packaged Rates , $515.59 , $515.59 , $515.59 , $515.59 , See APC Packaged Rates , $194.04 , $- , $- , $537.27 , $388.08
C1788,61514551,Hospital Chargemaster,Picc Line Solo W/O Sherlock,Outpatient,Outpatient Default Percent / Case Rate,278, $426.13 , $234.37 , $351.13 , See APC Packaged Rates , $298.29 , $166.19 , $411.17 , $412.96 , $219.47 , See APC Packaged Rates , See APC Packaged Rates , $141.90 , $141.90 , See APC Packaged Rates , See APC Packaged Rates , $396.30 , $396.30 , $396.30 , $396.30 , See APC Packaged Rates , $149.15 , $- , $- , $412.96 , $298.29
C1713,61514557,Hospital Chargemaster,Screw Locking Bone Rsp 5 X 14,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514558,Hospital Chargemaster,Screw Bone Locking Rsp 5 X 30,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514559,Hospital Chargemaster,Glenoid Head W/Retain Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514571,Hospital Chargemaster,Grip Plate Lg Vitallium 110M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514572,Hospital Chargemaster,Cable Vit D/M 2.0Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $977.13 , $537.42 , $781.70 , See APC Packaged Rates , $683.99 , $381.08 , $942.83 , $946.94 , $503.24 , See APC Packaged Rates , See APC Packaged Rates , $325.38 , $325.38 , See APC Packaged Rates , See APC Packaged Rates , $908.73 , $908.73 , $908.73 , $908.73 , See APC Packaged Rates , $342.00 , $586.28 , $325.38 , $946.94 , $683.99
C1713,61514576,Hospital Chargemaster,Screw Acutrak 2 7/5 X 50,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514577,Hospital Chargemaster,Screw Acutrak 2 5/5 X 50,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514591,Hospital Chargemaster,Anchor Healix Adv WOrtho Cord,Outpatient,Outpatient Default Percent / Case Rate,278, $945.00 , $519.75 , $778.68 , See APC Packaged Rates , $661.50 , $368.55 , $911.83 , $915.80 , $486.69 , See APC Packaged Rates , See APC Packaged Rates , $314.69 , $314.69 , See APC Packaged Rates , See APC Packaged Rates , $878.85 , $878.85 , $878.85 , $878.85 , See APC Packaged Rates , $330.75 , $- , $- , $915.80 , $661.50
C1713,61514592,Hospital Chargemaster,Sheath Bio-Intrafix Lg,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514593,Hospital Chargemaster,Screw Tapered Biointrafix,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514599,Hospital Chargemaster,Tibial Sheath Sm Bui Intrafix,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514600,Hospital Chargemaster,Screw Tapered 6-8 X 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514602,Hospital Chargemaster,Speedtrap Green/White,Outpatient,Outpatient Default Percent / Case Rate,278, $236.25 , $129.94 , $194.67 , See APC Packaged Rates , $165.38 , $92.14 , $227.96 , $228.95 , $121.67 , See APC Packaged Rates , See APC Packaged Rates , $78.67 , $78.67 , See APC Packaged Rates , See APC Packaged Rates , $219.71 , $219.71 , $219.71 , $219.71 , See APC Packaged Rates , $82.69 , $- , $- , $228.95 , $165.38
,61514605,Hospital Chargemaster,Humeral Cup 36Mm D X 4Mm T,Outpatient,Outpatient Default Percent / Case Rate,278," $4,095.00 "," $2,252.25 "," $3,276.00 ", See APC Packaged Rates ," $2,866.50 "," $1,597.05 "," $3,951.27 "," $3,968.46 "," $2,109.01 ", See APC Packaged Rates , See APC Packaged Rates ," $1,363.64 "," $1,363.64 ", See APC Packaged Rates , See APC Packaged Rates ," $3,808.35 "," $3,808.35 "," $3,808.35 "," $3,808.35 ", See APC Packaged Rates ," $1,433.25 "," $2,457.00 "," $1,363.64 "," $3,968.46 "," $2,866.50 "
,61514607,Hospital Chargemaster,Humeral Insert X3 - 36Mm X 4M,Outpatient,Outpatient Default Percent / Case Rate,278," $4,095.00 "," $2,252.25 "," $3,276.00 ", See APC Packaged Rates ," $2,866.50 "," $1,597.05 "," $3,951.27 "," $3,968.46 "," $2,109.01 ", See APC Packaged Rates , See APC Packaged Rates ," $1,363.64 "," $1,363.64 ", See APC Packaged Rates , See APC Packaged Rates ," $3,808.35 "," $3,808.35 "," $3,808.35 "," $3,808.35 ", See APC Packaged Rates ," $1,433.25 "," $2,457.00 "," $1,363.64 "," $3,968.46 "," $2,866.50 "
C1713,61514608,Hospital Chargemaster,Baseplate,Outpatient,Outpatient Default Percent / Case Rate,278," $4,725.00 "," $2,598.75 "," $3,893.40 ", See APC Packaged Rates ," $3,307.50 "," $1,842.75 "," $4,559.15 "," $4,579.00 "," $2,433.47 ", See APC Packaged Rates , See APC Packaged Rates ," $1,573.43 "," $1,573.43 ", See APC Packaged Rates , See APC Packaged Rates ," $4,394.25 "," $4,394.25 "," $4,394.25 "," $4,394.25 ", See APC Packaged Rates ," $1,653.75 ", $- , $- ," $4,579.00 "," $3,307.50 "
C1713,61514609,Hospital Chargemaster,Screw Peripheral 4.5M X 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $527.31 , $290.02 , $434.50 , See APC Packaged Rates , $369.12 , $205.65 , $508.80 , $511.02 , $271.58 , See APC Packaged Rates , See APC Packaged Rates , $175.59 , $175.59 , See APC Packaged Rates , See APC Packaged Rates , $490.40 , $490.40 , $490.40 , $490.40 , See APC Packaged Rates , $184.56 , $- , $- , $511.02 , $369.12
C1713,61514610,Hospital Chargemaster,Screw Peripheral 4.5M X 24M,Outpatient,Outpatient Default Percent / Case Rate,278, $527.31 , $290.02 , $434.50 , See APC Packaged Rates , $369.12 , $205.65 , $508.80 , $511.02 , $271.58 , See APC Packaged Rates , See APC Packaged Rates , $175.59 , $175.59 , See APC Packaged Rates , See APC Packaged Rates , $490.40 , $490.40 , $490.40 , $490.40 , See APC Packaged Rates , $184.56 , $- , $- , $511.02 , $369.12
C1713,61514611,Hospital Chargemaster,Peripheral Screw 4.5M X 28M,Outpatient,Outpatient Default Percent / Case Rate,278, $527.31 , $290.02 , $434.50 , See APC Packaged Rates , $369.12 , $205.65 , $508.80 , $511.02 , $271.58 , See APC Packaged Rates , See APC Packaged Rates , $175.59 , $175.59 , See APC Packaged Rates , See APC Packaged Rates , $490.40 , $490.40 , $490.40 , $490.40 , See APC Packaged Rates , $184.56 , $- , $- , $511.02 , $369.12
C1713,61514612,Hospital Chargemaster,Screw Center 6.5M X 32M,Outpatient,Outpatient Default Percent / Case Rate,278, $527.31 , $290.02 , $434.50 , See APC Packaged Rates , $369.12 , $205.65 , $508.80 , $511.02 , $271.58 , See APC Packaged Rates , See APC Packaged Rates , $175.59 , $175.59 , See APC Packaged Rates , See APC Packaged Rates , $490.40 , $490.40 , $490.40 , $490.40 , See APC Packaged Rates , $184.56 , $- , $- , $511.02 , $369.12
,61514613,Hospital Chargemaster,Glenosphere 36Mm D X 2Mm T,Outpatient,Outpatient Default Percent / Case Rate,278," $4,725.00 "," $2,598.75 "," $3,780.00 ", See APC Packaged Rates ," $3,307.50 "," $1,842.75 "," $4,559.15 "," $4,579.00 "," $2,433.47 ", See APC Packaged Rates , See APC Packaged Rates ," $1,573.43 "," $1,573.43 ", See APC Packaged Rates , See APC Packaged Rates ," $4,394.25 "," $4,394.25 "," $4,394.25 "," $4,394.25 ", See APC Packaged Rates ," $1,653.75 "," $2,835.00 "," $1,573.43 "," $4,579.00 "," $3,307.50 "
C1713,61514617,Hospital Chargemaster,Triathlon Cr Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,191.20 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 ", $- , $- ," $6,105.33 "," $4,410.00 "
,61514618,Hospital Chargemaster,Triathlon Tritanium BP Size 5,Outpatient,Outpatient Default Percent / Case Rate,278," $4,646.25 "," $2,555.44 "," $3,717.00 ", See APC Packaged Rates ," $3,252.38 "," $1,812.04 "," $4,483.17 "," $4,502.68 "," $2,392.91 ", See APC Packaged Rates , See APC Packaged Rates ," $1,547.20 "," $1,547.20 ", See APC Packaged Rates , See APC Packaged Rates ," $4,321.01 "," $4,321.01 "," $4,321.01 "," $4,321.01 ", See APC Packaged Rates ," $1,626.19 "," $2,787.75 "," $1,547.20 "," $4,502.68 "," $3,252.38 "
C1713,61514619,Hospital Chargemaster,Patella Tritanium A35 X 10,Outpatient,Outpatient Default Percent / Case Rate,278," $2,205.00 "," $1,212.75 "," $1,816.92 ", See APC Packaged Rates ," $1,543.50 ", $859.95 ," $2,127.60 "," $2,136.87 "," $1,135.62 ", See APC Packaged Rates , See APC Packaged Rates , $734.27 , $734.27 , See APC Packaged Rates , See APC Packaged Rates ," $2,050.65 "," $2,050.65 "," $2,050.65 "," $2,050.65 ", See APC Packaged Rates , $771.75 , $- , $- ," $2,136.87 "," $1,543.50 "
C1713,61514629,Hospital Chargemaster,"Truespan 12""",Outpatient,Outpatient Default Percent / Case Rate,278," $1,323.00 ", $727.65 ," $1,090.15 ", See APC Packaged Rates , $926.10 , $515.97 ," $1,276.56 "," $1,282.12 ", $681.37 , See APC Packaged Rates , See APC Packaged Rates , $440.56 , $440.56 , See APC Packaged Rates , See APC Packaged Rates ," $1,230.39 "," $1,230.39 "," $1,230.39 "," $1,230.39 ", See APC Packaged Rates , $463.05 , $- , $- ," $1,282.12 ", $926.10
C1713,61514636,Hospital Chargemaster,Screw Peripheral 4.5M 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514637,Hospital Chargemaster,Screw Center 6.5M 28M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514645,Hospital Chargemaster,Trident 0 Deg Insert 40M,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,984.94 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 ", $- , $- ," $3,510.56 "," $2,535.75 "
C1713,61514646,Hospital Chargemaster,Cocr Lfit Head V40 40M/+0,Outpatient,Outpatient Default Percent / Case Rate,278," $2,835.00 "," $1,559.25 "," $2,336.04 ", See APC Packaged Rates ," $1,984.50 "," $1,105.65 "," $2,735.49 "," $2,747.40 "," $1,460.08 ", See APC Packaged Rates , See APC Packaged Rates , $944.06 , $944.06 , See APC Packaged Rates , See APC Packaged Rates ," $2,636.55 "," $2,636.55 "," $2,636.55 "," $2,636.55 ", See APC Packaged Rates , $992.25 , $- , $- ," $2,747.40 "," $1,984.50 "
C1713,61514648,Hospital Chargemaster,Lupine Br Anchor W/Orthocord,Outpatient,Outpatient Default Percent / Case Rate,278, $945.00 , $519.75 , $778.68 , See APC Packaged Rates , $661.50 , $368.55 , $911.83 , $915.80 , $486.69 , See APC Packaged Rates , See APC Packaged Rates , $314.69 , $314.69 , See APC Packaged Rates , See APC Packaged Rates , $878.85 , $878.85 , $878.85 , $878.85 , See APC Packaged Rates , $330.75 , $- , $- , $915.80 , $661.50
C1713,61514649,Hospital Chargemaster,Bio-Intrafix Tapered Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514650,Hospital Chargemaster,Rigidloop Cortical Fixation,Outpatient,Outpatient Default Percent / Case Rate,278, $945.00 , $519.75 , $778.68 , See APC Packaged Rates , $661.50 , $368.55 , $911.83 , $915.80 , $486.69 , See APC Packaged Rates , See APC Packaged Rates , $314.69 , $314.69 , See APC Packaged Rates , See APC Packaged Rates , $878.85 , $878.85 , $878.85 , $878.85 , See APC Packaged Rates , $330.75 , $- , $- , $915.80 , $661.50
,61514653,Hospital Chargemaster,Tibial Insert Triathlon Px X3,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
,61514655,Hospital Chargemaster,Triathlon Cruciate Ret Femora,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,040.00 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 "," $3,780.00 "," $2,097.90 "," $6,105.33 "," $4,410.00 "
,61514663,Hospital Chargemaster,Tibial Insert Triathlon Ps X3,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
,61514666,Hospital Chargemaster,Patella Triathlon SymmetricX3,Outpatient,Outpatient Default Percent / Case Rate,278," $1,575.00 ", $866.25 ," $1,260.00 ", See APC Packaged Rates ," $1,102.50 ", $614.25 ," $1,519.72 "," $1,526.33 ", $811.16 , See APC Packaged Rates , See APC Packaged Rates , $524.48 , $524.48 , See APC Packaged Rates , See APC Packaged Rates ," $1,464.75 "," $1,464.75 "," $1,464.75 "," $1,464.75 ", See APC Packaged Rates , $551.25 , $945.00 , $524.48 ," $1,526.33 "," $1,102.50 "
,61514667,Hospital Chargemaster,Fem Component Triathlon Ps Ce,Outpatient,Outpatient Default Percent / Case Rate,278," $4,488.75 "," $2,468.81 "," $3,591.00 ", See APC Packaged Rates ," $3,142.13 "," $1,750.61 "," $4,331.19 "," $4,350.05 "," $2,311.80 ", See APC Packaged Rates , See APC Packaged Rates ," $1,494.75 "," $1,494.75 ", See APC Packaged Rates , See APC Packaged Rates ," $4,174.54 "," $4,174.54 "," $4,174.54 "," $4,174.54 ", See APC Packaged Rates ," $1,571.06 "," $2,693.25 "," $1,494.75 "," $4,350.05 "," $3,142.13 "
C1781,61514671,Hospital Chargemaster,Mesh Phasix St 6 X 8,Outpatient,Outpatient Default Percent / Case Rate,278," $16,033.50 "," $8,818.43 "," $13,211.60 ", See APC Packaged Rates ," $11,223.45 "," $6,253.07 "," $15,470.72 "," $15,538.06 "," $8,257.57 ", See APC Packaged Rates , See APC Packaged Rates ," $5,339.16 "," $5,339.16 ", See APC Packaged Rates , See APC Packaged Rates ," $14,911.16 "," $14,911.16 "," $14,911.16 "," $14,911.16 ", See APC Packaged Rates ," $5,611.73 ", $- , $- ," $15,538.06 "," $11,223.45 "
,61514672,Hospital Chargemaster,Patella Metal Backed Tritaniu,Outpatient,Outpatient Default Percent / Case Rate,278," $2,205.00 "," $1,212.75 "," $1,764.00 ", See APC Packaged Rates ," $1,543.50 ", $859.95 ," $2,127.60 "," $2,136.87 "," $1,135.62 ", See APC Packaged Rates , See APC Packaged Rates , $734.27 , $734.27 , See APC Packaged Rates , See APC Packaged Rates ," $2,050.65 "," $2,050.65 "," $2,050.65 "," $2,050.65 ", See APC Packaged Rates , $771.75 ," $1,323.00 ", $734.27 ," $2,136.87 "," $1,543.50 "
,61514673,Hospital Chargemaster,Triathlon Cr Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,040.00 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 "," $3,780.00 "," $2,097.90 "," $6,105.33 "," $4,410.00 "
,61514677,Hospital Chargemaster,Head Cocr Lfit 40Mm/+4,Outpatient,Outpatient Default Percent / Case Rate,278," $2,835.00 "," $1,559.25 "," $2,268.00 ", See APC Packaged Rates ," $1,984.50 "," $1,105.65 "," $2,735.49 "," $2,747.40 "," $1,460.08 ", See APC Packaged Rates , See APC Packaged Rates , $944.06 , $944.06 , See APC Packaged Rates , See APC Packaged Rates ," $2,636.55 "," $2,636.55 "," $2,636.55 "," $2,636.55 ", See APC Packaged Rates , $992.25 ," $1,701.00 ", $944.06 ," $2,747.40 "," $1,984.50 "
,61514678,Hospital Chargemaster,Triathlon Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $4,488.75 "," $2,468.81 "," $3,591.00 ", See APC Packaged Rates ," $3,142.13 "," $1,750.61 "," $4,331.19 "," $4,350.05 "," $2,311.80 ", See APC Packaged Rates , See APC Packaged Rates ," $1,494.75 "," $1,494.75 ", See APC Packaged Rates , See APC Packaged Rates ," $4,174.54 "," $4,174.54 "," $4,174.54 "," $4,174.54 ", See APC Packaged Rates ," $1,571.06 "," $2,693.25 "," $1,494.75 "," $4,350.05 "," $3,142.13 "
,61514680,Hospital Chargemaster,Triathlon Cr Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,591.38 "," $3,625.26 "," $5,273.10 ", See APC Packaged Rates ," $4,613.97 "," $2,570.64 "," $6,360.02 "," $6,387.71 "," $3,394.69 ", See APC Packaged Rates , See APC Packaged Rates ," $2,194.93 "," $2,194.93 ", See APC Packaged Rates , See APC Packaged Rates ," $6,129.98 "," $6,129.98 "," $6,129.98 "," $6,129.98 ", See APC Packaged Rates ," $2,306.98 "," $3,954.83 "," $2,194.93 "," $6,387.71 "," $4,613.97 "
C1713,61514681,Hospital Chargemaster,Triathlon Tritanium Baseplate,Outpatient,Outpatient Default Percent / Case Rate,278," $4,646.25 "," $2,555.44 "," $3,828.51 ", See APC Packaged Rates ," $3,252.38 "," $1,812.04 "," $4,483.17 "," $4,502.68 "," $2,392.91 ", See APC Packaged Rates , See APC Packaged Rates ," $1,547.20 "," $1,547.20 ", See APC Packaged Rates , See APC Packaged Rates ," $4,321.01 "," $4,321.01 "," $4,321.01 "," $4,321.01 ", See APC Packaged Rates ," $1,626.19 ", $- , $- ," $4,502.68 "," $3,252.38 "
,61514682,Hospital Chargemaster,Trident 0 Deg Insert 40Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
,61514691,Hospital Chargemaster,Triathlon Ps Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,040.00 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 "," $3,780.00 "," $2,097.90 "," $6,105.33 "," $4,410.00 "
,61514698,Hospital Chargemaster,Triathlon Ps Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,040.00 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 "," $3,780.00 "," $2,097.90 "," $6,105.33 "," $4,410.00 "
C1713,61514699,Hospital Chargemaster,Triathlon Ps X3 Tibial Insert,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,984.94 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 ", $- , $- ," $3,510.56 "," $2,535.75 "
C1713,61514700,Hospital Chargemaster,Triathlon Tritanium Baseplate,Outpatient,Outpatient Default Percent / Case Rate,278," $4,646.25 "," $2,555.44 "," $3,828.51 ", See APC Packaged Rates ," $3,252.38 "," $1,812.04 "," $4,483.17 "," $4,502.68 "," $2,392.91 ", See APC Packaged Rates , See APC Packaged Rates ," $1,547.20 "," $1,547.20 ", See APC Packaged Rates , See APC Packaged Rates ," $4,321.01 "," $4,321.01 "," $4,321.01 "," $4,321.01 ", See APC Packaged Rates ," $1,626.19 ", $- , $- ," $4,502.68 "," $3,252.38 "
C1713,61514701,Hospital Chargemaster,Screw 35M Atz 5-5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514703,Hospital Chargemaster,Triathlon Cr Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,040.00 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 "," $3,780.00 "," $2,097.90 "," $6,105.33 "," $4,410.00 "
C1713,61514704,Hospital Chargemaster,Triathlon Tritanium Baseplate,Outpatient,Outpatient Default Percent / Case Rate,278," $4,646.25 "," $2,555.44 "," $3,828.51 ", See APC Packaged Rates ," $3,252.38 "," $1,812.04 "," $4,483.17 "," $4,502.68 "," $2,392.91 ", See APC Packaged Rates , See APC Packaged Rates ," $1,547.20 "," $1,547.20 ", See APC Packaged Rates , See APC Packaged Rates ," $4,321.01 "," $4,321.01 "," $4,321.01 "," $4,321.01 ", See APC Packaged Rates ," $1,626.19 ", $- , $- ," $4,502.68 "," $3,252.38 "
,61514705,Hospital Chargemaster,Unitrax V40 Taper Sleeve -4Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $559.44 , $307.69 , $447.55 , See APC Packaged Rates , $391.61 , $218.18 , $539.80 , $542.15 , $288.12 , See APC Packaged Rates , See APC Packaged Rates , $186.29 , $186.29 , See APC Packaged Rates , See APC Packaged Rates , $520.28 , $520.28 , $520.28 , $520.28 , See APC Packaged Rates , $195.80 , $335.66 , $186.29 , $542.15 , $391.61
,61514720,Hospital Chargemaster,Triathlon Ps Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,040.00 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 "," $3,780.00 "," $2,097.90 "," $6,105.33 "," $4,410.00 "
C1713,61514724,Hospital Chargemaster,Screw Peripheral 4.5M 32M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514726,Hospital Chargemaster,Baseplate Centering Guide Rgt,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514728,Hospital Chargemaster,Triathlon Cr Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,040.00 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 "," $3,780.00 "," $2,097.90 "," $6,105.33 "," $4,410.00 "
,61514729,Hospital Chargemaster,Patella Tritanium Asymmetric,Outpatient,Outpatient Default Percent / Case Rate,278," $2,205.00 "," $1,212.75 "," $1,764.00 ", See APC Packaged Rates ," $1,543.50 ", $859.95 ," $2,127.60 "," $2,136.87 "," $1,135.62 ", See APC Packaged Rates , See APC Packaged Rates , $734.27 , $734.27 , See APC Packaged Rates , See APC Packaged Rates ," $2,050.65 "," $2,050.65 "," $2,050.65 "," $2,050.65 ", See APC Packaged Rates , $771.75 ," $1,323.00 ", $734.27 ," $2,136.87 "," $1,543.50 "
C1713,61514731,Hospital Chargemaster,Triathlon Ps Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $4,488.75 "," $2,468.81 "," $3,698.73 ", See APC Packaged Rates ," $3,142.13 "," $1,750.61 "," $4,331.19 "," $4,350.05 "," $2,311.80 ", See APC Packaged Rates , See APC Packaged Rates ," $1,494.75 "," $1,494.75 ", See APC Packaged Rates , See APC Packaged Rates ," $4,174.54 "," $4,174.54 "," $4,174.54 "," $4,174.54 ", See APC Packaged Rates ," $1,571.06 ", $- , $- ," $4,350.05 "," $3,142.13 "
,61514739,Hospital Chargemaster,Triathlon Tibial Ps X3 Insert,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
C1713,61514744,Hospital Chargemaster,Triathlon Ps Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,191.20 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 ", $- , $- ," $6,105.33 "," $4,410.00 "
C1713,61514759,Hospital Chargemaster,Screw 4.7 Acutrak 2 28.0M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514762,Hospital Chargemaster,Triathlon Ps Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,040.00 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 "," $3,780.00 "," $2,097.90 "," $6,105.33 "," $4,410.00 "
C1713,61514763,Hospital Chargemaster,Pin Absorbable Trim It 1.5M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,102.50 ", $606.38 , $908.46 , See APC Packaged Rates , $771.75 , $429.98 ," $1,063.80 "," $1,068.43 ", $567.81 , See APC Packaged Rates , See APC Packaged Rates , $367.13 , $367.13 , See APC Packaged Rates , See APC Packaged Rates ," $1,025.33 "," $1,025.33 "," $1,025.33 "," $1,025.33 ", See APC Packaged Rates , $385.88 , $- , $- ," $1,068.43 ", $771.75
C1713,61514764,Hospital Chargemaster,Pin Absorbable Trim It 2.0M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,102.50 ", $606.38 , $908.46 , See APC Packaged Rates , $771.75 , $429.98 ," $1,063.80 "," $1,068.43 ", $567.81 , See APC Packaged Rates , See APC Packaged Rates , $367.13 , $367.13 , See APC Packaged Rates , See APC Packaged Rates ," $1,025.33 "," $1,025.33 "," $1,025.33 "," $1,025.33 ", See APC Packaged Rates , $385.88 , $- , $- ," $1,068.43 ", $771.75
C1713,61514777,Hospital Chargemaster,Rigidloop Cortical Fixation,Outpatient,Outpatient Default Percent / Case Rate,278, $945.00 , $519.75 , $778.68 , See APC Packaged Rates , $661.50 , $368.55 , $911.83 , $915.80 , $486.69 , See APC Packaged Rates , See APC Packaged Rates , $314.69 , $314.69 , See APC Packaged Rates , See APC Packaged Rates , $878.85 , $878.85 , $878.85 , $878.85 , See APC Packaged Rates , $330.75 , $- , $- , $915.80 , $661.50
C1713,61514799,Hospital Chargemaster,Triathlon Tritanium Baseplate,Outpatient,Outpatient Default Percent / Case Rate,278," $4,646.25 "," $2,555.44 "," $3,828.51 ", See APC Packaged Rates ," $3,252.38 "," $1,812.04 "," $4,483.17 "," $4,502.68 "," $2,392.91 ", See APC Packaged Rates , See APC Packaged Rates ," $1,547.20 "," $1,547.20 ", See APC Packaged Rates , See APC Packaged Rates ," $4,321.01 "," $4,321.01 "," $4,321.01 "," $4,321.01 ", See APC Packaged Rates ," $1,626.19 ", $- , $- ," $4,502.68 "," $3,252.38 "
C1713,61514810,Hospital Chargemaster,Screw Cortical 2.3M X 22M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514811,Hospital Chargemaster,Screw Hexalobe 3.5M X 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514813,Hospital Chargemaster,Peg Cortical 2.3M X 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $365.40 , $200.97 , $301.09 , See APC Packaged Rates , $255.78 , $142.51 , $352.57 , $354.11 , $188.19 , See APC Packaged Rates , See APC Packaged Rates , $121.68 , $121.68 , See APC Packaged Rates , See APC Packaged Rates , $339.82 , $339.82 , $339.82 , $339.82 , See APC Packaged Rates , $127.89 , $- , $- , $354.11 , $255.78
C1713,61514814,Hospital Chargemaster,Screw Hexalobe 3.5M X 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514815,Hospital Chargemaster,Screw Hexalobe 3.5M X 14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514827,Hospital Chargemaster,Triathlon Ps X3 Tibial Insert,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
C1713,61514832,Hospital Chargemaster,Bone Screw 34.0 Std Acutrak 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514844,Hospital Chargemaster,Screw Locking Bone Glenoid,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514851,Hospital Chargemaster,Graft Posterior Tibialis 9-12,Outpatient,Outpatient Default Percent / Case Rate,278," $5,040.00 "," $2,772.00 "," $4,032.00 ", See APC Packaged Rates ," $3,528.00 "," $1,965.60 "," $4,863.10 "," $4,884.26 "," $2,595.70 ", See APC Packaged Rates , See APC Packaged Rates ," $1,678.32 "," $1,678.32 ", See APC Packaged Rates , See APC Packaged Rates ," $4,687.20 "," $4,687.20 "," $4,687.20 "," $4,687.20 ", See APC Packaged Rates ," $1,764.00 "," $3,024.00 "," $1,678.32 "," $4,884.26 "," $3,528.00 "
,61514855,Hospital Chargemaster,Tibial Insert X3 Triatholon T,Outpatient,Outpatient Default Percent / Case Rate,278," $7,800.00 "," $4,290.00 "," $6,240.00 ", See APC Packaged Rates ," $5,460.00 "," $3,042.00 "," $7,526.22 "," $7,558.98 "," $4,017.16 ", See APC Packaged Rates , See APC Packaged Rates ," $2,597.40 "," $2,597.40 ", See APC Packaged Rates , See APC Packaged Rates ," $7,254.00 "," $7,254.00 "," $7,254.00 "," $7,254.00 ", See APC Packaged Rates ," $2,730.00 "," $4,680.00 "," $2,597.40 "," $7,558.98 "," $5,460.00 "
L8699,61514856,Hospital Chargemaster,Tube Paparella Type II,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514861,Hospital Chargemaster,Screw Acutrak 2 - 4.7 40.0M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514864,Hospital Chargemaster,Screw Intrafix 8-10,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514869,Hospital Chargemaster,Graft Posterior Tibialis,Outpatient,Outpatient Default Percent / Case Rate,278," $4,095.00 "," $2,252.25 "," $3,374.28 ", See APC Packaged Rates ," $2,866.50 "," $1,597.05 "," $3,951.27 "," $3,968.46 "," $2,109.01 ", See APC Packaged Rates , See APC Packaged Rates ," $1,363.64 "," $1,363.64 ", See APC Packaged Rates , See APC Packaged Rates ," $3,808.35 "," $3,808.35 "," $3,808.35 "," $3,808.35 ", See APC Packaged Rates ," $1,433.25 ", $- , $- ," $3,968.46 "," $2,866.50 "
C1713,61514921,Hospital Chargemaster,Osteolock Bone Screw 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514922,Hospital Chargemaster,Osteolock Bone Screw 14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514923,Hospital Chargemaster,Osteolock Bone Screw 12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514927,Hospital Chargemaster,Triathlon Cr Fem Comp Beaded,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,191.20 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 ", $- , $- ," $6,105.33 "," $4,410.00 "
C1778,61514929,Hospital Chargemaster,Freedom 8-A Trial Lead Kit,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514935,Hospital Chargemaster,Accolade C Cs 127 Nk,Outpatient,Outpatient Default Percent / Case Rate,278," $5,197.50 "," $2,858.63 "," $4,158.00 ", See APC Packaged Rates ," $3,638.25 "," $2,027.03 "," $5,015.07 "," $5,036.90 "," $2,676.82 ", See APC Packaged Rates , See APC Packaged Rates ," $1,730.77 "," $1,730.77 ", See APC Packaged Rates , See APC Packaged Rates ," $4,833.68 "," $4,833.68 "," $4,833.68 "," $4,833.68 ", See APC Packaged Rates ," $1,819.13 "," $3,118.50 "," $1,730.77 "," $5,036.90 "," $3,638.25 "
,61514944,Hospital Chargemaster,Trident Ii Tritanium Cluster,Outpatient,Outpatient Default Percent / Case Rate,278," $4,095.00 "," $2,252.25 "," $3,276.00 ", See APC Packaged Rates ," $2,866.50 "," $1,597.05 "," $3,951.27 "," $3,968.46 "," $2,109.01 ", See APC Packaged Rates , See APC Packaged Rates ," $1,363.64 "," $1,363.64 ", See APC Packaged Rates , See APC Packaged Rates ," $3,808.35 "," $3,808.35 "," $3,808.35 "," $3,808.35 ", See APC Packaged Rates ," $1,433.25 "," $2,457.00 "," $1,363.64 "," $3,968.46 "," $2,866.50 "
C1713,61514945,Hospital Chargemaster,Low Profile Hex Screw 6.5M,Outpatient,Outpatient Default Percent / Case Rate,278, $388.98 , $213.94 , $320.52 , See APC Packaged Rates , $272.29 , $151.70 , $375.33 , $376.96 , $200.33 , See APC Packaged Rates , See APC Packaged Rates , $129.53 , $129.53 , See APC Packaged Rates , See APC Packaged Rates , $361.75 , $361.75 , $361.75 , $361.75 , See APC Packaged Rates , $136.14 , $- , $- , $376.96 , $272.29
,61514947,Hospital Chargemaster,Tritanium 11 Clusterhole 54E,Outpatient,Outpatient Default Percent / Case Rate,278," $4,095.00 "," $2,252.25 "," $3,276.00 ", See APC Packaged Rates ," $2,866.50 "," $1,597.05 "," $3,951.27 "," $3,968.46 "," $2,109.01 ", See APC Packaged Rates , See APC Packaged Rates ," $1,363.64 "," $1,363.64 ", See APC Packaged Rates , See APC Packaged Rates ," $3,808.35 "," $3,808.35 "," $3,808.35 "," $3,808.35 ", See APC Packaged Rates ," $1,433.25 "," $2,457.00 "," $1,363.64 "," $3,968.46 "," $2,866.50 "
C1713,61514948,Hospital Chargemaster,Hex Screw 6.5M/20M Low,Outpatient,Outpatient Default Percent / Case Rate,278, $389.55 , $214.25 , $320.99 , See APC Packaged Rates , $272.69 , $151.92 , $375.88 , $377.51 , $200.63 , See APC Packaged Rates , See APC Packaged Rates , $129.72 , $129.72 , See APC Packaged Rates , See APC Packaged Rates , $362.28 , $362.28 , $362.28 , $362.28 , See APC Packaged Rates , $136.34 , $- , $- , $377.51 , $272.69
L8682,61514949,Hospital Chargemaster,Stimq-4A Pns System,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514952,Hospital Chargemaster,Triathlon Ps X3 Tibial Insert,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,984.94 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 ", $- , $- ," $3,510.56 "," $2,535.75 "
,61514953,Hospital Chargemaster,Trident Ii Tritanium Cluster,Outpatient,Outpatient Default Percent / Case Rate,278," $4,095.00 "," $2,252.25 "," $3,276.00 ", See APC Packaged Rates ," $2,866.50 "," $1,597.05 "," $3,951.27 "," $3,968.46 "," $2,109.01 ", See APC Packaged Rates , See APC Packaged Rates ," $1,363.64 "," $1,363.64 ", See APC Packaged Rates , See APC Packaged Rates ," $3,808.35 "," $3,808.35 "," $3,808.35 "," $3,808.35 ", See APC Packaged Rates ," $1,433.25 "," $2,457.00 "," $1,363.64 "," $3,968.46 "," $2,866.50 "
C1785,61514954,Hospital Chargemaster,Azure Dr Mri Sure Scan,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514965,Hospital Chargemaster,Acutrak 2 45.0M 5.5 Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514966,Hospital Chargemaster,Trident 11 TritClusterhole 58,Outpatient,Outpatient Default Percent / Case Rate,278," $4,095.00 "," $2,252.25 "," $3,276.00 ", See APC Packaged Rates ," $2,866.50 "," $1,597.05 "," $3,951.27 "," $3,968.46 "," $2,109.01 ", See APC Packaged Rates , See APC Packaged Rates ," $1,363.64 "," $1,363.64 ", See APC Packaged Rates , See APC Packaged Rates ," $3,808.35 "," $3,808.35 "," $3,808.35 "," $3,808.35 ", See APC Packaged Rates ," $1,433.25 "," $2,457.00 "," $1,363.64 "," $3,968.46 "," $2,866.50 "
C1713,61514972,Hospital Chargemaster,45.0 M Acutrak 2 4.7 Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1767,61514980,Hospital Chargemaster,Stimw-4A Pms System,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61514984,Hospital Chargemaster,Triathlon Ps X3 Tibial Insert,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
C1713,61514987,Hospital Chargemaster,Triathlon Ps Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,191.20 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 ", $- , $- ," $6,105.33 "," $4,410.00 "
,61514988,Hospital Chargemaster,Trident Ii Tritanium Cluster,Outpatient,Outpatient Default Percent / Case Rate,278," $4,095.00 "," $2,252.25 "," $3,276.00 ", See APC Packaged Rates ," $2,866.50 "," $1,597.05 "," $3,951.27 "," $3,968.46 "," $2,109.01 ", See APC Packaged Rates , See APC Packaged Rates ," $1,363.64 "," $1,363.64 ", See APC Packaged Rates , See APC Packaged Rates ," $3,808.35 "," $3,808.35 "," $3,808.35 "," $3,808.35 ", See APC Packaged Rates ," $1,433.25 "," $2,457.00 "," $1,363.64 "," $3,968.46 "," $2,866.50 "
C1713,61514989,Hospital Chargemaster,Screw Ha3.5M Interfagmentary,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514990,Hospital Chargemaster,Screw 3.0M Bone/Thread N-Loc,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514991,Hospital Chargemaster,Screw 3.0M Bone/Thread N-Loc,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514992,Hospital Chargemaster,Screw 3.0M Bone Thread N-Loc,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514993,Hospital Chargemaster,Screw 4MX.5 Dbl Lead Loc 3.0,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514994,Hospital Chargemaster,Screw 4M X5 Dbl Lead Loc 3.0M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514995,Hospital Chargemaster,Screw 4MX5 Dbl Lead 3.0M Loc,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514996,Hospital Chargemaster,Screw 4M X5 Dbl Lead 3.0M Loc,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61514998,Hospital Chargemaster,Pin KT Metatarsophalangeal,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1897,61514999,Hospital Chargemaster,Trial Lead Kit,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515000,Hospital Chargemaster,Trident Ii Tritanium,Outpatient,Outpatient Default Percent / Case Rate,278," $4,095.00 "," $2,252.25 "," $3,374.28 ", See APC Packaged Rates ," $2,866.50 "," $1,597.05 "," $3,951.27 "," $3,968.46 "," $2,109.01 ", See APC Packaged Rates , See APC Packaged Rates ," $1,363.64 "," $1,363.64 ", See APC Packaged Rates , See APC Packaged Rates ," $3,808.35 "," $3,808.35 "," $3,808.35 "," $3,808.35 ", See APC Packaged Rates ," $1,433.25 ", $- , $- ," $3,968.46 "," $2,866.50 "
C1816,61515007,Hospital Chargemaster,Freedom 4 Neurostimulator,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515008,Hospital Chargemaster,Grip Plate Vitallium 150M Dal,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1767,61515011,Hospital Chargemaster,Stimq-4A Pns System,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61515020,Hospital Chargemaster,Triathlon Ps Fem Cem Componen,Outpatient,Outpatient Default Percent / Case Rate,278," $4,488.75 "," $2,468.81 "," $3,591.00 ", See APC Packaged Rates ," $3,142.13 "," $1,750.61 "," $4,331.19 "," $4,350.05 "," $2,311.80 ", See APC Packaged Rates , See APC Packaged Rates ," $1,494.75 "," $1,494.75 ", See APC Packaged Rates , See APC Packaged Rates ," $4,174.54 "," $4,174.54 "," $4,174.54 "," $4,174.54 ", See APC Packaged Rates ," $1,571.06 "," $2,693.25 "," $1,494.75 "," $4,350.05 "," $3,142.13 "
,61515022,Hospital Chargemaster,Reunion Rfx Humeral Fracture,Outpatient,Outpatient Default Percent / Case Rate,278," $11,970.00 "," $6,583.50 "," $9,576.00 ", See APC Packaged Rates ," $8,379.00 "," $4,668.30 "," $11,549.85 "," $11,600.13 "," $6,164.79 ", See APC Packaged Rates , See APC Packaged Rates ," $3,986.01 "," $3,986.01 ", See APC Packaged Rates , See APC Packaged Rates ," $11,132.10 "," $11,132.10 "," $11,132.10 "," $11,132.10 ", See APC Packaged Rates ," $4,189.50 "," $7,182.00 "," $3,986.01 "," $11,600.13 "," $8,379.00 "
C1713,61515023,Hospital Chargemaster,Screw 30.0M Acutrack 2 4.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515024,Hospital Chargemaster,Screw 35.0M Acutrack 2 4.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515036,Hospital Chargemaster,Triathlon Cr Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,191.20 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 ", $- , $- ," $6,105.33 "," $4,410.00 "
,61515042,Hospital Chargemaster,Triathlon Ps X3 Tibial Insert,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,898.00 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 "," $2,173.50 "," $1,206.29 "," $3,510.56 "," $2,535.75 "
C1713,61515046,Hospital Chargemaster,Screw Bone 22.0M Mini Acut 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515047,Hospital Chargemaster,Screw Bone 24.0M Acutrak Stan,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515048,Hospital Chargemaster,Screw Bone 28.0M Stand Acutr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61515054,Hospital Chargemaster,Accolade C Cs 127 Nk,Outpatient,Outpatient Default Percent / Case Rate,278," $5,197.50 "," $2,858.63 "," $4,158.00 ", See APC Packaged Rates ," $3,638.25 "," $2,027.03 "," $5,015.07 "," $5,036.90 "," $2,676.82 ", See APC Packaged Rates , See APC Packaged Rates ," $1,730.77 "," $1,730.77 ", See APC Packaged Rates , See APC Packaged Rates ," $4,833.68 "," $4,833.68 "," $4,833.68 "," $4,833.68 ", See APC Packaged Rates ," $1,819.13 "," $3,118.50 "," $1,730.77 "," $5,036.90 "," $3,638.25 "
C1713,61515055,Hospital Chargemaster,Screw Acutrak 2 50.0M 4.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515084,Hospital Chargemaster,Screw 7.3 Cannulated/Lock 50M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515110,Hospital Chargemaster,Triathlon Ps X3 Tibial Insert,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515116,Hospital Chargemaster,6.5M Center Screw 24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515121,Hospital Chargemaster,Grip Plate Vitallium 100M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515123,Hospital Chargemaster,GaMa 3S Nail/Lt 10X380Mx125,Outpatient,Outpatient Default Percent / Case Rate,278," $4,282.74 "," $2,355.51 "," $3,528.98 ", See APC Packaged Rates ," $2,997.92 "," $1,670.27 "," $4,132.42 "," $4,150.40 "," $2,205.70 ", See APC Packaged Rates , See APC Packaged Rates ," $1,426.15 "," $1,426.15 ", See APC Packaged Rates , See APC Packaged Rates ," $3,982.95 "," $3,982.95 "," $3,982.95 "," $3,982.95 ", See APC Packaged Rates ," $1,498.96 ", $- , $- ," $4,150.40 "," $2,997.92 "
C1776,61515134,Hospital Chargemaster,Itotal Cr-Ipoly-Implant Kit,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515135,Hospital Chargemaster,Lateral Plate Superior 4Hl/Rt,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515136,Hospital Chargemaster,Lock Screw 10 FlTrd 2.7ML12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515137,Hospital Chargemaster,Lock Screw 10 FlTrd 2.7M L14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515138,Hospital Chargemaster,Lock Screw 10 Fl/Trd 2.7M/16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515139,Hospital Chargemaster,Lock Screw 10 FlTrd 2.7ML18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515140,Hospital Chargemaster,Lock Screw 10 FlTrd 3.5ML12M,Outpatient,Outpatient Default Percent / Case Rate,278, $369.50 , $203.23 , $304.47 , See APC Packaged Rates , $258.65 , $144.11 , $356.53 , $358.08 , $190.30 , See APC Packaged Rates , See APC Packaged Rates , $123.04 , $123.04 , See APC Packaged Rates , See APC Packaged Rates , $343.64 , $343.64 , $343.64 , $343.64 , See APC Packaged Rates , $129.33 , $- , $- , $358.08 , $258.65
C1713,61515141,Hospital Chargemaster,Lock Screw 10 FlTrd 3.5ML16M,Outpatient,Outpatient Default Percent / Case Rate,278, $369.50 , $203.23 , $304.47 , See APC Packaged Rates , $258.65 , $144.11 , $356.53 , $358.08 , $190.30 , See APC Packaged Rates , See APC Packaged Rates , $123.04 , $123.04 , See APC Packaged Rates , See APC Packaged Rates , $343.64 , $343.64 , $343.64 , $343.64 , See APC Packaged Rates , $129.33 , $- , $- , $358.08 , $258.65
C1713,61515142,Hospital Chargemaster,Lock Screw 10 FlTrd 3.5ML18M,Outpatient,Outpatient Default Percent / Case Rate,278, $372.15 , $204.68 , $306.65 , See APC Packaged Rates , $260.51 , $145.14 , $359.09 , $360.65 , $191.66 , See APC Packaged Rates , See APC Packaged Rates , $123.93 , $123.93 , See APC Packaged Rates , See APC Packaged Rates , $346.10 , $346.10 , $346.10 , $346.10 , See APC Packaged Rates , $130.25 , $- , $- , $360.65 , $260.51
C1713,61515143,Hospital Chargemaster,Bone Screw 10 FlTrd 3.5ML16M,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515144,Hospital Chargemaster,Bobe Screw 10 FlTrd 3.5ML18M,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515151,Hospital Chargemaster,Flexible Nail PreCurved 2.5 X,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515152,Hospital Chargemaster,Flexible Nail Pre-Curved 3.0,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515155,Hospital Chargemaster,Triathlon Cr Fen Component,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515156,Hospital Chargemaster,GaMa 3 S Nail Right,Outpatient,Outpatient Default Percent / Case Rate,278," $4,367.67 "," $2,402.22 "," $3,598.96 ", See APC Packaged Rates ," $3,057.37 "," $1,703.39 "," $4,214.36 "," $4,232.71 "," $2,249.44 ", See APC Packaged Rates , See APC Packaged Rates ," $1,454.43 "," $1,454.43 ", See APC Packaged Rates , See APC Packaged Rates ," $4,061.93 "," $4,061.93 "," $4,061.93 "," $4,061.93 ", See APC Packaged Rates ," $1,528.68 ", $- , $- ," $4,232.71 "," $3,057.37 "
C1713,61515158,Hospital Chargemaster,Lecranon Plate/Lt/Ulna/3/65M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515159,Hospital Chargemaster,Distal Medial Humer Plate/4Hl,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515160,Hospital Chargemaster,Screw BoneT10 FlTrd 2.7 L50M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515161,Hospital Chargemaster,LocScrewT10 FulTrd 3.5M L10,Outpatient,Outpatient Default Percent / Case Rate,278, $369.50 , $203.23 , $304.47 , See APC Packaged Rates , $258.65 , $144.11 , $356.53 , $358.08 , $190.30 , See APC Packaged Rates , See APC Packaged Rates , $123.04 , $123.04 , See APC Packaged Rates , See APC Packaged Rates , $343.64 , $343.64 , $343.64 , $343.64 , See APC Packaged Rates , $129.33 , $- , $- , $358.08 , $258.65
C1713,61515162,Hospital Chargemaster,Lkg Screw T10 F/T 3.5M L14M,Outpatient,Outpatient Default Percent / Case Rate,278, $369.50 , $203.23 , $304.47 , See APC Packaged Rates , $258.65 , $144.11 , $356.53 , $358.08 , $190.30 , See APC Packaged Rates , See APC Packaged Rates , $123.04 , $123.04 , See APC Packaged Rates , See APC Packaged Rates , $343.64 , $343.64 , $343.64 , $343.64 , See APC Packaged Rates , $129.33 , $- , $- , $358.08 , $258.65
C1713,61515163,Hospital Chargemaster,LckScrew T10 FlTrd3.5M L20M,Outpatient,Outpatient Default Percent / Case Rate,278, $369.50 , $203.23 , $304.47 , See APC Packaged Rates , $258.65 , $144.11 , $356.53 , $358.08 , $190.30 , See APC Packaged Rates , See APC Packaged Rates , $123.04 , $123.04 , See APC Packaged Rates , See APC Packaged Rates , $343.64 , $343.64 , $343.64 , $343.64 , See APC Packaged Rates , $129.33 , $- , $- , $358.08 , $258.65
C1713,61515164,Hospital Chargemaster,Lck/Screw T10 Fl/Trd/3.5M/L46,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515165,Hospital Chargemaster,Bone Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515166,Hospital Chargemaster,Bone Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515167,Hospital Chargemaster,Bone Screw T10Fl/Trd/3.5/L22,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515168,Hospital Chargemaster,Bone Screw T10FlTrd 3.5ML40M,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515170,Hospital Chargemaster,GaMa 3S Nail Rt 10X340M X125,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515173,Hospital Chargemaster,6.5 M Center Screw - 36M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515174,Hospital Chargemaster,Screw Cannulated Ti 4.0 X 46M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515175,Hospital Chargemaster,Screw Cannulated Ti 4.0 X 55M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515176,Hospital Chargemaster,Screw Cannulated Ti 4.0 X 60M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515177,Hospital Chargemaster,Washer Ti Asnis Lll 4.0Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $42.75 , $23.51 , $35.23 , See APC Packaged Rates , $29.93 , $16.67 , $41.25 , $41.43 , $22.02 , See APC Packaged Rates , See APC Packaged Rates , $14.24 , $14.24 , See APC Packaged Rates , See APC Packaged Rates , $39.76 , $39.76 , $39.76 , $39.76 , See APC Packaged Rates , $14.96 , $- , $- , $41.43 , $29.93
C1713,61515180,Hospital Chargemaster,One Third Tubular Plate 5 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $624.39 , $343.41 , $514.50 , See APC Packaged Rates , $437.07 , $243.51 , $602.47 , $605.10 , $321.57 , See APC Packaged Rates , See APC Packaged Rates , $207.92 , $207.92 , See APC Packaged Rates , See APC Packaged Rates , $580.68 , $580.68 , $580.68 , $580.68 , See APC Packaged Rates , $218.54 , $- , $- , $605.10 , $437.07
C1713,61515181,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515182,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515183,Hospital Chargemaster,Plate Superior Decr 7 H/Left,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515184,Hospital Chargemaster,Srew Bone T10 FTred2.7M L16M,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515185,Hospital Chargemaster,Screw Bone Fl/Thred 2.7M/L18M,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515186,Hospital Chargemaster,Screw Bone F/Thred 3.5M/L12M,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515187,Hospital Chargemaster,Screw Bone F/Thred 3.5M/L12M,Outpatient,Outpatient Default Percent / Case Rate,278, $624.39 , $343.41 , $514.50 , See APC Packaged Rates , $437.07 , $243.51 , $602.47 , $605.10 , $321.57 , See APC Packaged Rates , See APC Packaged Rates , $207.92 , $207.92 , See APC Packaged Rates , See APC Packaged Rates , $580.68 , $580.68 , $580.68 , $580.68 , See APC Packaged Rates , $218.54 , $- , $- , $605.10 , $437.07
C1713,61515188,Hospital Chargemaster,Screw Bone 10 FThrd 2.7M L20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515189,Hospital Chargemaster,Screw Bone 10 FTred 2.7M L24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515190,Hospital Chargemaster,Screw Bone 10 FThrd 2.7M L28M,Outpatient,Outpatient Default Percent / Case Rate,278, $225.54 , $124.05 , $185.84 , See APC Packaged Rates , $157.88 , $87.96 , $217.62 , $218.57 , $116.16 , See APC Packaged Rates , See APC Packaged Rates , $75.10 , $75.10 , See APC Packaged Rates , See APC Packaged Rates , $209.75 , $209.75 , $209.75 , $209.75 , See APC Packaged Rates , $78.94 , $- , $- , $218.57 , $157.88
C1713,61515191,Hospital Chargemaster,Screw Bone 10 FThrd 2.7M L32M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515192,Hospital Chargemaster,Screw Bone 10 FThed 3.5M L42M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515193,Hospital Chargemaster,Blade Screwdriver10AoSelf R,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515194,Hospital Chargemaster,Plate Lat/Hum/Prox Lt 3H L86M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515195,Hospital Chargemaster,Screw Locking 4M 4.0M/L28M,Outpatient,Outpatient Default Percent / Case Rate,278, $371.31 , $204.22 , $305.96 , See APC Packaged Rates , $259.92 , $144.81 , $358.28 , $359.84 , $191.23 , See APC Packaged Rates , See APC Packaged Rates , $123.65 , $123.65 , See APC Packaged Rates , See APC Packaged Rates , $345.32 , $345.32 , $345.32 , $345.32 , See APC Packaged Rates , $129.96 , $- , $- , $359.84 , $259.92
C1713,61515196,Hospital Chargemaster,Screw Locking 4M 4.0M/L34M,Outpatient,Outpatient Default Percent / Case Rate,278, $362.69 , $199.48 , $298.86 , See APC Packaged Rates , $253.88 , $141.45 , $349.96 , $351.48 , $186.79 , See APC Packaged Rates , See APC Packaged Rates , $120.78 , $120.78 , See APC Packaged Rates , See APC Packaged Rates , $337.30 , $337.30 , $337.30 , $337.30 , See APC Packaged Rates , $126.94 , $- , $- , $351.48 , $253.88
C1713,61515197,Hospital Chargemaster,Screw Locking 4M 4.0M/L38M,Outpatient,Outpatient Default Percent / Case Rate,278, $362.69 , $199.48 , $298.86 , See APC Packaged Rates , $253.88 , $141.45 , $349.96 , $351.48 , $186.79 , See APC Packaged Rates , See APC Packaged Rates , $120.78 , $120.78 , See APC Packaged Rates , See APC Packaged Rates , $337.30 , $337.30 , $337.30 , $337.30 , See APC Packaged Rates , $126.94 , $- , $- , $351.48 , $253.88
C1713,61515198,Hospital Chargemaster,Screw Locking 4M 4.0M/L42M,Outpatient,Outpatient Default Percent / Case Rate,278, $414.41 , $227.93 , $341.47 , See APC Packaged Rates , $290.09 , $161.62 , $399.86 , $401.60 , $213.43 , See APC Packaged Rates , See APC Packaged Rates , $138.00 , $138.00 , See APC Packaged Rates , See APC Packaged Rates , $385.40 , $385.40 , $385.40 , $385.40 , See APC Packaged Rates , $145.04 , $- , $- , $401.60 , $290.09
C1713,61515200,Hospital Chargemaster,Screw Cortex Ti A 3.5Mm/L24Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515201,Hospital Chargemaster,Screw Cortex Ti A 3.5mm L26mm,Outpatient,Outpatient Default Percent / Case Rate,278, $30.18 , $16.60 , $24.87 , See APC Packaged Rates , $21.13 , $11.77 , $29.12 , $29.25 , $15.54 , See APC Packaged Rates , See APC Packaged Rates , $10.05 , $10.05 , See APC Packaged Rates , See APC Packaged Rates , $28.07 , $28.07 , $28.07 , $28.07 , See APC Packaged Rates , $10.56 , $- , $- , $29.25 , $21.13
C1713,61515202,Hospital Chargemaster,Screw Cortex Ti A 3.5mm/L28mm,Outpatient,Outpatient Default Percent / Case Rate,278, $43.10 , $23.71 , $35.51 , See APC Packaged Rates , $30.17 , $16.81 , $41.59 , $41.77 , $22.20 , See APC Packaged Rates , See APC Packaged Rates , $14.35 , $14.35 , See APC Packaged Rates , See APC Packaged Rates , $40.08 , $40.08 , $40.08 , $40.08 , See APC Packaged Rates , $15.09 , $- , $- , $41.77 , $30.17
C1713,61515203,Hospital Chargemaster,Screw Cortex Ti A 3.5mm/L32mm,Outpatient,Outpatient Default Percent / Case Rate,278, $58.25 , $32.04 , $48.00 , See APC Packaged Rates , $40.78 , $22.72 , $56.21 , $56.45 , $30.00 , See APC Packaged Rates , See APC Packaged Rates , $19.40 , $19.40 , See APC Packaged Rates , See APC Packaged Rates , $54.17 , $54.17 , $54.17 , $54.17 , See APC Packaged Rates , $20.39 , $- , $- , $56.45 , $40.78
C1713,61515205,Hospital Chargemaster,Screw Cortex Ti A 3.5Mm/L44Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515207,Hospital Chargemaster,K-Wire 0.045 1.143mm w/len,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515208,Hospital Chargemaster,Plate Volaer Narrow Rt8H XSrt,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515209,Hospital Chargemaster,Screw Lock T8 Thr 2.7M/L20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515210,Hospital Chargemaster,Screw Lck T8 F/Thrd 2.7M/L26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515211,Hospital Chargemaster,Screw Bone T8 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515212,Hospital Chargemaster,Screw Bone T8 F/Trd 2.7M L20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515213,Hospital Chargemaster,Screw Bone T8 F/Trd 2.7M L26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515214,Hospital Chargemaster,Screw Bone T8 F/Trd 2.7M L30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515215,Hospital Chargemaster,Triathlon Ps X3 Tibial Insert,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515216,Hospital Chargemaster,Tibia Plate Distal Medial,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515217,Hospital Chargemaster,Locking Screw 4M 4.0M/L14M,Outpatient,Outpatient Default Percent / Case Rate,278, $362.69 , $199.48 , $298.86 , See APC Packaged Rates , $253.88 , $141.45 , $349.96 , $351.48 , $186.79 , See APC Packaged Rates , See APC Packaged Rates , $120.78 , $120.78 , See APC Packaged Rates , See APC Packaged Rates , $337.30 , $337.30 , $337.30 , $337.30 , See APC Packaged Rates , $126.94 , $- , $- , $351.48 , $253.88
C1713,61515218,Hospital Chargemaster,Locking Screw 4M 4.0M/L18M,Outpatient,Outpatient Default Percent / Case Rate,278, $414.41 , $227.93 , $341.47 , See APC Packaged Rates , $290.09 , $161.62 , $399.86 , $401.60 , $213.43 , See APC Packaged Rates , See APC Packaged Rates , $138.00 , $138.00 , See APC Packaged Rates , See APC Packaged Rates , $385.40 , $385.40 , $385.40 , $385.40 , See APC Packaged Rates , $145.04 , $- , $- , $401.60 , $290.09
C1713,61515219,Hospital Chargemaster,Cortex Ti Screw 3.5M A 3.5mm,Outpatient,Outpatient Default Percent / Case Rate,278, $49.68 , $27.32 , $40.94 , See APC Packaged Rates , $34.78 , $19.38 , $47.94 , $48.14 , $25.59 , See APC Packaged Rates , See APC Packaged Rates , $16.54 , $16.54 , See APC Packaged Rates , See APC Packaged Rates , $46.20 , $46.20 , $46.20 , $46.20 , See APC Packaged Rates , $17.39 , $- , $- , $48.14 , $34.78
C1713,61515220,Hospital Chargemaster,Cortex Screw Ti 3.5mm A 3.5mm,Outpatient,Outpatient Default Percent / Case Rate,278, $17.18 , $9.45 , $14.16 , See APC Packaged Rates , $12.03 , $6.70 , $16.58 , $16.65 , $8.85 , See APC Packaged Rates , See APC Packaged Rates , $5.72 , $5.72 , See APC Packaged Rates , See APC Packaged Rates , $15.98 , $15.98 , $15.98 , $15.98 , See APC Packaged Rates , $6.01 , $- , $- , $16.65 , $12.03
C1713,61515222,Hospital Chargemaster,Tibial Nail T2 Std,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515223,Hospital Chargemaster,Locking Screw T2 F/T 5Mx65M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515224,Hospital Chargemaster,One Third Tubular Plate 4 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $655.55 , $360.55 , $540.17 , See APC Packaged Rates , $458.89 , $255.66 , $632.54 , $635.29 , $337.62 , See APC Packaged Rates , See APC Packaged Rates , $218.30 , $218.30 , See APC Packaged Rates , See APC Packaged Rates , $609.66 , $609.66 , $609.66 , $609.66 , See APC Packaged Rates , $229.44 , $- , $- , $635.29 , $458.89
C1713,61515225,Hospital Chargemaster,Triathlon Cr Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515226,Hospital Chargemaster,OneThird Tubular Plate 7 Hole,Outpatient,Outpatient Default Percent / Case Rate,278, $624.39 , $343.41 , $514.50 , See APC Packaged Rates , $437.07 , $243.51 , $602.47 , $605.10 , $321.57 , See APC Packaged Rates , See APC Packaged Rates , $207.92 , $207.92 , See APC Packaged Rates , See APC Packaged Rates , $580.68 , $580.68 , $580.68 , $580.68 , See APC Packaged Rates , $218.54 , $- , $- , $605.10 , $437.07
C1713,61515227,Hospital Chargemaster,Bone Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515228,Hospital Chargemaster,Bone Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515229,Hospital Chargemaster,Bone Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515232,Hospital Chargemaster,Screw Headless Lgh 2.5M 18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515235,Hospital Chargemaster,Acu-Loc 2 Vdr Plt Std R,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515236,Hospital Chargemaster,Screw Cortical 2.3Mx22M NoTog,Outpatient,Outpatient Default Percent / Case Rate,278, $283.50 , $155.93 , $233.60 , See APC Packaged Rates , $198.45 , $110.57 , $273.55 , $274.74 , $146.01 , See APC Packaged Rates , See APC Packaged Rates , $94.41 , $94.41 , See APC Packaged Rates , See APC Packaged Rates , $263.66 , $263.66 , $263.66 , $263.66 , See APC Packaged Rates , $99.23 , $- , $- , $274.74 , $198.45
C1713,61515237,Hospital Chargemaster,Screw Lock T2 F/T 5Mx47.5M,Outpatient,Outpatient Default Percent / Case Rate,278, $353.18 , $194.25 , $291.02 , See APC Packaged Rates , $247.23 , $137.74 , $340.78 , $342.27 , $181.89 , See APC Packaged Rates , See APC Packaged Rates , $117.61 , $117.61 , See APC Packaged Rates , See APC Packaged Rates , $328.46 , $328.46 , $328.46 , $328.46 , See APC Packaged Rates , $123.61 , $- , $- , $342.27 , $247.23
,61515238,Hospital Chargemaster,Gamma Nail 3S Rt 10X400mmX125,Outpatient,Outpatient Default Percent / Case Rate,278," $4,282.74 "," $2,355.51 "," $3,426.19 ", See APC Packaged Rates ," $2,997.92 "," $1,670.27 "," $4,132.42 "," $4,150.40 "," $2,205.70 ", See APC Packaged Rates , See APC Packaged Rates ," $1,426.15 "," $1,426.15 ", See APC Packaged Rates , See APC Packaged Rates ," $3,982.95 "," $3,982.95 "," $3,982.95 "," $3,982.95 ", See APC Packaged Rates ," $1,498.96 "," $2,569.64 "," $1,426.15 "," $4,150.40 "," $2,997.92 "
C1713,61515239,Hospital Chargemaster,Asnis 111 Ss Cann Scr 6.5X80M,Outpatient,Outpatient Default Percent / Case Rate,278, $544.32 , $299.38 , $448.52 , See APC Packaged Rates , $381.02 , $212.28 , $525.21 , $527.50 , $280.34 , See APC Packaged Rates , See APC Packaged Rates , $181.26 , $181.26 , See APC Packaged Rates , See APC Packaged Rates , $506.22 , $506.22 , $506.22 , $506.22 , See APC Packaged Rates , $190.51 , $- , $- , $527.50 , $381.02
C1713,61515240,Hospital Chargemaster,Asniss 111 Ss Cannulated Scr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515246,Hospital Chargemaster,Locking Cortical Peg 2.3M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515247,Hospital Chargemaster,Cannulated Screw Ti 4.0X42M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515248,Hospital Chargemaster,Cannulated Screw Ti 4.0X50M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515249,Hospital Chargemaster,Bone Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515254,Hospital Chargemaster,6.5M Low Profi Hex Screw 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $393.12 , $216.22 , $323.93 , See APC Packaged Rates , $275.18 , $153.32 , $379.32 , $380.97 , $202.46 , See APC Packaged Rates , See APC Packaged Rates , $130.91 , $130.91 , See APC Packaged Rates , See APC Packaged Rates , $365.60 , $365.60 , $365.60 , $365.60 , See APC Packaged Rates , $137.59 , $- , $- , $380.97 , $275.18
C1713,61515256,Hospital Chargemaster,Bone Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515257,Hospital Chargemaster,Nail GaMa 3S Rt 10X36M X125,Outpatient,Outpatient Default Percent / Case Rate,278," $4,395.97 "," $2,417.78 "," $3,622.28 ", See APC Packaged Rates ," $3,077.18 "," $1,714.43 "," $4,241.67 "," $4,260.13 "," $2,264.01 ", See APC Packaged Rates , See APC Packaged Rates ," $1,463.86 "," $1,463.86 ", See APC Packaged Rates , See APC Packaged Rates ," $4,088.25 "," $4,088.25 "," $4,088.25 "," $4,088.25 ", See APC Packaged Rates ," $1,538.59 ", $- , $- ," $4,260.13 "," $3,077.18 "
C1713,61515258,Hospital Chargemaster,Tibia Component Sz 5 16M Poly,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515259,Hospital Chargemaster,Screw Cortical Self Tap,Outpatient,Outpatient Default Percent / Case Rate,278, $65.52 , $36.04 , $53.99 , See APC Packaged Rates , $45.86 , $25.55 , $63.22 , $63.50 , $33.74 , See APC Packaged Rates , See APC Packaged Rates , $21.82 , $21.82 , See APC Packaged Rates , See APC Packaged Rates , $60.93 , $60.93 , $60.93 , $60.93 , See APC Packaged Rates , $22.93 , $- , $- , $63.50 , $45.86
C1713,61515260,Hospital Chargemaster,Compression Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515261,Hospital Chargemaster,Hip Plate Srt Barr 130Deg 3 H,Outpatient,Outpatient Default Percent / Case Rate,278, $969.26 , $533.09 , $798.67 , See APC Packaged Rates , $678.48 , $378.01 , $935.24 , $939.31 , $499.19 , See APC Packaged Rates , See APC Packaged Rates , $322.76 , $322.76 , See APC Packaged Rates , See APC Packaged Rates , $901.41 , $901.41 , $901.41 , $901.41 , See APC Packaged Rates , $339.24 , $- , $- , $939.31 , $678.48
C1713,61515263,Hospital Chargemaster,Fibula Plate Dis/Lat 3 Hole,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515264,Hospital Chargemaster,Screw Bone T10 FlTh 6.5ML26M,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515265,Hospital Chargemaster,GaMa Nail 3S Lseft 10X360M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515266,Hospital Chargemaster,Screw Asnis Iii Ss Cannulated,Outpatient,Outpatient Default Percent / Case Rate,278, $544.32 , $299.38 , $448.52 , See APC Packaged Rates , $381.02 , $212.28 , $525.21 , $527.50 , $280.34 , See APC Packaged Rates , See APC Packaged Rates , $181.26 , $181.26 , See APC Packaged Rates , See APC Packaged Rates , $506.22 , $506.22 , $506.22 , $506.22 , See APC Packaged Rates , $190.51 , $- , $- , $527.50 , $381.02
C1713,61515267,Hospital Chargemaster,Screw Asnis Iii S Can 6.5X95M,Outpatient,Outpatient Default Percent / Case Rate,278, $544.32 , $299.38 , $448.52 , See APC Packaged Rates , $381.02 , $212.28 , $525.21 , $527.50 , $280.34 , See APC Packaged Rates , See APC Packaged Rates , $181.26 , $181.26 , See APC Packaged Rates , See APC Packaged Rates , $506.22 , $506.22 , $506.22 , $506.22 , See APC Packaged Rates , $190.51 , $- , $- , $527.50 , $381.02
C1713,61515268,Hospital Chargemaster,Screw Ti Asnis Iii Can 8.0X85,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515269,Hospital Chargemaster,Screw Tia Sni Iii Can 8.0X90M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515270,Hospital Chargemaster,Screw Ti Asnis Iii Cannulated,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515271,Hospital Chargemaster,Screw Ti Asni Iii Can 8.0X100,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515281,Hospital Chargemaster,"Acu-Loc 2 Vdr Pit, Narrow R",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515282,Hospital Chargemaster,Non Locking Hexalobe Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $236.25 , $129.94 , $194.67 , See APC Packaged Rates , $165.38 , $92.14 , $227.96 , $228.95 , $121.67 , See APC Packaged Rates , See APC Packaged Rates , $78.67 , $78.67 , See APC Packaged Rates , See APC Packaged Rates , $219.71 , $219.71 , $219.71 , $219.71 , See APC Packaged Rates , $82.69 , $- , $- , $228.95 , $165.38
C1713,61515283,Hospital Chargemaster,Locking Cortical Peg,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515285,Hospital Chargemaster,Micro Acutrak Bone Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515286,Hospital Chargemaster,Micro Acutrak Bone Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515287,Hospital Chargemaster,Micro Acutrak Bone Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515289,Hospital Chargemaster,Screw Cancellous TI 6mm,Outpatient,Outpatient Default Percent / Case Rate,278, $95.76 , $52.67 , $78.91 , See APC Packaged Rates , $67.03 , $37.35 , $92.40 , $92.80 , $49.32 , See APC Packaged Rates , See APC Packaged Rates , $31.89 , $31.89 , See APC Packaged Rates , See APC Packaged Rates , $89.06 , $89.06 , $89.06 , $89.06 , See APC Packaged Rates , $33.52 , $- , $- , $92.80 , $67.03
C1713,61515290,Hospital Chargemaster,Distal Lateral Femur Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515291,Hospital Chargemaster,Screw Locking 5.0M/L40M,Outpatient,Outpatient Default Percent / Case Rate,278, $437.60 , $240.68 , $360.58 , See APC Packaged Rates , $306.32 , $170.66 , $422.24 , $424.08 , $225.37 , See APC Packaged Rates , See APC Packaged Rates , $145.72 , $145.72 , See APC Packaged Rates , See APC Packaged Rates , $406.97 , $406.97 , $406.97 , $406.97 , See APC Packaged Rates , $153.16 , $- , $- , $424.08 , $306.32
C1713,61515292,Hospital Chargemaster,Screw Locking 5.0M /L46M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515293,Hospital Chargemaster,Screw Locking 5.0M /L50M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515294,Hospital Chargemaster,Screw Locking 5.0M /L70M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515295,Hospital Chargemaster,Screw Locking 5.0M/L75M,Outpatient,Outpatient Default Percent / Case Rate,278, $401.23 , $220.68 , $330.61 , See APC Packaged Rates , $280.86 , $156.48 , $387.15 , $388.83 , $206.64 , See APC Packaged Rates , See APC Packaged Rates , $133.61 , $133.61 , See APC Packaged Rates , See APC Packaged Rates , $373.14 , $373.14 , $373.14 , $373.14 , See APC Packaged Rates , $140.43 , $- , $- , $388.83 , $280.86
C1713,61515296,Hospital Chargemaster,Screw Locking 5.0M/L80M,Outpatient,Outpatient Default Percent / Case Rate,278, $415.78 , $228.68 , $342.60 , See APC Packaged Rates , $291.05 , $162.15 , $401.19 , $402.93 , $214.14 , See APC Packaged Rates , See APC Packaged Rates , $138.45 , $138.45 , See APC Packaged Rates , See APC Packaged Rates , $386.68 , $386.68 , $386.68 , $386.68 , See APC Packaged Rates , $145.52 , $- , $- , $402.93 , $291.05
C1713,61515297,Hospital Chargemaster,Cortex Ti Screw 4.5Mm / L38Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $91.76 , $50.47 , $75.61 , See APC Packaged Rates , $64.23 , $35.79 , $88.54 , $88.92 , $47.26 , See APC Packaged Rates , See APC Packaged Rates , $30.56 , $30.56 , See APC Packaged Rates , See APC Packaged Rates , $85.34 , $85.34 , $85.34 , $85.34 , See APC Packaged Rates , $32.12 , $- , $- , $88.92 , $64.23
C1713,61515298,Hospital Chargemaster,Cortex Screw T1 4.5mm/L46mm,Outpatient,Outpatient Default Percent / Case Rate,278, $84.99 , $46.74 , $70.03 , See APC Packaged Rates , $59.49 , $33.15 , $82.01 , $82.36 , $43.77 , See APC Packaged Rates , See APC Packaged Rates , $28.30 , $28.30 , See APC Packaged Rates , See APC Packaged Rates , $79.04 , $79.04 , $79.04 , $79.04 , See APC Packaged Rates , $29.75 , $- , $- , $82.36 , $59.49
C1713,61515299,Hospital Chargemaster,Coretx TI Screw 4.5mm,Outpatient,Outpatient Default Percent / Case Rate,278, $84.99 , $46.74 , $70.03 , See APC Packaged Rates , $59.49 , $33.15 , $82.01 , $82.36 , $43.77 , See APC Packaged Rates , See APC Packaged Rates , $28.30 , $28.30 , See APC Packaged Rates , See APC Packaged Rates , $79.04 , $79.04 , $79.04 , $79.04 , See APC Packaged Rates , $29.75 , $- , $- , $82.36 , $59.49
C1713,61515302,Hospital Chargemaster,Tibia Component Sz4 11M Ps,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515303,Hospital Chargemaster,Cancellous Ti Screw 4.0Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515304,Hospital Chargemaster,Proximal Lateral Tibia Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515305,Hospital Chargemaster,Locking Screw 4.0M/L50M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515306,Hospital Chargemaster,Locking Screw 4.0M/L65M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515307,Hospital Chargemaster,Locking Screw 4.0M/L70M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515308,Hospital Chargemaster,Cortex TI Screw 3.5Mm/L40Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $47.88 , $26.33 , $39.45 , See APC Packaged Rates , $33.52 , $18.67 , $46.20 , $46.40 , $24.66 , See APC Packaged Rates , See APC Packaged Rates , $15.94 , $15.94 , See APC Packaged Rates , See APC Packaged Rates , $44.53 , $44.53 , $44.53 , $44.53 , See APC Packaged Rates , $16.76 , $- , $- , $46.40 , $33.52
C1713,61515309,Hospital Chargemaster,Cortex Ti Screw 3.5Mm/L80Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515310,Hospital Chargemaster,Hydroset Xt 10Cc,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515311,Hospital Chargemaster,Screw Headless 4.0M Lgth 48M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515313,Hospital Chargemaster,Kwire Non-Threaded 4.0Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515314,Hospital Chargemaster,GaMa Nail 3S Rt 10X420Mx125,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515315,Hospital Chargemaster,Plate Olecranon 4 Hole Right,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515316,Hospital Chargemaster,Screw Bone T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61515318,Hospital Chargemaster,Graft Gracillis Tendon,Outpatient,Outpatient Default Percent / Case Rate,278," $3,780.00 "," $2,079.00 "," $3,024.00 ", See APC Packaged Rates ," $2,646.00 "," $1,474.20 "," $3,647.32 "," $3,663.20 "," $1,946.78 ", See APC Packaged Rates , See APC Packaged Rates ," $1,258.74 "," $1,258.74 ", See APC Packaged Rates , See APC Packaged Rates ," $3,515.40 "," $3,515.40 "," $3,515.40 "," $3,515.40 ", See APC Packaged Rates ," $1,323.00 "," $2,268.00 "," $1,258.74 "," $3,663.20 "," $2,646.00 "
C1713,61515320,Hospital Chargemaster,Nail GaMa 3S Lft 10X340Mx125,Outpatient,Outpatient Default Percent / Case Rate,278," $4,622.44 "," $2,542.34 "," $3,808.89 ", See APC Packaged Rates ," $3,235.71 "," $1,802.75 "," $4,460.19 "," $4,479.61 "," $2,380.65 ", See APC Packaged Rates , See APC Packaged Rates ," $1,539.27 "," $1,539.27 ", See APC Packaged Rates , See APC Packaged Rates ," $4,298.87 "," $4,298.87 "," $4,298.87 "," $4,298.87 ", See APC Packaged Rates ," $1,617.85 ", $- , $- ," $4,479.61 "," $3,235.71 "
C1713,61515321,Hospital Chargemaster,Screw Hex Lock 3.5M X 14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515322,Hospital Chargemaster,Peg Cortical Loc 23.M X 14M,Outpatient,Outpatient Default Percent / Case Rate,278, $302.40 , $166.32 , $249.18 , See APC Packaged Rates , $211.68 , $117.94 , $291.79 , $293.06 , $155.74 , See APC Packaged Rates , See APC Packaged Rates , $100.70 , $100.70 , See APC Packaged Rates , See APC Packaged Rates , $281.23 , $281.23 , $281.23 , $281.23 , See APC Packaged Rates , $105.84 , $- , $- , $293.06 , $211.68
C1713,61515323,Hospital Chargemaster,Screw Cortical Loc 2.3Mx14M,Outpatient,Outpatient Default Percent / Case Rate,278, $283.50 , $155.93 , $233.60 , See APC Packaged Rates , $198.45 , $110.57 , $273.55 , $274.74 , $146.01 , See APC Packaged Rates , See APC Packaged Rates , $94.41 , $94.41 , See APC Packaged Rates , See APC Packaged Rates , $263.66 , $263.66 , $263.66 , $263.66 , See APC Packaged Rates , $99.23 , $- , $- , $274.74 , $198.45
C1713,61515325,Hospital Chargemaster,Screw Asnis Cann 111 6.5X50M,Outpatient,Outpatient Default Percent / Case Rate,278, $615.26 , $338.39 , $506.97 , See APC Packaged Rates , $430.68 , $239.95 , $593.66 , $596.25 , $316.87 , See APC Packaged Rates , See APC Packaged Rates , $204.88 , $204.88 , See APC Packaged Rates , See APC Packaged Rates , $572.19 , $572.19 , $572.19 , $572.19 , See APC Packaged Rates , $215.34 , $- , $- , $596.25 , $430.68
C1713,61515326,Hospital Chargemaster,Plate Superior Decreased 6,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515328,Hospital Chargemaster,GaMa Nail 3S Rt 10X400M X125,Outpatient,Outpatient Default Percent / Case Rate,278, $591.61 , $325.39 , $487.49 , See APC Packaged Rates , $414.13 , $230.73 , $570.84 , $573.33 , $304.69 , See APC Packaged Rates , See APC Packaged Rates , $197.01 , $197.01 , See APC Packaged Rates , See APC Packaged Rates , $550.20 , $550.20 , $550.20 , $550.20 , See APC Packaged Rates , $207.06 , $- , $- , $573.33 , $414.13
C1713,61515329,Hospital Chargemaster,Screw Asnis Iii Can 8.0X100,Outpatient,Outpatient Default Percent / Case Rate,278, $615.26 , $338.39 , $506.97 , See APC Packaged Rates , $430.68 , $239.95 , $593.66 , $596.25 , $316.87 , See APC Packaged Rates , See APC Packaged Rates , $204.88 , $204.88 , See APC Packaged Rates , See APC Packaged Rates , $572.19 , $572.19 , $572.19 , $572.19 , See APC Packaged Rates , $215.34 , $- , $- , $596.25 , $430.68
C1713,61515330,Hospital Chargemaster,Screw Lag Ti 10.5X115M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,098.85 ", $604.37 , $905.45 , See APC Packaged Rates , $769.20 , $428.55 ," $1,060.28 "," $1,064.90 ", $565.93 , See APC Packaged Rates , See APC Packaged Rates , $365.92 , $365.92 , See APC Packaged Rates , See APC Packaged Rates ," $1,021.93 "," $1,021.93 "," $1,021.93 "," $1,021.93 ", See APC Packaged Rates , $384.60 , $- , $- ," $1,064.90 ", $769.20
C1713,61515331,Hospital Chargemaster,Clusterhole 60G Tri/Tritan 11,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515333,Hospital Chargemaster,Screw Cann Ti Asnis 4X44M,Outpatient,Outpatient Default Percent / Case Rate,278, $348.77 , $191.82 , $287.39 , See APC Packaged Rates , $244.14 , $136.02 , $336.53 , $337.99 , $179.62 , See APC Packaged Rates , See APC Packaged Rates , $116.14 , $116.14 , See APC Packaged Rates , See APC Packaged Rates , $324.36 , $324.36 , $324.36 , $324.36 , See APC Packaged Rates , $122.07 , $- , $- , $337.99 , $244.14
C1713,61515334,Hospital Chargemaster,Screw Cann Ti Asnis 111 4X46M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515335,Hospital Chargemaster,Screw Cann Ti Asnis 111 4X46M,Outpatient,Outpatient Default Percent / Case Rate,278, $348.77 , $191.82 , $287.39 , See APC Packaged Rates , $244.14 , $136.02 , $336.53 , $337.99 , $179.62 , See APC Packaged Rates , See APC Packaged Rates , $116.14 , $116.14 , See APC Packaged Rates , See APC Packaged Rates , $324.36 , $324.36 , $324.36 , $324.36 , See APC Packaged Rates , $122.07 , $- , $- , $337.99 , $244.14
C1713,61515338,Hospital Chargemaster,Humeral Stem Reunion 13Mxl97M,Outpatient,Outpatient Default Percent / Case Rate,278," $11,864.16 "," $6,525.29 "," $9,776.07 ", See APC Packaged Rates ," $8,304.91 "," $4,627.02 "," $11,447.73 "," $11,497.56 "," $6,110.28 ", See APC Packaged Rates , See APC Packaged Rates ," $3,950.77 "," $3,950.77 ", See APC Packaged Rates , See APC Packaged Rates ," $11,033.67 "," $11,033.67 "," $11,033.67 "," $11,033.67 ", See APC Packaged Rates ," $4,152.46 ", $- , $- ," $11,497.56 "," $8,304.91 "
C1713,61515339,Hospital Chargemaster,Humeral Insert X3 Cons 36Mx4,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515340,Hospital Chargemaster,Glenosphere 36M Dia X 6M Thk,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515341,Hospital Chargemaster,Screw Loc 2.3X6M Cross Pin,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515342,Hospital Chargemaster,Screw Lock 2.3X8M Cross Pin,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515343,Hospital Chargemaster,Screw Lock 2.3X10M Cros Pin,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515344,Hospital Chargemaster,Plate Rotation 5H 2.3M Profyl,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515345,Hospital Chargemaster,Screw Bone 2.3X6M Cross Pin,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515346,Hospital Chargemaster,Screw Bone 2.3X8M Cross Pin,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515347,Hospital Chargemaster,Screw Bone 2.3X10M Crs/Pin St,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515349,Hospital Chargemaster,Plate 16 H Stght Profyle Xs,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515350,Hospital Chargemaster,Plate Lock 1.7 Pro/Hand 16H S,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515351,Hospital Chargemaster,Screw Bone 1.7X8M Cross Pin,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515352,Hospital Chargemaster,Screw Bone 1.7X10M Crs/Pin St,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515353,Hospital Chargemaster,Screw Bone 1.7X12M Crs/Pin St,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515354,Hospital Chargemaster,Screw Bone 1.7X13M Cross Pin,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515359,Hospital Chargemaster,Triathlon Pkr Insert Xx,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515360,Hospital Chargemaster,Triathlon Pkr Insert Xx,Outpatient,Outpatient Default Percent / Case Rate,278," $1,353.28 ", $744.30 ," $1,115.10 ", See APC Packaged Rates , $947.30 , $527.78 ," $1,305.78 "," $1,311.46 ", $696.97 , See APC Packaged Rates , See APC Packaged Rates , $450.64 , $450.64 , See APC Packaged Rates , See APC Packaged Rates ," $1,258.55 "," $1,258.55 "," $1,258.55 "," $1,258.55 ", See APC Packaged Rates , $473.65 , $- , $- ," $1,311.46 ", $947.30
C1713,61515362,Hospital Chargemaster,Asnis Iii Ss Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $544.32 , $299.38 , $448.52 , See APC Packaged Rates , $381.02 , $212.28 , $525.21 , $527.50 , $280.34 , See APC Packaged Rates , See APC Packaged Rates , $181.26 , $181.26 , See APC Packaged Rates , See APC Packaged Rates , $506.22 , $506.22 , $506.22 , $506.22 , See APC Packaged Rates , $190.51 , $- , $- , $527.50 , $381.02
C1713,61515364,Hospital Chargemaster,Ss Cannulated Screw Washer,Outpatient,Outpatient Default Percent / Case Rate,278, $142.13 , $78.17 , $117.12 , See APC Packaged Rates , $99.49 , $55.43 , $137.14 , $137.74 , $73.20 , See APC Packaged Rates , See APC Packaged Rates , $47.33 , $47.33 , See APC Packaged Rates , See APC Packaged Rates , $132.18 , $132.18 , $132.18 , $132.18 , See APC Packaged Rates , $49.75 , $- , $- , $137.74 , $99.49
C1713,61515366,Hospital Chargemaster,Milagro Screw 5 X 12,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515367,Hospital Chargemaster,Milagro Screw 6 X 12,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515368,Hospital Chargemaster,Screw Lock/Ft 3.5M X L22M,Outpatient,Outpatient Default Percent / Case Rate,278, $369.50 , $203.23 , $304.47 , See APC Packaged Rates , $258.65 , $144.11 , $356.53 , $358.08 , $190.30 , See APC Packaged Rates , See APC Packaged Rates , $123.04 , $123.04 , See APC Packaged Rates , See APC Packaged Rates , $343.64 , $343.64 , $343.64 , $343.64 , See APC Packaged Rates , $129.33 , $- , $- , $358.08 , $258.65
C1713,61515369,Hospital Chargemaster,Screw Bone T10 Ft 3.5M /L30M,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515370,Hospital Chargemaster,Screw Bone T10 Ft 3.5M/L36M,Outpatient,Outpatient Default Percent / Case Rate,278, $213.45 , $117.40 , $175.88 , See APC Packaged Rates , $149.42 , $83.25 , $205.96 , $206.85 , $109.93 , See APC Packaged Rates , See APC Packaged Rates , $71.08 , $71.08 , See APC Packaged Rates , See APC Packaged Rates , $198.51 , $198.51 , $198.51 , $198.51 , See APC Packaged Rates , $74.71 , $- , $- , $206.85 , $149.42
C1713,61515371,Hospital Chargemaster,Plate Supr Decreased 7Hole/Rt,Outpatient,Outpatient Default Percent / Case Rate,278," $2,109.87 "," $1,160.43 "," $1,738.53 ", See APC Packaged Rates ," $1,476.91 ", $822.85 ," $2,035.81 "," $2,044.68 "," $1,086.63 ", See APC Packaged Rates , See APC Packaged Rates , $702.59 , $702.59 , See APC Packaged Rates , See APC Packaged Rates ," $1,962.18 "," $1,962.18 "," $1,962.18 "," $1,962.18 ", See APC Packaged Rates , $738.45 , $- , $- ," $2,044.68 "," $1,476.91 "
C1713,61515372,Hospital Chargemaster,Nail Tibial T2/Std 9M X 345M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515376,Hospital Chargemaster,Plate Broad Compression 12,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515377,Hospital Chargemaster,Crew Locking T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515378,Hospital Chargemaster,Screw 5M Locking 5.0M/L32M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515379,Hospital Chargemaster,Screw 5M Locking 5.0M/L36M,Outpatient,Outpatient Default Percent / Case Rate,278, $437.60 , $240.68 , $360.58 , See APC Packaged Rates , $306.32 , $170.66 , $422.24 , $424.08 , $225.37 , See APC Packaged Rates , See APC Packaged Rates , $145.72 , $145.72 , See APC Packaged Rates , See APC Packaged Rates , $406.97 , $406.97 , $406.97 , $406.97 , See APC Packaged Rates , $153.16 , $- , $- , $424.08 , $306.32
C1713,61515380,Hospital Chargemaster,Screw Periprosthetic Locking,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515381,Hospital Chargemaster,Screw Periprosthetic Locking,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515382,Hospital Chargemaster,Screw 4.5M Cortex Ti A 4.5M,Outpatient,Outpatient Default Percent / Case Rate,278, $84.99 , $46.74 , $70.03 , See APC Packaged Rates , $59.49 , $33.15 , $82.01 , $82.36 , $43.77 , See APC Packaged Rates , See APC Packaged Rates , $28.30 , $28.30 , See APC Packaged Rates , See APC Packaged Rates , $79.04 , $79.04 , $79.04 , $79.04 , See APC Packaged Rates , $29.75 , $- , $- , $82.36 , $59.49
C1713,61515383,Hospital Chargemaster,Screw 4.5M Cortex Ti A 4.5M,Outpatient,Outpatient Default Percent / Case Rate,278, $98.53 , $54.19 , $81.19 , See APC Packaged Rates , $68.97 , $38.43 , $95.07 , $95.49 , $50.74 , See APC Packaged Rates , See APC Packaged Rates , $32.81 , $32.81 , See APC Packaged Rates , See APC Packaged Rates , $91.63 , $91.63 , $91.63 , $91.63 , See APC Packaged Rates , $34.49 , $- , $- , $95.49 , $68.97
C1713,61515384,Hospital Chargemaster,Plt 2 Vdr Narrow L Acu-Loc,Outpatient,Outpatient Default Percent / Case Rate,278," $4,013.10 "," $2,207.21 "," $3,306.79 ", See APC Packaged Rates ," $2,809.17 "," $1,565.11 "," $3,872.24 "," $3,889.10 "," $2,066.83 ", See APC Packaged Rates , See APC Packaged Rates ," $1,336.36 "," $1,336.36 ", See APC Packaged Rates , See APC Packaged Rates ," $3,732.18 "," $3,732.18 "," $3,732.18 "," $3,732.18 ", See APC Packaged Rates ," $1,404.59 ", $- , $- ," $3,889.10 "," $2,809.17 "
C1713,61515385,Hospital Chargemaster,Screw Locking Hexalobe,Outpatient,Outpatient Default Percent / Case Rate,278, $393.75 , $216.56 , $324.45 , See APC Packaged Rates , $275.63 , $153.56 , $379.93 , $381.58 , $202.79 , See APC Packaged Rates , See APC Packaged Rates , $131.12 , $131.12 , See APC Packaged Rates , See APC Packaged Rates , $366.19 , $366.19 , $366.19 , $366.19 , See APC Packaged Rates , $137.81 , $- , $- , $381.58 , $275.63
C1713,61515386,Hospital Chargemaster,Cortical Peg Loc 2.3M X 18M,Outpatient,Outpatient Default Percent / Case Rate,278, $302.40 , $166.32 , $249.18 , See APC Packaged Rates , $211.68 , $117.94 , $291.79 , $293.06 , $155.74 , See APC Packaged Rates , See APC Packaged Rates , $100.70 , $100.70 , See APC Packaged Rates , See APC Packaged Rates , $281.23 , $281.23 , $281.23 , $281.23 , See APC Packaged Rates , $105.84 , $- , $- , $293.06 , $211.68
C1713,61515389,Hospital Chargemaster,Headless Screw 2.5M Length,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515390,Hospital Chargemaster,Headless Screw 4.0M Length,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515391,Hospital Chargemaster,Humereal Head 40 X 14,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515395,Hospital Chargemaster,T2 F/T Locking Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $347.76 , $191.27 , $286.55 , See APC Packaged Rates , $243.43 , $135.63 , $335.55 , $337.01 , $179.10 , See APC Packaged Rates , See APC Packaged Rates , $115.80 , $115.80 , See APC Packaged Rates , See APC Packaged Rates , $323.42 , $323.42 , $323.42 , $323.42 , See APC Packaged Rates , $121.72 , $- , $- , $337.01 , $243.43
C1713,61515396,Hospital Chargemaster,Y-Plate Slim 4 Shaft Holes T8,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515397,Hospital Chargemaster,Screw Bone T8 F/T 2.4M /L10M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515398,Hospital Chargemaster,Screw Bone T8 F/T 2.4M/ L12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515399,Hospital Chargemaster,Screw Bone T8 F/T 2.7M /L12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515403,Hospital Chargemaster,Bonescrew 3.5M X 18M Ti,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515404,Hospital Chargemaster,Bonescrew 3.5M X 20M Ti,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515405,Hospital Chargemaster,Bonescrew 3.5M X 32M Ti,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515406,Hospital Chargemaster,Ar Small Socket Insert,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515407,Hospital Chargemaster,Altivate Reverse Humeral Stem,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515408,Hospital Chargemaster,Triathlon Ts Plus Tibial,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515410,Hospital Chargemaster,Trident O Deg Insert 40M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515411,Hospital Chargemaster,Trident Ii Tritanium,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515412,Hospital Chargemaster,Self Tap Cortical Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515413,Hospital Chargemaster,Standard Barrel Hip Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515414,Hospital Chargemaster,Asnis Iii Ss Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $615.26 , $338.39 , $506.97 , See APC Packaged Rates , $430.68 , $239.95 , $593.66 , $596.25 , $316.87 , See APC Packaged Rates , See APC Packaged Rates , $204.88 , $204.88 , See APC Packaged Rates , See APC Packaged Rates , $572.19 , $572.19 , $572.19 , $572.19 , See APC Packaged Rates , $215.34 , $- , $- , $596.25 , $430.68
C1713,61515415,Hospital Chargemaster,Asnis Iii Ss Cannulated Scr,Outpatient,Outpatient Default Percent / Case Rate,278, $615.26 , $338.39 , $506.97 , See APC Packaged Rates , $430.68 , $239.95 , $593.66 , $596.25 , $316.87 , See APC Packaged Rates , See APC Packaged Rates , $204.88 , $204.88 , See APC Packaged Rates , See APC Packaged Rates , $572.19 , $572.19 , $572.19 , $572.19 , See APC Packaged Rates , $215.34 , $- , $- , $596.25 , $430.68
C1713,61515416,Hospital Chargemaster,Olecranon Plate 6 Hole/Left,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515417,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515419,Hospital Chargemaster,Screw Ti Lag 10.5X105M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,017.77 ", $559.77 , $838.64 , See APC Packaged Rates , $712.44 , $396.93 , $982.05 , $986.32 , $524.17 , See APC Packaged Rates , See APC Packaged Rates , $338.92 , $338.92 , See APC Packaged Rates , See APC Packaged Rates , $946.53 , $946.53 , $946.53 , $946.53 , See APC Packaged Rates , $356.22 , $- , $- , $986.32 , $712.44
C1713,61515421,Hospital Chargemaster,OneThird Tubular Plate 12Hole,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515422,Hospital Chargemaster,Asnis Iii Ss Cannulated Scr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515423,Hospital Chargemaster,Asnis Iii Ss Cannulated Scr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515426,Hospital Chargemaster,Ti one third tb plate 6 hole,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515427,Hospital Chargemaster,Cortex Ti Screw A-3.5Mm/L14Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515429,Hospital Chargemaster,T2 F/T Locking Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $347.76 , $191.27 , $286.55 , See APC Packaged Rates , $243.43 , $135.63 , $335.55 , $337.01 , $179.10 , See APC Packaged Rates , See APC Packaged Rates , $115.80 , $115.80 , See APC Packaged Rates , See APC Packaged Rates , $323.42 , $323.42 , $323.42 , $323.42 , See APC Packaged Rates , $121.72 , $- , $- , $337.01 , $243.43
C1713,61515430,Hospital Chargemaster,Ti Cannulated Screw 4.0X40M,Outpatient,Outpatient Default Percent / Case Rate,278, $386.63 , $212.65 , $318.58 , See APC Packaged Rates , $270.64 , $150.79 , $373.06 , $374.68 , $199.12 , See APC Packaged Rates , See APC Packaged Rates , $128.75 , $128.75 , See APC Packaged Rates , See APC Packaged Rates , $359.57 , $359.57 , $359.57 , $359.57 , See APC Packaged Rates , $135.32 , $- , $- , $374.68 , $270.64
C1713,61515431,Hospital Chargemaster,OneThird Tubular Plate 3Hold,Outpatient,Outpatient Default Percent / Case Rate,278, $579.41 , $318.68 , $477.43 , See APC Packaged Rates , $405.59 , $225.97 , $559.07 , $561.51 , $298.41 , See APC Packaged Rates , See APC Packaged Rates , $192.94 , $192.94 , See APC Packaged Rates , See APC Packaged Rates , $538.85 , $538.85 , $538.85 , $538.85 , See APC Packaged Rates , $202.79 , $- , $- , $561.51 , $405.59
C1713,61515432,Hospital Chargemaster,Bone Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515433,Hospital Chargemaster,Rigidloop Cortical Fixation,Outpatient,Outpatient Default Percent / Case Rate,278, $787.50 , $433.13 , $648.90 , See APC Packaged Rates , $551.25 , $307.13 , $759.86 , $763.17 , $405.58 , See APC Packaged Rates , See APC Packaged Rates , $262.24 , $262.24 , See APC Packaged Rates , See APC Packaged Rates , $732.38 , $732.38 , $732.38 , $732.38 , See APC Packaged Rates , $275.63 , $- , $- , $763.17 , $551.25
C1713,61515437,Hospital Chargemaster,Plate Lateral Superior 3H/Rt,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515438,Hospital Chargemaster,Screw Bone T 10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $225.54 , $124.05 , $185.84 , See APC Packaged Rates , $157.88 , $87.96 , $217.62 , $218.57 , $116.16 , See APC Packaged Rates , See APC Packaged Rates , $75.10 , $75.10 , See APC Packaged Rates , See APC Packaged Rates , $209.75 , $209.75 , $209.75 , $209.75 , See APC Packaged Rates , $78.94 , $- , $- , $218.57 , $157.88
C1713,61515440,Hospital Chargemaster,No2 Triatholon Ts Plus Tibial,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515441,Hospital Chargemaster,Non-Locking Hexalobe Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $236.25 , $129.94 , $194.67 , See APC Packaged Rates , $165.38 , $92.14 , $227.96 , $228.95 , $121.67 , See APC Packaged Rates , See APC Packaged Rates , $78.67 , $78.67 , See APC Packaged Rates , See APC Packaged Rates , $219.71 , $219.71 , $219.71 , $219.71 , See APC Packaged Rates , $82.69 , $- , $- , $228.95 , $165.38
C1713,61515442,Hospital Chargemaster,Screw 5.5 Acutrak 55.00 M 2 R,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515443,Hospital Chargemaster,Guide Wire 3.2x300mm Asnis III,Outpatient,Outpatient Default Percent / Case Rate,278, $92.61 , $50.94 , $76.31 , See APC Packaged Rates , $64.83 , $36.12 , $89.36 , $89.75 , $47.70 , See APC Packaged Rates , See APC Packaged Rates , $30.84 , $30.84 , See APC Packaged Rates , See APC Packaged Rates , $86.13 , $86.13 , $86.13 , $86.13 , See APC Packaged Rates , $32.41 , $- , $- , $89.75 , $64.83
C1713,61515444,Hospital Chargemaster,Compression Plate Variax,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515445,Hospital Chargemaster,Screw Bone T8 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515446,Hospital Chargemaster,Screw Headless Compression A,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515447,Hospital Chargemaster,Screw Headless Compression A,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515449,Hospital Chargemaster,Ps All-Polyethylene Tibia,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515450,Hospital Chargemaster,Distal Lateral Fibula Plate,Outpatient,Outpatient Default Percent / Case Rate,278," $1,309.83 ", $720.41 ," $1,079.30 ", See APC Packaged Rates , $916.88 , $510.83 ," $1,263.85 "," $1,269.36 ", $674.59 , See APC Packaged Rates , See APC Packaged Rates , $436.17 , $436.17 , See APC Packaged Rates , See APC Packaged Rates ," $1,218.14 "," $1,218.14 "," $1,218.14 "," $1,218.14 ", See APC Packaged Rates , $458.44 , $- , $- ," $1,269.36 ", $916.88
C1713,61515451,Hospital Chargemaster,GaMa 3 S Nail Right 10X320M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515452,Hospital Chargemaster,T2 +5M End Cap,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515453,Hospital Chargemaster,T2 Std Tibial Nail 9Mx285M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515455,Hospital Chargemaster,Acu-Loc 2 Vdr Plt Std Long R,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515456,Hospital Chargemaster,Non-Toggling Cortical Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515458,Hospital Chargemaster,Tibial Insert 6 Tri/Poly 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515459,Hospital Chargemaster,Nail HuMeral Nail Lft 220M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515461,Hospital Chargemaster,Ti one third Tub plate 10 hol,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515462,Hospital Chargemaster,OneThird Tubular Plate 2 Hole,Outpatient,Outpatient Default Percent / Case Rate,278, $608.49 , $334.67 , $501.40 , See APC Packaged Rates , $425.94 , $237.31 , $587.13 , $589.69 , $313.38 , See APC Packaged Rates , See APC Packaged Rates , $202.63 , $202.63 , See APC Packaged Rates , See APC Packaged Rates , $565.90 , $565.90 , $565.90 , $565.90 , See APC Packaged Rates , $212.97 , $- , $- , $589.69 , $425.94
C1713,61515463,Hospital Chargemaster,OneThird Tubular Plate 8 Hole,Outpatient,Outpatient Default Percent / Case Rate,278, $624.39 , $343.41 , $514.50 , See APC Packaged Rates , $437.07 , $243.51 , $602.47 , $605.10 , $321.57 , See APC Packaged Rates , See APC Packaged Rates , $207.92 , $207.92 , See APC Packaged Rates , See APC Packaged Rates , $580.68 , $580.68 , $580.68 , $580.68 , See APC Packaged Rates , $218.54 , $- , $- , $605.10 , $437.07
C1713,61515464,Hospital Chargemaster,OneThird Tubular Plate 9 Hole,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515465,Hospital Chargemaster,OneThird Tubular Plate 10 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515466,Hospital Chargemaster,OneThird Tubular Plate 14 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515467,Hospital Chargemaster,OneThird Tubular Plate 16 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515468,Hospital Chargemaster,Prox Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515469,Hospital Chargemaster,Prox Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515470,Hospital Chargemaster,Prox Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515471,Hospital Chargemaster,Prox Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515472,Hospital Chargemaster,Prox Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515473,Hospital Chargemaster,Prox Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515474,Hospital Chargemaster,Prox Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515475,Hospital Chargemaster,Prox Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278," $4,368.74 "," $2,402.81 "," $3,599.84 ", See APC Packaged Rates ," $3,058.12 "," $1,703.81 "," $4,215.40 "," $4,233.75 "," $2,249.99 ", See APC Packaged Rates , See APC Packaged Rates ," $1,454.79 "," $1,454.79 ", See APC Packaged Rates , See APC Packaged Rates ," $4,062.93 "," $4,062.93 "," $4,062.93 "," $4,062.93 ", See APC Packaged Rates ," $1,529.06 ", $- , $- ," $4,233.75 "," $3,058.12 "
C1713,61515476,Hospital Chargemaster,Prox Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278," $4,368.74 "," $2,402.81 "," $3,599.84 ", See APC Packaged Rates ," $3,058.12 "," $1,703.81 "," $4,215.40 "," $4,233.75 "," $2,249.99 ", See APC Packaged Rates , See APC Packaged Rates ," $1,454.79 "," $1,454.79 ", See APC Packaged Rates , See APC Packaged Rates ," $4,062.93 "," $4,062.93 "," $4,062.93 "," $4,062.93 ", See APC Packaged Rates ," $1,529.06 ", $- , $- ," $4,233.75 "," $3,058.12 "
C1713,61515477,Hospital Chargemaster,Prox Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515478,Hospital Chargemaster,Prox Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515479,Hospital Chargemaster,Prox Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515480,Hospital Chargemaster,Prox Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515481,Hospital Chargemaster,Prox Lateral Tibia Plate F,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515482,Hospital Chargemaster,Prox Lateral Tibia Plate F,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515483,Hospital Chargemaster,Prox Lateral Tibia Plate F,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515484,Hospital Chargemaster,Prox Lateral Tibia Plate F,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515485,Hospital Chargemaster,Prox Lateral Tibia Plate F,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515486,Hospital Chargemaster,Prox Lateral Tibia Plate F,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515487,Hospital Chargemaster,Prox Lateral Tibia Plate F,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515488,Hospital Chargemaster,Prox Lateral Tibia Plate F,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515489,Hospital Chargemaster,Prox Lateral Tibia Plate F,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515490,Hospital Chargemaster,Prox Lateral Tibia Plate F,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515491,Hospital Chargemaster,Prox Lateral Tibia Plate F,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515492,Hospital Chargemaster,Prox Lateral Tibia Plate F,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515493,Hospital Chargemaster,Prox Lateral Tibia Plate F,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515494,Hospital Chargemaster,Distal Medial Tibia Plate For,Outpatient,Outpatient Default Percent / Case Rate,278," $4,026.77 "," $2,214.72 "," $3,318.06 ", See APC Packaged Rates ," $2,818.74 "," $1,570.44 "," $3,885.43 "," $3,902.34 "," $2,073.87 ", See APC Packaged Rates , See APC Packaged Rates ," $1,340.91 "," $1,340.91 ", See APC Packaged Rates , See APC Packaged Rates ," $3,744.90 "," $3,744.90 "," $3,744.90 "," $3,744.90 ", See APC Packaged Rates ," $1,409.37 ", $- , $- ," $3,902.34 "," $2,818.74 "
C1713,61515495,Hospital Chargemaster,Distal Medial Tibia Plate For,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515496,Hospital Chargemaster,Distal Medial Tibia Plate For,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515497,Hospital Chargemaster,Distal Medial Tibia Plate For,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515498,Hospital Chargemaster,Distal Medial Tibia Plate For,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515499,Hospital Chargemaster,Distal Medial Tibia Plate For,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515500,Hospital Chargemaster,Distal Medial Tibia Plate For,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515501,Hospital Chargemaster,Distal Medial Tibia Plate For,Outpatient,Outpatient Default Percent / Case Rate,278," $4,264.41 "," $2,345.43 "," $3,513.87 ", See APC Packaged Rates ," $2,985.09 "," $1,663.12 "," $4,114.73 "," $4,132.64 "," $2,196.26 ", See APC Packaged Rates , See APC Packaged Rates ," $1,420.05 "," $1,420.05 ", See APC Packaged Rates , See APC Packaged Rates ," $3,965.90 "," $3,965.90 "," $3,965.90 "," $3,965.90 ", See APC Packaged Rates ," $1,492.54 ", $- , $- ," $4,132.64 "," $2,985.09 "
C1713,61515502,Hospital Chargemaster,Distal Medial Tibia Plate For,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515503,Hospital Chargemaster,Distal Medial Tibia Plate For,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515504,Hospital Chargemaster,Distal Medial Tibia Plate For,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515505,Hospital Chargemaster,Distal AnteroLat Tibia Pla,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515506,Hospital Chargemaster,Distal AnteroLat Tibia Pla,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515507,Hospital Chargemaster,Distal AnteroLat Tibia Pla,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515508,Hospital Chargemaster,Distal AnteroLat Tibia Pla,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515509,Hospital Chargemaster,Distal AnteroLat Tibia Pla,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515510,Hospital Chargemaster,Distal AnteroLat Tibia Pla,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515511,Hospital Chargemaster,Distal AnteroLat Tibia Pla,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515512,Hospital Chargemaster,Distal AnteroLat Tibia Pla,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515513,Hospital Chargemaster,Distal AnteroLat Tibia Pla,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515514,Hospital Chargemaster,Distal AnteroLat Tibia Pla,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515515,Hospital Chargemaster,Distal AnteroLat Tibia Pla,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515516,Hospital Chargemaster,Distal AnteroLat Tibia Pla,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515517,Hospital Chargemaster,Lock Comp Plate Narrow 4 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515518,Hospital Chargemaster,Lock Comp Plate Narrow 5 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515519,Hospital Chargemaster,Lock Comp Plate Narrow 6 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515520,Hospital Chargemaster,Lock Comp Plate Narrow 7 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515521,Hospital Chargemaster,Lock Comp Plate Narrow 8 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515522,Hospital Chargemaster,Lock Comp Plate Narrow 9 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515523,Hospital Chargemaster,Lock Comp Plate Narrow 10 H,Outpatient,Outpatient Default Percent / Case Rate,278," $4,136.90 "," $2,275.30 "," $3,408.81 ", See APC Packaged Rates ," $2,895.83 "," $1,613.39 "," $3,991.69 "," $4,009.07 "," $2,130.59 ", See APC Packaged Rates , See APC Packaged Rates ," $1,377.59 "," $1,377.59 ", See APC Packaged Rates , See APC Packaged Rates ," $3,847.32 "," $3,847.32 "," $3,847.32 "," $3,847.32 ", See APC Packaged Rates ," $1,447.92 ", $- , $- ," $4,009.07 "," $2,895.83 "
C1713,61515524,Hospital Chargemaster,Lock Comp Plate Narrow 12 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515525,Hospital Chargemaster,Lock Comp Plate Narrow 14 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515526,Hospital Chargemaster,Lock Comp Plate Broad 6 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515527,Hospital Chargemaster,Lock Comp Plate Broad 7 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515528,Hospital Chargemaster,Lock Comp Plate Broad 8 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515529,Hospital Chargemaster,Lock Comp Plate Broad 9 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515530,Hospital Chargemaster,Lock Comp Plate Broad 10 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515531,Hospital Chargemaster,Lock Comp Plate Broad 11 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515532,Hospital Chargemaster,Lock Comp Plate Broad 13 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515533,Hospital Chargemaster,Lock Comp Plate Broad 14 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515534,Hospital Chargemaster,Superior Plate Decreased 6 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515535,Hospital Chargemaster,Superior Plate Decreased 8 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515536,Hospital Chargemaster,Superior Plate Decreased - 10,Outpatient,Outpatient Default Percent / Case Rate,278," $2,577.96 "," $1,417.88 "," $2,124.24 ", See APC Packaged Rates ," $1,804.57 "," $1,005.40 "," $2,487.47 "," $2,498.30 "," $1,327.70 ", See APC Packaged Rates , See APC Packaged Rates , $858.46 , $858.46 , See APC Packaged Rates , See APC Packaged Rates ," $2,397.50 "," $2,397.50 "," $2,397.50 "," $2,397.50 ", See APC Packaged Rates , $902.29 , $- , $- ," $2,498.30 "," $1,804.57 "
C1713,61515537,Hospital Chargemaster,Superior Plate Decreased 8 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515538,Hospital Chargemaster,Superior Plate Decreased - 10,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515539,Hospital Chargemaster,Superior Plate Decreased 6 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515540,Hospital Chargemaster,Superior Plate Decreased 8 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515541,Hospital Chargemaster,Superior Plate Decreased 6 H,Outpatient,Outpatient Default Percent / Case Rate,278," $2,833.74 "," $1,558.56 "," $2,335.00 ", See APC Packaged Rates ," $1,983.62 "," $1,105.16 "," $2,734.28 "," $2,746.18 "," $1,459.43 ", See APC Packaged Rates , See APC Packaged Rates , $943.64 , $943.64 , See APC Packaged Rates , See APC Packaged Rates ," $2,635.38 "," $2,635.38 "," $2,635.38 "," $2,635.38 ", See APC Packaged Rates , $991.81 , $- , $- ," $2,746.18 "," $1,983.62 "
C1713,61515542,Hospital Chargemaster,Superior Plate Decreased 8 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515543,Hospital Chargemaster,Superior Plate Increased 8 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515544,Hospital Chargemaster,Superior Plate Increased - 10,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515545,Hospital Chargemaster,Superior Plate Increased 8 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515546,Hospital Chargemaster,Superior Plate Increased - 10,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515547,Hospital Chargemaster,Superior Plate Increased 6 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515548,Hospital Chargemaster,Superior Plate Increased 8 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515549,Hospital Chargemaster,Superior Plate Increased 6 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515550,Hospital Chargemaster,Superior Plate Increased 8 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515551,Hospital Chargemaster,Superior Lateral Plate 3 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515552,Hospital Chargemaster,Superior Lateral Plate 4 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515553,Hospital Chargemaster,Superior Lateral Plate 5 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515554,Hospital Chargemaster,Superior Lateral Plate 7 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515555,Hospital Chargemaster,Superior Lateral Plate 5 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515556,Hospital Chargemaster,Superior Lateral Plate 7 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515557,Hospital Chargemaster,Anterior Midshaft Plate 6 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515558,Hospital Chargemaster,Anterior Midshaft Plate 7 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515559,Hospital Chargemaster,Anterior Midshaft Plate 8 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515560,Hospital Chargemaster,Anterior Midshaft Plate 10 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515561,Hospital Chargemaster,Anterior Lateral Plate 6 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515562,Hospital Chargemaster,Anterior Lateral Plate 7 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515563,Hospital Chargemaster,Anterior Lateral Plate 8 Ho,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515564,Hospital Chargemaster,Distal Lat Humerus Plate F,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515565,Hospital Chargemaster,Distal Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515566,Hospital Chargemaster,Distal Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515567,Hospital Chargemaster,Distal Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515568,Hospital Chargemaster,Distal Lat Humerus Plate F,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515569,Hospital Chargemaster,Distal Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515570,Hospital Chargemaster,Distal Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515571,Hospital Chargemaster,Distal Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515572,Hospital Chargemaster,Distal Posterior Lat Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515573,Hospital Chargemaster,Distal Posterior Lat Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515574,Hospital Chargemaster,Distal Posterior Lat Humer,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515575,Hospital Chargemaster,Distal Posterior Lat Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515576,Hospital Chargemaster,Distal Posterior Lat Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515577,Hospital Chargemaster,Distal Medial Humerus Plate -,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515578,Hospital Chargemaster,Distal Medial Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515579,Hospital Chargemaster,Distal Medial Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515580,Hospital Chargemaster,Distal Posterior Medial Humer,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515581,Hospital Chargemaster,Distal Posterior Medial Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515582,Hospital Chargemaster,Distal Posterior Medial Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515583,Hospital Chargemaster,Distal Posterior Medial Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515584,Hospital Chargemaster,Distal Posterior Medial Humer,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515585,Hospital Chargemaster,Distal Posterior Medial Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515586,Hospital Chargemaster,Distal Posterior Medial Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515587,Hospital Chargemaster,Distal Posterior Medial Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515588,Hospital Chargemaster,Olecranon Plate For Lt Ulna,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515589,Hospital Chargemaster,Olecranon Plate 4 Hole /Lt,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515590,Hospital Chargemaster,Olecranon Plate 6 Hole / Lt,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515591,Hospital Chargemaster,Olecranon Plate 8 Hole / Lt,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515592,Hospital Chargemaster,Olecranon Plate For Rt Ulna,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515593,Hospital Chargemaster,Olecranon Plate 4 Hole / Rt,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515594,Hospital Chargemaster,Olecranon Plate 6 Hole / Rt,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515595,Hospital Chargemaster,Olecranon Plate 8 Hole / Rt,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515596,Hospital Chargemaster,Distal Medial Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515597,Hospital Chargemaster,Distal Medial Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515598,Hospital Chargemaster,Distal Medial Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515599,Hospital Chargemaster,Distal Medial Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515600,Hospital Chargemaster,Variax Comp Plate Narrow Str,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515601,Hospital Chargemaster,Variax Compplate Narrow Stra,Outpatient,Outpatient Default Percent / Case Rate,278, $984.06 , $541.23 , $810.87 , See APC Packaged Rates , $688.84 , $383.78 , $949.52 , $953.65 , $506.81 , See APC Packaged Rates , See APC Packaged Rates , $327.69 , $327.69 , See APC Packaged Rates , See APC Packaged Rates , $915.18 , $915.18 , $915.18 , $915.18 , See APC Packaged Rates , $344.42 , $- , $- , $953.65 , $688.84
C1713,61515602,Hospital Chargemaster,Variax Comp Plate 7 HoleL90 W,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515603,Hospital Chargemaster,Variax Comp Plate Narrow Str,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515604,Hospital Chargemaster,Variax Comp Plate Narrow Str,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515605,Hospital Chargemaster,Variax Comp Plate Narrow Str,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515606,Hospital Chargemaster,Variax Comp Plate Narrow Str,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515607,Hospital Chargemaster,Variax Comp Plate Narrow Str,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515608,Hospital Chargemaster,Variax Comp Plate 7 Hole/L90M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515609,Hospital Chargemaster,Variax Comp Plate 7 Hole/L91M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515610,Hospital Chargemaster,Variax Comp Plate Broad Stra,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515611,Hospital Chargemaster,Variax Comp Plate Broad Stra,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515612,Hospital Chargemaster,Variax Comp Plate Broad Stra,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515613,Hospital Chargemaster,Variax Comp Plate 7 Hole/L91M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515614,Hospital Chargemaster,Variax Comp Plate Broad Stra,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515615,Hospital Chargemaster,Variax Comp Plate Broad Curv,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515616,Hospital Chargemaster,Variax Comp Plate Broad Curv,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515617,Hospital Chargemaster,Variax Comp Plate Broad Curv,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515618,Hospital Chargemaster,Variax Comp Plate Broad Curv,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515619,Hospital Chargemaster,Variax Comp Plate Broad Curv,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515620,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515621,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515622,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515623,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515624,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515625,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515626,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515627,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515628,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515629,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515630,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515631,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515632,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515633,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515634,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515635,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515636,Hospital Chargemaster,Asnis Iii Ss Cannulated Scr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515637,Hospital Chargemaster,Bonescrew T8 Full Thread 2.4M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515638,Hospital Chargemaster,Bonescrew T8 Full Thread 2.4M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515639,Hospital Chargemaster,Bonescrew T8 Full Thread 2.4M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515640,Hospital Chargemaster,Bonescrew T8 Full Thread 2.4M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515641,Hospital Chargemaster,Bonescrew T8 Full Thread 2.4M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515642,Hospital Chargemaster,Bonescrew T8 Full Thread 2.4M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515643,Hospital Chargemaster,Bonescrew T8 Full Thread 2.4M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515644,Hospital Chargemaster,Bonescrew T8 Full Thread 2.4M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515645,Hospital Chargemaster,Bonescrew T8 Full Thread 2.4M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515646,Hospital Chargemaster,Bonescrew T8 Full Thread 2.4M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515647,Hospital Chargemaster,Bonescrew T8 Full Thread 2.4M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515648,Hospital Chargemaster,Bonescrew T8 Full Thread 2.4M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515649,Hospital Chargemaster,Bonescrew T8 Full Thread 2.4M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515650,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515651,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515652,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515653,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515654,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515655,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515656,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515657,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515658,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515659,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515660,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515661,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515662,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515663,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515664,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515665,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515666,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515667,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515668,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515669,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515670,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515671,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515672,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515673,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515674,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515675,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515676,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515677,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515678,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515679,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515680,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515681,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515682,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515683,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515684,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515685,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515686,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515687,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515688,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515689,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515690,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515691,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515692,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515693,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515694,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515695,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515696,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515697,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515698,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515699,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515700,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515701,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515702,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515703,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515704,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515705,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515706,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515707,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515708,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515709,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515710,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515711,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515712,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515713,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515714,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515715,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515716,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515717,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515718,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515719,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515720,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $369.50 , $203.23 , $304.47 , See APC Packaged Rates , $258.65 , $144.11 , $356.53 , $358.08 , $190.30 , See APC Packaged Rates , See APC Packaged Rates , $123.04 , $123.04 , See APC Packaged Rates , See APC Packaged Rates , $343.64 , $343.64 , $343.64 , $343.64 , See APC Packaged Rates , $129.33 , $- , $- , $358.08 , $258.65
C1713,61515721,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515722,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $414.54 , $228.00 , $341.58 , See APC Packaged Rates , $290.18 , $161.67 , $399.99 , $401.73 , $213.50 , See APC Packaged Rates , See APC Packaged Rates , $138.04 , $138.04 , See APC Packaged Rates , See APC Packaged Rates , $385.52 , $385.52 , $385.52 , $385.52 , See APC Packaged Rates , $145.09 , $- , $- , $401.73 , $290.18
C1713,61515723,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515724,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515725,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515726,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515727,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $414.54 , $228.00 , $341.58 , See APC Packaged Rates , $290.18 , $161.67 , $399.99 , $401.73 , $213.50 , See APC Packaged Rates , See APC Packaged Rates , $138.04 , $138.04 , See APC Packaged Rates , See APC Packaged Rates , $385.52 , $385.52 , $385.52 , $385.52 , See APC Packaged Rates , $145.09 , $- , $- , $401.73 , $290.18
C1713,61515728,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515729,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515730,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515731,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515732,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515733,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515734,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515735,Hospital Chargemaster,Locking Screw T10 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515736,Hospital Chargemaster,Bonescrew T10 Full Thread 3.5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515737,Hospital Chargemaster,Bonescrew T10 Full Thread 3.5,Outpatient,Outpatient Default Percent / Case Rate,278, $201.35 , $110.74 , $165.91 , See APC Packaged Rates , $140.95 , $78.53 , $194.28 , $195.13 , $103.70 , See APC Packaged Rates , See APC Packaged Rates , $67.05 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $187.26 , $187.26 , $187.26 , $187.26 , See APC Packaged Rates , $70.47 , $- , $- , $195.13 , $140.95
C1713,61515738,Hospital Chargemaster,Bonescrew T10 Full Thread 3.5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515739,Hospital Chargemaster,Bonescrew T10 Full Thread 3.5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515740,Hospital Chargemaster,Bonescrew T10 Full Thread 3.5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515741,Hospital Chargemaster,Bonescrew T10 Full Thread 3.5,Outpatient,Outpatient Default Percent / Case Rate,278, $225.54 , $124.05 , $185.84 , See APC Packaged Rates , $157.88 , $87.96 , $217.62 , $218.57 , $116.16 , See APC Packaged Rates , See APC Packaged Rates , $75.10 , $75.10 , See APC Packaged Rates , See APC Packaged Rates , $209.75 , $209.75 , $209.75 , $209.75 , See APC Packaged Rates , $78.94 , $- , $- , $218.57 , $157.88
C1713,61515742,Hospital Chargemaster,Bonescrew T10 Full Thread 3.5,Outpatient,Outpatient Default Percent / Case Rate,278, $209.41 , $115.18 , $172.55 , See APC Packaged Rates , $146.59 , $81.67 , $202.06 , $202.94 , $107.85 , See APC Packaged Rates , See APC Packaged Rates , $69.73 , $69.73 , See APC Packaged Rates , See APC Packaged Rates , $194.75 , $194.75 , $194.75 , $194.75 , See APC Packaged Rates , $73.29 , $- , $- , $202.94 , $146.59
C1713,61515743,Hospital Chargemaster,Bonescrew T10 Full Thread 3.5,Outpatient,Outpatient Default Percent / Case Rate,278, $225.54 , $124.05 , $185.84 , See APC Packaged Rates , $157.88 , $87.96 , $217.62 , $218.57 , $116.16 , See APC Packaged Rates , See APC Packaged Rates , $75.10 , $75.10 , See APC Packaged Rates , See APC Packaged Rates , $209.75 , $209.75 , $209.75 , $209.75 , See APC Packaged Rates , $78.94 , $- , $- , $218.57 , $157.88
C1713,61515744,Hospital Chargemaster,4M Lock Screw 4.0M / L16M,Outpatient,Outpatient Default Percent / Case Rate,278, $414.41 , $227.93 , $341.47 , See APC Packaged Rates , $290.09 , $161.62 , $399.86 , $401.60 , $213.43 , See APC Packaged Rates , See APC Packaged Rates , $138.00 , $138.00 , See APC Packaged Rates , See APC Packaged Rates , $385.40 , $385.40 , $385.40 , $385.40 , See APC Packaged Rates , $145.04 , $- , $- , $401.60 , $290.09
C1713,61515745,Hospital Chargemaster,4M Lock Screw 4.0M / L20M,Outpatient,Outpatient Default Percent / Case Rate,278, $362.69 , $199.48 , $298.86 , See APC Packaged Rates , $253.88 , $141.45 , $349.96 , $351.48 , $186.79 , See APC Packaged Rates , See APC Packaged Rates , $120.78 , $120.78 , See APC Packaged Rates , See APC Packaged Rates , $337.30 , $337.30 , $337.30 , $337.30 , See APC Packaged Rates , $126.94 , $- , $- , $351.48 , $253.88
C1713,61515746,Hospital Chargemaster,4M Lock Screw 4.0M / L22M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515747,Hospital Chargemaster,4M Lock Screw 4.0M / L24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515748,Hospital Chargemaster,4M Lock Screw 4.0M / L26M,Outpatient,Outpatient Default Percent / Case Rate,278, $362.69 , $199.48 , $298.86 , See APC Packaged Rates , $253.88 , $141.45 , $349.96 , $351.48 , $186.79 , See APC Packaged Rates , See APC Packaged Rates , $120.78 , $120.78 , See APC Packaged Rates , See APC Packaged Rates , $337.30 , $337.30 , $337.30 , $337.30 , See APC Packaged Rates , $126.94 , $- , $- , $351.48 , $253.88
C1713,61515749,Hospital Chargemaster,4M Lock Screw 4.0M / L30,Outpatient,Outpatient Default Percent / Case Rate,278, $393.72 , $216.55 , $324.43 , See APC Packaged Rates , $275.60 , $153.55 , $379.90 , $381.55 , $202.77 , See APC Packaged Rates , See APC Packaged Rates , $131.11 , $131.11 , See APC Packaged Rates , See APC Packaged Rates , $366.16 , $366.16 , $366.16 , $366.16 , See APC Packaged Rates , $137.80 , $- , $- , $381.55 , $275.60
C1713,61515750,Hospital Chargemaster,4M Lock Screw 4.0M / L32M,Outpatient,Outpatient Default Percent / Case Rate,278, $362.69 , $199.48 , $298.86 , See APC Packaged Rates , $253.88 , $141.45 , $349.96 , $351.48 , $186.79 , See APC Packaged Rates , See APC Packaged Rates , $120.78 , $120.78 , See APC Packaged Rates , See APC Packaged Rates , $337.30 , $337.30 , $337.30 , $337.30 , See APC Packaged Rates , $126.94 , $- , $- , $351.48 , $253.88
C1713,61515751,Hospital Chargemaster,4M Lock Screw 4.0M / L36M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515752,Hospital Chargemaster,4M Lock Screw 4.0M / L40M,Outpatient,Outpatient Default Percent / Case Rate,278, $414.41 , $227.93 , $341.47 , See APC Packaged Rates , $290.09 , $161.62 , $399.86 , $401.60 , $213.43 , See APC Packaged Rates , See APC Packaged Rates , $138.00 , $138.00 , See APC Packaged Rates , See APC Packaged Rates , $385.40 , $385.40 , $385.40 , $385.40 , See APC Packaged Rates , $145.04 , $- , $- , $401.60 , $290.09
C1713,61515753,Hospital Chargemaster,4M Lock Screw 4.0M / L44M,Outpatient,Outpatient Default Percent / Case Rate,278, $414.41 , $227.93 , $341.47 , See APC Packaged Rates , $290.09 , $161.62 , $399.86 , $401.60 , $213.43 , See APC Packaged Rates , See APC Packaged Rates , $138.00 , $138.00 , See APC Packaged Rates , See APC Packaged Rates , $385.40 , $385.40 , $385.40 , $385.40 , See APC Packaged Rates , $145.04 , $- , $- , $401.60 , $290.09
C1713,61515754,Hospital Chargemaster,4M Lock Screw 4.0M / L46M,Outpatient,Outpatient Default Percent / Case Rate,278, $414.41 , $227.93 , $341.47 , See APC Packaged Rates , $290.09 , $161.62 , $399.86 , $401.60 , $213.43 , See APC Packaged Rates , See APC Packaged Rates , $138.00 , $138.00 , See APC Packaged Rates , See APC Packaged Rates , $385.40 , $385.40 , $385.40 , $385.40 , See APC Packaged Rates , $145.04 , $- , $- , $401.60 , $290.09
C1713,61515755,Hospital Chargemaster,4M Lock Screw 4.0M / L48M,Outpatient,Outpatient Default Percent / Case Rate,278, $388.55 , $213.70 , $320.17 , See APC Packaged Rates , $271.99 , $151.53 , $374.91 , $376.54 , $200.11 , See APC Packaged Rates , See APC Packaged Rates , $129.39 , $129.39 , See APC Packaged Rates , See APC Packaged Rates , $361.35 , $361.35 , $361.35 , $361.35 , See APC Packaged Rates , $135.99 , $- , $- , $376.54 , $271.99
C1713,61515757,Hospital Chargemaster,4M Lock Screw 4.0M / L60M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515758,Hospital Chargemaster,4M Lock Screw 4.0M / L75M,Outpatient,Outpatient Default Percent / Case Rate,278, $414.41 , $227.93 , $341.47 , See APC Packaged Rates , $290.09 , $161.62 , $399.86 , $401.60 , $213.43 , See APC Packaged Rates , See APC Packaged Rates , $138.00 , $138.00 , See APC Packaged Rates , See APC Packaged Rates , $385.40 , $385.40 , $385.40 , $385.40 , See APC Packaged Rates , $145.04 , $- , $- , $401.60 , $290.09
C1713,61515759,Hospital Chargemaster,4M Lock Screw 4.0M / L80M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515760,Hospital Chargemaster,4M Lock Screw 4.0M / L85M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515761,Hospital Chargemaster,4M Lock Screw 4.0M / L90M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515762,Hospital Chargemaster,4M Lock Screw 4.0M / L95M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515763,Hospital Chargemaster,5M Lock Screw 5.0M / L14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515764,Hospital Chargemaster,5M Lock Screw 5.0M / L16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515765,Hospital Chargemaster,5M Lock Screw 5.0M / L18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515766,Hospital Chargemaster,5M Lock Screw 5.0M / L20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515767,Hospital Chargemaster,5M Lock Screw 5.0M / L22M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515768,Hospital Chargemaster,5M Lock Screw 5.0M / L24M,Outpatient,Outpatient Default Percent / Case Rate,278, $383.04 , $210.67 , $315.62 , See APC Packaged Rates , $268.13 , $149.39 , $369.60 , $371.20 , $197.27 , See APC Packaged Rates , See APC Packaged Rates , $127.55 , $127.55 , See APC Packaged Rates , See APC Packaged Rates , $356.23 , $356.23 , $356.23 , $356.23 , See APC Packaged Rates , $134.06 , $- , $- , $371.20 , $268.13
C1713,61515769,Hospital Chargemaster,5M Lock Screw 5.0M / L26M,Outpatient,Outpatient Default Percent / Case Rate,278, $437.60 , $240.68 , $360.58 , See APC Packaged Rates , $306.32 , $170.66 , $422.24 , $424.08 , $225.37 , See APC Packaged Rates , See APC Packaged Rates , $145.72 , $145.72 , See APC Packaged Rates , See APC Packaged Rates , $406.97 , $406.97 , $406.97 , $406.97 , See APC Packaged Rates , $153.16 , $- , $- , $424.08 , $306.32
C1713,61515770,Hospital Chargemaster,5M Lock Screw 5.0M / L28M,Outpatient,Outpatient Default Percent / Case Rate,278, $437.60 , $240.68 , $360.58 , See APC Packaged Rates , $306.32 , $170.66 , $422.24 , $424.08 , $225.37 , See APC Packaged Rates , See APC Packaged Rates , $145.72 , $145.72 , See APC Packaged Rates , See APC Packaged Rates , $406.97 , $406.97 , $406.97 , $406.97 , See APC Packaged Rates , $153.16 , $- , $- , $424.08 , $306.32
C1713,61515771,Hospital Chargemaster,5M Lock Screw 5.0M / L30,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515772,Hospital Chargemaster,5M Lock Screw 5.0M / L34M,Outpatient,Outpatient Default Percent / Case Rate,278, $437.60 , $240.68 , $360.58 , See APC Packaged Rates , $306.32 , $170.66 , $422.24 , $424.08 , $225.37 , See APC Packaged Rates , See APC Packaged Rates , $145.72 , $145.72 , See APC Packaged Rates , See APC Packaged Rates , $406.97 , $406.97 , $406.97 , $406.97 , See APC Packaged Rates , $153.16 , $- , $- , $424.08 , $306.32
C1713,61515773,Hospital Chargemaster,5M Lock Screw 5.0M / L38M,Outpatient,Outpatient Default Percent / Case Rate,278, $437.60 , $240.68 , $360.58 , See APC Packaged Rates , $306.32 , $170.66 , $422.24 , $424.08 , $225.37 , See APC Packaged Rates , See APC Packaged Rates , $145.72 , $145.72 , See APC Packaged Rates , See APC Packaged Rates , $406.97 , $406.97 , $406.97 , $406.97 , See APC Packaged Rates , $153.16 , $- , $- , $424.08 , $306.32
C1713,61515774,Hospital Chargemaster,5M Lock Screw 5.0M / L42M,Outpatient,Outpatient Default Percent / Case Rate,278, $437.60 , $240.68 , $360.58 , See APC Packaged Rates , $306.32 , $170.66 , $422.24 , $424.08 , $225.37 , See APC Packaged Rates , See APC Packaged Rates , $145.72 , $145.72 , See APC Packaged Rates , See APC Packaged Rates , $406.97 , $406.97 , $406.97 , $406.97 , See APC Packaged Rates , $153.16 , $- , $- , $424.08 , $306.32
C1713,61515775,Hospital Chargemaster,5M Lock Screw 5.0M / L44M,Outpatient,Outpatient Default Percent / Case Rate,278, $437.60 , $240.68 , $360.58 , See APC Packaged Rates , $306.32 , $170.66 , $422.24 , $424.08 , $225.37 , See APC Packaged Rates , See APC Packaged Rates , $145.72 , $145.72 , See APC Packaged Rates , See APC Packaged Rates , $406.97 , $406.97 , $406.97 , $406.97 , See APC Packaged Rates , $153.16 , $- , $- , $424.08 , $306.32
C1713,61515776,Hospital Chargemaster,5M Lock Screw 5.0M / L48M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515777,Hospital Chargemaster,5M Lock Screw 5.0M / L55M,Outpatient,Outpatient Default Percent / Case Rate,278, $437.60 , $240.68 , $360.58 , See APC Packaged Rates , $306.32 , $170.66 , $422.24 , $424.08 , $225.37 , See APC Packaged Rates , See APC Packaged Rates , $145.72 , $145.72 , See APC Packaged Rates , See APC Packaged Rates , $406.97 , $406.97 , $406.97 , $406.97 , See APC Packaged Rates , $153.16 , $- , $- , $424.08 , $306.32
C1713,61515778,Hospital Chargemaster,5M Lock Screw 5.0M / L60M,Outpatient,Outpatient Default Percent / Case Rate,278, $437.60 , $240.68 , $360.58 , See APC Packaged Rates , $306.32 , $170.66 , $422.24 , $424.08 , $225.37 , See APC Packaged Rates , See APC Packaged Rates , $145.72 , $145.72 , See APC Packaged Rates , See APC Packaged Rates , $406.97 , $406.97 , $406.97 , $406.97 , See APC Packaged Rates , $153.16 , $- , $- , $424.08 , $306.32
C1713,61515779,Hospital Chargemaster,5M Lock Screw 5.0M / L65M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515780,Hospital Chargemaster,5M Lock Screw 5.0M / L85M,Outpatient,Outpatient Default Percent / Case Rate,278, $437.60 , $240.68 , $360.58 , See APC Packaged Rates , $306.32 , $170.66 , $422.24 , $424.08 , $225.37 , See APC Packaged Rates , See APC Packaged Rates , $145.72 , $145.72 , See APC Packaged Rates , See APC Packaged Rates , $406.97 , $406.97 , $406.97 , $406.97 , See APC Packaged Rates , $153.16 , $- , $- , $424.08 , $306.32
C1713,61515781,Hospital Chargemaster,5M Lock Screw 5.0M / L90M,Outpatient,Outpatient Default Percent / Case Rate,278, $437.60 , $240.68 , $360.58 , See APC Packaged Rates , $306.32 , $170.66 , $422.24 , $424.08 , $225.37 , See APC Packaged Rates , See APC Packaged Rates , $145.72 , $145.72 , See APC Packaged Rates , See APC Packaged Rates , $406.97 , $406.97 , $406.97 , $406.97 , See APC Packaged Rates , $153.16 , $- , $- , $424.08 , $306.32
C1713,61515782,Hospital Chargemaster,5M Lock Screw 5.0M / L95M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515783,Hospital Chargemaster,Periprosthetic Lock Screw 5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515784,Hospital Chargemaster,Periprosthetic Lock Screw 5,Outpatient,Outpatient Default Percent / Case Rate,278, $505.70 , $278.14 , $416.70 , See APC Packaged Rates , $353.99 , $197.22 , $487.95 , $490.07 , $260.45 , See APC Packaged Rates , See APC Packaged Rates , $168.40 , $168.40 , See APC Packaged Rates , See APC Packaged Rates , $470.30 , $470.30 , $470.30 , $470.30 , See APC Packaged Rates , $177.00 , $- , $- , $490.07 , $353.99
C1713,61515785,Hospital Chargemaster,Periprosthetic Lock Screw 5,Outpatient,Outpatient Default Percent / Case Rate,278, $505.70 , $278.14 , $416.70 , See APC Packaged Rates , $353.99 , $197.22 , $487.95 , $490.07 , $260.45 , See APC Packaged Rates , See APC Packaged Rates , $168.40 , $168.40 , See APC Packaged Rates , See APC Packaged Rates , $470.30 , $470.30 , $470.30 , $470.30 , See APC Packaged Rates , $177.00 , $- , $- , $490.07 , $353.99
C1713,61515786,Hospital Chargemaster,Periprosthetic Lock Screw 5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515787,Hospital Chargemaster,Periprosthetic Lock Screw 5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515789,Hospital Chargemaster,Cann 4.0M Twist Drill W/ Ao,Outpatient,Outpatient Default Percent / Case Rate,278, $603.86 , $332.12 , $497.58 , See APC Packaged Rates , $422.70 , $235.51 , $582.66 , $585.20 , $311.00 , See APC Packaged Rates , See APC Packaged Rates , $201.09 , $201.09 , See APC Packaged Rates , See APC Packaged Rates , $561.59 , $561.59 , $561.59 , $561.59 , See APC Packaged Rates , $211.35 , $- , $- , $585.20 , $422.70
C1713,61515811,Hospital Chargemaster,"Tap Ao, For 3.5M Screws",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515812,Hospital Chargemaster,"Tap Ao, For 2.7M Screws",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515813,Hospital Chargemaster,"Tap Ao, For 2.4M Screws",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515814,Hospital Chargemaster,"Drill Bit, Ao, Scaled2.6 X 2",Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515815,Hospital Chargemaster,Temp. Plate Fixator Ao Fittin,Outpatient,Outpatient Default Percent / Case Rate,278, $597.74 , $328.76 , $492.54 , See APC Packaged Rates , $418.42 , $233.12 , $576.76 , $579.27 , $307.85 , See APC Packaged Rates , See APC Packaged Rates , $199.05 , $199.05 , See APC Packaged Rates , See APC Packaged Rates , $555.90 , $555.90 , $555.90 , $555.90 , See APC Packaged Rates , $209.21 , $- , $- , $579.27 , $418.42
C1713,61515818,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X40M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515819,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X45M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515820,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X55M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515821,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X60M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515822,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X75M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515823,Hospital Chargemaster,Asnis Iii Ss Cann Scr6.5X100M,Outpatient,Outpatient Default Percent / Case Rate,278, $615.26 , $338.39 , $506.97 , See APC Packaged Rates , $430.68 , $239.95 , $593.66 , $596.25 , $316.87 , See APC Packaged Rates , See APC Packaged Rates , $204.88 , $204.88 , See APC Packaged Rates , See APC Packaged Rates , $572.19 , $572.19 , $572.19 , $572.19 , See APC Packaged Rates , $215.34 , $- , $- , $596.25 , $430.68
C1713,61515824,Hospital Chargemaster,Asnis Iii Ss Cann Scr6.5X105M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515825,Hospital Chargemaster,Asnis Iii Ss Cann Scr6.5X110M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515826,Hospital Chargemaster,Asnis Iii Ss Cann Scr6.5X115M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515827,Hospital Chargemaster,Asnis Iii Ss Cann Scr6.5X120M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515828,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X55M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515829,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X60M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515830,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X65M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515831,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X70M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515832,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X75M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515833,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X80M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515834,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X85M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515835,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X95M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515836,Hospital Chargemaster,Asnis Iii Ss Cann Scr6.5X100M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515837,Hospital Chargemaster,Asnis Iii Ss Cann Scr6.5X105M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515838,Hospital Chargemaster,Asnis Iii Ss Cann Scr6.5X110M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515839,Hospital Chargemaster,Asnis Iii Ss Cann Scr6.5X115M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515840,Hospital Chargemaster,Asnis Iii Ss Cann Scr6.5X120M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515841,Hospital Chargemaster,Asnis Iii Ss Cann Scr 8X40M P,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515842,Hospital Chargemaster,Asnis Iii Ss Cann Scr 8X45M P,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515843,Hospital Chargemaster,Asnis Iii Ss Cann Scr 8X50M P,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515844,Hospital Chargemaster,Asnis Iii Ss Cann Scr 8X55M P,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515845,Hospital Chargemaster,Asnis Iii Ss Cann Scr 8X60M P,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515846,Hospital Chargemaster,Asnis Iii Ss Cann Scr 8X65M P,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515847,Hospital Chargemaster,Asnis Iii Ss Cann Scr 8X70M P,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515848,Hospital Chargemaster,Asnis Iii Ss Cann Scr 8X75M P,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515849,Hospital Chargemaster,Asnis Iii Ss Cann Scr 8X105M,Outpatient,Outpatient Default Percent / Case Rate,278, $615.26 , $338.39 , $506.97 , See APC Packaged Rates , $430.68 , $239.95 , $593.66 , $596.25 , $316.87 , See APC Packaged Rates , See APC Packaged Rates , $204.88 , $204.88 , See APC Packaged Rates , See APC Packaged Rates , $572.19 , $572.19 , $572.19 , $572.19 , See APC Packaged Rates , $215.34 , $- , $- , $596.25 , $430.68
C1713,61515850,Hospital Chargemaster,Asnis Iii Ss Cann Scr 8X110M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515851,Hospital Chargemaster,Asnis Iii Ss Cann Scr 8X115M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515852,Hospital Chargemaster,Asnis Iii Ss Cann Scr 8X120M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515853,Hospital Chargemaster,Distal Lateral Fibula Plate 6,Outpatient,Outpatient Default Percent / Case Rate,278," $1,427.90 ", $785.35 ," $1,176.59 ", See APC Packaged Rates , $999.53 , $556.88 ," $1,377.78 "," $1,383.78 ", $735.40 , See APC Packaged Rates , See APC Packaged Rates , $475.49 , $475.49 , See APC Packaged Rates , See APC Packaged Rates ," $1,327.95 "," $1,327.95 "," $1,327.95 "," $1,327.95 ", See APC Packaged Rates , $499.77 , $- , $- ," $1,383.78 ", $999.53
C1713,61515854,Hospital Chargemaster,Distal Lateral Fibula Plate 7,Outpatient,Outpatient Default Percent / Case Rate,278," $1,622.88 ", $892.58 ," $1,337.25 ", See APC Packaged Rates ," $1,136.02 ", $632.92 ," $1,565.92 "," $1,572.73 ", $835.82 , See APC Packaged Rates , See APC Packaged Rates , $540.42 , $540.42 , See APC Packaged Rates , See APC Packaged Rates ," $1,509.28 "," $1,509.28 "," $1,509.28 "," $1,509.28 ", See APC Packaged Rates , $568.01 , $- , $- ," $1,572.73 "," $1,136.02 "
C1713,61515855,Hospital Chargemaster,Distal Lateral Fibula Plate 8,Outpatient,Outpatient Default Percent / Case Rate,278," $1,622.88 ", $892.58 ," $1,337.25 ", See APC Packaged Rates ," $1,136.02 ", $632.92 ," $1,565.92 "," $1,572.73 ", $835.82 , See APC Packaged Rates , See APC Packaged Rates , $540.42 , $540.42 , See APC Packaged Rates , See APC Packaged Rates ," $1,509.28 "," $1,509.28 "," $1,509.28 "," $1,509.28 ", See APC Packaged Rates , $568.01 , $- , $- ," $1,572.73 "," $1,136.02 "
C1713,61515856,Hospital Chargemaster,Distal Lateral Fibula Plate 9,Outpatient,Outpatient Default Percent / Case Rate,278," $1,622.88 ", $892.58 ," $1,337.25 ", See APC Packaged Rates ," $1,136.02 ", $632.92 ," $1,565.92 "," $1,572.73 ", $835.82 , See APC Packaged Rates , See APC Packaged Rates , $540.42 , $540.42 , See APC Packaged Rates , See APC Packaged Rates ," $1,509.28 "," $1,509.28 "," $1,509.28 "," $1,509.28 ", See APC Packaged Rates , $568.01 , $- , $- ," $1,572.73 "," $1,136.02 "
C1713,61515857,Hospital Chargemaster,Countersink For Screws 02.73.,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515858,Hospital Chargemaster,Hii Mri 10 Hole Pin Clamp,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515859,Hospital Chargemaster,Hoffmann3 Rod To Rod Coupling,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515860,Hospital Chargemaster,Rod To Rod Coupling Multiplan,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515861,Hospital Chargemaster,Hoffmann3 Pin To Rod Coupling,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515862,Hospital Chargemaster,Pin To Rod Coupling Multiplan,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515863,Hospital Chargemaster,Hoffmann3 Pin To Rod Coupling,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515864,Hospital Chargemaster,Hoffmann3 5 Hole Pin Clamp Di,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515865,Hospital Chargemaster,Hoffmann3 Post Straight Dia 1,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515866,Hospital Chargemaster,Hoffmann3 Post 30 Deg Angled,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515867,Hospital Chargemaster,Hoffmann3 5 Hole Pin Clamp 2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515868,Hospital Chargemaster,Hoffmann3 Connect Rod Dia 1,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515869,Hospital Chargemaster,Hoffmann3 Connect Rod Dia 1,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515870,Hospital Chargemaster,Hoffmann3 Connect Rod Dia 1,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515871,Hospital Chargemaster,Hoffmann3 Connect Rod Dia 1,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515872,Hospital Chargemaster,Hoffmann3 Connect Rod Dia 1,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515873,Hospital Chargemaster,Hoffmann3 Connect Rod Dia 1,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515874,Hospital Chargemaster,Hoffmann3 Connect Rod Dia 1,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515875,Hospital Chargemaster,Hoffmann3 Connect Rod Dia 1,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515876,Hospital Chargemaster,5X120 Apex SD Half Pin 35 Thr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515877,Hospital Chargemaster,5X150 Apex SD Half Pin 40 Thr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515878,Hospital Chargemaster,5X180 Apex SD Half Pin 50 Thr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515879,Hospital Chargemaster,5X200 Apex SD Half Pin 60 Thr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515880,Hospital Chargemaster,5X250 Apex SD Half Pin 70 Thr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515881,Hospital Chargemaster,SelfDrilling Half Pin Apex Di,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515882,Hospital Chargemaster,Apex Transfix 4X250 Pin 5X50T,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515883,Hospital Chargemaster,Gray Pt Drill 3.2Mx200M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515884,Hospital Chargemaster,Gray Pt Drill 4.0Mx200M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515885,Hospital Chargemaster,Gray Pt Drill 4.5Mx200M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515886,Hospital Chargemaster,Dorsal Smartloc Plate Standa,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515887,Hospital Chargemaster,Dorsal Smartloc Plate Standa,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515888,Hospital Chargemaster,Dorsal Smartloc Plate Wide R,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515889,Hospital Chargemaster,Dorsal Smartloc Plate Wide Lt,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515890,Hospital Chargemaster,Dorsal Smartloc Dr Plate Stan,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515891,Hospital Chargemaster,Dorsal Smartloc Dr Plate Stan,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515892,Hospital Chargemaster,Dorsal Smartloc Dr Plate Wide,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515893,Hospital Chargemaster,Dorsal Smartloc Dr Plate Wide,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515894,Hospital Chargemaster,Volar Smartloc Dr Plate Narr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515895,Hospital Chargemaster,Volar Smartloc Dr Plate Narr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515896,Hospital Chargemaster,Volar Smartloc Dr Plate Stan,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515897,Hospital Chargemaster,Volar Smartloc Dr Plate Stan,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515898,Hospital Chargemaster,Volar Smartloc Dr Plate Narr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515899,Hospital Chargemaster,Volar Smartloc Dr Plate Narr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515900,Hospital Chargemaster,Volar Smartloc Dr Plate Stan,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515901,Hospital Chargemaster,Volar Smartloc Dr Plate Stan,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515902,Hospital Chargemaster,Radial Column Smartlock Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515903,Hospital Chargemaster,Radial Column Smartlock Plate,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515904,Hospital Chargemaster,Ulnar Column Smartloc Plate S,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515905,Hospital Chargemaster,Ulnar Column Smartloc Plate S,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515906,Hospital Chargemaster,Ulnar Column Smartloc Plate L,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515907,Hospital Chargemaster,Ulnar Column Smartloc Plate L,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515908,Hospital Chargemaster,Volar Dr Plate Narrow Lt 8 H,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515909,Hospital Chargemaster,Volar Dr Plate Inter L,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515910,Hospital Chargemaster,Volar Dr Plate Inter L,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515911,Hospital Chargemaster,Volar Dr Plate Inter L,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515912,Hospital Chargemaster,Volar Dr Plate Inter R,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515913,Hospital Chargemaster,Volar Dr Plate Inter R,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515914,Hospital Chargemaster,Volar Dr Plate Inter R,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515915,Hospital Chargemaster,Volar Dr Plate Stand Lt 10,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515916,Hospital Chargemaster,Volar Dr Plate Stand Rt 10,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515917,Hospital Chargemaster,4.0 X14M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515918,Hospital Chargemaster,4.0 X16M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515919,Hospital Chargemaster,4.0 X18M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515920,Hospital Chargemaster,4.0 X20M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515921,Hospital Chargemaster,4.0 X22M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515922,Hospital Chargemaster,4.0 X24M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515923,Hospital Chargemaster,4.0 X26M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515924,Hospital Chargemaster,4.0 X28M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515925,Hospital Chargemaster,4.0 X30M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515926,Hospital Chargemaster,4.0 X32M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $386.63 , $212.65 , $318.58 , See APC Packaged Rates , $270.64 , $150.79 , $373.06 , $374.68 , $199.12 , See APC Packaged Rates , See APC Packaged Rates , $128.75 , $128.75 , See APC Packaged Rates , See APC Packaged Rates , $359.57 , $359.57 , $359.57 , $359.57 , See APC Packaged Rates , $135.32 , $- , $- , $374.68 , $270.64
C1713,61515927,Hospital Chargemaster,4.0 X34M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515928,Hospital Chargemaster,4.0 X36M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $348.77 , $191.82 , $287.39 , See APC Packaged Rates , $244.14 , $136.02 , $336.53 , $337.99 , $179.62 , See APC Packaged Rates , See APC Packaged Rates , $116.14 , $116.14 , See APC Packaged Rates , See APC Packaged Rates , $324.36 , $324.36 , $324.36 , $324.36 , See APC Packaged Rates , $122.07 , $- , $- , $337.99 , $244.14
C1713,61515929,Hospital Chargemaster,4.0 X38M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $348.77 , $191.82 , $287.39 , See APC Packaged Rates , $244.14 , $136.02 , $336.53 , $337.99 , $179.62 , See APC Packaged Rates , See APC Packaged Rates , $116.14 , $116.14 , See APC Packaged Rates , See APC Packaged Rates , $324.36 , $324.36 , $324.36 , $324.36 , See APC Packaged Rates , $122.07 , $- , $- , $337.99 , $244.14
C1713,61515930,Hospital Chargemaster,4.0 X40M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $348.77 , $191.82 , $287.39 , See APC Packaged Rates , $244.14 , $136.02 , $336.53 , $337.99 , $179.62 , See APC Packaged Rates , See APC Packaged Rates , $116.14 , $116.14 , See APC Packaged Rates , See APC Packaged Rates , $324.36 , $324.36 , $324.36 , $324.36 , See APC Packaged Rates , $122.07 , $- , $- , $337.99 , $244.14
C1713,61515931,Hospital Chargemaster,4.0 X42M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $386.63 , $212.65 , $318.58 , See APC Packaged Rates , $270.64 , $150.79 , $373.06 , $374.68 , $199.12 , See APC Packaged Rates , See APC Packaged Rates , $128.75 , $128.75 , See APC Packaged Rates , See APC Packaged Rates , $359.57 , $359.57 , $359.57 , $359.57 , See APC Packaged Rates , $135.32 , $- , $- , $374.68 , $270.64
C1713,61515932,Hospital Chargemaster,4.0 X50M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $355.08 , $195.29 , $292.59 , See APC Packaged Rates , $248.56 , $138.48 , $342.62 , $344.11 , $182.87 , See APC Packaged Rates , See APC Packaged Rates , $118.24 , $118.24 , See APC Packaged Rates , See APC Packaged Rates , $330.22 , $330.22 , $330.22 , $330.22 , See APC Packaged Rates , $124.28 , $- , $- , $344.11 , $248.56
C1713,61515933,Hospital Chargemaster,4.0 X55M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $367.70 , $202.24 , $302.98 , See APC Packaged Rates , $257.39 , $143.40 , $354.79 , $356.34 , $189.37 , See APC Packaged Rates , See APC Packaged Rates , $122.44 , $122.44 , See APC Packaged Rates , See APC Packaged Rates , $341.96 , $341.96 , $341.96 , $341.96 , See APC Packaged Rates , $128.70 , $- , $- , $356.34 , $257.39
C1713,61515934,Hospital Chargemaster,4.0 X60M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $348.77 , $191.82 , $287.39 , See APC Packaged Rates , $244.14 , $136.02 , $336.53 , $337.99 , $179.62 , See APC Packaged Rates , See APC Packaged Rates , $116.14 , $116.14 , See APC Packaged Rates , See APC Packaged Rates , $324.36 , $324.36 , $324.36 , $324.36 , See APC Packaged Rates , $122.07 , $- , $- , $337.99 , $244.14
C1713,61515935,Hospital Chargemaster,4.0 X65M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $348.77 , $191.82 , $287.39 , See APC Packaged Rates , $244.14 , $136.02 , $336.53 , $337.99 , $179.62 , See APC Packaged Rates , See APC Packaged Rates , $116.14 , $116.14 , See APC Packaged Rates , See APC Packaged Rates , $324.36 , $324.36 , $324.36 , $324.36 , See APC Packaged Rates , $122.07 , $- , $- , $337.99 , $244.14
C1713,61515936,Hospital Chargemaster,4.0 X70M Ti Cannulated Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $386.63 , $212.65 , $318.58 , See APC Packaged Rates , $270.64 , $150.79 , $373.06 , $374.68 , $199.12 , See APC Packaged Rates , See APC Packaged Rates , $128.75 , $128.75 , See APC Packaged Rates , See APC Packaged Rates , $359.57 , $359.57 , $359.57 , $359.57 , See APC Packaged Rates , $135.32 , $- , $- , $374.68 , $270.64
C1713,61515937,Hospital Chargemaster,2.5M Headed Screw Len 10M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515938,Hospital Chargemaster,2.5M Headed Screw Len 12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515939,Hospital Chargemaster,2.5M Headed Screw Len 14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515940,Hospital Chargemaster,2.5M Headed Screw Len 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515941,Hospital Chargemaster,2.5M Headed Screw Len 18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515942,Hospital Chargemaster,2.5M Headed Screw Len 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515943,Hospital Chargemaster,2.5M Headed Screw Len 22M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515944,Hospital Chargemaster,2.5M Headed Screw Len 24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515945,Hospital Chargemaster,2.5M Headed Screw Len 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515946,Hospital Chargemaster,2.5M Headed Screw Len 28M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515947,Hospital Chargemaster,2.5M Headed Screw Len 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515948,Hospital Chargemaster,2.5M Headed Screw Len 32M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515949,Hospital Chargemaster,2.5M Headed Screw Len 34M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515950,Hospital Chargemaster,2.5M Headed Screw Len 36M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515951,Hospital Chargemaster,2.5M Headed Screw Len 38M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515952,Hospital Chargemaster,2.5M Headed Screw Len 40M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515953,Hospital Chargemaster,3.0M Headed Screw Len 10M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515954,Hospital Chargemaster,3.0M Headed Screw Len 12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515955,Hospital Chargemaster,3.0M Headed Screw Len 14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515956,Hospital Chargemaster,3.0M Headed Screw Len 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515957,Hospital Chargemaster,3.0M Headed Screw Len 18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515958,Hospital Chargemaster,3.0M Headed Screw Len 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515959,Hospital Chargemaster,3.0M Headed Screw Len 22M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515960,Hospital Chargemaster,3.0M Headed Screw Len 24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515961,Hospital Chargemaster,3.0M Headed Screw Len 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515962,Hospital Chargemaster,3.0M Headed Screw Len 28M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515963,Hospital Chargemaster,3.0M Headed Screw Len 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $427.33 , $235.03 , $352.12 , See APC Packaged Rates , $299.13 , $166.66 , $412.33 , $414.13 , $220.08 , See APC Packaged Rates , See APC Packaged Rates , $142.30 , $142.30 , See APC Packaged Rates , See APC Packaged Rates , $397.42 , $397.42 , $397.42 , $397.42 , See APC Packaged Rates , $149.57 , $- , $- , $414.13 , $299.13
C1713,61515964,Hospital Chargemaster,3.0M Headed Screw Len 32M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515965,Hospital Chargemaster,3.0M Headed Screw Len 34M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515966,Hospital Chargemaster,3.0M Headed Screw Len 36M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515967,Hospital Chargemaster,3.0M Headed Screw Len 38M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515968,Hospital Chargemaster,3.0M Headed Screw Len 40M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515969,Hospital Chargemaster,4.0M Headed Screw Len 12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515970,Hospital Chargemaster,4.0M Headed Screw Len 14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515971,Hospital Chargemaster,4.0M Headed Screw Len 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515972,Hospital Chargemaster,4.0M Headed Screw Len 18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515973,Hospital Chargemaster,4.0M Headed Screw Len 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515974,Hospital Chargemaster,4.0M Headed Screw Len 22M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515975,Hospital Chargemaster,4.0M Headed Screw Len 24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515976,Hospital Chargemaster,4.0M Headed Screw Len 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515977,Hospital Chargemaster,4.0M Headed Screw Len 28M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515978,Hospital Chargemaster,4.0M Headed Screw Len 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515979,Hospital Chargemaster,4.0M Headed Screw Len 32M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515980,Hospital Chargemaster,4.0M Headed Screw Len 34M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515981,Hospital Chargemaster,4.0M Headed Screw Len 36M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515982,Hospital Chargemaster,4.0M Headed Screw Len 38M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515983,Hospital Chargemaster,4.0M Headed Screw Len 40M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515984,Hospital Chargemaster,4.0M Headed Screw Len 42M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515985,Hospital Chargemaster,4.0M Headed Screw Len 44M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515986,Hospital Chargemaster,4.0M Headed Screw Len 46M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515987,Hospital Chargemaster,4.0M Headed Screw Len 48M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515988,Hospital Chargemaster,4.0M Headed Screw Len 50M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515989,Hospital Chargemaster,2.5M Headless Screw Len 10M,Outpatient,Outpatient Default Percent / Case Rate,278, $744.53 , $409.49 , $613.49 , See APC Packaged Rates , $521.17 , $290.37 , $718.40 , $721.52 , $383.45 , See APC Packaged Rates , See APC Packaged Rates , $247.93 , $247.93 , See APC Packaged Rates , See APC Packaged Rates , $692.41 , $692.41 , $692.41 , $692.41 , See APC Packaged Rates , $260.59 , $- , $- , $721.52 , $521.17
C1713,61515990,Hospital Chargemaster,2.5M Headless Screw Len 12M,Outpatient,Outpatient Default Percent / Case Rate,278, $710.96 , $391.03 , $585.83 , See APC Packaged Rates , $497.67 , $277.27 , $686.01 , $688.99 , $366.16 , See APC Packaged Rates , See APC Packaged Rates , $236.75 , $236.75 , See APC Packaged Rates , See APC Packaged Rates , $661.19 , $661.19 , $661.19 , $661.19 , See APC Packaged Rates , $248.84 , $- , $- , $688.99 , $497.67
C1713,61515991,Hospital Chargemaster,2.5M Headless Screw Len 14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515992,Hospital Chargemaster,2.5M Headless Screw Len 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515993,Hospital Chargemaster,2.5M Headless Screw Len 18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515994,Hospital Chargemaster,2.5M Headless Screw Len 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515995,Hospital Chargemaster,2.5M Headless Screw Len 22M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515996,Hospital Chargemaster,2.5M Headless Screw Len 24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515997,Hospital Chargemaster,2.5M Headless Screw Len 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515998,Hospital Chargemaster,2.5M Headless Screw Len 28M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61515999,Hospital Chargemaster,2.5M Headless Screw Len 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516034,Hospital Chargemaster,4.0Mm Headless Screw Len 38Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516035,Hospital Chargemaster,4.0mm headless screw,Outpatient,Outpatient Default Percent / Case Rate,278, $677.38 , $372.56 , $558.16 , See APC Packaged Rates , $474.17 , $264.18 , $653.60 , $656.45 , $348.86 , See APC Packaged Rates , See APC Packaged Rates , $225.57 , $225.57 , See APC Packaged Rates , See APC Packaged Rates , $629.96 , $629.96 , $629.96 , $629.96 , See APC Packaged Rates , $237.08 , $- , $- , $656.45 , $474.17
C1713,61516036,Hospital Chargemaster,4.0Mm Headless Screw Len 42Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516037,Hospital Chargemaster,4.0Mm Headless Screw Len 44Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516039,Hospital Chargemaster,4.0Mm Headless Screw Len 50Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516043,Hospital Chargemaster,Bonescrew 3.5M X 14M Ti,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516044,Hospital Chargemaster,Bonescrew 3.5M X 16M Ti,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516045,Hospital Chargemaster,Bonescrew 3.5M X 30M Ti,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516046,Hospital Chargemaster,Socket Insert Sm Ar 32M Semi,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516047,Hospital Chargemaster,Humeral Stem Altivate Humeral,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516048,Hospital Chargemaster,4M Lock Screw 4.0M / L55M,Outpatient,Outpatient Default Percent / Case Rate,278, $362.69 , $199.48 , $298.86 , See APC Packaged Rates , $253.88 , $141.45 , $349.96 , $351.48 , $186.79 , See APC Packaged Rates , See APC Packaged Rates , $120.78 , $120.78 , See APC Packaged Rates , See APC Packaged Rates , $337.30 , $337.30 , $337.30 , $337.30 , See APC Packaged Rates , $126.94 , $- , $- , $351.48 , $253.88
C1713,61516049,Hospital Chargemaster,2.5M Headless Screw Len 32M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516050,Hospital Chargemaster,2.5M Headless Screw Len 34M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516051,Hospital Chargemaster,2.5M Headless Screw Len 36M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516052,Hospital Chargemaster,2.5M Headless Screw Len 38M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516053,Hospital Chargemaster,2.5M Headless Screw Len 40M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516054,Hospital Chargemaster,3.0M Headless Screw Len 10M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516055,Hospital Chargemaster,3.0M Headless Screw Len 12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516056,Hospital Chargemaster,3.0M Headless Screw Len 14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516057,Hospital Chargemaster,3.0M Headless Screw Len 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516058,Hospital Chargemaster,3.0M Headless Screw Len 18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516059,Hospital Chargemaster,3.0M Headless Screw Len 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516060,Hospital Chargemaster,3.0M Headless Screw Len 22M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516061,Hospital Chargemaster,3.0M Headless Screw Len 24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516062,Hospital Chargemaster,3.0M Headless Screw Len 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516063,Hospital Chargemaster,3.0M Headless Screw Len 28M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516064,Hospital Chargemaster,3.0M Headless Screw Len 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516065,Hospital Chargemaster,3.0M Headless Screw Len 32M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516066,Hospital Chargemaster,3.0M Headless Screw Len 34M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516067,Hospital Chargemaster,3.0M Headless Screw Len 36M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516068,Hospital Chargemaster,3.0M Headless Screw Len 38M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516069,Hospital Chargemaster,3.0M Headless Screw Len 40M,Outpatient,Outpatient Default Percent / Case Rate,278, $744.53 , $409.49 , $613.49 , See APC Packaged Rates , $521.17 , $290.37 , $718.40 , $721.52 , $383.45 , See APC Packaged Rates , See APC Packaged Rates , $247.93 , $247.93 , See APC Packaged Rates , See APC Packaged Rates , $692.41 , $692.41 , $692.41 , $692.41 , See APC Packaged Rates , $260.59 , $- , $- , $721.52 , $521.17
C1713,61516070,Hospital Chargemaster,4.0M Headless Screw Len 12M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516071,Hospital Chargemaster,4.0M Headless Screw Len 14M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516072,Hospital Chargemaster,4.0M Headless Screw Len 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516073,Hospital Chargemaster,4.0M Headless Screw Len 18M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516074,Hospital Chargemaster,4.0M Headless Screw Len 20M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516075,Hospital Chargemaster,4.0M Headless Screw Len 22M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516076,Hospital Chargemaster,4.0M Headless Screw Len 24M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516077,Hospital Chargemaster,4.0M Headless Screw Len 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516078,Hospital Chargemaster,4.0M Headless Screw Len 28M,Outpatient,Outpatient Default Percent / Case Rate,278, $677.38 , $372.56 , $558.16 , See APC Packaged Rates , $474.17 , $264.18 , $653.60 , $656.45 , $348.86 , See APC Packaged Rates , See APC Packaged Rates , $225.57 , $225.57 , See APC Packaged Rates , See APC Packaged Rates , $629.96 , $629.96 , $629.96 , $629.96 , See APC Packaged Rates , $237.08 , $- , $- , $656.45 , $474.17
C1713,61516079,Hospital Chargemaster,4.0M Headless Screw Len 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516080,Hospital Chargemaster,4.0M Headless Screw Len 32M,Outpatient,Outpatient Default Percent / Case Rate,278, $744.53 , $409.49 , $613.49 , See APC Packaged Rates , $521.17 , $290.37 , $718.40 , $721.52 , $383.45 , See APC Packaged Rates , See APC Packaged Rates , $247.93 , $247.93 , See APC Packaged Rates , See APC Packaged Rates , $692.41 , $692.41 , $692.41 , $692.41 , See APC Packaged Rates , $260.59 , $- , $- , $721.52 , $521.17
C1713,61516081,Hospital Chargemaster,4.0M Headless Screw Len 34M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516082,Hospital Chargemaster,4.0M Headless Screw Len 36M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516083,Hospital Chargemaster,4.0M Headless Screw Len 38M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516084,Hospital Chargemaster,4.0M Headless Screw Len 40M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516085,Hospital Chargemaster,4.0M Headless Screw Len 42M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516086,Hospital Chargemaster,4.0M Headless Screw Len 44M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516087,Hospital Chargemaster,4.0M Headless Screw Len 46M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516088,Hospital Chargemaster,4.0M Headless Screw Len 50M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516091,Hospital Chargemaster,Rest Mod Conical Distal Stem,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516092,Hospital Chargemaster,Dall Miles Medium Vitallium,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516097,Hospital Chargemaster,Femoral Nail T2 12Mx340M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516098,Hospital Chargemaster,Long Nail Kit,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516103,Hospital Chargemaster,Ti Lag Screw 10.5X80M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516104,Hospital Chargemaster,Troch Nail For GaMa 3 S Nail,Outpatient,Outpatient Default Percent / Case Rate,278," $3,163.86 "," $1,740.12 "," $2,607.02 ", See APC Packaged Rates ," $2,214.70 "," $1,233.91 "," $3,052.81 "," $3,066.10 "," $1,629.45 ", See APC Packaged Rates , See APC Packaged Rates ," $1,053.57 "," $1,053.57 ", See APC Packaged Rates , See APC Packaged Rates ," $2,942.39 "," $2,942.39 "," $2,942.39 "," $2,942.39 ", See APC Packaged Rates ," $1,107.35 ", $- , $- ," $3,066.10 "," $2,214.70 "
C1713,61516105,Hospital Chargemaster,Screw Cancellous Ti 4Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516106,Hospital Chargemaster,Screw Cancellous Ti 4Mm A,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516107,Hospital Chargemaster,Screw Cortex Ti 3.5Mm A 3.5Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516109,Hospital Chargemaster,Exeter V40 Stem 35.5M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516110,Hospital Chargemaster,Triathlon Ps X3 Tibial Insert,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,984.94 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 ", $- , $- ," $3,510.56 "," $2,535.75 "
C1713,61516112,Hospital Chargemaster,Cortex Screw 3.5Mm / L60Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61516121,Hospital Chargemaster,Stent Advanix Pre/Load10Fx7Cm,Outpatient,Outpatient Default Percent / Case Rate,278, $411.33 , $226.23 , $329.06 , See APC Packaged Rates , $287.93 , $160.42 , $396.89 , $398.62 , $211.84 , See APC Packaged Rates , See APC Packaged Rates , $136.97 , $136.97 , See APC Packaged Rates , See APC Packaged Rates , $382.54 , $382.54 , $382.54 , $382.54 , See APC Packaged Rates , $143.97 , $246.80 , $136.97 , $398.62 , $287.93
,61516129,Hospital Chargemaster,Stent Pancreatic Advantix,Outpatient,Outpatient Default Percent / Case Rate,278, $532.82 , $293.05 , $426.26 , See APC Packaged Rates , $372.97 , $207.80 , $514.12 , $516.36 , $274.41 , See APC Packaged Rates , See APC Packaged Rates , $177.43 , $177.43 , See APC Packaged Rates , See APC Packaged Rates , $495.52 , $495.52 , $495.52 , $495.52 , See APC Packaged Rates , $186.49 , $319.69 , $177.43 , $516.36 , $372.97
C1713,61516146,Hospital Chargemaster,Clusterhole 46C Tritan 11 Tri,Outpatient,Outpatient Default Percent / Case Rate,278," $4,095.00 "," $2,252.25 "," $3,374.28 ", See APC Packaged Rates ," $2,866.50 "," $1,597.05 "," $3,951.27 "," $3,968.46 "," $2,109.01 ", See APC Packaged Rates , See APC Packaged Rates ," $1,363.64 "," $1,363.64 ", See APC Packaged Rates , See APC Packaged Rates ," $3,808.35 "," $3,808.35 "," $3,808.35 "," $3,808.35 ", See APC Packaged Rates ," $1,433.25 ", $- , $- ," $3,968.46 "," $2,866.50 "
C1713,61516147,Hospital Chargemaster,Glenosphere 32 Dia X 6M Thk,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516150,Hospital Chargemaster,Asnis III Washer Cannulated,Outpatient,Outpatient Default Percent / Case Rate,278, $80.64 , $44.35 , $66.45 , See APC Packaged Rates , $56.45 , $31.45 , $77.81 , $78.15 , $41.53 , See APC Packaged Rates , See APC Packaged Rates , $26.85 , $26.85 , See APC Packaged Rates , See APC Packaged Rates , $75.00 , $75.00 , $75.00 , $75.00 , See APC Packaged Rates , $28.22 , $- , $- , $78.15 , $56.45
C1713,61516153,Hospital Chargemaster,GaMa Nail 3S Lft 10X320Mx125,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516154,Hospital Chargemaster,Screw Hexalobe Loc 3.5Mx8M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516155,Hospital Chargemaster,Screw 40.0M Acutrak 2 5.5,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516156,Hospital Chargemaster,Y-Plate Broad 2 Shaft Holes,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516159,Hospital Chargemaster,Lfit Head 40M/+12 V40,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516160,Hospital Chargemaster,Tibial Insert Ps X3 Triathlon,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516164,Hospital Chargemaster,Tibial Nail T2 Std 10Mx315M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516165,Hospital Chargemaster,Tibial Insert X3 Poly 16M Tri,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516166,Hospital Chargemaster,Femoral Dis Augment 5M 4 Left,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516167,Hospital Chargemaster,Tri Ts Femur Sz 4 Left,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516168,Hospital Chargemaster,No 6 Triathlon Ts Plus Tibial,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516170,Hospital Chargemaster,Broad Straight Plate 5 Hole,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516171,Hospital Chargemaster,Cancellous Ti Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516173,Hospital Chargemaster,Cortex Ti Screw 3.5Mm/L30Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $49.68 , $27.32 , $40.94 , See APC Packaged Rates , $34.78 , $19.38 , $47.94 , $48.14 , $25.59 , See APC Packaged Rates , See APC Packaged Rates , $16.54 , $16.54 , See APC Packaged Rates , See APC Packaged Rates , $46.20 , $46.20 , $46.20 , $46.20 , See APC Packaged Rates , $17.39 , $- , $- , $48.14 , $34.78
C1713,61516174,Hospital Chargemaster,T2 Supracondylar Nail,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516175,Hospital Chargemaster,T2 F/T Locking Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $374.85 , $206.17 , $308.88 , See APC Packaged Rates , $262.40 , $146.19 , $361.69 , $363.27 , $193.06 , See APC Packaged Rates , See APC Packaged Rates , $124.83 , $124.83 , See APC Packaged Rates , See APC Packaged Rates , $348.61 , $348.61 , $348.61 , $348.61 , See APC Packaged Rates , $131.20 , $- , $- , $363.27 , $262.40
C1713,61516179,Hospital Chargemaster,Ti Lag Screw 10.5X120M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516180,Hospital Chargemaster,GaMa 3S Nail Left,Outpatient,Outpatient Default Percent / Case Rate,278," $4,282.74 "," $2,355.51 "," $3,528.98 ", See APC Packaged Rates ," $2,997.92 "," $1,670.27 "," $4,132.42 "," $4,150.40 "," $2,205.70 ", See APC Packaged Rates , See APC Packaged Rates ," $1,426.15 "," $1,426.15 ", See APC Packaged Rates , See APC Packaged Rates ," $3,982.95 "," $3,982.95 "," $3,982.95 "," $3,982.95 ", See APC Packaged Rates ," $1,498.96 ", $- , $- ," $4,150.40 "," $2,997.92 "
C1713,61516181,Hospital Chargemaster,Triathlon Ps Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,191.20 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 ", $- , $- ," $6,105.33 "," $4,410.00 "
C1713,61516182,Hospital Chargemaster,Reunion Tsa-Press Fit Humeral,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516183,Hospital Chargemaster,X3 Humeral Insert 36M X 8,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516184,Hospital Chargemaster,Acu-Loc 2 Vdr Plt Wide L,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61516187,Hospital Chargemaster,Biliary Stent 5Cm X 10 Fr,Outpatient,Outpatient Default Percent / Case Rate,278, $406.35 , $223.49 , $325.08 , See APC Packaged Rates , $284.45 , $158.48 , $392.09 , $393.79 , $209.28 , See APC Packaged Rates , See APC Packaged Rates , $135.31 , $135.31 , See APC Packaged Rates , See APC Packaged Rates , $377.91 , $377.91 , $377.91 , $377.91 , See APC Packaged Rates , $142.22 , $243.81 , $135.31 , $393.79 , $284.45
,61516188,Hospital Chargemaster,Biliary Stent 7Cm X 10Fr,Outpatient,Outpatient Default Percent / Case Rate,278, $406.35 , $223.49 , $325.08 , See APC Packaged Rates , $284.45 , $158.48 , $392.09 , $393.79 , $209.28 , See APC Packaged Rates , See APC Packaged Rates , $135.31 , $135.31 , See APC Packaged Rates , See APC Packaged Rates , $377.91 , $377.91 , $377.91 , $377.91 , See APC Packaged Rates , $142.22 , $243.81 , $135.31 , $393.79 , $284.45
C2625,61516189,Hospital Chargemaster,Biliary Stent 9Cm X 10Fr,Outpatient,Outpatient Default Percent / Case Rate,278, $406.35 , $223.49 , $334.83 , See APC Packaged Rates , $284.45 , $158.48 , $392.09 , $393.79 , $209.28 , See APC Packaged Rates , See APC Packaged Rates , $135.31 , $135.31 , See APC Packaged Rates , See APC Packaged Rates , $377.91 , $377.91 , $377.91 , $377.91 , See APC Packaged Rates , $142.22 , $- , $- , $393.79 , $284.45
,61516191,Hospital Chargemaster,Pancreatic Geenen Stent 3Cm X,Outpatient,Outpatient Default Percent / Case Rate,278, $406.35 , $223.49 , $325.08 , See APC Packaged Rates , $284.45 , $158.48 , $392.09 , $393.79 , $209.28 , See APC Packaged Rates , See APC Packaged Rates , $135.31 , $135.31 , See APC Packaged Rates , See APC Packaged Rates , $377.91 , $377.91 , $377.91 , $377.91 , See APC Packaged Rates , $142.22 , $243.81 , $135.31 , $393.79 , $284.45
C1713,61516192,Hospital Chargemaster,Pancreatic Geenen Stent 5Cm X,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516193,Hospital Chargemaster,Pancreatic Geenen Stent 7Cm X,Outpatient,Outpatient Default Percent / Case Rate,278, $406.35 , $223.49 , $334.83 , See APC Packaged Rates , $284.45 , $158.48 , $392.09 , $393.79 , $209.28 , See APC Packaged Rates , See APC Packaged Rates , $135.31 , $135.31 , See APC Packaged Rates , See APC Packaged Rates , $377.91 , $377.91 , $377.91 , $377.91 , See APC Packaged Rates , $142.22 , $- , $- , $393.79 , $284.45
C1713,61516195,Hospital Chargemaster,T2F/T Locking Screw 4Mx35M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516196,Hospital Chargemaster,Non Toggling Cortical Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $283.50 , $155.93 , $233.60 , See APC Packaged Rates , $198.45 , $110.57 , $273.55 , $274.74 , $146.01 , See APC Packaged Rates , See APC Packaged Rates , $94.41 , $94.41 , See APC Packaged Rates , See APC Packaged Rates , $263.66 , $263.66 , $263.66 , $263.66 , See APC Packaged Rates , $99.23 , $- , $- , $274.74 , $198.45
C1713,61516198,Hospital Chargemaster,Hydroset Xt 15Cc,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516201,Hospital Chargemaster,Omnifit Eon 132,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516204,Hospital Chargemaster,T2 Recon Lag Screw 6.5Mx90M,Outpatient,Outpatient Default Percent / Case Rate,278, $447.93 , $246.36 , $369.09 , See APC Packaged Rates , $313.55 , $174.69 , $432.21 , $434.09 , $230.69 , See APC Packaged Rates , See APC Packaged Rates , $149.16 , $149.16 , See APC Packaged Rates , See APC Packaged Rates , $416.57 , $416.57 , $416.57 , $416.57 , See APC Packaged Rates , $156.78 , $- , $- , $434.09 , $313.55
C1713,61516205,Hospital Chargemaster,T2 Recob Lag Screw 6.5Mx95M,Outpatient,Outpatient Default Percent / Case Rate,278, $479.81 , $263.90 , $395.36 , See APC Packaged Rates , $335.87 , $187.13 , $462.97 , $464.98 , $247.11 , See APC Packaged Rates , See APC Packaged Rates , $159.78 , $159.78 , See APC Packaged Rates , See APC Packaged Rates , $446.22 , $446.22 , $446.22 , $446.22 , See APC Packaged Rates , $167.93 , $- , $- , $464.98 , $335.87
C1713,61516206,Hospital Chargemaster,Femoral Nail Gt Right 10X340M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516211,Hospital Chargemaster,Locking Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $497.54 , $273.65 , $409.97 , See APC Packaged Rates , $348.28 , $194.04 , $480.08 , $482.17 , $256.24 , See APC Packaged Rates , See APC Packaged Rates , $165.68 , $165.68 , See APC Packaged Rates , See APC Packaged Rates , $462.71 , $462.71 , $462.71 , $462.71 , See APC Packaged Rates , $174.14 , $- , $- , $482.17 , $348.28
C1713,61516212,Hospital Chargemaster,Locking Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $497.54 , $273.65 , $409.97 , See APC Packaged Rates , $348.28 , $194.04 , $480.08 , $482.17 , $256.24 , See APC Packaged Rates , See APC Packaged Rates , $165.68 , $165.68 , See APC Packaged Rates , See APC Packaged Rates , $462.71 , $462.71 , $462.71 , $462.71 , See APC Packaged Rates , $174.14 , $- , $- , $482.17 , $348.28
C1713,61516213,Hospital Chargemaster,Nail Troch For GaMa 3 S Nails,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516219,Hospital Chargemaster,Plate 3 Hole TI one third tub,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516221,Hospital Chargemaster,Cancellous Ti Screw 4Mm Full,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516222,Hospital Chargemaster,Cannulated Compression Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516223,Hospital Chargemaster,Cannulated Screw Compression,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516224,Hospital Chargemaster,Cannulated Screw Compression,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516229,Hospital Chargemaster,Vitoss Foam Pack 1.2Cc,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516233,Hospital Chargemaster,Screw Set UBlade Lag Titanium,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516234,Hospital Chargemaster,T2 Huneral Nail 9M X 260M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516237,Hospital Chargemaster,Hip Plate Barrel 130Deg 3 Hol,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516240,Hospital Chargemaster,Pin Apex Transfix 5/6 40X300,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516242,Hospital Chargemaster,Long Nail Kit R1/5 Ti Left,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516243,Hospital Chargemaster,Long Nail Kit R1/5 Ti Right,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516246,Hospital Chargemaster,Narrow Lock Plate 2.0 L34M,Outpatient,Outpatient Default Percent / Case Rate,278," $2,551.50 "," $1,403.33 "," $2,102.44 ", See APC Packaged Rates ," $1,786.05 ", $995.09 ," $2,461.94 "," $2,472.66 "," $1,314.07 ", See APC Packaged Rates , See APC Packaged Rates , $849.65 , $849.65 , See APC Packaged Rates , See APC Packaged Rates ," $2,372.90 "," $2,372.90 "," $2,372.90 "," $2,372.90 ", See APC Packaged Rates , $893.03 , $- , $- ," $2,472.66 "," $1,786.05 "
C1713,61516247,Hospital Chargemaster,Locking Screw T6 2.0M L9M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516248,Hospital Chargemaster,Locking Screw T6 2.0M L10M,Outpatient,Outpatient Default Percent / Case Rate,278, $748.91 , $411.90 , $617.10 , See APC Packaged Rates , $524.24 , $292.07 , $722.62 , $725.77 , $385.70 , See APC Packaged Rates , See APC Packaged Rates , $249.39 , $249.39 , See APC Packaged Rates , See APC Packaged Rates , $696.49 , $696.49 , $696.49 , $696.49 , See APC Packaged Rates , $262.12 , $- , $- , $725.77 , $524.24
C1713,61516249,Hospital Chargemaster,Bone Screw T6 2.0M L10M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516250,Hospital Chargemaster,Bone Screw T6 2.0M L11M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516254,Hospital Chargemaster,Narrow Lock Plate 2.7 L32M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516255,Hospital Chargemaster,6.7M Low Profile Hex Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $366.91 , $201.80 , $302.33 , See APC Packaged Rates , $256.84 , $143.09 , $354.03 , $355.57 , $188.97 , See APC Packaged Rates , See APC Packaged Rates , $122.18 , $122.18 , See APC Packaged Rates , See APC Packaged Rates , $341.23 , $341.23 , $341.23 , $341.23 , See APC Packaged Rates , $128.42 , $- , $- , $355.57 , $256.84
C1713,61516258,Hospital Chargemaster,Screw Lag 10.5 X 75M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516259,Hospital Chargemaster,Screw Lag 10.5 X 80 M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516260,Hospital Chargemaster,Screw Lag 10.5 X 85 M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516261,Hospital Chargemaster,Screw Lag 10.5 X 90 M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516262,Hospital Chargemaster,Screw Lag 10.5 A 95 M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516263,Hospital Chargemaster,Screw Lag 10.5 X 100 M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,480.82 ", $814.45 ," $1,220.20 ", See APC Packaged Rates ," $1,036.57 ", $577.52 ," $1,428.84 "," $1,435.06 ", $762.65 , See APC Packaged Rates , See APC Packaged Rates , $493.11 , $493.11 , See APC Packaged Rates , See APC Packaged Rates ," $1,377.16 "," $1,377.16 "," $1,377.16 "," $1,377.16 ", See APC Packaged Rates , $518.29 , $- , $- ," $1,435.06 "," $1,036.57 "
C1713,61516264,Hospital Chargemaster,Screw Lag 10.5 X 105 M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516265,Hospital Chargemaster,Screw Lag 10.5 X 110 M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516266,Hospital Chargemaster,Screw Lag 10.5 X 115 M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516267,Hospital Chargemaster,Screw Lag 10.5 X 120 M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516271,Hospital Chargemaster,Milagro Interference Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516273,Hospital Chargemaster,Fixation Nail Screw Ti Troch,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516274,Hospital Chargemaster,T2 Recon Lag Screw 6.5Mx75M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516275,Hospital Chargemaster,T2 Recon Lag Screw 6.5Mx80M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516278,Hospital Chargemaster,Cortex Ti Screw 3.5Mm / L70Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516279,Hospital Chargemaster,Triathlon Ps Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,300.00 "," $3,465.00 "," $5,191.20 ", See APC Packaged Rates ," $4,410.00 "," $2,457.00 "," $6,078.87 "," $6,105.33 "," $3,244.63 ", See APC Packaged Rates , See APC Packaged Rates ," $2,097.90 "," $2,097.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,859.00 "," $5,859.00 "," $5,859.00 "," $5,859.00 ", See APC Packaged Rates ," $2,205.00 ", $- , $- ," $6,105.33 "," $4,410.00 "
C1713,61516287,Hospital Chargemaster,Ti Lag Screw 10.5X75M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,017.77 ", $559.77 , $838.64 , See APC Packaged Rates , $712.44 , $396.93 , $982.05 , $986.32 , $524.17 , See APC Packaged Rates , See APC Packaged Rates , $338.92 , $338.92 , See APC Packaged Rates , See APC Packaged Rates , $946.53 , $946.53 , $946.53 , $946.53 , See APC Packaged Rates , $356.22 , $- , $- , $986.32 , $712.44
C1713,61516288,Hospital Chargemaster,Self Drilling Half Pin Apex,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516290,Hospital Chargemaster,Triathlon Ps X3 Tibial Insert,Outpatient,Outpatient Default Percent / Case Rate,278," $3,622.50 "," $1,992.38 "," $2,984.94 ", See APC Packaged Rates ," $2,535.75 "," $1,412.78 "," $3,495.35 "," $3,510.56 "," $1,865.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,206.29 "," $1,206.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,368.93 "," $3,368.93 "," $3,368.93 "," $3,368.93 ", See APC Packaged Rates ," $1,267.88 ", $- , $- ," $3,510.56 "," $2,535.75 "
C1713,61516291,Hospital Chargemaster,Cannulated Screw 4.0X30M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516293,Hospital Chargemaster,T2 Recon Lag Screw 6.5M X,Outpatient,Outpatient Default Percent / Case Rate,278, $447.93 , $246.36 , $369.09 , See APC Packaged Rates , $313.55 , $174.69 , $432.21 , $434.09 , $230.69 , See APC Packaged Rates , See APC Packaged Rates , $149.16 , $149.16 , See APC Packaged Rates , See APC Packaged Rates , $416.57 , $416.57 , $416.57 , $416.57 , See APC Packaged Rates , $156.78 , $- , $- , $434.09 , $313.55
C1713,61516294,Hospital Chargemaster,Femoral Nail Gt Right 10 X,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516295,Hospital Chargemaster,Locking Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $421.00 , $231.55 , $346.90 , See APC Packaged Rates , $294.70 , $164.19 , $406.22 , $407.99 , $216.82 , See APC Packaged Rates , See APC Packaged Rates , $140.19 , $140.19 , See APC Packaged Rates , See APC Packaged Rates , $391.53 , $391.53 , $391.53 , $391.53 , See APC Packaged Rates , $147.35 , $- , $- , $407.99 , $294.70
C1713,61516296,Hospital Chargemaster,Locking Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516297,Hospital Chargemaster,Triathlon Tibial Insert Ts,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516298,Hospital Chargemaster,Femoral Distal Augment 10M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516300,Hospital Chargemaster,Locking Screw T2 F/T 5M X,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516301,Hospital Chargemaster,Vdr 2 Prox Plt Std R Acu-Loc,Outpatient,Outpatient Default Percent / Case Rate,278," $4,013.10 "," $2,207.21 "," $3,306.79 ", See APC Packaged Rates ," $2,809.17 "," $1,565.11 "," $3,872.24 "," $3,889.10 "," $2,066.83 ", See APC Packaged Rates , See APC Packaged Rates ," $1,336.36 "," $1,336.36 ", See APC Packaged Rates , See APC Packaged Rates ," $3,732.18 "," $3,732.18 "," $3,732.18 "," $3,732.18 ", See APC Packaged Rates ," $1,404.59 ", $- , $- ," $3,889.10 "," $2,809.17 "
C1713,61516303,Hospital Chargemaster,X3 Triathlon Cs Insert #3 9M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516304,Hospital Chargemaster,T.5M Low Profile Hex Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516306,Hospital Chargemaster,Humeral Head Standard Sr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516307,Hospital Chargemaster,Humeral Head Standard Sr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516308,Hospital Chargemaster,Humeral Stem 14M Press Fit,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516309,Hospital Chargemaster,Femur Plate Rt Distal Lateral,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516310,Hospital Chargemaster,Screw Headless Compression,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516313,Hospital Chargemaster,Nail T2 Supracondylar Nail,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516314,Hospital Chargemaster,Screw Locking T2 F/T 5M X,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516321,Hospital Chargemaster,Size 11 Accolde 11 127 Deg,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516322,Hospital Chargemaster,Size 11 Accolde 11 127 Deg,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516323,Hospital Chargemaster,Exeter V40 Stem 44M No2,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516327,Hospital Chargemaster,Screw T2 F/T Locking Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516328,Hospital Chargemaster,Reunion Tsa Sr Standard,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516329,Hospital Chargemaster,Acu-Loc 2 Vdr Pit Narrow Long,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516330,Hospital Chargemaster,Healix Advance Anchor 4.9M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516331,Hospital Chargemaster,T2 Long Proximal Humeral Nail,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516334,Hospital Chargemaster,Cable Sleeve Set 2.0M D/M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516336,Hospital Chargemaster,Foam Pk Bbtrauma Vitoss 10 Cc,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516337,Hospital Chargemaster,Femur Plate Lt Rt 20 Hl L414M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516342,Hospital Chargemaster,Nail Humeral T2 8Mx260M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516343,Hospital Chargemaster,Nail Tibial 10X330 M,Outpatient,Outpatient Default Percent / Case Rate,278," $3,396.05 "," $1,867.83 "," $2,798.35 ", See APC Packaged Rates ," $2,377.24 "," $1,324.46 "," $3,276.85 "," $3,291.11 "," $1,749.03 ", See APC Packaged Rates , See APC Packaged Rates ," $1,130.88 "," $1,130.88 ", See APC Packaged Rates , See APC Packaged Rates ," $3,158.33 "," $3,158.33 "," $3,158.33 "," $3,158.33 ", See APC Packaged Rates ," $1,188.62 ", $- , $- ," $3,291.11 "," $2,377.24 "
C1713,61516345,Hospital Chargemaster,Screw Locking,Outpatient,Outpatient Default Percent / Case Rate,278, $421.00 , $231.55 , $346.90 , See APC Packaged Rates , $294.70 , $164.19 , $406.22 , $407.99 , $216.82 , See APC Packaged Rates , See APC Packaged Rates , $140.19 , $140.19 , See APC Packaged Rates , See APC Packaged Rates , $391.53 , $391.53 , $391.53 , $391.53 , See APC Packaged Rates , $147.35 , $- , $- , $407.99 , $294.70
C1713,61516346,Hospital Chargemaster,Screw Locking,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516347,Hospital Chargemaster,Screw Locking,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516353,Hospital Chargemaster,Milagro Advance Screw 12x30mm,Outpatient,Outpatient Default Percent / Case Rate,278," $1,181.25 ", $649.69 , $973.35 , See APC Packaged Rates , $826.88 , $460.69 ," $1,139.79 "," $1,144.75 ", $608.37 , See APC Packaged Rates , See APC Packaged Rates , $393.36 , $393.36 , See APC Packaged Rates , See APC Packaged Rates ," $1,098.56 "," $1,098.56 "," $1,098.56 "," $1,098.56 ", See APC Packaged Rates , $413.44 , $- , $- ," $1,144.75 ", $826.88
C1713,61516356,Hospital Chargemaster,Femur Plate Distal Lateral,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516357,Hospital Chargemaster,4.5Mm Cortex Ti Screw 4.5Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $84.99 , $46.74 , $70.03 , See APC Packaged Rates , $59.49 , $33.15 , $82.01 , $82.36 , $43.77 , See APC Packaged Rates , See APC Packaged Rates , $28.30 , $28.30 , See APC Packaged Rates , See APC Packaged Rates , $79.04 , $79.04 , $79.04 , $79.04 , See APC Packaged Rates , $29.75 , $- , $- , $82.36 , $59.49
C1713,61516359,Hospital Chargemaster,4.5Mm Cortex Ti Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $84.99 , $46.74 , $70.03 , See APC Packaged Rates , $59.49 , $33.15 , $82.01 , $82.36 , $43.77 , See APC Packaged Rates , See APC Packaged Rates , $28.30 , $28.30 , See APC Packaged Rates , See APC Packaged Rates , $79.04 , $79.04 , $79.04 , $79.04 , See APC Packaged Rates , $29.75 , $- , $- , $82.36 , $59.49
C1713,61516361,Hospital Chargemaster,Plate Proxamal Narrow L 2 Vdr,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516362,Hospital Chargemaster,5.5 Healix Advanced Sp Peek,Outpatient,Outpatient Default Percent / Case Rate,278," $1,071.00 ", $589.05 , $882.50 , See APC Packaged Rates , $749.70 , $417.69 ," $1,033.41 "," $1,037.91 ", $551.59 , See APC Packaged Rates , See APC Packaged Rates , $356.64 , $356.64 , See APC Packaged Rates , See APC Packaged Rates , $996.03 , $996.03 , $996.03 , $996.03 , See APC Packaged Rates , $374.85 , $- , $- ," $1,037.91 ", $749.70
C1713,61516368,Hospital Chargemaster,Rsp Spacer W/Retaining Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516369,Hospital Chargemaster,Encore Reverse Shoulder,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516370,Hospital Chargemaster,Acu-Loc Dorsal Plate Std Left,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516371,Hospital Chargemaster,2.3M Profyle Hand Lock,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516372,Hospital Chargemaster,2.3X11M Bone Screwscross,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516373,Hospital Chargemaster,T2 Recon Lag Screw 6.5M X,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516374,Hospital Chargemaster,T2 Recon Lag Screw 6.5M X,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516375,Hospital Chargemaster,Femoral Nail Gt Right,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516376,Hospital Chargemaster,Locking Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61516380,Hospital Chargemaster,Spiked Ligament Staple,Outpatient,Outpatient Default Percent / Case Rate,278, $248.85 , $136.87 , $205.05 , See APC Packaged Rates , $174.20 , $97.05 , $240.12 , $241.16 , $128.16 , See APC Packaged Rates , See APC Packaged Rates , $82.87 , $82.87 , See APC Packaged Rates , See APC Packaged Rates , $231.43 , $231.43 , $231.43 , $231.43 , See APC Packaged Rates , $87.10 , $- , $- , $241.16 , $174.20
C1713,61516381,Hospital Chargemaster,Spiked Ligament Staple,Outpatient,Outpatient Default Percent / Case Rate,278, $248.85 , $136.87 , $205.05 , See APC Packaged Rates , $174.20 , $97.05 , $240.12 , $241.16 , $128.16 , See APC Packaged Rates , See APC Packaged Rates , $82.87 , $82.87 , See APC Packaged Rates , See APC Packaged Rates , $231.43 , $231.43 , $231.43 , $231.43 , See APC Packaged Rates , $87.10 , $- , $- , $241.16 , $174.20
C1713,61573104,Hospital Chargemaster,Screw Conical 3.5 Slf/Tp 70M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1713,61573105,Hospital Chargemaster,Screw Conical 3.5 Slf/Tp 75M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1788,61585186,Hospital Chargemaster,Power Port 8Fr Sing Groshong,Outpatient,Outpatient Default Percent / Case Rate,278, $913.50 , $502.43 , $752.72 , See APC Packaged Rates , $639.45 , $356.27 , $881.44 , $885.27 , $470.47 , See APC Packaged Rates , See APC Packaged Rates , $304.20 , $304.20 , See APC Packaged Rates , See APC Packaged Rates , $849.56 , $849.56 , $849.56 , $849.56 , See APC Packaged Rates , $319.73 , $- , $- , $885.27 , $639.45
C1874,61585256,Hospital Chargemaster,Ureteral Contour Stent 6X28,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61585292,Hospital Chargemaster,Mesh Oval Dulex 18X24 2M,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61585395,Hospital Chargemaster,Mesh Proloop Large,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61585396,Hospital Chargemaster,Proloop Mesh Medium,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61585397,Hospital Chargemaster,Proloop Mesh Small,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
C1781,61585593,Hospital Chargemaster,Proloop Mesh X-Lrg,Outpatient,Outpatient Default Percent / Case Rate,278, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
,61501834,Hospital Chargemaster,Bed Side Recliner,Outpatient,Outpatient Default Percent / Case Rate,290, $38.40 , $21.12 , $30.72 , See APC Packaged Rates , $26.88 , $14.98 , $37.05 , $37.21 , $19.78 , See APC Packaged Rates , See APC Packaged Rates , $25.77 , $25.77 , See APC Packaged Rates , See APC Packaged Rates , $35.71 , $35.71 , $35.71 , $35.71 , See APC Packaged Rates , $13.44 , $23.04 , $13.44 , $37.21 , $26.88
C9803,5212010803,Hospital Chargemaster,Specimen Collect Sars/Cov Any,Outpatient,Outpatient Default Percent / Case Rate,300, $45.00 , $24.75 , $37.08 , $29.53 , $31.50 , $17.55 , $43.42 , $43.61 , $23.18 , $29.53 , $29.53 , $30.20 , $30.20 , $31.01 , $30.12 , $37.49 , $37.49 , $40.18 , $40.18 , $29.53 , $15.75 , $27.59 , $15.75 , $43.61 , $31.50
81229,5212010007,Hospital Chargemaster,Cytogen M Array Copy No&Snp,Outpatient,Outpatient Default Percent / Case Rate,300," $2,320.00 "," $2,148.32 "," $1,911.68 ", See APC Packaged Rates ," $1,624.00 ", $904.80 ," $5,105.90 "," $3,426.06 "," $3,280.39 ", See APC Packaged Rates , See APC Packaged Rates ," $1,556.72 "," $1,556.72 ", See APC Packaged Rates , See APC Packaged Rates ," $1,836.58 "," $1,836.58 "," $1,883.86 "," $1,883.86 ", See APC Packaged Rates , $962.78 ," $1,392.00 ", $904.80 ," $5,105.90 "," $1,624.00 "
81317,5212010025,Hospital Chargemaster,Pms2 Gene Full Seq Analysis,Outpatient,Outpatient Default Percent / Case Rate,300," $1,705.00 "," $1,252.88 "," $1,404.92 ", See APC Packaged Rates ," $1,193.50 ", $664.95 ," $3,112.08 "," $2,088.21 "," $1,999.42 ", See APC Packaged Rates , See APC Packaged Rates ," $1,144.06 "," $1,144.06 ", See APC Packaged Rates , See APC Packaged Rates ," $1,071.08 "," $1,071.08 "," $1,098.65 "," $1,098.65 ", See APC Packaged Rates , $561.49 , $811.80 , $561.49 ," $3,112.08 "," $1,193.50 "
81292,5212010016,Hospital Chargemaster,Mlh1 Gene Full Seq,Outpatient,Outpatient Default Percent / Case Rate,300," $1,351.00 "," $1,250.84 "," $1,113.22 ", See APC Packaged Rates , $945.70 , $526.89 ," $2,972.49 "," $1,994.54 "," $1,909.74 ", See APC Packaged Rates , See APC Packaged Rates , $906.52 , $906.52 , See APC Packaged Rates , See APC Packaged Rates ," $1,069.33 "," $1,069.33 "," $1,096.86 "," $1,096.86 ", See APC Packaged Rates , $560.57 , $810.48 , $526.89 ," $2,972.49 ", $945.70
81298,5212010020,Hospital Chargemaster,Msh6 Gene Full Seq,Outpatient,Outpatient Default Percent / Case Rate,300," $1,284.00 "," $1,188.71 "," $1,058.02 ", See APC Packaged Rates , $898.80 , $500.76 ," $2,824.96 "," $1,895.55 "," $1,814.95 ", See APC Packaged Rates , See APC Packaged Rates , $861.56 , $861.56 , See APC Packaged Rates , See APC Packaged Rates ," $1,016.21 "," $1,016.21 "," $1,042.37 "," $1,042.37 ", See APC Packaged Rates , $532.73 , $770.22 , $500.76 ," $2,824.96 ", $898.80
81226,5212010005,Hospital Chargemaster,Cyp2D6 Gene Com Variants,Outpatient,Outpatient Default Percent / Case Rate,300, $986.00 , $835.09 , $812.46 , See APC Packaged Rates , $690.20 , $384.54 ," $1,984.29 "," $1,331.46 "," $1,274.85 ", See APC Packaged Rates , See APC Packaged Rates , $661.61 , $661.61 , See APC Packaged Rates , See APC Packaged Rates , $713.91 , $713.91 , $732.29 , $732.29 , See APC Packaged Rates , $374.24 , $541.09 , $374.24 ," $1,984.29 ", $690.20
81295,5212010018,Hospital Chargemaster,Msh2 Gene Full Seq,Outpatient,Outpatient Default Percent / Case Rate,300, $763.00 , $706.91 , $628.71 , See APC Packaged Rates , $534.10 , $297.57 ," $1,679.76 "," $1,127.12 "," $1,079.19 ", See APC Packaged Rates , See APC Packaged Rates , $511.97 , $511.97 , See APC Packaged Rates , See APC Packaged Rates , $604.33 , $604.33 , $619.89 , $619.89 , See APC Packaged Rates , $316.81 , $458.04 , $297.57 ," $1,679.76 ", $534.10
81405,5212010033,Hospital Chargemaster,Mopath Procedure Level 6,Outpatient,Outpatient Default Percent / Case Rate,300," $1,370.00 ", $558.10 ," $1,128.88 ", See APC Packaged Rates , $959.00 , $534.30 ," $1,326.05 ", $889.78 , $851.95 , See APC Packaged Rates , See APC Packaged Rates , $919.27 , $919.27 , See APC Packaged Rates , See APC Packaged Rates , $477.12 , $477.12 , $489.40 , $489.40 , See APC Packaged Rates , $250.11 , $361.62 , $250.11 ," $1,326.05 ", $959.00
81170,5212010001,Hospital Chargemaster,Abl1 Gene,Outpatient,Outpatient Default Percent / Case Rate,300, $724.00 , $555.60 , $596.58 , See APC Packaged Rates , $506.80 , $282.36 ," $1,319.71 ", $885.52 , $847.87 , See APC Packaged Rates , See APC Packaged Rates , $809.62 , $785.05 , See APC Packaged Rates , See APC Packaged Rates , $474.98 , $474.98 , $487.21 , $487.21 , See APC Packaged Rates , $249.00 , $360.00 , $249.00 ," $1,319.71 ", $506.80
81311,5212010023,Hospital Chargemaster,Nras Gene Variants Exon 2&3,Outpatient,Outpatient Default Percent / Case Rate,300, $863.00 , $547.80 , $711.11 , See APC Packaged Rates , $604.10 , $336.57 ," $1,302.26 ", $873.82 , $836.66 , See APC Packaged Rates , See APC Packaged Rates , $726.76 , $704.71 , See APC Packaged Rates , See APC Packaged Rates , $468.30 , $468.30 , $480.36 , $480.36 , See APC Packaged Rates , $245.49 , $354.95 , $245.49 ," $1,302.26 ", $604.10
81225,5212010004,Hospital Chargemaster,Cyp2C19 Gene Com Variants,Outpatient,Outpatient Default Percent / Case Rate,300, $637.00 , $539.60 , $524.89 , See APC Packaged Rates , $445.90 , $248.43 ," $1,281.63 ", $859.98 , $823.41 , See APC Packaged Rates , See APC Packaged Rates , $427.43 , $427.43 , See APC Packaged Rates , See APC Packaged Rates , $461.29 , $461.29 , $473.17 , $473.17 , See APC Packaged Rates , $241.82 , $349.63 , $241.82 ," $1,281.63 ", $445.90
81300,5212010021,Hospital Chargemaster,Msh6 Gene Dup/Delete Variant,Outpatient,Outpatient Default Percent / Case Rate,300, $476.00 , $440.78 , $392.22 , See APC Packaged Rates , $333.20 , $185.64 ," $1,046.88 ", $702.45 , $672.59 , See APC Packaged Rates , See APC Packaged Rates , $319.40 , $319.40 , See APC Packaged Rates , See APC Packaged Rates , $376.81 , $376.81 , $386.51 , $386.51 , See APC Packaged Rates , $197.54 , $285.60 , $185.64 ," $1,046.88 ", $333.20
81342,5212010028,Hospital Chargemaster,Trg Gene Rearrangement Anal,Outpatient,Outpatient Default Percent / Case Rate,300, $600.00 , $414.63 , $494.40 , See APC Packaged Rates , $420.00 , $234.00 ," $1,094.45 ", $734.37 , $703.15 , See APC Packaged Rates , See APC Packaged Rates , $402.60 , $402.60 , See APC Packaged Rates , See APC Packaged Rates , $342.83 , $342.83 , $351.66 , $351.66 , See APC Packaged Rates , $167.25 , $268.66 , $167.25 ," $1,094.45 ", $420.00
81261,5212010011,Hospital Chargemaster,Igh Gene Rearrange Amp Meth,Outpatient,Outpatient Default Percent / Case Rate,300, $589.00 , $407.42 , $485.34 , See APC Packaged Rates , $412.30 , $229.71 ," $1,075.42 ", $721.61 , $690.93 , See APC Packaged Rates , See APC Packaged Rates , $395.22 , $395.22 , See APC Packaged Rates , See APC Packaged Rates , $336.87 , $336.87 , $345.54 , $345.54 , See APC Packaged Rates , $164.32 , $263.99 , $164.32 ," $1,075.42 ", $412.30
81297,5212010019,Hospital Chargemaster,Msh2 Gene Dup/Delete Variant,Outpatient,Outpatient Default Percent / Case Rate,300, $331.00 , $395.03 , $272.74 , See APC Packaged Rates , $231.70 , $129.09 , $939.02 , $630.08 , $603.29 , See APC Packaged Rates , See APC Packaged Rates , $222.10 , $222.10 , See APC Packaged Rates , See APC Packaged Rates , $331.00 , $331.00 , $331.00 , $331.00 , See APC Packaged Rates , $177.04 , $255.96 , $129.09 , $939.02 , $231.70
81319,5212010026,Hospital Chargemaster,Pms2 Gene Dup/Delet Variants,Outpatient,Outpatient Default Percent / Case Rate,300, $484.00 , $376.88 , $398.82 , See APC Packaged Rates , $338.80 , $188.76 , $896.19 , $601.34 , $575.77 , See APC Packaged Rates , See APC Packaged Rates , $324.76 , $324.76 , See APC Packaged Rates , See APC Packaged Rates , $322.19 , $322.19 , $330.49 , $330.49 , See APC Packaged Rates , $168.91 , $244.20 , $168.91 , $896.19 , $338.80
81294,5212010017,Hospital Chargemaster,Mlh1 Gene Dup/Delete Variant,Outpatient,Outpatient Default Percent / Case Rate,300, $405.00 , $374.84 , $333.72 , See APC Packaged Rates , $283.50 , $157.95 , $891.42 , $598.15 , $572.71 , See APC Packaged Rates , See APC Packaged Rates , $271.76 , $271.76 , See APC Packaged Rates , See APC Packaged Rates , $320.45 , $320.45 , $328.70 , $328.70 , See APC Packaged Rates , $167.99 , $242.88 , $157.95 , $891.42 , $283.50
81275,5212010014,Hospital Chargemaster,Kras Gene Variants Exon 2,Outpatient,Outpatient Default Percent / Case Rate,300, $488.00 , $357.90 , $402.11 , See APC Packaged Rates , $341.60 , $190.32 , $850.19 , $570.48 , $546.22 , See APC Packaged Rates , See APC Packaged Rates , $327.45 , $327.45 , See APC Packaged Rates , See APC Packaged Rates , $305.96 , $305.96 , $313.84 , $313.84 , See APC Packaged Rates , $160.39 , $231.90 , $160.39 , $850.19 , $341.60
81340,5212010027,Hospital Chargemaster,Trb@ Gene Rearrange Amplify,Outpatient,Outpatient Default Percent / Case Rate,300, $300.00 , $429.90 , $247.20 , See APC Packaged Rates , $210.00 , $117.00 ," $1,135.71 ", $762.06 , $729.66 , See APC Packaged Rates , See APC Packaged Rates , $201.30 , $201.30 , See APC Packaged Rates , See APC Packaged Rates , $300.00 , $300.00 , $300.00 , $300.00 , See APC Packaged Rates , $173.40 , $278.56 , $117.00 ," $1,135.71 ", $210.00
81210,5212010002,Hospital Chargemaster,Braf Gene,Outpatient,Outpatient Default Percent / Case Rate,300, $500.00 , $324.84 , $412.00 , See APC Packaged Rates , $350.00 , $195.00 , $772.47 , $518.33 , $496.29 , See APC Packaged Rates , See APC Packaged Rates , $335.50 , $335.50 , See APC Packaged Rates , See APC Packaged Rates , $277.71 , $277.71 , $284.86 , $284.86 , See APC Packaged Rates , $145.58 , $210.48 , $145.58 , $772.47 , $350.00
81227,5212010006,Hospital Chargemaster,Cyp2C9 Gene Com Variants,Outpatient,Outpatient Default Percent / Case Rate,300, $392.00 , $323.75 , $323.01 , See APC Packaged Rates , $274.40 , $152.88 , $769.28 , $516.19 , $494.24 , See APC Packaged Rates , See APC Packaged Rates , $263.03 , $263.03 , See APC Packaged Rates , See APC Packaged Rates , $276.77 , $276.77 , $283.89 , $283.89 , See APC Packaged Rates , $145.09 , $209.77 , $145.09 , $769.28 , $274.40
81264,5212010012,Hospital Chargemaster,Igk Rearrangeabn Clonal Pop,Outpatient,Outpatient Default Percent / Case Rate,300, $445.00 , $319.90 , $366.68 , See APC Packaged Rates , $311.50 , $173.55 , $812.12 , $544.93 , $521.76 , See APC Packaged Rates , See APC Packaged Rates , $298.60 , $298.60 , See APC Packaged Rates , See APC Packaged Rates , $273.48 , $273.48 , $280.52 , $280.52 , See APC Packaged Rates , $143.36 , $207.28 , $143.36 , $812.12 , $311.50
81402,5212010032,Hospital Chargemaster,Mopath Procedure Level 3,Outpatient,Outpatient Default Percent / Case Rate,300, $463.00 , $278.41 , $381.51 , See APC Packaged Rates , $324.10 , $180.57 , $661.43 , $443.82 , $424.95 , See APC Packaged Rates , See APC Packaged Rates , $310.67 , $310.67 , See APC Packaged Rates , See APC Packaged Rates , $238.01 , $238.01 , $244.13 , $244.13 , See APC Packaged Rates , $124.76 , $180.40 , $124.76 , $661.43 , $324.10
81376,5212010030,Hospital Chargemaster,Hla Ii Typing 1 Locus Lr,Outpatient,Outpatient Default Percent / Case Rate,300, $363.00 , $251.50 , $299.11 , See APC Packaged Rates , $254.10 , $141.57 , $664.62 , $445.96 , $427.00 , See APC Packaged Rates , See APC Packaged Rates , $243.57 , $243.57 , See APC Packaged Rates , See APC Packaged Rates , $207.95 , $207.95 , $213.30 , $213.30 , See APC Packaged Rates , $101.44 , $162.96 , $101.44 , $664.62 , $254.10
81219,5212010003,Hospital Chargemaster,Calr Gene Com Variants,Outpatient,Outpatient Default Percent / Case Rate,300, $475.00 , $250.28 , $391.40 , See APC Packaged Rates , $332.50 , $185.25 , $661.43 , $443.82 , $424.95 , See APC Packaged Rates , See APC Packaged Rates , $407.07 , $394.72 , See APC Packaged Rates , See APC Packaged Rates , $206.95 , $206.95 , $212.28 , $212.28 , See APC Packaged Rates , $100.95 , $162.17 , $100.95 , $661.43 , $332.50
81257,5212010010,Hospital Chargemaster,Hba1/Hba2 Gene,Outpatient,Outpatient Default Percent / Case Rate,300, $350.00 , $189.39 , $288.40 , See APC Packaged Rates , $245.00 , $136.50 , $450.46 , $302.26 , $289.41 , See APC Packaged Rates , See APC Packaged Rates , $234.85 , $234.85 , See APC Packaged Rates , See APC Packaged Rates , $161.91 , $161.91 , $166.08 , $166.08 , See APC Packaged Rates , $84.87 , $122.71 , $84.87 , $450.46 , $245.00
81270,5212010013,Hospital Chargemaster,Jak2 Gene,Outpatient,Outpatient Default Percent / Case Rate,300, $324.00 , $188.63 , $266.98 , See APC Packaged Rates , $226.80 , $126.36 , $498.06 , $334.20 , $319.99 , See APC Packaged Rates , See APC Packaged Rates , $217.40 , $217.40 , See APC Packaged Rates , See APC Packaged Rates , $155.96 , $155.96 , $159.97 , $159.97 , See APC Packaged Rates , $76.08 , $122.22 , $76.08 , $498.06 , $226.80
86860,5212010041,Hospital Chargemaster,Rbc Antibody Elution,Outpatient,Outpatient Default Percent / Case Rate,300, $139.00 , $268.04 , $114.54 , $178.30 , $97.30 , $54.21 , $458.30 , $307.52 , $294.44 , $178.30 , $178.30 , $93.27 , $93.27 , $187.22 , $181.87 , $139.00 , $139.00 , $139.00 , $139.00 , $178.30 , $27.22 , $173.68 , $27.22 , $458.30 , $97.30
86972,5212010057,Hospital Chargemaster,Rbc Pretx Incubatj W/Density,Outpatient,Outpatient Default Percent / Case Rate,300, $124.00 , $268.04 , $102.18 , $178.30 , $86.80 , $48.36 , $119.65 , $120.17 , $250.99 , $178.30 , $178.30 , $83.20 , $83.20 , $187.22 , $181.87 , $124.00 , $124.00 , $124.00 , $124.00 , $178.30 , $35.04 , $173.68 , $35.04 , $268.04 , $86.80
81291,5212010015,Hospital Chargemaster,Mthfr Gene,Outpatient,Outpatient Default Percent / Case Rate,300, $234.00 , $121.01 , $192.82 , See APC Packaged Rates , $163.80 , $91.26 , $287.09 , $192.64 , $184.45 , See APC Packaged Rates , See APC Packaged Rates , $157.01 , $157.01 , See APC Packaged Rates , See APC Packaged Rates , $103.44 , $103.44 , $106.11 , $106.11 , See APC Packaged Rates , $54.23 , $78.41 , $54.23 , $287.09 , $163.80
86870,5212010042,Hospital Chargemaster,Rbc Antibody Identification,Outpatient,Outpatient Default Percent / Case Rate,300, $100.00 , $507.86 , $82.40 , $348.19 , $70.00 , $39.00 , $868.33 , $582.65 , $557.88 , $348.19 , $348.19 , $67.10 , $67.10 , $365.60 , $355.15 , $100.00 , $100.00 , $100.00 , $100.00 , $348.19 , $37.06 , $329.06 , $37.06 , $868.33 , $70.00
86850,5212010040,Hospital Chargemaster,Rbc Antibody Screen,Outpatient,Outpatient Default Percent / Case Rate,300, $198.00 , $94.41 , $163.15 , $59.41 , $138.60 , $77.22 , $161.43 , $108.32 , $103.72 , $59.41 , $59.41 , $132.86 , $132.86 , $62.38 , $60.60 , $88.22 , $88.22 , $90.49 , $90.49 , $59.41 , $8.11 , $11.72 , $8.11 , $163.15 , $138.60
86971,5212010056,Hospital Chargemaster,Rbc Pretx Incubatj W/Enzymes,Outpatient,Outpatient Default Percent / Case Rate,300, $78.00 , $507.86 , $64.27 , $348.19 , $54.60 , $30.42 , $868.33 , $582.65 , $557.88 , $348.19 , $348.19 , $52.34 , $52.34 , $365.60 , $355.15 , $78.00 , $78.00 , $78.00 , $78.00 , $348.19 , $19.98 , $329.06 , $19.98 , $868.33 , $54.60
86886,5212010045,Hospital Chargemaster,Coombs Test Indirect Titer,Outpatient,Outpatient Default Percent / Case Rate,300, $73.00 , $268.04 , $60.15 , $178.30 , $51.10 , $28.47 , $458.30 , $307.52 , $294.44 , $178.30 , $178.30 , $17.25 , $16.72 , $187.22 , $181.87 , $73.00 , $73.00 , $73.00 , $73.00 , $178.30 , $4.31 , $6.90 , $4.31 , $458.30 , $51.10
86920,5212010052,Hospital Chargemaster,Compatibility Test Spin,Outpatient,Outpatient Default Percent / Case Rate,300, $73.00 , $268.04 , $60.15 , $178.30 , $51.10 , $28.47 , $458.30 , $307.52 , $294.44 , $178.30 , $178.30 , $48.98 , $48.98 , $187.22 , $181.87 , $73.00 , $73.00 , $73.00 , $73.00 , $178.30 , $30.13 , $173.68 , $28.47 , $458.30 , $51.10
86902,5212010048,Hospital Chargemaster,Blood Type Antigen Donor Ea,Outpatient,Outpatient Default Percent / Case Rate,300, $73.00 , $507.86 , $60.15 , $348.19 , $51.10 , $28.47 , $868.33 , $582.65 , $557.88 , $348.19 , $348.19 , $13.22 , $12.82 , $365.60 , $355.15 , $73.00 , $73.00 , $73.00 , $73.00 , $348.19 , $5.28 , $7.62 , $5.28 , $868.33 , $51.10
86922,5212010053,Hospital Chargemaster,Compatibility Test Antiglob,Outpatient,Outpatient Default Percent / Case Rate,300, $68.00 , $268.04 , $56.03 , $178.30 , $47.60 , $26.52 , $458.30 , $307.52 , $294.44 , $178.30 , $178.30 , $45.63 , $45.63 , $187.22 , $181.87 , $68.00 , $68.00 , $68.00 , $68.00 , $178.30 , $32.15 , $173.68 , $26.52 , $458.30 , $47.60
86970,5212010055,Hospital Chargemaster,Rbc Pretx Incubatj W/Chemicl,Outpatient,Outpatient Default Percent / Case Rate,300, $73.00 , $59.49 , $60.15 , $40.47 , $51.10 , $28.47 , $101.71 , $68.24 , $65.34 , $40.47 , $40.47 , $48.98 , $48.98 , $42.49 , $41.28 , $64.48 , $64.48 , $66.14 , $66.14 , $40.47 , $25.19 , $38.54 , $25.19 , $101.71 , $51.10
86904,5212010049,Hospital Chargemaster,Blood Typing Patient Serum,Outpatient,Outpatient Default Percent / Case Rate,300, $68.00 , $59.49 , $56.03 , $40.47 , $47.60 , $26.52 , $101.71 , $68.24 , $65.34 , $40.47 , $40.47 , $31.96 , $30.99 , $42.49 , $41.28 , $63.27 , $63.27 , $64.89 , $64.89 , $40.47 , $13.56 , $19.61 , $13.56 , $101.71 , $47.60
86978,5212010059,Hospital Chargemaster,Rbc Pretreatment Serum,Outpatient,Outpatient Default Percent / Case Rate,300, $68.00 , $59.49 , $56.03 , $40.47 , $47.60 , $26.52 , $101.71 , $68.24 , $65.34 , $40.47 , $40.47 , $45.63 , $45.63 , $42.49 , $41.28 , $61.57 , $61.57 , $63.16 , $63.16 , $40.47 , $30.13 , $38.54 , $26.52 , $101.71 , $47.60
86906,5212010051,Hospital Chargemaster,Bld Typing Serologic Rh Phnt,Outpatient,Outpatient Default Percent / Case Rate,300, $55.00 , $59.49 , $45.32 , $40.47 , $38.50 , $21.45 , $101.71 , $68.24 , $65.34 , $40.47 , $40.47 , $19.56 , $18.97 , $42.49 , $41.28 , $55.00 , $55.00 , $55.00 , $55.00 , $40.47 , $6.44 , $10.33 , $6.44 , $101.71 , $38.50
86976,5212010058,Hospital Chargemaster,Rbc Serum Pretx Id Dilution,Outpatient,Outpatient Default Percent / Case Rate,300, $139.00 , $31.80 , $114.54 , $29.53 , $97.30 , $54.21 , $54.36 , $36.47 , $34.92 , $29.53 , $29.53 , $93.27 , $93.27 , $31.01 , $30.12 , $46.61 , $46.61 , $47.81 , $47.81 , $29.53 , $30.13 , $20.60 , $20.60 , $114.54 , $97.30
86885,5212010044,Hospital Chargemaster,Coombs Test Indirect Qual,Outpatient,Outpatient Default Percent / Case Rate,300, $42.00 , $268.04 , $34.61 , $178.30 , $29.40 , $16.38 , $458.30 , $307.52 , $294.44 , $178.30 , $178.30 , $17.25 , $16.72 , $187.22 , $181.87 , $42.00 , $42.00 , $42.00 , $42.00 , $178.30 , $4.75 , $7.63 , $4.75 , $458.30 , $29.40
86905,5212010050,Hospital Chargemaster,Blood Typing Rbc Antigens,Outpatient,Outpatient Default Percent / Case Rate,300, $40.00 , $507.86 , $32.96 , $348.19 , $28.00 , $15.60 , $868.33 , $582.65 , $557.88 , $348.19 , $348.19 , $12.85 , $12.46 , $365.60 , $355.15 , $40.00 , $40.00 , $40.00 , $40.00 , $348.19 , $3.18 , $5.10 , $3.18 , $868.33 , $28.00
86900,5212010046,Hospital Chargemaster,Blood Typing Serologic Abo,Outpatient,Outpatient Default Percent / Case Rate,300, $32.00 , $197.20 , $26.37 , $134.80 , $22.40 , $12.48 , $337.18 , $226.25 , $216.63 , $134.80 , $134.80 , $11.54 , $11.19 , $141.54 , $137.50 , $32.00 , $32.00 , $32.00 , $32.00 , $134.80 , $2.47 , $3.98 , $2.47 , $337.18 , $22.40
86880,5212010043,Hospital Chargemaster,Coombs Test Direct,Outpatient,Outpatient Default Percent / Case Rate,300, $30.00 , $59.49 , $24.72 , $66.55 , $21.00 , $11.70 , $101.71 , $68.24 , $65.34 , $66.55 , $66.55 , $17.13 , $16.61 , $69.87 , $67.88 , $30.00 , $30.00 , $30.00 , $30.00 , $66.55 , $4.47 , $7.19 , $4.47 , $101.71 , $21.00
86901,5212010047,Hospital Chargemaster,Blood Typing Serologic Rh(D),Outpatient,Outpatient Default Percent / Case Rate,300, $30.00 , $59.49 , $24.72 , $40.47 , $21.00 , $11.70 , $101.71 , $68.24 , $65.34 , $40.47 , $40.47 , $9.83 , $9.53 , $42.49 , $41.28 , $30.00 , $30.00 , $30.00 , $30.00 , $40.47 , $2.47 , $3.98 , $2.47 , $101.71 , $21.00
36415,5212010787,Hospital Chargemaster,Routine Venipuncture,Outpatient,Outpatient Default Percent / Case Rate,300, $16.00 , $8.80 , $13.18 , See APC Packaged Rates , $11.20 , $6.24 , $12.68 , $8.51 , $8.15 , See APC Packaged Rates , See APC Packaged Rates , $7.02 , $6.81 , See APC Packaged Rates , See APC Packaged Rates , $3.86 , $3.86 , $3.96 , $3.96 , See APC Packaged Rates , $2.49 , $3.60 , $2.49 , $13.18 , $11.20
81596,5212010038,Hospital Chargemaster,Nfct Ds Chrnc Hcv 6 Assays,Outpatient,Outpatient Default Percent / Case Rate,300, $216.00 , $133.70 , $177.98 , See APC Packaged Rates , $151.20 , $84.24 , $199.89 , $134.13 , $128.43 , See APC Packaged Rates , See APC Packaged Rates , $177.37 , $171.99 , See APC Packaged Rates , See APC Packaged Rates , $114.29 , $114.29 , $117.23 , $117.23 , See APC Packaged Rates , $59.91 , $86.63 , $59.91 , $199.89 , $151.20
81450,5212010609,Hospital Chargemaster,Targeted Genomic Seq Analys,Outpatient,Outpatient Default Percent / Case Rate,301," $2,412.00 "," $1,406.65 "," $1,987.49 ", See APC Packaged Rates ," $1,688.40 ", $940.68 ," $3,343.65 "," $2,243.59 "," $2,148.20 ", See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates ," $1,202.53 "," $1,202.53 "," $1,233.49 "," $1,233.49 ", See APC Packaged Rates , $630.39 , $911.44 , $- ," $3,343.65 "," $1,688.40 "
81220,5212010592,Hospital Chargemaster,Cftr Gene Com Variants,Outpatient,Outpatient Default Percent / Case Rate,301," $1,670.00 "," $1,030.82 "," $1,376.08 ", See APC Packaged Rates ," $1,169.00 ", $651.30 ," $2,449.04 "," $1,643.31 "," $1,573.44 ", See APC Packaged Rates , See APC Packaged Rates ," $1,120.57 "," $1,120.57 ", See APC Packaged Rates , See APC Packaged Rates , $881.23 , $881.23 , $903.92 , $903.92 , See APC Packaged Rates , $461.97 , $667.92 , $461.97 ," $2,449.04 "," $1,169.00 "
81235,5212010593,Hospital Chargemaster,Egfr Gene Com Variants,Outpatient,Outpatient Default Percent / Case Rate,301, $993.00 , $601.12 , $818.23 , See APC Packaged Rates , $695.10 , $387.27 ," $1,429.14 ", $958.95 , $918.18 , See APC Packaged Rates , See APC Packaged Rates , $666.30 , $666.30 , See APC Packaged Rates , See APC Packaged Rates , $513.90 , $513.90 , $527.13 , $527.13 , See APC Packaged Rates , $269.40 , $389.50 , $269.40 ," $1,429.14 ", $695.10
81263,5212010598,Hospital Chargemaster,Igh Vari Regional Mutation,Outpatient,Outpatient Default Percent / Case Rate,301, $877.00 , $606.05 , $722.65 , See APC Packaged Rates , $613.90 , $342.03 ," $1,600.45 "," $1,073.91 "," $1,028.24 ", See APC Packaged Rates , See APC Packaged Rates , $588.47 , $588.47 , See APC Packaged Rates , See APC Packaged Rates , $501.10 , $501.10 , $514.00 , $514.00 , See APC Packaged Rates , $244.45 , $392.69 , $244.45 ," $1,600.45 ", $613.90
81406,5212010608,Hospital Chargemaster,Mopath Procedure Level 7,Outpatient,Outpatient Default Percent / Case Rate,301, $780.00 , $523.89 , $642.72 , See APC Packaged Rates , $546.00 , $304.20 ," $1,245.14 ", $835.49 , $799.96 , See APC Packaged Rates , See APC Packaged Rates , $523.38 , $523.38 , See APC Packaged Rates , See APC Packaged Rates , $447.88 , $447.88 , $459.41 , $459.41 , See APC Packaged Rates , $234.78 , $339.46 , $234.78 ," $1,245.14 ", $546.00
G0483,5212010793,Hospital Chargemaster,Drug test def 22+ classes,Outpatient,Outpatient Default Percent / Case Rate,301, $610.00 , $335.50 , $502.64 , See APC Packaged Rates , $427.00 , $237.90 ," $1,086.53 ", $729.06 , $698.06 , See APC Packaged Rates , See APC Packaged Rates , $409.31 , $409.31 , See APC Packaged Rates , See APC Packaged Rates , $317.66 , $317.66 , $325.85 , $325.85 , See APC Packaged Rates , $213.50 , $296.30 , $213.50 ," $1,086.53 ", $427.00
81206,5212010590,Hospital Chargemaster,Bcr/Abl1 Gene Major Bp,Outpatient,Outpatient Default Percent / Case Rate,301, $488.00 , $337.40 , $402.11 , See APC Packaged Rates , $341.60 , $190.32 , $891.42 , $598.15 , $572.71 , See APC Packaged Rates , See APC Packaged Rates , $327.45 , $327.45 , See APC Packaged Rates , See APC Packaged Rates , $278.97 , $278.97 , $286.15 , $286.15 , See APC Packaged Rates , $136.07 , $218.62 , $136.07 , $891.42 , $341.60
81381,5212010605,Hospital Chargemaster,Hla I Typing 1 Allele Hr,Outpatient,Outpatient Default Percent / Case Rate,301, $281.00 , $314.65 , $231.54 , See APC Packaged Rates , $196.70 , $109.59 , $747.08 , $501.29 , $479.97 , See APC Packaged Rates , See APC Packaged Rates , $188.55 , $188.55 , See APC Packaged Rates , See APC Packaged Rates , $269.00 , $269.00 , $275.93 , $275.93 , See APC Packaged Rates , $141.02 , $203.88 , $109.59 , $747.08 , $196.70
81207,5212010591,Hospital Chargemaster,Bcr/Abl1 Gene Minor Bp,Outpatient,Outpatient Default Percent / Case Rate,301, $431.00 , $298.04 , $355.14 , See APC Packaged Rates , $301.70 , $168.09 , $786.73 , $527.89 , $505.45 , See APC Packaged Rates , See APC Packaged Rates , $289.20 , $289.20 , See APC Packaged Rates , See APC Packaged Rates , $246.44 , $246.44 , $252.78 , $252.78 , See APC Packaged Rates , $120.22 , $193.12 , $120.22 , $786.73 , $301.70
88264,5212010611,Hospital Chargemaster,Chromosome Analysis 20-25,Outpatient,Outpatient Default Percent / Case Rate,301, $885.00 , $267.82 , $729.24 , See APC Packaged Rates , $619.50 , $345.15 , $677.30 , $454.47 , $435.14 , See APC Packaged Rates , See APC Packaged Rates , $631.73 , $612.56 , See APC Packaged Rates , See APC Packaged Rates , $228.96 , $228.96 , $234.86 , $234.86 , See APC Packaged Rates , $120.03 , $173.53 , $120.03 , $729.24 , $619.50
81401,5212010607,Hospital Chargemaster,Mopath Procedure Level 2,Outpatient,Outpatient Default Percent / Case Rate,301, $550.00 , $253.72 , $453.20 , See APC Packaged Rates , $385.00 , $214.50 , $602.76 , $404.45 , $387.25 , See APC Packaged Rates , See APC Packaged Rates , $369.05 , $369.05 , See APC Packaged Rates , See APC Packaged Rates , $216.90 , $216.90 , $222.49 , $222.49 , See APC Packaged Rates , $113.71 , $164.40 , $113.71 , $602.76 , $385.00
G0482,5212010792,Hospital Chargemaster,Drug test def 15-21 classes,Outpatient,Outpatient Default Percent / Case Rate,301, $221.00 , $121.55 , $182.10 , See APC Packaged Rates , $154.70 , $86.19 , $873.98 , $586.44 , $561.51 , See APC Packaged Rates , See APC Packaged Rates , $148.29 , $148.29 , See APC Packaged Rates , See APC Packaged Rates , $221.00 , $221.00 , $221.00 , $221.00 , See APC Packaged Rates , $77.35 , $238.49 , $77.35 , $873.98 , $154.70
81382,5212010606,Hospital Chargemaster,Hla Ii Typing 1 Loc Hr,Outpatient,Outpatient Default Percent / Case Rate,301, $368.00 , $254.50 , $303.23 , See APC Packaged Rates , $257.60 , $143.52 , $672.53 , $451.27 , $432.08 , See APC Packaged Rates , See APC Packaged Rates , $246.93 , $246.93 , See APC Packaged Rates , See APC Packaged Rates , $210.44 , $210.44 , $215.86 , $215.86 , See APC Packaged Rates , $102.65 , $164.90 , $102.65 , $672.53 , $257.60
84112,5212010481,Hospital Chargemaster,Eval Amniotic Fluid Protein,Outpatient,Outpatient Default Percent / Case Rate,301, $306.00 , $181.70 , $252.14 , See APC Packaged Rates , $214.20 , $119.34 , $431.44 , $289.49 , $277.19 , See APC Packaged Rates , See APC Packaged Rates , $222.70 , $215.94 , See APC Packaged Rates , See APC Packaged Rates , $155.33 , $155.33 , $159.33 , $159.33 , See APC Packaged Rates , $81.43 , $117.73 , $81.43 , $431.44 , $214.20
84233,5212010515,Hospital Chargemaster,Assay Of Estrogen,Outpatient,Outpatient Default Percent / Case Rate,301, $610.00 , $162.75 , $502.64 , See APC Packaged Rates , $427.00 , $237.90 , $387.02 , $259.69 , $248.65 , See APC Packaged Rates , See APC Packaged Rates , $216.61 , $210.04 , See APC Packaged Rates , See APC Packaged Rates , $139.13 , $139.13 , $142.71 , $142.71 , See APC Packaged Rates , $72.94 , $105.46 , $72.94 , $502.64 , $427.00
88346,5212010612,Hospital Chargemaster,Immunofluor Antb 1St Stain,Outpatient,Outpatient Default Percent / Case Rate,301, $135.00 , $507.86 , $111.24 , $348.19 , $94.50 , $52.65 , $868.33 , $582.65 , $557.88 , $348.19 , $348.19 , $98.05 , $95.07 , $365.60 , $355.15 , $135.00 , $135.00 , $135.00 , $135.00 , $348.19 , $90.94 , $329.06 , $52.65 , $868.33 , $94.50
81374,5212010603,Hospital Chargemaster,Hla I Typing 1 Antigen Lr,Outpatient,Outpatient Default Percent / Case Rate,301, $297.00 , $149.70 , $244.73 , See APC Packaged Rates , $207.90 , $115.83 , $394.97 , $265.03 , $253.76 , See APC Packaged Rates , See APC Packaged Rates , $199.29 , $199.29 , See APC Packaged Rates , See APC Packaged Rates , $124.39 , $124.39 , $127.60 , $127.60 , See APC Packaged Rates , $61.69 , $97.00 , $61.69 , $394.97 , $207.90
81241,5212010595,Hospital Chargemaster,F5 Gene,Outpatient,Outpatient Default Percent / Case Rate,301, $331.00 , $135.88 , $272.74 , See APC Packaged Rates , $231.70 , $129.09 , $331.50 , $222.44 , $212.98 , See APC Packaged Rates , See APC Packaged Rates , $222.10 , $222.10 , See APC Packaged Rates , See APC Packaged Rates , $116.16 , $116.16 , $119.16 , $119.16 , See APC Packaged Rates , $60.90 , $88.04 , $60.90 , $331.50 , $231.70
83013,5212010371,Hospital Chargemaster,H Pylori (C-13) Breath,Outpatient,Outpatient Default Percent / Case Rate,301, $258.00 , $138.60 , $212.59 , See APC Packaged Rates , $180.60 , $100.62 , $366.39 , $245.85 , $235.40 , See APC Packaged Rates , See APC Packaged Rates , $228.71 , $221.77 , See APC Packaged Rates , See APC Packaged Rates , $114.61 , $114.61 , $117.56 , $117.56 , See APC Packaged Rates , $55.90 , $89.81 , $55.90 , $366.39 , $180.60
81256,5212010597,Hospital Chargemaster,Hfe Gene,Outpatient,Outpatient Default Percent / Case Rate,301, $294.00 , $134.49 , $242.26 , See APC Packaged Rates , $205.80 , $114.66 , $355.29 , $238.40 , $228.26 , See APC Packaged Rates , See APC Packaged Rates , $197.27 , $197.27 , See APC Packaged Rates , See APC Packaged Rates , $111.21 , $111.21 , $114.07 , $114.07 , See APC Packaged Rates , $54.24 , $87.14 , $54.24 , $355.29 , $205.80
82731,5212010326,Hospital Chargemaster,Assay Of Fetal Fibronectin,Outpatient,Outpatient Default Percent / Case Rate,301, $300.00 , $132.55 , $247.20 , See APC Packaged Rates , $210.00 , $117.00 , $350.56 , $235.22 , $225.22 , See APC Packaged Rates , See APC Packaged Rates , $218.70 , $212.06 , See APC Packaged Rates , See APC Packaged Rates , $109.60 , $109.60 , $112.42 , $112.42 , See APC Packaged Rates , $53.46 , $85.88 , $53.46 , $350.56 , $210.00
81240,5212010594,Hospital Chargemaster,F2 Gene,Outpatient,Outpatient Default Percent / Case Rate,301, $270.00 , $121.66 , $222.48 , See APC Packaged Rates , $189.00 , $105.30 , $288.70 , $193.72 , $185.48 , See APC Packaged Rates , See APC Packaged Rates , $181.17 , $181.17 , See APC Packaged Rates , See APC Packaged Rates , $104.00 , $104.00 , $106.68 , $106.68 , See APC Packaged Rates , $54.52 , $78.83 , $54.52 , $288.70 , $189.00
80050,5212010062,Hospital Chargemaster,General Health Panel,Outpatient,Outpatient Default Percent / Case Rate,301, $286.00 , $87.43 , $235.66 , See APC Packaged Rates , $200.20 , $111.54 , $207.79 , $139.42 , $133.50 , See APC Packaged Rates , See APC Packaged Rates , $74.88 , $72.61 , See APC Packaged Rates , See APC Packaged Rates , $103.49 , $103.49 , $106.15 , $106.15 , See APC Packaged Rates , $37.64 , $56.65 , $37.64 , $235.66 , $200.20
82664,5212010312,Hospital Chargemaster,Electrophoretic Test,Outpatient,Outpatient Default Percent / Case Rate,301, $159.00 , $113.90 , $131.02 , See APC Packaged Rates , $111.30 , $62.01 , $271.22 , $181.99 , $174.25 , See APC Packaged Rates , See APC Packaged Rates , $115.53 , $112.02 , See APC Packaged Rates , See APC Packaged Rates , $97.37 , $97.37 , $99.87 , $99.87 , See APC Packaged Rates , $51.05 , $73.80 , $51.05 , $271.22 , $111.30
G0480,5212010790,Hospital Chargemaster,Drug test def 1-7 classes,Outpatient,Outpatient Default Percent / Case Rate,301, $98.00 , $53.90 , $80.75 , See APC Packaged Rates , $68.60 , $38.22 , $504.40 , $338.45 , $324.06 , See APC Packaged Rates , See APC Packaged Rates , $65.76 , $65.76 , See APC Packaged Rates , See APC Packaged Rates , $98.00 , $98.00 , $98.00 , $98.00 , See APC Packaged Rates , $34.30 , $137.32 , $34.30 , $504.40 , $68.60
81243,5212010596,Hospital Chargemaster,Fmr1 Gene Detection,Outpatient,Outpatient Default Percent / Case Rate,301, $393.00 , $105.64 , $323.83 , See APC Packaged Rates , $275.10 , $153.27 , $250.62 , $168.17 , $161.02 , See APC Packaged Rates , See APC Packaged Rates , $263.70 , $263.70 , See APC Packaged Rates , See APC Packaged Rates , $90.31 , $90.31 , $92.63 , $92.63 , See APC Packaged Rates , $47.35 , $68.45 , $47.35 , $323.83 , $275.10
84410,5212010540,Hospital Chargemaster,Testosterone Bioavailable,Outpatient,Outpatient Default Percent / Case Rate,301, $189.00 , $105.53 , $155.74 , See APC Packaged Rates , $132.30 , $73.71 , $279.17 , $187.32 , $179.36 , See APC Packaged Rates , See APC Packaged Rates , $178.26 , $172.85 , See APC Packaged Rates , See APC Packaged Rates , $87.26 , $87.26 , $89.51 , $89.51 , See APC Packaged Rates , $42.56 , $68.38 , $42.56 , $279.17 , $132.30
84445,5212010550,Hospital Chargemaster,Assay Of Tsi Globulin,Outpatient,Outpatient Default Percent / Case Rate,301, $236.00 , $104.66 , $194.46 , See APC Packaged Rates , $165.20 , $92.04 , $275.99 , $185.19 , $177.31 , See APC Packaged Rates , See APC Packaged Rates , $171.03 , $165.84 , See APC Packaged Rates , See APC Packaged Rates , $86.52 , $86.52 , $88.75 , $88.75 , See APC Packaged Rates , $42.22 , $67.81 , $42.22 , $275.99 , $165.20
89230,6500011930,Hospital Chargemaster,Sweat Collection,Outpatient,Outpatient Default Percent / Case Rate,301, $84.00 , $94.41 , $69.22 , $59.41 , $58.80 , $32.76 , $161.43 , $108.32 , $103.72 , $59.41 , $59.41 , $56.36 , $56.36 , $62.38 , $60.60 , $84.00 , $84.00 , $84.00 , $84.00 , $59.41 , $2.03 , $61.18 , $2.03 , $161.43 , $58.80
80074,5212010068,Hospital Chargemaster,Acute Hepatitis Panel,Outpatient,Outpatient Default Percent / Case Rate,301, $311.00 , $98.03 , $256.26 , See APC Packaged Rates , $217.70 , $121.29 , $258.54 , $173.48 , $166.11 , See APC Packaged Rates , See APC Packaged Rates , $189.07 , $183.34 , See APC Packaged Rates , See APC Packaged Rates , $81.05 , $81.05 , $83.13 , $83.13 , See APC Packaged Rates , $39.53 , $63.52 , $39.53 , $258.54 , $217.70
83698,5212010427,Hospital Chargemaster,Assay Lipoprotein Pla2,Outpatient,Outpatient Default Percent / Case Rate,301, $137.00 , $85.77 , $112.89 , See APC Packaged Rates , $95.90 , $53.43 , $203.02 , $136.23 , $130.44 , See APC Packaged Rates , See APC Packaged Rates , $116.53 , $113.00 , See APC Packaged Rates , See APC Packaged Rates , $73.33 , $73.33 , $75.21 , $75.21 , See APC Packaged Rates , $38.43 , $55.57 , $38.43 , $203.02 , $95.90
83970,5212010463,Hospital Chargemaster,Assay Of Parathormone,Outpatient,Outpatient Default Percent / Case Rate,301, $267.00 , $84.93 , $220.01 , See APC Packaged Rates , $186.90 , $104.13 , $223.65 , $150.07 , $143.69 , See APC Packaged Rates , See APC Packaged Rates , $173.51 , $168.25 , See APC Packaged Rates , See APC Packaged Rates , $70.23 , $70.23 , $72.04 , $72.04 , See APC Packaged Rates , $34.26 , $55.03 , $34.26 , $223.65 , $186.90
82088,5212010211,Hospital Chargemaster,Assay Of Aldosterone,Outpatient,Outpatient Default Percent / Case Rate,301, $396.00 , $83.86 , $326.30 , See APC Packaged Rates , $277.20 , $154.44 , $222.07 , $149.01 , $142.68 , See APC Packaged Rates , See APC Packaged Rates , $76.28 , $73.97 , See APC Packaged Rates , See APC Packaged Rates , $69.34 , $69.34 , $71.13 , $71.13 , See APC Packaged Rates , $33.82 , $54.34 , $33.82 , $326.30 , $277.20
84150,5212010495,Hospital Chargemaster,Assay Of Prostaglandin,Outpatient,Outpatient Default Percent / Case Rate,301, $107.00 , $77.36 , $88.17 , See APC Packaged Rates , $74.90 , $41.73 , $184.00 , $123.46 , $118.21 , See APC Packaged Rates , See APC Packaged Rates , $83.96 , $81.41 , See APC Packaged Rates , See APC Packaged Rates , $66.13 , $66.13 , $67.83 , $67.83 , See APC Packaged Rates , $34.67 , $50.12 , $34.67 , $184.00 , $74.90
82024,5212010202,Hospital Chargemaster,Assay Of Acth,Outpatient,Outpatient Default Percent / Case Rate,301, $315.00 , $79.47 , $259.56 , See APC Packaged Rates , $220.50 , $122.85 , $209.36 , $140.48 , $134.51 , See APC Packaged Rates , See APC Packaged Rates , $69.66 , $67.55 , See APC Packaged Rates , See APC Packaged Rates , $65.71 , $65.71 , $67.40 , $67.40 , See APC Packaged Rates , $32.05 , $51.49 , $32.05 , $259.56 , $220.50
82652,5212010308,Hospital Chargemaster,Vid 1 25-Dihydroxy,Outpatient,Outpatient Default Percent / Case Rate,301, $290.00 , $79.23 , $238.96 , See APC Packaged Rates , $203.00 , $113.10 , $209.36 , $140.48 , $134.51 , See APC Packaged Rates , See APC Packaged Rates , $136.14 , $132.01 , See APC Packaged Rates , See APC Packaged Rates , $65.51 , $65.51 , $67.20 , $67.20 , See APC Packaged Rates , $31.96 , $51.34 , $31.96 , $238.96 , $203.00
84238,5212010518,Hospital Chargemaster,Assay Nonendocrine Receptor,Outpatient,Outpatient Default Percent / Case Rate,301, $303.00 , $75.25 , $249.67 , See APC Packaged Rates , $212.10 , $118.17 , $198.26 , $133.03 , $127.38 , See APC Packaged Rates , See APC Packaged Rates , $153.71 , $149.05 , See APC Packaged Rates , See APC Packaged Rates , $62.22 , $62.22 , $63.82 , $63.82 , See APC Packaged Rates , $30.35 , $48.76 , $30.35 , $249.67 , $212.10
83880,5212010449,Hospital Chargemaster,Assay Of Natriuretic Peptide,Outpatient,Outpatient Default Percent / Case Rate,301, $234.00 , $77.60 , $192.82 , See APC Packaged Rates , $163.80 , $91.26 , $184.00 , $123.46 , $118.21 , See APC Packaged Rates , See APC Packaged Rates , $113.86 , $110.41 , See APC Packaged Rates , See APC Packaged Rates , $62.16 , $62.16 , $63.76 , $63.76 , See APC Packaged Rates , $32.59 , $47.11 , $32.59 , $192.82 , $163.80
84126,5212010484,Hospital Chargemaster,Assay Of Feces Porphyrins,Outpatient,Outpatient Default Percent / Case Rate,301, $137.00 , $72.43 , $112.89 , See APC Packaged Rates , $95.90 , $53.43 , $172.90 , $116.01 , $111.08 , See APC Packaged Rates , See APC Packaged Rates , $85.67 , $83.07 , See APC Packaged Rates , See APC Packaged Rates , $61.93 , $61.93 , $63.52 , $63.52 , See APC Packaged Rates , $32.45 , $46.93 , $32.45 , $172.90 , $95.90
84586,5212010576,Hospital Chargemaster,Assay Of Vip,Outpatient,Outpatient Default Percent / Case Rate,301, $369.00 , $72.71 , $304.06 , See APC Packaged Rates , $258.30 , $143.91 , $191.92 , $128.78 , $123.30 , See APC Packaged Rates , See APC Packaged Rates , $64.21 , $62.26 , See APC Packaged Rates , See APC Packaged Rates , $60.11 , $60.11 , $61.66 , $61.66 , See APC Packaged Rates , $29.31 , $47.11 , $29.31 , $304.06 , $258.30
84588,5212010577,Hospital Chargemaster,Assay Of Vasopressin,Outpatient,Outpatient Default Percent / Case Rate,301, $396.00 , $69.84 , $326.30 , See APC Packaged Rates , $277.20 , $154.44 , $184.00 , $123.46 , $118.21 , See APC Packaged Rates , See APC Packaged Rates , $115.27 , $111.77 , See APC Packaged Rates , See APC Packaged Rates , $57.74 , $57.74 , $59.23 , $59.23 , See APC Packaged Rates , $28.17 , $45.25 , $28.17 , $326.30 , $277.20
84431,5212010543,Hospital Chargemaster,Thromboxane Urine,Outpatient,Outpatient Default Percent / Case Rate,301, $76.00 , $65.02 , $62.62 , See APC Packaged Rates , $53.20 , $29.64 , $153.85 , $103.23 , $98.84 , See APC Packaged Rates , See APC Packaged Rates , $55.32 , $53.64 , See APC Packaged Rates , See APC Packaged Rates , $55.59 , $55.59 , $57.02 , $57.02 , See APC Packaged Rates , $29.14 , $42.13 , $29.14 , $153.85 , $53.20
82671,5212010315,Hospital Chargemaster,Assay Of Estrogens,Outpatient,Outpatient Default Percent / Case Rate,301, $444.00 , $66.47 , $365.86 , See APC Packaged Rates , $310.80 , $173.16 , $176.05 , $118.13 , $113.11 , See APC Packaged Rates , See APC Packaged Rates , $108.62 , $105.33 , See APC Packaged Rates , See APC Packaged Rates , $54.96 , $54.96 , $56.37 , $56.37 , See APC Packaged Rates , $26.81 , $43.07 , $26.81 , $365.86 , $310.80
83704,5212010430,Hospital Chargemaster,Lipoprotein Bld Quan Part,Outpatient,Outpatient Default Percent / Case Rate,301, $137.00 , $64.93 , $112.89 , See APC Packaged Rates , $95.90 , $53.43 , $171.32 , $114.95 , $110.07 , See APC Packaged Rates , See APC Packaged Rates , $108.30 , $105.01 , See APC Packaged Rates , See APC Packaged Rates , $54.73 , $54.73 , $56.14 , $56.14 , See APC Packaged Rates , $28.37 , $42.07 , $28.37 , $171.32 , $95.90
83701,5212010429,Hospital Chargemaster,Lipoprotein Bld Hr Fraction,Outpatient,Outpatient Default Percent / Case Rate,301, $117.00 , $62.71 , $96.41 , See APC Packaged Rates , $81.90 , $45.63 , $149.11 , $100.05 , $95.80 , See APC Packaged Rates , See APC Packaged Rates , $85.20 , $82.61 , See APC Packaged Rates , See APC Packaged Rates , $53.61 , $53.61 , $54.99 , $54.99 , See APC Packaged Rates , $28.10 , $40.63 , $28.10 , $149.11 , $81.90
82633,5212010304,Hospital Chargemaster,Desoxycorticosterone,Outpatient,Outpatient Default Percent / Case Rate,301, $164.00 , $63.76 , $135.14 , See APC Packaged Rates , $114.80 , $63.96 , $168.13 , $112.82 , $108.02 , See APC Packaged Rates , See APC Packaged Rates , $69.66 , $67.55 , See APC Packaged Rates , See APC Packaged Rates , $52.71 , $52.71 , $54.07 , $54.07 , See APC Packaged Rates , $25.72 , $41.32 , $25.72 , $168.13 , $114.80
84260,5212010522,Hospital Chargemaster,Assay Of Serotonin,Outpatient,Outpatient Default Percent / Case Rate,301, $332.00 , $63.76 , $273.57 , See APC Packaged Rates , $232.40 , $129.48 , $168.13 , $112.82 , $108.02 , See APC Packaged Rates , See APC Packaged Rates , $104.20 , $101.04 , See APC Packaged Rates , See APC Packaged Rates , $52.71 , $52.71 , $54.07 , $54.07 , See APC Packaged Rates , $25.72 , $41.32 , $25.72 , $273.57 , $232.40
83937,5212010459,Hospital Chargemaster,Assay Of Osteocalcin,Outpatient,Outpatient Default Percent / Case Rate,301, $225.00 , $61.41 , $185.40 , See APC Packaged Rates , $157.50 , $87.75 , $161.79 , $108.56 , $103.95 , See APC Packaged Rates , See APC Packaged Rates , $100.41 , $97.36 , See APC Packaged Rates , See APC Packaged Rates , $50.79 , $50.79 , $52.10 , $52.10 , See APC Packaged Rates , $24.77 , $39.79 , $24.77 , $185.40 , $157.50
82306,5212010247,Hospital Chargemaster,Vitamin D 25 Hydroxy,Outpatient,Outpatient Default Percent / Case Rate,301, $258.00 , $60.91 , $212.59 , See APC Packaged Rates , $180.60 , $100.62 , $160.21 , $107.50 , $102.93 , See APC Packaged Rates , See APC Packaged Rates , $97.34 , $94.39 , See APC Packaged Rates , See APC Packaged Rates , $50.38 , $50.38 , $51.67 , $51.67 , See APC Packaged Rates , $24.57 , $39.47 , $24.57 , $212.59 , $180.60
83088,5212010391,Hospital Chargemaster,Assay Of Histamine,Outpatient,Outpatient Default Percent / Case Rate,301, $320.00 , $60.76 , $263.68 , See APC Packaged Rates , $224.00 , $124.80 , $160.21 , $107.50 , $102.93 , See APC Packaged Rates , See APC Packaged Rates , $99.33 , $96.32 , See APC Packaged Rates , See APC Packaged Rates , $50.25 , $50.25 , $51.55 , $51.55 , See APC Packaged Rates , $24.50 , $39.37 , $24.50 , $263.68 , $224.00
82157,5212010229,Hospital Chargemaster,Assay Of Androstenedione,Outpatient,Outpatient Default Percent / Case Rate,301, $155.00 , $60.25 , $127.72 , See APC Packaged Rates , $108.50 , $60.45 , $158.61 , $106.43 , $101.90 , See APC Packaged Rates , See APC Packaged Rates , $68.07 , $66.01 , See APC Packaged Rates , See APC Packaged Rates , $49.81 , $49.81 , $51.09 , $51.09 , See APC Packaged Rates , $24.30 , $39.04 , $24.30 , $158.61 , $108.50
82634,5212010305,Hospital Chargemaster,Deoxycortisol,Outpatient,Outpatient Default Percent / Case Rate,301, $369.00 , $60.25 , $304.06 , See APC Packaged Rates , $258.30 , $143.91 , $158.61 , $106.43 , $101.90 , See APC Packaged Rates , See APC Packaged Rates , $73.22 , $71.00 , See APC Packaged Rates , See APC Packaged Rates , $49.81 , $49.81 , $51.09 , $51.09 , See APC Packaged Rates , $24.30 , $39.04 , $24.30 , $304.06 , $258.30
82154,5212010228,Hospital Chargemaster,Androstanediol Glucuronide,Outpatient,Outpatient Default Percent / Case Rate,301, $86.00 , $59.34 , $70.86 , See APC Packaged Rates , $60.20 , $33.54 , $157.03 , $105.37 , $100.89 , See APC Packaged Rates , See APC Packaged Rates , $62.67 , $60.76 , See APC Packaged Rates , See APC Packaged Rates , $49.05 , $49.05 , $50.32 , $50.32 , See APC Packaged Rates , $23.93 , $38.45 , $23.93 , $157.03 , $60.20
80307,5212010110,Hospital Chargemaster,Drug Test Prsmv Chem Anlyzr,Outpatient,Outpatient Default Percent / Case Rate,301, $250.00 , $119.73 , $206.00 , See APC Packaged Rates , $175.00 , $97.50 , $315.64 , $211.79 , $202.79 , See APC Packaged Rates , See APC Packaged Rates , $196.09 , $190.14 , See APC Packaged Rates , See APC Packaged Rates , $81.72 , $81.72 , $83.82 , $83.82 , See APC Packaged Rates , $51.57 , $77.58 , $51.57 , $315.64 , $175.00
84207,5212010511,Hospital Chargemaster,Assay Of Vitamin B-6,Outpatient,Outpatient Default Percent / Case Rate,301, $171.00 , $57.82 , $140.90 , See APC Packaged Rates , $119.70 , $66.69 , $152.27 , $102.17 , $97.83 , See APC Packaged Rates , See APC Packaged Rates , $58.64 , $56.86 , See APC Packaged Rates , See APC Packaged Rates , $47.81 , $47.81 , $49.04 , $49.04 , See APC Packaged Rates , $23.33 , $37.46 , $23.33 , $152.27 , $119.70
82670,5212010314,Hospital Chargemaster,Assay Of Estradiol,Outpatient,Outpatient Default Percent / Case Rate,301, $128.00 , $57.49 , $105.47 , See APC Packaged Rates , $89.60 , $49.92 , $152.27 , $102.17 , $97.83 , See APC Packaged Rates , See APC Packaged Rates , $94.00 , $91.15 , See APC Packaged Rates , See APC Packaged Rates , $47.53 , $47.53 , $48.75 , $48.75 , See APC Packaged Rates , $23.19 , $37.25 , $23.19 , $152.27 , $89.60
81007,5212010192,Hospital Chargemaster,Urine Screen For Bacteria,Outpatient,Outpatient Default Percent / Case Rate,301, $117.00 , $55.52 , $96.41 , See APC Packaged Rates , $81.90 , $45.63 , $131.67 , $88.35 , $84.59 , See APC Packaged Rates , See APC Packaged Rates , $4.07 , $3.95 , See APC Packaged Rates , See APC Packaged Rates , $47.47 , $47.47 , $48.69 , $48.69 , See APC Packaged Rates , $24.88 , $35.98 , $3.95 , $131.67 , $81.90
82507,5212010280,Hospital Chargemaster,Assay Of Citrate,Outpatient,Outpatient Default Percent / Case Rate,301, $157.00 , $57.21 , $129.37 , See APC Packaged Rates , $109.90 , $61.23 , $150.69 , $101.11 , $96.81 , See APC Packaged Rates , See APC Packaged Rates , $93.51 , $90.67 , See APC Packaged Rates , See APC Packaged Rates , $47.32 , $47.32 , $48.53 , $48.53 , See APC Packaged Rates , $23.07 , $37.07 , $23.07 , $150.69 , $109.90
84182,5212010507,Hospital Chargemaster,Protein Western Blot Test,Outpatient,Outpatient Default Percent / Case Rate,301, $270.00 , $54.10 , $222.48 , See APC Packaged Rates , $189.00 , $105.30 , $84.12 , $56.45 , $54.05 , See APC Packaged Rates , See APC Packaged Rates , $60.54 , $58.70 , See APC Packaged Rates , See APC Packaged Rates , $46.25 , $46.25 , $47.44 , $47.44 , See APC Packaged Rates , $24.25 , $35.05 , $24.25 , $222.48 , $189.00
83498,5212010396,Hospital Chargemaster,Assay Of Progesterone 17-D,Outpatient,Outpatient Default Percent / Case Rate,301, $246.00 , $55.91 , $202.70 , See APC Packaged Rates , $172.20 , $95.94 , $147.50 , $98.98 , $94.77 , See APC Packaged Rates , See APC Packaged Rates , $68.07 , $66.01 , See APC Packaged Rates , See APC Packaged Rates , $46.22 , $46.22 , $47.41 , $47.41 , See APC Packaged Rates , $22.55 , $36.23 , $22.55 , $202.70 , $172.20
84145,5212010493,Hospital Chargemaster,Procalcitonin (Pct),Outpatient,Outpatient Default Percent / Case Rate,301, $110.00 , $55.13 , $90.64 , See APC Packaged Rates , $77.00 , $42.90 , $145.93 , $97.92 , $93.75 , See APC Packaged Rates , See APC Packaged Rates , $88.19 , $85.52 , See APC Packaged Rates , See APC Packaged Rates , $45.76 , $45.76 , $46.94 , $46.94 , See APC Packaged Rates , $22.59 , $35.72 , $22.59 , $145.93 , $77.00
82308,5212010248,Hospital Chargemaster,Assay Of Calcitonin,Outpatient,Outpatient Default Percent / Case Rate,301, $225.00 , $55.13 , $185.40 , See APC Packaged Rates , $157.50 , $87.75 , $145.93 , $97.92 , $93.75 , See APC Packaged Rates , See APC Packaged Rates , $62.97 , $61.06 , See APC Packaged Rates , See APC Packaged Rates , $45.59 , $45.59 , $46.77 , $46.77 , See APC Packaged Rates , $22.23 , $35.72 , $22.23 , $185.40 , $157.50
82240,5212010239,Hospital Chargemaster,Bile Acids Cholylglycine,Outpatient,Outpatient Default Percent / Case Rate,301, $154.00 , $54.69 , $126.90 , See APC Packaged Rates , $107.80 , $60.06 , $144.35 , $96.86 , $92.74 , See APC Packaged Rates , See APC Packaged Rates , $89.36 , $86.65 , See APC Packaged Rates , See APC Packaged Rates , $45.22 , $45.22 , $46.39 , $46.39 , See APC Packaged Rates , $22.07 , $35.44 , $22.07 , $144.35 , $107.80
83864,5212010444,Hospital Chargemaster,Mucopolysaccharides,Outpatient,Outpatient Default Percent / Case Rate,301, $255.00 , $52.78 , $210.12 , See APC Packaged Rates , $178.50 , $99.45 , $125.30 , $84.07 , $80.50 , See APC Packaged Rates , See APC Packaged Rates , $66.95 , $64.92 , See APC Packaged Rates , See APC Packaged Rates , $45.12 , $45.12 , $46.28 , $46.28 , See APC Packaged Rates , $23.66 , $34.20 , $23.66 , $210.12 , $178.50
84403,5212010539,Hospital Chargemaster,Assay Of Total Testosterone,Outpatient,Outpatient Default Percent / Case Rate,301, $430.00 , $53.12 , $354.32 , See APC Packaged Rates , $301.00 , $167.70 , $139.59 , $93.66 , $89.68 , See APC Packaged Rates , See APC Packaged Rates , $85.64 , $83.05 , See APC Packaged Rates , See APC Packaged Rates , $43.92 , $43.92 , $45.05 , $45.05 , See APC Packaged Rates , $21.42 , $34.42 , $21.42 , $354.32 , $301.00
82030,5212010203,Hospital Chargemaster,Assay Of Adp & Amp,Outpatient,Outpatient Default Percent / Case Rate,301, $340.00 , $53.10 , $280.16 , See APC Packaged Rates , $238.00 , $132.60 , $139.59 , $93.66 , $89.68 , See APC Packaged Rates , See APC Packaged Rates , $23.96 , $23.23 , See APC Packaged Rates , See APC Packaged Rates , $43.90 , $43.90 , $45.03 , $45.03 , See APC Packaged Rates , $21.41 , $34.40 , $21.41 , $280.16 , $238.00
84255,5212010521,Hospital Chargemaster,Assay Of Selenium,Outpatient,Outpatient Default Percent / Case Rate,301, $122.00 , $52.54 , $100.53 , See APC Packaged Rates , $85.40 , $47.58 , $138.01 , $92.60 , $88.67 , See APC Packaged Rates , See APC Packaged Rates , $85.85 , $83.25 , See APC Packaged Rates , See APC Packaged Rates , $43.44 , $43.44 , $44.56 , $44.56 , See APC Packaged Rates , $21.19 , $34.04 , $21.19 , $138.01 , $85.40
83916,5212010453,Hospital Chargemaster,Oligoclonal Bands,Outpatient,Outpatient Default Percent / Case Rate,301, $176.00 , $50.73 , $145.02 , See APC Packaged Rates , $123.20 , $68.64 , $120.56 , $80.90 , $77.46 , See APC Packaged Rates , See APC Packaged Rates , $58.64 , $56.86 , See APC Packaged Rates , See APC Packaged Rates , $43.36 , $43.36 , $44.48 , $44.48 , See APC Packaged Rates , $22.72 , $32.87 , $22.72 , $145.02 , $123.20
82108,5212010217,Hospital Chargemaster,Assay Of Aluminum,Outpatient,Outpatient Default Percent / Case Rate,301, $118.00 , $52.43 , $97.23 , See APC Packaged Rates , $82.60 , $46.02 , $138.01 , $92.60 , $88.67 , See APC Packaged Rates , See APC Packaged Rates , $85.71 , $83.11 , See APC Packaged Rates , See APC Packaged Rates , $43.36 , $43.36 , $44.48 , $44.48 , See APC Packaged Rates , $21.14 , $33.97 , $21.14 , $138.01 , $82.60
84402,5212010538,Hospital Chargemaster,Assay Of Free Testosterone,Outpatient,Outpatient Default Percent / Case Rate,301, $147.00 , $52.41 , $121.13 , See APC Packaged Rates , $102.90 , $57.33 , $138.01 , $92.60 , $88.67 , See APC Packaged Rates , See APC Packaged Rates , $88.10 , $85.43 , See APC Packaged Rates , See APC Packaged Rates , $43.35 , $43.35 , $44.46 , $44.46 , See APC Packaged Rates , $21.14 , $33.96 , $21.14 , $138.01 , $102.90
82382,5212010264,Hospital Chargemaster,Assay Urine Catecholamines,Outpatient,Outpatient Default Percent / Case Rate,301, $152.00 , $50.56 , $125.25 , See APC Packaged Rates , $106.40 , $59.28 , $120.56 , $80.90 , $77.46 , See APC Packaged Rates , See APC Packaged Rates , $66.11 , $64.10 , See APC Packaged Rates , See APC Packaged Rates , $43.22 , $43.22 , $44.34 , $44.34 , See APC Packaged Rates , $22.67 , $32.76 , $22.67 , $125.25 , $106.40
82626,5212010302,Hospital Chargemaster,Dehydroepiandrosterone,Outpatient,Outpatient Default Percent / Case Rate,301, $291.00 , $52.00 , $239.78 , See APC Packaged Rates , $203.70 , $113.49 , $138.01 , $92.60 , $88.67 , See APC Packaged Rates , See APC Packaged Rates , $84.99 , $82.41 , See APC Packaged Rates , See APC Packaged Rates , $42.99 , $42.99 , $44.10 , $44.10 , See APC Packaged Rates , $20.98 , $33.70 , $20.98 , $239.78 , $203.70
82384,5212010266,Hospital Chargemaster,Assay Three Catecholamines,Outpatient,Outpatient Default Percent / Case Rate,301, $206.00 , $51.97 , $169.74 , See APC Packaged Rates , $144.20 , $80.34 , $138.01 , $92.60 , $88.67 , See APC Packaged Rates , See APC Packaged Rates , $71.98 , $69.79 , See APC Packaged Rates , See APC Packaged Rates , $42.96 , $42.96 , $44.07 , $44.07 , See APC Packaged Rates , $20.95 , $33.67 , $20.95 , $169.74 , $144.20
83785,5212010438,Hospital Chargemaster,Assay Of Manganese,Outpatient,Outpatient Default Percent / Case Rate,301, $263.00 , $50.62 , $216.71 , See APC Packaged Rates , $184.10 , $102.57 , $133.24 , $89.41 , $85.61 , See APC Packaged Rates , See APC Packaged Rates , $82.67 , $80.16 , See APC Packaged Rates , See APC Packaged Rates , $42.67 , $42.67 , $43.77 , $43.77 , See APC Packaged Rates , $22.11 , $32.80 , $22.11 , $216.71 , $184.10
82679,5212010318,Hospital Chargemaster,Assay Of Estrone,Outpatient,Outpatient Default Percent / Case Rate,301, $246.00 , $57.06 , $202.70 , See APC Packaged Rates , $172.20 , $95.94 , $134.82 , $90.47 , $86.62 , See APC Packaged Rates , See APC Packaged Rates , $83.96 , $81.41 , See APC Packaged Rates , See APC Packaged Rates , $42.45 , $42.45 , $43.55 , $43.55 , See APC Packaged Rates , $20.71 , $33.28 , $20.71 , $202.70 , $172.20
84206,5212010510,Hospital Chargemaster,Assay Of Proinsulin,Outpatient,Outpatient Default Percent / Case Rate,301, $215.00 , $49.43 , $177.16 , See APC Packaged Rates , $150.50 , $83.85 , $117.38 , $78.76 , $75.41 , See APC Packaged Rates , See APC Packaged Rates , $59.93 , $58.11 , See APC Packaged Rates , See APC Packaged Rates , $42.25 , $42.25 , $43.34 , $43.34 , See APC Packaged Rates , $22.16 , $32.03 , $22.16 , $177.16 , $150.50
83885,5212010451,Hospital Chargemaster,Assay Of Nickel,Outpatient,Outpatient Default Percent / Case Rate,301, $91.00 , $50.43 , $74.98 , See APC Packaged Rates , $63.70 , $35.49 , $133.24 , $89.41 , $85.61 , See APC Packaged Rates , See APC Packaged Rates , $82.41 , $79.91 , See APC Packaged Rates , See APC Packaged Rates , $41.70 , $41.70 , $42.77 , $42.77 , See APC Packaged Rates , $20.34 , $32.68 , $20.34 , $133.24 , $63.70
83505,5212010398,Hospital Chargemaster,Assay Total Hydroxyproline,Outpatient,Outpatient Default Percent / Case Rate,301, $369.00 , $50.02 , $304.06 , See APC Packaged Rates , $258.30 , $143.91 , $131.67 , $88.35 , $84.59 , See APC Packaged Rates , See APC Packaged Rates , $57.59 , $55.84 , See APC Packaged Rates , See APC Packaged Rates , $41.36 , $41.36 , $42.43 , $42.43 , See APC Packaged Rates , $20.17 , $32.41 , $20.17 , $304.06 , $258.30
82803,5212010340,Hospital Chargemaster,Blood Gases Any Combination,Outpatient,Outpatient Default Percent / Case Rate,301, $86.00 , $48.28 , $70.86 , See APC Packaged Rates , $60.20 , $33.54 , $114.19 , $76.62 , $73.37 , See APC Packaged Rates , See APC Packaged Rates , $65.08 , $63.10 , See APC Packaged Rates , See APC Packaged Rates , $41.27 , $41.27 , $42.33 , $42.33 , See APC Packaged Rates , $21.64 , $31.28 , $21.64 , $114.19 , $60.20
82677,5212010317,Hospital Chargemaster,Assay Of Estriol,Outpatient,Outpatient Default Percent / Case Rate,301, $90.00 , $49.76 , $74.16 , See APC Packaged Rates , $63.00 , $35.10 , $131.67 , $88.35 , $84.59 , See APC Packaged Rates , See APC Packaged Rates , $46.78 , $45.36 , See APC Packaged Rates , See APC Packaged Rates , $41.15 , $41.15 , $42.21 , $42.21 , See APC Packaged Rates , $20.07 , $32.24 , $20.07 , $131.67 , $63.00
82300,5212010246,Hospital Chargemaster,Assay Of Cadmium,Outpatient,Outpatient Default Percent / Case Rate,301, $207.00 , $47.63 , $170.57 , See APC Packaged Rates , $144.90 , $80.73 , $125.30 , $84.07 , $80.50 , See APC Packaged Rates , See APC Packaged Rates , $77.81 , $75.44 , See APC Packaged Rates , See APC Packaged Rates , $39.58 , $39.58 , $40.60 , $40.60 , See APC Packaged Rates , $19.63 , $30.86 , $19.63 , $170.57 , $144.90
84143,5212010491,Hospital Chargemaster,Assay Of 17-Hydroxypregneno,Outpatient,Outpatient Default Percent / Case Rate,301, $280.00 , $46.93 , $230.72 , See APC Packaged Rates , $196.00 , $109.20 , $123.72 , $83.02 , $79.49 , See APC Packaged Rates , See APC Packaged Rates , $72.82 , $70.61 , See APC Packaged Rates , See APC Packaged Rates , $38.81 , $38.81 , $39.81 , $39.81 , See APC Packaged Rates , $18.94 , $30.41 , $18.94 , $230.72 , $196.00
83500,5212010397,Hospital Chargemaster,Assay Free Hydroxyproline,Outpatient,Outpatient Default Percent / Case Rate,301, $294.00 , $46.61 , $242.26 , See APC Packaged Rates , $205.80 , $114.66 , $123.72 , $83.02 , $79.49 , See APC Packaged Rates , See APC Packaged Rates , $59.72 , $57.90 , See APC Packaged Rates , See APC Packaged Rates , $38.53 , $38.53 , $39.52 , $39.52 , See APC Packaged Rates , $18.79 , $30.20 , $18.79 , $242.26 , $205.80
83789,5212010439,Hospital Chargemaster,Mass Spectrometry Qual/Quan,Outpatient,Outpatient Default Percent / Case Rate,301, $85.00 , $44.65 , $70.04 , See APC Packaged Rates , $59.50 , $33.15 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $61.33 , $59.47 , See APC Packaged Rates , See APC Packaged Rates , $38.18 , $38.18 , $39.16 , $39.16 , See APC Packaged Rates , $20.01 , $28.93 , $20.01 , $106.27 , $59.50
82542,5212010287,Hospital Chargemaster,Col Chromotography Qual/Quan,Outpatient,Outpatient Default Percent / Case Rate,301, $240.00 , $44.61 , $197.76 , See APC Packaged Rates , $168.00 , $93.60 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $61.33 , $59.47 , See APC Packaged Rates , See APC Packaged Rates , $38.15 , $38.15 , $39.13 , $39.13 , See APC Packaged Rates , $20.00 , $28.91 , $20.00 , $197.76 , $168.00
82627,5212010303,Hospital Chargemaster,Dehydroepiandrosterone,Outpatient,Outpatient Default Percent / Case Rate,301, $200.00 , $45.76 , $164.80 , See APC Packaged Rates , $140.00 , $78.00 , $120.56 , $80.90 , $77.46 , See APC Packaged Rates , See APC Packaged Rates , $66.85 , $64.83 , See APC Packaged Rates , See APC Packaged Rates , $37.82 , $37.82 , $38.80 , $38.80 , See APC Packaged Rates , $18.45 , $29.65 , $18.45 , $164.80 , $140.00
84244,5212010519,Hospital Chargemaster,Assay Of Renin,Outpatient,Outpatient Default Percent / Case Rate,301, $169.00 , $45.26 , $139.26 , See APC Packaged Rates , $118.30 , $65.91 , $118.96 , $79.82 , $76.43 , See APC Packaged Rates , See APC Packaged Rates , $73.90 , $71.66 , See APC Packaged Rates , See APC Packaged Rates , $37.42 , $37.42 , $38.39 , $38.39 , See APC Packaged Rates , $18.25 , $29.33 , $18.25 , $139.26 , $118.30
83661,5212010420,Hospital Chargemaster,L/S Ratio Fetal Lung,Outpatient,Outpatient Default Percent / Case Rate,301, $158.00 , $45.24 , $130.19 , See APC Packaged Rates , $110.60 , $61.62 , $118.96 , $79.82 , $76.43 , See APC Packaged Rates , See APC Packaged Rates , $73.92 , $71.68 , See APC Packaged Rates , See APC Packaged Rates , $37.41 , $37.41 , $38.37 , $38.37 , See APC Packaged Rates , $18.25 , $29.32 , $18.25 , $130.19 , $110.60
83018,5212010374,Hospital Chargemaster,Heavy Metal Quant Each Nes,Outpatient,Outpatient Default Percent / Case Rate,301, $121.00 , $45.21 , $99.70 , See APC Packaged Rates , $84.70 , $47.19 , $118.96 , $79.82 , $76.43 , See APC Packaged Rates , See APC Packaged Rates , $73.85 , $71.61 , See APC Packaged Rates , See APC Packaged Rates , $37.38 , $37.38 , $38.34 , $38.34 , See APC Packaged Rates , $18.23 , $29.29 , $18.23 , $118.96 , $84.70
83918,5212010454,Hospital Chargemaster,Organic Acids Total Quant,Outpatient,Outpatient Default Percent / Case Rate,301, $140.00 , $43.71 , $115.36 , See APC Packaged Rates , $98.00 , $54.60 , $103.09 , $69.17 , $66.23 , See APC Packaged Rates , See APC Packaged Rates , $52.39 , $50.80 , See APC Packaged Rates , See APC Packaged Rates , $37.36 , $37.36 , $38.32 , $38.32 , See APC Packaged Rates , $19.58 , $28.32 , $19.58 , $115.36 , $98.00
84270,5212010523,Hospital Chargemaster,Assay Of Sex Hormone Globul,Outpatient,Outpatient Default Percent / Case Rate,301, $154.00 , $44.73 , $126.90 , See APC Packaged Rates , $107.80 , $60.06 , $117.38 , $78.76 , $75.41 , See APC Packaged Rates , See APC Packaged Rates , $73.08 , $70.86 , See APC Packaged Rates , See APC Packaged Rates , $36.98 , $36.98 , $37.93 , $37.93 , See APC Packaged Rates , $18.03 , $28.98 , $18.03 , $126.90 , $107.80
82672,5212010316,Hospital Chargemaster,Assay Of Estrogen,Outpatient,Outpatient Default Percent / Case Rate,301, $160.00 , $44.65 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $117.38 , $78.76 , $75.41 , See APC Packaged Rates , See APC Packaged Rates , $72.94 , $70.72 , See APC Packaged Rates , See APC Packaged Rates , $36.92 , $36.92 , $37.87 , $37.87 , See APC Packaged Rates , $18.01 , $28.93 , $18.01 , $131.84 , $112.00
82963,5212010358,Hospital Chargemaster,Assay Of Glucosidase,Outpatient,Outpatient Default Percent / Case Rate,301, $387.00 , $44.21 , $318.89 , See APC Packaged Rates , $270.90 , $150.93 , $117.38 , $78.76 , $75.41 , See APC Packaged Rates , See APC Packaged Rates , $72.26 , $70.07 , See APC Packaged Rates , See APC Packaged Rates , $36.55 , $36.55 , $37.49 , $37.49 , See APC Packaged Rates , $17.82 , $28.64 , $17.82 , $318.89 , $270.90
82131,5212010221,Hospital Chargemaster,Amino Acids Single Quant,Outpatient,Outpatient Default Percent / Case Rate,301, $547.00 , $42.56 , $450.73 , See APC Packaged Rates , $382.90 , $213.33 , $101.51 , $68.11 , $65.22 , See APC Packaged Rates , See APC Packaged Rates , $35.97 , $34.87 , See APC Packaged Rates , See APC Packaged Rates , $36.38 , $36.38 , $37.31 , $37.31 , See APC Packaged Rates , $19.07 , $27.58 , $19.07 , $450.73 , $382.90
84305,5212010529,Hospital Chargemaster,Assay Of Somatomedin,Outpatient,Outpatient Default Percent / Case Rate,301, $180.00 , $43.76 , $148.32 , See APC Packaged Rates , $126.00 , $70.20 , $115.80 , $77.70 , $74.40 , See APC Packaged Rates , See APC Packaged Rates , $58.29 , $56.52 , See APC Packaged Rates , See APC Packaged Rates , $36.18 , $36.18 , $37.11 , $37.11 , See APC Packaged Rates , $17.65 , $28.36 , $17.65 , $148.32 , $126.00
84425,5212010541,Hospital Chargemaster,Assay Of Vitamin B-1,Outpatient,Outpatient Default Percent / Case Rate,301, $160.00 , $43.69 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $115.80 , $77.70 , $74.40 , See APC Packaged Rates , See APC Packaged Rates , $71.42 , $69.25 , See APC Packaged Rates , See APC Packaged Rates , $36.12 , $36.12 , $37.05 , $37.05 , See APC Packaged Rates , $17.62 , $28.31 , $17.62 , $131.84 , $112.00
84144,5212010492,Hospital Chargemaster,Assay Of Progesterone,Outpatient,Outpatient Default Percent / Case Rate,301, $128.00 , $42.93 , $105.47 , See APC Packaged Rates , $89.60 , $49.92 , $112.62 , $75.56 , $72.35 , See APC Packaged Rates , See APC Packaged Rates , $65.47 , $63.49 , See APC Packaged Rates , See APC Packaged Rates , $35.50 , $35.50 , $36.42 , $36.42 , See APC Packaged Rates , $17.31 , $27.82 , $17.31 , $112.62 , $89.60
83150,5212010393,Hospital Chargemaster,Assay Of Homovanillic Acid,Outpatient,Outpatient Default Percent / Case Rate,301, $220.00 , $41.50 , $181.28 , See APC Packaged Rates , $154.00 , $85.80 , $104.70 , $70.25 , $67.26 , See APC Packaged Rates , See APC Packaged Rates , $65.08 , $63.10 , See APC Packaged Rates , See APC Packaged Rates , $35.49 , $35.49 , $36.40 , $36.40 , See APC Packaged Rates , $18.60 , $26.89 , $18.60 , $181.28 , $154.00
84681,5212010584,Hospital Chargemaster,Assay Of C-Peptide,Outpatient,Outpatient Default Percent / Case Rate,301, $180.00 , $42.84 , $148.32 , See APC Packaged Rates , $126.00 , $70.20 , $112.62 , $75.56 , $72.35 , See APC Packaged Rates , See APC Packaged Rates , $69.97 , $67.84 , See APC Packaged Rates , See APC Packaged Rates , $35.41 , $35.41 , $36.32 , $36.32 , See APC Packaged Rates , $17.28 , $27.76 , $17.28 , $148.32 , $126.00
84140,5212010490,Hospital Chargemaster,Assay Of Pregnenolone,Outpatient,Outpatient Default Percent / Case Rate,301, $92.00 , $42.54 , $75.81 , See APC Packaged Rates , $64.40 , $35.88 , $112.62 , $75.56 , $72.35 , See APC Packaged Rates , See APC Packaged Rates , $69.54 , $67.43 , See APC Packaged Rates , See APC Packaged Rates , $35.18 , $35.18 , $36.08 , $36.08 , See APC Packaged Rates , $17.16 , $27.56 , $17.16 , $112.62 , $64.40
82657,5212010310,Hospital Chargemaster,Enzyme Cell Activity,Outpatient,Outpatient Default Percent / Case Rate,301, $165.00 , $41.06 , $135.96 , See APC Packaged Rates , $115.50 , $64.35 , $98.35 , $66.00 , $63.19 , See APC Packaged Rates , See APC Packaged Rates , $61.33 , $59.47 , See APC Packaged Rates , See APC Packaged Rates , $35.10 , $35.10 , $36.01 , $36.01 , See APC Packaged Rates , $18.40 , $26.60 , $18.40 , $135.96 , $115.50
82163,5212010231,Hospital Chargemaster,Assay Of Angiotensin Ii,Outpatient,Outpatient Default Percent / Case Rate,301, $93.00 , $42.23 , $76.63 , See APC Packaged Rates , $65.10 , $36.27 , $111.04 , $74.51 , $71.34 , See APC Packaged Rates , See APC Packaged Rates , $36.78 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $34.92 , $34.92 , $35.82 , $35.82 , See APC Packaged Rates , $17.03 , $27.36 , $17.03 , $111.04 , $65.10
82495,5212010279,Hospital Chargemaster,Assay Of Chromium,Outpatient,Outpatient Default Percent / Case Rate,301, $231.00 , $41.73 , $190.34 , See APC Packaged Rates , $161.70 , $90.09 , $109.46 , $73.45 , $70.32 , See APC Packaged Rates , See APC Packaged Rates , $68.21 , $66.14 , See APC Packaged Rates , See APC Packaged Rates , $34.50 , $34.50 , $35.39 , $35.39 , See APC Packaged Rates , $16.83 , $27.04 , $16.83 , $190.34 , $161.70
84252,5212010520,Hospital Chargemaster,Assay Of Vitamin B-2,Outpatient,Outpatient Default Percent / Case Rate,301, $213.00 , $41.65 , $175.51 , See APC Packaged Rates , $149.10 , $83.07 , $109.46 , $73.45 , $70.32 , See APC Packaged Rates , See APC Packaged Rates , $68.05 , $65.98 , See APC Packaged Rates , See APC Packaged Rates , $34.42 , $34.42 , $35.31 , $35.31 , See APC Packaged Rates , $16.80 , $26.99 , $16.80 , $175.51 , $149.10
80375,5212010166,Hospital Chargemaster,Drug/Substance Nos 1-3,Outpatient,Outpatient Default Percent / Case Rate,301, $248.00 , $41.43 , $204.35 , See APC Packaged Rates , $173.60 , $96.72 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $34.41 , $34.41 , $35.30 , $35.30 , See APC Packaged Rates , $86.80 , $- , $- , $204.35 , $173.60
80171,5212010084,Hospital Chargemaster,Drug Screen Quant Gabapentin,Outpatient,Outpatient Default Percent / Case Rate,301, $109.00 , $40.13 , $89.82 , See APC Packaged Rates , $76.30 , $42.51 , $95.17 , $63.86 , $61.14 , See APC Packaged Rates , See APC Packaged Rates , $44.44 , $43.09 , See APC Packaged Rates , See APC Packaged Rates , $34.30 , $34.30 , $35.18 , $35.18 , See APC Packaged Rates , $17.99 , $26.00 , $17.99 , $95.17 , $76.30
83921,5212010456,Hospital Chargemaster,Organic Acid Single Quant,Outpatient,Outpatient Default Percent / Case Rate,301, $75.00 , $39.28 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $93.59 , $62.80 , $60.13 , See APC Packaged Rates , See APC Packaged Rates , $55.90 , $54.21 , See APC Packaged Rates , See APC Packaged Rates , $33.58 , $33.58 , $34.44 , $34.44 , See APC Packaged Rates , $17.61 , $25.45 , $17.61 , $93.59 , $52.50
83630,5212010415,Hospital Chargemaster,Lactoferrin Fecal (Qual),Outpatient,Outpatient Default Percent / Case Rate,301, $78.00 , $40.39 , $64.27 , See APC Packaged Rates , $54.60 , $30.42 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $39.34 , $38.14 , See APC Packaged Rates , See APC Packaged Rates , $33.43 , $33.43 , $34.29 , $34.29 , See APC Packaged Rates , $16.36 , $26.17 , $16.36 , $106.27 , $54.60
83631,5212010416,Hospital Chargemaster,Lactoferrin Fecal (Quant),Outpatient,Outpatient Default Percent / Case Rate,301, $173.00 , $40.39 , $142.55 , See APC Packaged Rates , $121.10 , $67.47 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $67.37 , $65.32 , See APC Packaged Rates , See APC Packaged Rates , $33.41 , $33.41 , $34.27 , $34.27 , See APC Packaged Rates , $16.29 , $26.17 , $16.29 , $142.55 , $121.10
83993,5212010466,Hospital Chargemaster,Assay For Calprotectin Fecal,Outpatient,Outpatient Default Percent / Case Rate,301, $93.00 , $40.39 , $76.63 , See APC Packaged Rates , $65.10 , $36.27 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $67.37 , $65.32 , See APC Packaged Rates , See APC Packaged Rates , $33.41 , $33.41 , $34.27 , $34.27 , See APC Packaged Rates , $16.29 , $26.17 , $16.29 , $106.27 , $65.10
82172,5212010233,Hospital Chargemaster,Assay Of Apolipoprotein,Outpatient,Outpatient Default Percent / Case Rate,301, $86.00 , $39.06 , $70.86 , See APC Packaged Rates , $60.20 , $33.54 , $93.59 , $62.80 , $60.13 , See APC Packaged Rates , See APC Packaged Rates , $52.11 , $50.53 , See APC Packaged Rates , See APC Packaged Rates , $33.39 , $33.39 , $34.25 , $34.25 , See APC Packaged Rates , $17.50 , $25.31 , $17.50 , $93.59 , $60.20
83015,5212010373,Hospital Chargemaster,Heavy Metal Qual Any Anal,Outpatient,Outpatient Default Percent / Case Rate,301, $87.00 , $38.78 , $71.69 , See APC Packaged Rates , $60.90 , $33.93 , $103.09 , $69.17 , $66.23 , See APC Packaged Rates , See APC Packaged Rates , $63.34 , $61.42 , See APC Packaged Rates , See APC Packaged Rates , $33.15 , $33.15 , $34.00 , $34.00 , See APC Packaged Rates , $17.38 , $25.13 , $17.38 , $103.09 , $60.90
82600,5212010297,Hospital Chargemaster,Assay Of Cyanide,Outpatient,Outpatient Default Percent / Case Rate,301, $182.00 , $39.91 , $149.97 , See APC Packaged Rates , $127.40 , $70.98 , $104.70 , $70.25 , $67.26 , See APC Packaged Rates , See APC Packaged Rates , $43.50 , $42.18 , See APC Packaged Rates , See APC Packaged Rates , $33.01 , $33.01 , $33.86 , $33.86 , See APC Packaged Rates , $16.10 , $25.86 , $16.10 , $149.97 , $127.40
84146,5212010494,Hospital Chargemaster,Assay Of Prolactin,Outpatient,Outpatient Default Percent / Case Rate,301, $194.00 , $39.87 , $159.86 , See APC Packaged Rates , $135.80 , $75.66 , $104.70 , $70.25 , $67.26 , See APC Packaged Rates , See APC Packaged Rates , $81.46 , $78.98 , See APC Packaged Rates , See APC Packaged Rates , $32.96 , $32.96 , $33.81 , $33.81 , See APC Packaged Rates , $16.09 , $25.84 , $16.09 , $159.86 , $135.80
80323,5212010114,Hospital Chargemaster,Alkaloids Nos,Outpatient,Outpatient Default Percent / Case Rate,301, $158.00 , $28.08 , $130.19 , See APC Packaged Rates , $110.60 , $61.62 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $32.52 , $32.52 , $33.35 , $33.35 , See APC Packaged Rates , $55.30 , $- , $- , $130.19 , $110.60
83664,5212010423,Hospital Chargemaster,Lamellar Bdy Fetal Lung,Outpatient,Outpatient Default Percent / Case Rate,301, $80.00 , $38.91 , $65.92 , See APC Packaged Rates , $56.00 , $31.20 , $103.09 , $69.17 , $66.23 , See APC Packaged Rates , See APC Packaged Rates , $16.05 , $15.57 , See APC Packaged Rates , See APC Packaged Rates , $32.33 , $32.33 , $33.17 , $33.17 , See APC Packaged Rates , $16.03 , $25.21 , $15.57 , $103.09 , $56.00
82175,5212010234,Hospital Chargemaster,Assay Of Arsenic,Outpatient,Outpatient Default Percent / Case Rate,301, $222.00 , $39.04 , $182.93 , See APC Packaged Rates , $155.40 , $86.58 , $103.09 , $69.17 , $66.23 , See APC Packaged Rates , See APC Packaged Rates , $45.75 , $44.36 , See APC Packaged Rates , See APC Packaged Rates , $32.27 , $32.27 , $33.10 , $33.10 , See APC Packaged Rates , $15.74 , $25.30 , $15.74 , $182.93 , $155.40
82378,5212010261,Hospital Chargemaster,Carcinoembryonic Antigen,Outpatient,Outpatient Default Percent / Case Rate,301, $88.00 , $39.02 , $72.51 , See APC Packaged Rates , $61.60 , $34.32 , $103.09 , $69.17 , $66.23 , See APC Packaged Rates , See APC Packaged Rates , $61.03 , $59.18 , See APC Packaged Rates , See APC Packaged Rates , $32.26 , $32.26 , $33.09 , $33.09 , See APC Packaged Rates , $15.73 , $25.28 , $15.73 , $103.09 , $61.60
80159,5212010076,Hospital Chargemaster,Drug Assay Clozapine,Outpatient,Outpatient Default Percent / Case Rate,301, $168.00 , $38.06 , $138.43 , See APC Packaged Rates , $117.60 , $65.52 , $99.93 , $67.06 , $64.20 , See APC Packaged Rates , See APC Packaged Rates , $61.99 , $60.11 , See APC Packaged Rates , See APC Packaged Rates , $32.12 , $32.12 , $32.94 , $32.94 , See APC Packaged Rates , $16.72 , $24.66 , $16.72 , $138.43 , $117.60
82668,5212010313,Hospital Chargemaster,Assay Of Erythropoietin,Outpatient,Outpatient Default Percent / Case Rate,301, $160.00 , $38.67 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $101.51 , $68.11 , $65.22 , See APC Packaged Rates , See APC Packaged Rates , $39.12 , $37.94 , See APC Packaged Rates , See APC Packaged Rates , $31.98 , $31.98 , $32.80 , $32.80 , See APC Packaged Rates , $15.59 , $25.06 , $15.59 , $131.84 , $112.00
82523,5212010281,Hospital Chargemaster,Collagen Crosslinks,Outpatient,Outpatient Default Percent / Case Rate,301, $105.00 , $42.73 , $86.52 , See APC Packaged Rates , $73.50 , $40.95 , $101.51 , $68.11 , $65.22 , See APC Packaged Rates , See APC Packaged Rates , $40.39 , $39.16 , See APC Packaged Rates , See APC Packaged Rates , $31.79 , $31.79 , $32.61 , $32.61 , See APC Packaged Rates , $15.50 , $24.91 , $15.50 , $101.51 , $73.50
80332,5212010123,Hospital Chargemaster,Antidepressants Class 1 Or 2,Outpatient,Outpatient Default Percent / Case Rate,301, $150.00 , $27.59 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $31.66 , $31.66 , $32.47 , $32.47 , See APC Packaged Rates , $52.50 , $- , $- , $123.60 , $105.00
83001,5212010364,Hospital Chargemaster,Assay Of Gonadotropin (Fsh),Outpatient,Outpatient Default Percent / Case Rate,301, $132.00 , $42.48 , $108.77 , See APC Packaged Rates , $92.40 , $51.48 , $101.51 , $68.11 , $65.22 , See APC Packaged Rates , See APC Packaged Rates , $57.26 , $55.52 , See APC Packaged Rates , See APC Packaged Rates , $31.61 , $31.61 , $32.42 , $32.42 , See APC Packaged Rates , $15.42 , $24.78 , $15.42 , $108.77 , $92.40
82735,5212010327,Hospital Chargemaster,Assay Of Fluoride,Outpatient,Outpatient Default Percent / Case Rate,301, $164.00 , $38.15 , $135.14 , See APC Packaged Rates , $114.80 , $63.96 , $101.51 , $68.11 , $65.22 , See APC Packaged Rates , See APC Packaged Rates , $37.95 , $36.80 , See APC Packaged Rates , See APC Packaged Rates , $31.55 , $31.55 , $32.36 , $32.36 , See APC Packaged Rates , $15.39 , $24.72 , $15.39 , $135.14 , $114.80
83002,5212010365,Hospital Chargemaster,Assay Of Gonadotropin (Lh),Outpatient,Outpatient Default Percent / Case Rate,301, $130.00 , $42.34 , $107.12 , See APC Packaged Rates , $91.00 , $50.70 , $99.93 , $67.06 , $64.20 , See APC Packaged Rates , See APC Packaged Rates , $57.49 , $55.75 , See APC Packaged Rates , See APC Packaged Rates , $31.50 , $31.50 , $32.31 , $32.31 , See APC Packaged Rates , $15.38 , $24.68 , $15.38 , $107.12 , $91.00
82726,5212010324,Hospital Chargemaster,Long Chain Fatty Acids,Outpatient,Outpatient Default Percent / Case Rate,301, $219.00 , $37.15 , $180.46 , See APC Packaged Rates , $153.30 , $85.41 , $98.35 , $66.00 , $63.19 , See APC Packaged Rates , See APC Packaged Rates , $61.33 , $59.47 , See APC Packaged Rates , See APC Packaged Rates , $31.39 , $31.39 , $32.20 , $32.20 , See APC Packaged Rates , $16.40 , $24.07 , $16.40 , $180.46 , $153.30
84153,5212010497,Hospital Chargemaster,Assay Of Psa Total,Outpatient,Outpatient Default Percent / Case Rate,301, $84.00 , $37.85 , $69.22 , See APC Packaged Rates , $58.80 , $32.76 , $99.93 , $67.06 , $64.20 , See APC Packaged Rates , See APC Packaged Rates , $61.03 , $59.18 , See APC Packaged Rates , See APC Packaged Rates , $31.30 , $31.30 , $32.11 , $32.11 , See APC Packaged Rates , $15.26 , $24.53 , $15.26 , $99.93 , $58.80
84154,5212010498,Hospital Chargemaster,Assay Of Psa Free,Outpatient,Outpatient Default Percent / Case Rate,301, $86.00 , $37.85 , $70.86 , See APC Packaged Rates , $60.20 , $33.54 , $99.93 , $67.06 , $64.20 , See APC Packaged Rates , See APC Packaged Rates , $62.48 , $60.58 , See APC Packaged Rates , See APC Packaged Rates , $31.30 , $31.30 , $32.11 , $32.11 , See APC Packaged Rates , $15.26 , $24.53 , $15.26 , $99.93 , $60.20
84307,5212010530,Hospital Chargemaster,Assay Of Somatostatin,Outpatient,Outpatient Default Percent / Case Rate,301, $251.00 , $37.61 , $206.82 , See APC Packaged Rates , $175.70 , $97.89 , $99.93 , $67.06 , $64.20 , See APC Packaged Rates , See APC Packaged Rates , $37.32 , $36.19 , See APC Packaged Rates , See APC Packaged Rates , $31.10 , $31.10 , $31.90 , $31.90 , See APC Packaged Rates , $15.16 , $24.37 , $15.16 , $206.82 , $175.70
82373,5212010257,Hospital Chargemaster,Assay C-D Transfer Measure,Outpatient,Outpatient Default Percent / Case Rate,301, $300.00 , $37.15 , $247.20 , See APC Packaged Rates , $210.00 , $117.00 , $98.35 , $66.00 , $63.19 , See APC Packaged Rates , See APC Packaged Rates , $61.33 , $59.47 , See APC Packaged Rates , See APC Packaged Rates , $30.72 , $30.72 , $31.51 , $31.51 , See APC Packaged Rates , $15.00 , $24.07 , $15.00 , $247.20 , $210.00
83021,5212010376,Hospital Chargemaster,Hemoglobin Chromotography,Outpatient,Outpatient Default Percent / Case Rate,301, $84.00 , $37.15 , $69.22 , See APC Packaged Rates , $58.80 , $32.76 , $98.35 , $66.00 , $63.19 , See APC Packaged Rates , See APC Packaged Rates , $61.33 , $59.47 , See APC Packaged Rates , See APC Packaged Rates , $30.72 , $30.72 , $31.51 , $31.51 , See APC Packaged Rates , $15.00 , $24.07 , $15.00 , $98.35 , $58.80
80158,5212010075,Hospital Chargemaster,Drug Assay Cyclosporine,Outpatient,Outpatient Default Percent / Case Rate,301, $220.00 , $37.15 , $181.28 , See APC Packaged Rates , $154.00 , $85.80 , $98.35 , $66.00 , $63.19 , See APC Packaged Rates , See APC Packaged Rates , $25.06 , $24.30 , See APC Packaged Rates , See APC Packaged Rates , $30.70 , $30.70 , $31.49 , $31.49 , See APC Packaged Rates , $14.97 , $24.07 , $14.97 , $181.28 , $154.00
84449,5212010552,Hospital Chargemaster,Assay Of Transcortin,Outpatient,Outpatient Default Percent / Case Rate,301, $81.00 , $37.04 , $66.74 , See APC Packaged Rates , $56.70 , $31.59 , $98.35 , $66.00 , $63.19 , See APC Packaged Rates , See APC Packaged Rates , $59.13 , $57.34 , See APC Packaged Rates , See APC Packaged Rates , $30.63 , $30.63 , $31.41 , $31.41 , See APC Packaged Rates , $14.94 , $24.00 , $14.94 , $98.35 , $56.70
84166,5212010505,Hospital Chargemaster,Protein E-Phoresis/Urine/Csf,Outpatient,Outpatient Default Percent / Case Rate,301, $90.00 , $36.69 , $74.16 , See APC Packaged Rates , $63.00 , $35.10 , $84.12 , $56.45 , $54.05 , See APC Packaged Rates , See APC Packaged Rates , $61.24 , $59.38 , See APC Packaged Rates , See APC Packaged Rates , $30.33 , $30.33 , $31.11 , $31.11 , See APC Packaged Rates , $14.80 , $23.77 , $14.80 , $84.12 , $63.00
82941,5212010346,Hospital Chargemaster,Assay Of Gastrin,Outpatient,Outpatient Default Percent / Case Rate,301, $106.00 , $36.28 , $87.34 , See APC Packaged Rates , $74.20 , $41.34 , $95.17 , $63.86 , $61.14 , See APC Packaged Rates , See APC Packaged Rates , $59.32 , $57.52 , See APC Packaged Rates , See APC Packaged Rates , $29.99 , $29.99 , $30.77 , $30.77 , See APC Packaged Rates , $14.63 , $23.51 , $14.63 , $95.17 , $74.20
83491,5212010394,Hospital Chargemaster,Assay Of Corticosteroids 17,Outpatient,Outpatient Default Percent / Case Rate,301, $196.00 , $36.06 , $161.50 , See APC Packaged Rates , $137.20 , $76.44 , $95.17 , $63.86 , $61.14 , See APC Packaged Rates , See APC Packaged Rates , $43.10 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $29.96 , $29.96 , $30.74 , $30.74 , See APC Packaged Rates , $14.86 , $23.36 , $14.86 , $161.50 , $137.20
82725,5212010323,Hospital Chargemaster,Assay Of Blood Fatty Acids,Outpatient,Outpatient Default Percent / Case Rate,301, $136.00 , $34.76 , $112.06 , See APC Packaged Rates , $95.20 , $53.04 , $82.49 , $55.35 , $53.00 , See APC Packaged Rates , See APC Packaged Rates , $45.21 , $43.84 , See APC Packaged Rates , See APC Packaged Rates , $29.72 , $29.72 , $30.48 , $30.48 , See APC Packaged Rates , $15.58 , $22.52 , $15.58 , $112.06 , $95.20
82747,5212010329,Hospital Chargemaster,Assay Of Folic Acid Rbc,Outpatient,Outpatient Default Percent / Case Rate,301, $184.00 , $35.65 , $151.62 , See APC Packaged Rates , $128.80 , $71.76 , $93.59 , $62.80 , $60.13 , See APC Packaged Rates , See APC Packaged Rates , $52.74 , $51.14 , See APC Packaged Rates , See APC Packaged Rates , $29.59 , $29.59 , $30.36 , $30.36 , See APC Packaged Rates , $14.64 , $23.10 , $14.64 , $151.62 , $128.80
80299,5212010107,Hospital Chargemaster,Quantitative Assay Drug,Outpatient,Outpatient Default Percent / Case Rate,301, $247.00 , $34.52 , $203.53 , See APC Packaged Rates , $172.90 , $96.33 , $82.49 , $55.35 , $53.00 , See APC Packaged Rates , See APC Packaged Rates , $41.39 , $40.14 , See APC Packaged Rates , See APC Packaged Rates , $29.52 , $29.52 , $30.28 , $30.28 , See APC Packaged Rates , $15.48 , $22.37 , $15.48 , $203.53 , $172.90
82757,5212010330,Hospital Chargemaster,Assay Of Semen Fructose,Outpatient,Outpatient Default Percent / Case Rate,301, $243.00 , $35.67 , $200.23 , See APC Packaged Rates , $170.10 , $94.77 , $93.59 , $62.80 , $60.13 , See APC Packaged Rates , See APC Packaged Rates , $58.34 , $56.57 , See APC Packaged Rates , See APC Packaged Rates , $29.50 , $29.50 , $30.26 , $30.26 , See APC Packaged Rates , $14.40 , $23.11 , $14.40 , $200.23 , $170.10
83873,5212010446,Hospital Chargemaster,Assay Of Csf Protein,Outpatient,Outpatient Default Percent / Case Rate,301, $201.00 , $35.41 , $165.62 , See APC Packaged Rates , $140.70 , $78.39 , $93.59 , $62.80 , $60.13 , See APC Packaged Rates , See APC Packaged Rates , $57.87 , $56.11 , See APC Packaged Rates , See APC Packaged Rates , $29.27 , $29.27 , $30.03 , $30.03 , See APC Packaged Rates , $14.27 , $22.94 , $14.27 , $165.62 , $140.70
83727,5212010435,Hospital Chargemaster,Assay Of Lrh Hormone,Outpatient,Outpatient Default Percent / Case Rate,301, $200.00 , $35.37 , $164.80 , See APC Packaged Rates , $140.00 , $78.00 , $93.59 , $62.80 , $60.13 , See APC Packaged Rates , See APC Packaged Rates , $63.34 , $61.42 , See APC Packaged Rates , See APC Packaged Rates , $29.24 , $29.24 , $29.99 , $29.99 , See APC Packaged Rates , $14.26 , $22.92 , $14.26 , $164.80 , $140.00
83519,5212010401,Hospital Chargemaster,Ria Nonantibody,Outpatient,Outpatient Default Percent / Case Rate,301, $485.00 , $34.08 , $399.64 , See APC Packaged Rates , $339.50 , $189.15 , $80.88 , $54.27 , $51.96 , See APC Packaged Rates , See APC Packaged Rates , $45.44 , $44.06 , See APC Packaged Rates , See APC Packaged Rates , $29.13 , $29.13 , $29.88 , $29.88 , See APC Packaged Rates , $15.27 , $22.08 , $15.27 , $399.64 , $339.50
82239,5212010238,Hospital Chargemaster,Bile Acids Total,Outpatient,Outpatient Default Percent / Case Rate,301, $57.00 , $35.24 , $46.97 , See APC Packaged Rates , $39.90 , $22.23 , $93.59 , $62.80 , $60.13 , See APC Packaged Rates , See APC Packaged Rates , $57.61 , $55.86 , See APC Packaged Rates , See APC Packaged Rates , $29.13 , $29.13 , $29.88 , $29.88 , See APC Packaged Rates , $14.22 , $22.84 , $14.22 , $93.59 , $39.90
83090,5212010392,Hospital Chargemaster,Assay Of Homocystine,Outpatient,Outpatient Default Percent / Case Rate,301, $100.00 , $34.71 , $82.40 , See APC Packaged Rates , $70.00 , $39.00 , $91.99 , $61.72 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $57.28 , $55.55 , See APC Packaged Rates , See APC Packaged Rates , $29.12 , $29.12 , $29.87 , $29.87 , See APC Packaged Rates , $14.87 , $22.49 , $14.87 , $91.99 , $70.00
84181,5212010506,Hospital Chargemaster,Western Blot Test,Outpatient,Outpatient Default Percent / Case Rate,301, $270.00 , $35.04 , $222.48 , See APC Packaged Rates , $189.00 , $105.30 , $84.12 , $56.45 , $54.05 , See APC Packaged Rates , See APC Packaged Rates , $57.28 , $55.55 , See APC Packaged Rates , See APC Packaged Rates , $28.96 , $28.96 , $29.71 , $29.71 , See APC Packaged Rates , $14.14 , $22.70 , $14.14 , $222.48 , $189.00
83835,5212010441,Hospital Chargemaster,Assay Of Metanephrines,Outpatient,Outpatient Default Percent / Case Rate,301, $56.00 , $34.85 , $46.14 , See APC Packaged Rates , $39.20 , $21.84 , $91.99 , $61.72 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $56.98 , $55.25 , See APC Packaged Rates , See APC Packaged Rates , $28.83 , $28.83 , $29.57 , $29.57 , See APC Packaged Rates , $14.06 , $22.58 , $14.06 , $91.99 , $39.20
84481,5212010559,Hospital Chargemaster,Free Assay (Ft-3),Outpatient,Outpatient Default Percent / Case Rate,301, $344.00 , $34.85 , $283.46 , See APC Packaged Rates , $240.80 , $134.16 , $91.99 , $61.72 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $56.98 , $55.25 , See APC Packaged Rates , See APC Packaged Rates , $28.83 , $28.83 , $29.57 , $29.57 , See APC Packaged Rates , $14.06 , $22.58 , $14.06 , $283.46 , $240.80
82017,5212010201,Hospital Chargemaster,Acylcarnitines Quant,Outpatient,Outpatient Default Percent / Case Rate,301, $282.00 , $34.71 , $232.37 , See APC Packaged Rates , $197.40 , $109.98 , $91.99 , $61.72 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $36.32 , $35.21 , See APC Packaged Rates , See APC Packaged Rates , $28.70 , $28.70 , $29.44 , $29.44 , See APC Packaged Rates , $14.01 , $22.49 , $14.01 , $232.37 , $197.40
82139,5212010224,Hospital Chargemaster,Amino Acids Quan 6 Or More,Outpatient,Outpatient Default Percent / Case Rate,301, $426.00 , $34.71 , $351.02 , See APC Packaged Rates , $298.20 , $166.14 , $91.99 , $61.72 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $36.32 , $35.21 , See APC Packaged Rates , See APC Packaged Rates , $28.70 , $28.70 , $29.44 , $29.44 , See APC Packaged Rates , $14.01 , $22.49 , $14.01 , $351.02 , $298.20
82261,5212010243,Hospital Chargemaster,Assay Of Biotinidase,Outpatient,Outpatient Default Percent / Case Rate,301, $135.00 , $34.71 , $111.24 , See APC Packaged Rates , $94.50 , $52.65 , $91.99 , $61.72 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $36.32 , $35.21 , See APC Packaged Rates , See APC Packaged Rates , $28.70 , $28.70 , $29.44 , $29.44 , See APC Packaged Rates , $14.01 , $22.49 , $14.01 , $111.24 , $94.50
82379,5212010262,Hospital Chargemaster,Assay Of Carnitine,Outpatient,Outpatient Default Percent / Case Rate,301, $293.00 , $34.71 , $241.43 , See APC Packaged Rates , $205.10 , $114.27 , $91.99 , $61.72 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $36.32 , $35.21 , See APC Packaged Rates , See APC Packaged Rates , $28.70 , $28.70 , $29.44 , $29.44 , See APC Packaged Rates , $14.01 , $22.49 , $14.01 , $241.43 , $205.10
83080,5212010390,Hospital Chargemaster,Assay Of B Hexosaminidase,Outpatient,Outpatient Default Percent / Case Rate,301, $357.00 , $34.71 , $294.17 , See APC Packaged Rates , $249.90 , $139.23 , $91.99 , $61.72 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $36.32 , $35.21 , See APC Packaged Rates , See APC Packaged Rates , $28.70 , $28.70 , $29.44 , $29.44 , See APC Packaged Rates , $14.01 , $22.49 , $14.01 , $294.17 , $249.90
82106,5212010215,Hospital Chargemaster,Alpha-Fetoprotein Amniotic,Outpatient,Outpatient Default Percent / Case Rate,301," $1,375.00 ", $34.52 ," $1,133.00 ", See APC Packaged Rates , $962.50 , $536.25 , $90.41 , $60.66 , $58.08 , See APC Packaged Rates , See APC Packaged Rates , $56.39 , $54.68 , See APC Packaged Rates , See APC Packaged Rates , $28.63 , $28.63 , $29.36 , $29.36 , See APC Packaged Rates , $14.11 , $22.37 , $14.11 ," $1,133.00 ", $962.50
84443,5212010549,Hospital Chargemaster,Assay Thyroid Stim Hormone,Outpatient,Outpatient Default Percent / Case Rate,301, $90.00 , $38.43 , $74.16 , See APC Packaged Rates , $63.00 , $35.10 , $91.99 , $61.72 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $66.13 , $64.12 , See APC Packaged Rates , See APC Packaged Rates , $28.60 , $28.60 , $29.33 , $29.33 , See APC Packaged Rates , $13.94 , $22.40 , $13.94 , $91.99 , $63.00
82710,5212010321,Hospital Chargemaster,Fats/Lipids Feces Quant,Outpatient,Outpatient Default Percent / Case Rate,301, $240.00 , $34.58 , $197.76 , See APC Packaged Rates , $168.00 , $93.60 , $91.99 , $61.72 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $56.49 , $54.77 , See APC Packaged Rates , See APC Packaged Rates , $28.60 , $28.60 , $29.33 , $29.33 , See APC Packaged Rates , $13.94 , $22.40 , $13.94 , $197.76 , $168.00
84577,5212010572,Hospital Chargemaster,Assay Of Feces/Urobilinogen,Outpatient,Outpatient Default Percent / Case Rate,301, $164.00 , $34.58 , $135.14 , See APC Packaged Rates , $114.80 , $63.96 , $91.99 , $61.72 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $41.96 , $40.68 , See APC Packaged Rates , See APC Packaged Rates , $28.60 , $28.60 , $29.33 , $29.33 , See APC Packaged Rates , $13.94 , $22.40 , $13.94 , $135.14 , $114.80
82105,5212010214,Hospital Chargemaster,Alpha-Fetoprotein Serum,Outpatient,Outpatient Default Percent / Case Rate,301, $80.00 , $34.52 , $65.92 , See APC Packaged Rates , $56.00 , $31.20 , $90.41 , $60.66 , $58.08 , See APC Packaged Rates , See APC Packaged Rates , $56.39 , $54.68 , See APC Packaged Rates , See APC Packaged Rates , $28.53 , $28.53 , $29.27 , $29.27 , See APC Packaged Rates , $13.92 , $22.37 , $13.92 , $90.41 , $56.00
80192,5212010097,Hospital Chargemaster,Assay Of Procainamide,Outpatient,Outpatient Default Percent / Case Rate,301, $98.00 , $34.47 , $80.75 , See APC Packaged Rates , $68.60 , $38.22 , $90.41 , $60.66 , $58.08 , See APC Packaged Rates , See APC Packaged Rates , $58.64 , $56.86 , See APC Packaged Rates , See APC Packaged Rates , $28.50 , $28.50 , $29.24 , $29.24 , See APC Packaged Rates , $13.91 , $22.33 , $13.91 , $90.41 , $68.60
82530,5212010284,Hospital Chargemaster,Cortisol Free,Outpatient,Outpatient Default Percent / Case Rate,301, $149.00 , $34.39 , $122.78 , See APC Packaged Rates , $104.30 , $58.11 , $90.41 , $60.66 , $58.08 , See APC Packaged Rates , See APC Packaged Rates , $56.65 , $54.93 , See APC Packaged Rates , See APC Packaged Rates , $28.43 , $28.43 , $29.16 , $29.16 , See APC Packaged Rates , $13.87 , $22.28 , $13.87 , $122.78 , $104.30
83003,5212010366,Hospital Chargemaster,Assay Growth Hormone (Hgh),Outpatient,Outpatient Default Percent / Case Rate,301, $71.00 , $34.30 , $58.50 , See APC Packaged Rates , $49.70 , $27.69 , $90.41 , $60.66 , $58.08 , See APC Packaged Rates , See APC Packaged Rates , $56.75 , $55.02 , See APC Packaged Rates , See APC Packaged Rates , $28.36 , $28.36 , $29.09 , $29.09 , See APC Packaged Rates , $13.84 , $22.22 , $13.84 , $90.41 , $49.70
80188,5212010095,Hospital Chargemaster,Assay Of Primidone,Outpatient,Outpatient Default Percent / Case Rate,301, $80.00 , $34.15 , $65.92 , See APC Packaged Rates , $56.00 , $31.20 , $90.41 , $60.66 , $58.08 , See APC Packaged Rates , See APC Packaged Rates , $36.78 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $28.23 , $28.23 , $28.95 , $28.95 , See APC Packaged Rates , $13.76 , $22.13 , $13.76 , $90.41 , $56.00
82785,5212010337,Hospital Chargemaster,Assay Of Ige,Outpatient,Outpatient Default Percent / Case Rate,301, $116.00 , $33.87 , $95.58 , See APC Packaged Rates , $81.20 , $45.24 , $88.83 , $59.60 , $57.07 , See APC Packaged Rates , See APC Packaged Rates , $55.39 , $53.71 , See APC Packaged Rates , See APC Packaged Rates , $28.01 , $28.01 , $28.73 , $28.73 , See APC Packaged Rates , $13.66 , $21.95 , $13.66 , $95.58 , $81.20
82135,5212010222,Hospital Chargemaster,Assay Aminolevulinic Acid,Outpatient,Outpatient Default Percent / Case Rate,301, $231.00 , $33.85 , $190.34 , See APC Packaged Rates , $161.70 , $90.09 , $88.83 , $59.60 , $57.07 , See APC Packaged Rates , See APC Packaged Rates , $50.82 , $49.28 , See APC Packaged Rates , See APC Packaged Rates , $28.00 , $28.00 , $28.72 , $28.72 , See APC Packaged Rates , $13.65 , $21.94 , $13.65 , $190.34 , $161.70
80170,5212010083,Hospital Chargemaster,Assay Of Gentamicin,Outpatient,Outpatient Default Percent / Case Rate,301, $76.00 , $33.71 , $62.62 , See APC Packaged Rates , $53.20 , $29.64 , $88.83 , $59.60 , $57.07 , See APC Packaged Rates , See APC Packaged Rates , $55.13 , $53.46 , See APC Packaged Rates , See APC Packaged Rates , $27.87 , $27.87 , $28.59 , $28.59 , See APC Packaged Rates , $13.59 , $21.84 , $13.59 , $88.83 , $53.20
84600,5212010581,Hospital Chargemaster,Assay Of Volatiles,Outpatient,Outpatient Default Percent / Case Rate,301, $136.00 , $33.10 , $112.06 , See APC Packaged Rates , $95.20 , $53.04 , $87.25 , $58.55 , $56.06 , See APC Packaged Rates , See APC Packaged Rates , $34.61 , $33.56 , See APC Packaged Rates , See APC Packaged Rates , $27.76 , $27.76 , $28.48 , $28.48 , See APC Packaged Rates , $14.20 , $21.44 , $14.20 , $112.06 , $95.20
82533,5212010285,Hospital Chargemaster,Total Cortisol,Outpatient,Outpatient Default Percent / Case Rate,301, $76.00 , $33.54 , $62.62 , See APC Packaged Rates , $53.20 , $29.64 , $88.83 , $59.60 , $57.07 , See APC Packaged Rates , See APC Packaged Rates , $55.60 , $53.91 , See APC Packaged Rates , See APC Packaged Rates , $27.73 , $27.73 , $28.45 , $28.45 , See APC Packaged Rates , $13.54 , $21.73 , $13.54 , $88.83 , $53.20
83825,5212010440,Hospital Chargemaster,Assay Of Mercury,Outpatient,Outpatient Default Percent / Case Rate,301, $197.00 , $33.45 , $162.33 , See APC Packaged Rates , $137.90 , $76.83 , $88.83 , $59.60 , $57.07 , See APC Packaged Rates , See APC Packaged Rates , $48.91 , $47.42 , See APC Packaged Rates , See APC Packaged Rates , $27.66 , $27.66 , $28.37 , $28.37 , See APC Packaged Rates , $13.49 , $21.67 , $13.49 , $162.33 , $137.90
82232,5212010237,Hospital Chargemaster,Assay Of Beta-2 Protein,Outpatient,Outpatient Default Percent / Case Rate,301, $150.00 , $33.28 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 , $87.25 , $58.55 , $56.06 , See APC Packaged Rates , See APC Packaged Rates , $50.47 , $48.94 , See APC Packaged Rates , See APC Packaged Rates , $27.52 , $27.52 , $28.23 , $28.23 , See APC Packaged Rates , $13.44 , $21.56 , $13.44 , $123.60 , $105.00
80200,5212010103,Hospital Chargemaster,Assay Of Tobramycin,Outpatient,Outpatient Default Percent / Case Rate,301, $128.00 , $33.19 , $105.47 , See APC Packaged Rates , $89.60 , $49.92 , $87.25 , $58.55 , $56.06 , See APC Packaged Rates , See APC Packaged Rates , $37.51 , $36.37 , See APC Packaged Rates , See APC Packaged Rates , $27.44 , $27.44 , $28.15 , $28.15 , See APC Packaged Rates , $13.38 , $21.50 , $13.38 , $105.47 , $89.60
83520,5212010402,Hospital Chargemaster,Immunoassay Quant Nos Nonab,Outpatient,Outpatient Default Percent / Case Rate,301, $90.00 , $31.98 , $74.16 , See APC Packaged Rates , $63.00 , $35.10 , $76.15 , $51.10 , $48.92 , See APC Packaged Rates , See APC Packaged Rates , $54.43 , $52.78 , See APC Packaged Rates , See APC Packaged Rates , $27.35 , $27.35 , $28.05 , $28.05 , See APC Packaged Rates , $14.34 , $20.72 , $14.34 , $76.15 , $63.00
84432,5212010544,Hospital Chargemaster,Assay Of Thyroglobulin,Outpatient,Outpatient Default Percent / Case Rate,301, $60.00 , $33.04 , $49.44 , See APC Packaged Rates , $42.00 , $23.40 , $87.25 , $58.55 , $56.06 , See APC Packaged Rates , See APC Packaged Rates , $54.03 , $52.39 , See APC Packaged Rates , See APC Packaged Rates , $27.33 , $27.33 , $28.04 , $28.04 , See APC Packaged Rates , $13.33 , $21.41 , $13.33 , $87.25 , $42.00
82274,5212010244,Hospital Chargemaster,Assay Test For Blood Fecal,Outpatient,Outpatient Default Percent / Case Rate,301, $65.00 , $36.37 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $85.65 , $57.47 , $55.02 , See APC Packaged Rates , See APC Packaged Rates , $48.79 , $47.31 , See APC Packaged Rates , See APC Packaged Rates , $27.07 , $27.07 , $27.77 , $27.77 , See APC Packaged Rates , $13.22 , $21.20 , $13.22 , $85.65 , $45.50
84591,5212010579,Hospital Chargemaster,Assay Of Nos Vitamin,Outpatient,Outpatient Default Percent / Case Rate,301, $68.00 , $31.60 , $56.03 , See APC Packaged Rates , $47.60 , $26.52 , $74.54 , $50.02 , $47.89 , See APC Packaged Rates , See APC Packaged Rates , $39.36 , $38.16 , See APC Packaged Rates , See APC Packaged Rates , $27.01 , $27.01 , $27.71 , $27.71 , See APC Packaged Rates , $14.16 , $20.47 , $14.16 , $74.54 , $47.60
83992,5212010465,Hospital Chargemaster,Assay For Phencyclidine,Outpatient,Outpatient Default Percent / Case Rate,301, $112.00 , $31.11 , $92.29 , See APC Packaged Rates , $78.40 , $43.68 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $36.78 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $26.84 , $26.84 , $27.53 , $27.53 , See APC Packaged Rates , $34.47 , $51.90 , $26.84 , $190.34 , $78.40
82985,5212010363,Hospital Chargemaster,Assay Of Glycated Protein,Outpatient,Outpatient Default Percent / Case Rate,301, $70.00 , $34.47 , $57.68 , See APC Packaged Rates , $49.00 , $27.30 , $82.49 , $55.35 , $53.00 , See APC Packaged Rates , See APC Packaged Rates , $50.68 , $49.15 , See APC Packaged Rates , See APC Packaged Rates , $26.53 , $26.53 , $27.22 , $27.22 , See APC Packaged Rates , $13.91 , $20.11 , $13.91 , $82.49 , $49.00
84585,5212010575,Hospital Chargemaster,Assay Of Urine Vma,Outpatient,Outpatient Default Percent / Case Rate,301, $120.00 , $31.89 , $98.88 , See APC Packaged Rates , $84.00 , $46.80 , $84.07 , $56.41 , $54.01 , See APC Packaged Rates , See APC Packaged Rates , $52.14 , $50.55 , See APC Packaged Rates , See APC Packaged Rates , $26.36 , $26.36 , $27.04 , $27.04 , See APC Packaged Rates , $12.87 , $20.66 , $12.87 , $98.88 , $84.00
80348,5212010139,Hospital Chargemaster,Drug Screening Buprenorphine,Outpatient,Outpatient Default Percent / Case Rate,301, $264.00 , $24.85 , $217.54 , See APC Packaged Rates , $184.80 , $102.96 , $45.30 , $30.40 , $29.10 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $26.15 , $26.15 , $26.82 , $26.82 , See APC Packaged Rates , $92.40 , $- , $- , $217.54 , $184.80
82190,5212010236,Hospital Chargemaster,Atomic Absorption,Outpatient,Outpatient Default Percent / Case Rate,301, $240.00 , $30.67 , $197.76 , See APC Packaged Rates , $168.00 , $93.60 , $80.88 , $54.27 , $51.96 , See APC Packaged Rates , See APC Packaged Rates , $22.91 , $22.21 , See APC Packaged Rates , See APC Packaged Rates , $25.76 , $25.76 , $26.43 , $26.43 , See APC Packaged Rates , $13.20 , $19.87 , $13.20 , $197.76 , $168.00
80352,5212010143,Hospital Chargemaster,Cannabinoid Synthetic 7/More,Outpatient,Outpatient Default Percent / Case Rate,301, $80.00 , $22.59 , $65.92 , See APC Packaged Rates , $56.00 , $31.20 , $44.58 , $29.91 , $28.64 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.73 , $25.73 , $26.40 , $26.40 , See APC Packaged Rates , $28.00 , $- , $- , $65.92 , $56.00
80150,5212010071,Hospital Chargemaster,Assay Of Amikacin,Outpatient,Outpatient Default Percent / Case Rate,301, $159.00 , $31.02 , $131.02 , See APC Packaged Rates , $111.30 , $62.01 , $82.49 , $55.35 , $53.00 , See APC Packaged Rates , See APC Packaged Rates , $39.12 , $37.94 , See APC Packaged Rates , See APC Packaged Rates , $25.66 , $25.66 , $26.32 , $26.32 , See APC Packaged Rates , $12.51 , $20.10 , $12.51 , $131.02 , $111.30
82607,5212010298,Hospital Chargemaster,Vitami B-12,Outpatient,Outpatient Default Percent / Case Rate,301, $71.00 , $31.02 , $58.50 , See APC Packaged Rates , $49.70 , $27.69 , $82.49 , $55.35 , $53.00 , See APC Packaged Rates , See APC Packaged Rates , $43.80 , $42.48 , See APC Packaged Rates , See APC Packaged Rates , $25.66 , $25.66 , $26.32 , $26.32 , See APC Packaged Rates , $12.51 , $20.10 , $12.51 , $82.49 , $49.70
84163,5212010503,Hospital Chargemaster,Pappa Serum,Outpatient,Outpatient Default Percent / Case Rate,301, $56.00 , $30.98 , $46.14 , See APC Packaged Rates , $39.20 , $21.84 , $82.49 , $55.35 , $53.00 , See APC Packaged Rates , See APC Packaged Rates , $51.67 , $50.10 , See APC Packaged Rates , See APC Packaged Rates , $25.61 , $25.61 , $26.27 , $26.27 , See APC Packaged Rates , $12.49 , $20.08 , $12.49 , $82.49 , $39.20
84702,5212010585,Hospital Chargemaster,Chorionic Gonadotropin Test,Outpatient,Outpatient Default Percent / Case Rate,301, $143.00 , $30.98 , $117.83 , See APC Packaged Rates , $100.10 , $55.77 , $82.49 , $55.35 , $53.00 , See APC Packaged Rates , See APC Packaged Rates , $50.61 , $49.08 , See APC Packaged Rates , See APC Packaged Rates , $25.61 , $25.61 , $26.27 , $26.27 , See APC Packaged Rates , $12.49 , $20.08 , $12.49 , $117.83 , $100.10
80356,5212010147,Hospital Chargemaster,Heroin Metabolite,Outpatient,Outpatient Default Percent / Case Rate,301, $115.00 , $22.78 , $94.76 , See APC Packaged Rates , $80.50 , $44.85 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.41 , $25.41 , $26.07 , $26.07 , See APC Packaged Rates , $40.25 , $- , $- , $106.27 , $80.50
82693,5212010319,Hospital Chargemaster,Assay Of Ethylene Glycol,Outpatient,Outpatient Default Percent / Case Rate,301, $83.00 , $30.67 , $68.39 , See APC Packaged Rates , $58.10 , $32.37 , $80.88 , $54.27 , $51.96 , See APC Packaged Rates , See APC Packaged Rates , $50.10 , $48.58 , See APC Packaged Rates , See APC Packaged Rates , $25.35 , $25.35 , $26.00 , $26.00 , See APC Packaged Rates , $12.37 , $19.87 , $12.37 , $80.88 , $58.10
80173,5212010085,Hospital Chargemaster,Assay Of Haloperidol,Outpatient,Outpatient Default Percent / Case Rate,301, $224.00 , $29.97 , $184.58 , See APC Packaged Rates , $156.80 , $87.36 , $79.30 , $53.21 , $50.95 , See APC Packaged Rates , See APC Packaged Rates , $49.44 , $47.94 , See APC Packaged Rates , See APC Packaged Rates , $25.26 , $25.26 , $25.91 , $25.91 , See APC Packaged Rates , $13.10 , $19.42 , $13.10 , $184.58 , $156.80
84080,5212010473,Hospital Chargemaster,Assay Alkaline Phosphatases,Outpatient,Outpatient Default Percent / Case Rate,301, $98.00 , $30.43 , $80.75 , See APC Packaged Rates , $68.60 , $38.22 , $80.88 , $54.27 , $51.96 , See APC Packaged Rates , See APC Packaged Rates , $36.78 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $25.15 , $25.15 , $25.80 , $25.80 , See APC Packaged Rates , $12.27 , $19.72 , $12.27 , $80.88 , $68.60
84442,5212010548,Hospital Chargemaster,Assay Of Thyroid Activity,Outpatient,Outpatient Default Percent / Case Rate,301, $209.00 , $30.43 , $172.22 , See APC Packaged Rates , $146.30 , $81.51 , $80.88 , $54.27 , $51.96 , See APC Packaged Rates , See APC Packaged Rates , $49.75 , $48.24 , See APC Packaged Rates , See APC Packaged Rates , $25.15 , $25.15 , $25.80 , $25.80 , See APC Packaged Rates , $12.27 , $19.72 , $12.27 , $172.22 , $146.30
84120,5212010483,Hospital Chargemaster,Assay Of Urine Porphyrins,Outpatient,Outpatient Default Percent / Case Rate,301, $80.00 , $30.28 , $65.92 , See APC Packaged Rates , $56.00 , $31.20 , $79.30 , $53.21 , $50.95 , See APC Packaged Rates , See APC Packaged Rates , $38.73 , $37.55 , See APC Packaged Rates , See APC Packaged Rates , $25.03 , $25.03 , $25.67 , $25.67 , See APC Packaged Rates , $12.20 , $19.62 , $12.20 , $79.30 , $56.00
82746,5212010328,Hospital Chargemaster,Assay Of Folic Acid Serum,Outpatient,Outpatient Default Percent / Case Rate,301, $64.00 , $30.26 , $52.74 , See APC Packaged Rates , $44.80 , $24.96 , $79.30 , $53.21 , $50.95 , See APC Packaged Rates , See APC Packaged Rates , $44.93 , $43.56 , See APC Packaged Rates , See APC Packaged Rates , $25.01 , $25.01 , $25.66 , $25.66 , See APC Packaged Rates , $12.20 , $19.61 , $12.20 , $79.30 , $44.80
80176,5212010087,Hospital Chargemaster,Assay Of Lidocaine,Outpatient,Outpatient Default Percent / Case Rate,301, $171.00 , $30.22 , $140.90 , See APC Packaged Rates , $119.70 , $66.69 , $79.30 , $53.21 , $50.95 , See APC Packaged Rates , See APC Packaged Rates , $37.51 , $36.37 , See APC Packaged Rates , See APC Packaged Rates , $25.00 , $25.00 , $25.64 , $25.64 , See APC Packaged Rates , $12.19 , $19.58 , $12.19 , $140.90 , $119.70
80194,5212010098,Hospital Chargemaster,Assay Of Quinidine,Outpatient,Outpatient Default Percent / Case Rate,301, $90.00 , $30.04 , $74.16 , See APC Packaged Rates , $63.00 , $35.10 , $79.30 , $53.21 , $50.95 , See APC Packaged Rates , See APC Packaged Rates , $48.09 , $46.63 , See APC Packaged Rates , See APC Packaged Rates , $24.84 , $24.84 , $25.48 , $25.48 , See APC Packaged Rates , $12.11 , $19.46 , $12.11 , $79.30 , $63.00
82164,5212010232,Hospital Chargemaster,Angiotensin I Enzyme Test,Outpatient,Outpatient Default Percent / Case Rate,301, $127.00 , $30.04 , $104.65 , See APC Packaged Rates , $88.90 , $49.53 , $79.30 , $53.21 , $50.95 , See APC Packaged Rates , See APC Packaged Rates , $47.67 , $46.22 , See APC Packaged Rates , See APC Packaged Rates , $24.84 , $24.84 , $25.48 , $25.48 , See APC Packaged Rates , $12.11 , $19.46 , $12.11 , $104.65 , $88.90
84134,5212010487,Hospital Chargemaster,Assay Of Prealbumin,Outpatient,Outpatient Default Percent / Case Rate,301, $80.00 , $30.02 , $65.92 , See APC Packaged Rates , $56.00 , $31.20 , $79.30 , $53.21 , $50.95 , See APC Packaged Rates , See APC Packaged Rates , $49.07 , $47.58 , See APC Packaged Rates , See APC Packaged Rates , $24.83 , $24.83 , $25.47 , $25.47 , See APC Packaged Rates , $12.10 , $19.45 , $12.10 , $79.30 , $56.00
82140,5212010225,Hospital Chargemaster,Assay Of Ammonia,Outpatient,Outpatient Default Percent / Case Rate,301, $68.00 , $29.98 , $56.03 , See APC Packaged Rates , $47.60 , $26.52 , $79.30 , $53.21 , $50.95 , See APC Packaged Rates , See APC Packaged Rates , $36.78 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $24.80 , $24.80 , $25.43 , $25.43 , See APC Packaged Rates , $12.09 , $19.43 , $12.09 , $79.30 , $47.60
80156,5212010073,Hospital Chargemaster,Assay Carbamazepine Total,Outpatient,Outpatient Default Percent / Case Rate,301, $77.00 , $29.97 , $63.45 , See APC Packaged Rates , $53.90 , $30.03 , $79.30 , $53.21 , $50.95 , See APC Packaged Rates , See APC Packaged Rates , $36.78 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $24.78 , $24.78 , $25.42 , $25.42 , See APC Packaged Rates , $12.09 , $19.42 , $12.09 , $79.30 , $53.90
82978,5212010361,Hospital Chargemaster,Assay Of Glutathione,Outpatient,Outpatient Default Percent / Case Rate,301, $66.00 , $29.34 , $54.38 , See APC Packaged Rates , $46.20 , $25.74 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $47.95 , $46.49 , See APC Packaged Rates , See APC Packaged Rates , $24.73 , $24.73 , $25.37 , $25.37 , See APC Packaged Rates , $12.83 , $19.01 , $12.83 , $77.73 , $46.20
83582,5212010409,Hospital Chargemaster,Assay Of Ketogenic Steroids,Outpatient,Outpatient Default Percent / Case Rate,301, $152.00 , $29.17 , $125.25 , See APC Packaged Rates , $106.40 , $59.28 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $50.08 , $48.56 , See APC Packaged Rates , See APC Packaged Rates , $24.63 , $24.63 , $25.26 , $25.26 , See APC Packaged Rates , $12.85 , $18.90 , $12.85 , $125.25 , $106.40
82104,5212010213,Hospital Chargemaster,Alpha-1-Antitrypsin Pheno,Outpatient,Outpatient Default Percent / Case Rate,301, $90.00 , $29.76 , $74.16 , See APC Packaged Rates , $63.00 , $35.10 , $79.30 , $53.21 , $50.95 , See APC Packaged Rates , See APC Packaged Rates , $38.26 , $37.10 , See APC Packaged Rates , See APC Packaged Rates , $24.61 , $24.61 , $25.24 , $25.24 , See APC Packaged Rates , $12.00 , $19.28 , $12.00 , $79.30 , $63.00
84202,5212010508,Hospital Chargemaster,Assay Rbc Protoporphyrin,Outpatient,Outpatient Default Percent / Case Rate,301, $152.00 , $29.52 , $125.25 , See APC Packaged Rates , $106.40 , $59.28 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $32.10 , $31.13 , See APC Packaged Rates , See APC Packaged Rates , $24.41 , $24.41 , $25.04 , $25.04 , See APC Packaged Rates , $11.91 , $19.13 , $11.91 , $125.25 , $106.40
82608,5212010299,Hospital Chargemaster,B-12 Binding Capacity,Outpatient,Outpatient Default Percent / Case Rate,301, $164.00 , $29.47 , $135.14 , See APC Packaged Rates , $114.80 , $63.96 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $48.18 , $46.72 , See APC Packaged Rates , See APC Packaged Rates , $24.37 , $24.37 , $24.99 , $24.99 , See APC Packaged Rates , $11.89 , $19.09 , $11.89 , $135.14 , $114.80
82943,5212010347,Hospital Chargemaster,Assay Of Glucagon,Outpatient,Outpatient Default Percent / Case Rate,301, $213.00 , $29.41 , $175.51 , See APC Packaged Rates , $149.10 , $83.07 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $48.06 , $46.61 , See APC Packaged Rates , See APC Packaged Rates , $24.32 , $24.32 , $24.95 , $24.95 , See APC Packaged Rates , $11.87 , $19.06 , $11.87 , $175.51 , $149.10
80184,5212010092,Hospital Chargemaster,Assay Of Phenobarbital,Outpatient,Outpatient Default Percent / Case Rate,301, $58.00 , $28.34 , $47.79 , See APC Packaged Rates , $40.60 , $22.62 , $66.62 , $44.70 , $42.80 , See APC Packaged Rates , See APC Packaged Rates , $34.30 , $33.26 , See APC Packaged Rates , See APC Packaged Rates , $24.23 , $24.23 , $24.85 , $24.85 , See APC Packaged Rates , $12.70 , $18.36 , $12.70 , $66.62 , $40.60
84446,5212010551,Hospital Chargemaster,Assay Of Vitamin E,Outpatient,Outpatient Default Percent / Case Rate,301, $80.00 , $29.17 , $65.92 , See APC Packaged Rates , $56.00 , $31.20 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $47.69 , $46.24 , See APC Packaged Rates , See APC Packaged Rates , $24.13 , $24.13 , $24.76 , $24.76 , See APC Packaged Rates , $11.77 , $18.90 , $11.77 , $77.73 , $56.00
84480,5212010558,Hospital Chargemaster,Assay Triiodothyronine (T3),Outpatient,Outpatient Default Percent / Case Rate,301, $128.00 , $29.17 , $105.47 , See APC Packaged Rates , $89.60 , $49.92 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $47.69 , $46.24 , See APC Packaged Rates , See APC Packaged Rates , $24.13 , $24.13 , $24.76 , $24.76 , See APC Packaged Rates , $11.77 , $18.90 , $11.77 , $105.47 , $89.60
80198,5212010101,Hospital Chargemaster,Assay Of Theophylline,Outpatient,Outpatient Default Percent / Case Rate,301, $55.00 , $29.09 , $45.32 , See APC Packaged Rates , $38.50 , $21.45 , $76.15 , $51.10 , $48.92 , See APC Packaged Rates , See APC Packaged Rates , $39.87 , $38.66 , See APC Packaged Rates , See APC Packaged Rates , $24.06 , $24.06 , $24.68 , $24.68 , See APC Packaged Rates , $11.73 , $18.85 , $11.73 , $76.15 , $38.50
82397,5212010269,Hospital Chargemaster,Chemiluminescent Assay,Outpatient,Outpatient Default Percent / Case Rate,301, $201.00 , $29.06 , $165.62 , See APC Packaged Rates , $140.70 , $78.39 , $76.15 , $51.10 , $48.92 , See APC Packaged Rates , See APC Packaged Rates , $35.97 , $34.87 , See APC Packaged Rates , See APC Packaged Rates , $24.03 , $24.03 , $24.65 , $24.65 , See APC Packaged Rates , $11.72 , $18.83 , $11.72 , $165.62 , $140.70
82128,5212010220,Hospital Chargemaster,Amino Acids Mult Qual,Outpatient,Outpatient Default Percent / Case Rate,301, $113.00 , $28.54 , $93.11 , See APC Packaged Rates , $79.10 , $44.07 , $76.15 , $51.10 , $48.92 , See APC Packaged Rates , See APC Packaged Rates , $45.33 , $43.95 , See APC Packaged Rates , See APC Packaged Rates , $23.61 , $23.61 , $24.22 , $24.22 , See APC Packaged Rates , $11.51 , $18.49 , $11.51 , $93.11 , $79.10
80169,5212010082,Hospital Chargemaster,Drug Assay Everolimus,Outpatient,Outpatient Default Percent / Case Rate,301, $112.00 , $28.26 , $92.29 , See APC Packaged Rates , $78.40 , $43.68 , $74.54 , $50.02 , $47.89 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $23.37 , $23.37 , $23.97 , $23.97 , See APC Packaged Rates , $11.39 , $18.31 , $11.39 , $92.29 , $78.40
80195,5212010099,Hospital Chargemaster,Assay Of Sirolimus,Outpatient,Outpatient Default Percent / Case Rate,301, $194.00 , $28.26 , $159.86 , See APC Packaged Rates , $135.80 , $75.66 , $74.54 , $50.02 , $47.89 , See APC Packaged Rates , See APC Packaged Rates , $25.01 , $24.26 , See APC Packaged Rates , See APC Packaged Rates , $23.37 , $23.37 , $23.97 , $23.97 , See APC Packaged Rates , $11.39 , $18.31 , $11.39 , $159.86 , $135.80
80197,5212010100,Hospital Chargemaster,Assay Of Tacrolimus,Outpatient,Outpatient Default Percent / Case Rate,301, $179.00 , $28.26 , $147.50 , See APC Packaged Rates , $125.30 , $69.81 , $74.54 , $50.02 , $47.89 , See APC Packaged Rates , See APC Packaged Rates , $29.39 , $28.50 , See APC Packaged Rates , See APC Packaged Rates , $23.37 , $23.37 , $23.97 , $23.97 , See APC Packaged Rates , $11.39 , $18.31 , $11.39 , $147.50 , $125.30
84597,5212010580,Hospital Chargemaster,Assay Of Vitamin K,Outpatient,Outpatient Default Percent / Case Rate,301, $316.00 , $28.22 , $260.38 , See APC Packaged Rates , $221.20 , $123.24 , $74.54 , $50.02 , $47.89 , See APC Packaged Rates , See APC Packaged Rates , $28.57 , $27.70 , See APC Packaged Rates , See APC Packaged Rates , $23.35 , $23.35 , $23.95 , $23.95 , See APC Packaged Rates , $11.39 , $18.29 , $11.39 , $260.38 , $221.20
82330,5212010250,Hospital Chargemaster,Assay Of Calcium,Outpatient,Outpatient Default Percent / Case Rate,301, $115.00 , $31.26 , $94.76 , See APC Packaged Rates , $80.50 , $44.85 , $74.54 , $50.02 , $47.89 , See APC Packaged Rates , See APC Packaged Rates , $26.63 , $25.82 , See APC Packaged Rates , See APC Packaged Rates , $23.27 , $23.27 , $23.87 , $23.87 , See APC Packaged Rates , $11.36 , $18.24 , $11.36 , $94.76 , $80.50
G0328,5212010789,Hospital Chargemaster,Fecal blood scrn immunoassay,Outpatient,Outpatient Default Percent / Case Rate,301, $60.00 , $33.00 , $49.44 , See APC Packaged Rates , $42.00 , $23.40 , $85.65 , $57.47 , $55.02 , See APC Packaged Rates , See APC Packaged Rates , $40.26 , $40.26 , See APC Packaged Rates , See APC Packaged Rates , $23.22 , $23.22 , $23.82 , $23.82 , See APC Packaged Rates , $21.00 , $21.66 , $21.00 , $85.65 , $42.00
82728,5212010325,Hospital Chargemaster,Assay Of Ferritin,Outpatient,Outpatient Default Percent / Case Rate,301, $51.00 , $28.06 , $42.02 , See APC Packaged Rates , $35.70 , $19.89 , $74.54 , $50.02 , $47.89 , See APC Packaged Rates , See APC Packaged Rates , $36.78 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $23.20 , $23.20 , $23.79 , $23.79 , See APC Packaged Rates , $11.31 , $18.18 , $11.31 , $74.54 , $35.70
83883,5212010450,Hospital Chargemaster,Assay Nephelometry Not Spec,Outpatient,Outpatient Default Percent / Case Rate,301, $58.00 , $27.98 , $47.79 , See APC Packaged Rates , $40.60 , $22.62 , $74.54 , $50.02 , $47.89 , See APC Packaged Rates , See APC Packaged Rates , $38.19 , $37.03 , See APC Packaged Rates , See APC Packaged Rates , $23.13 , $23.13 , $23.73 , $23.73 , See APC Packaged Rates , $11.29 , $18.13 , $11.29 , $74.54 , $40.60
80164,5212010079,Hospital Chargemaster,Assay Dipropylacetic Acd Tot,Outpatient,Outpatient Default Percent / Case Rate,301, $67.00 , $27.87 , $55.21 , See APC Packaged Rates , $46.90 , $26.13 , $72.96 , $48.96 , $46.88 , See APC Packaged Rates , See APC Packaged Rates , $36.78 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $23.04 , $23.04 , $23.64 , $23.64 , See APC Packaged Rates , $11.23 , $18.06 , $11.23 , $72.96 , $46.90
80165,5212010080,Hospital Chargemaster,Dipropylacetic Acid Free,Outpatient,Outpatient Default Percent / Case Rate,301, $51.00 , $27.87 , $42.02 , See APC Packaged Rates , $35.70 , $19.89 , $72.96 , $48.96 , $46.88 , See APC Packaged Rates , See APC Packaged Rates , $45.30 , $43.93 , See APC Packaged Rates , See APC Packaged Rates , $23.04 , $23.04 , $23.64 , $23.64 , See APC Packaged Rates , $11.23 , $18.06 , $11.23 , $72.96 , $35.70
80202,5212010105,Hospital Chargemaster,Assay Of Vancomycin,Outpatient,Outpatient Default Percent / Case Rate,301, $89.00 , $27.87 , $73.34 , See APC Packaged Rates , $62.30 , $34.71 , $72.96 , $48.96 , $46.88 , See APC Packaged Rates , See APC Packaged Rates , $36.78 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $23.04 , $23.04 , $23.64 , $23.64 , See APC Packaged Rates , $11.23 , $18.06 , $11.23 , $73.34 , $62.30
84210,5212010512,Hospital Chargemaster,Assay Of Pyruvate,Outpatient,Outpatient Default Percent / Case Rate,301, $154.00 , $26.82 , $126.90 , See APC Packaged Rates , $107.80 , $60.06 , $63.44 , $42.57 , $40.76 , See APC Packaged Rates , See APC Packaged Rates , $23.96 , $23.23 , See APC Packaged Rates , See APC Packaged Rates , $22.92 , $22.92 , $23.51 , $23.51 , See APC Packaged Rates , $12.01 , $17.38 , $12.01 , $126.90 , $107.80
83945,5212010460,Hospital Chargemaster,Assay Of Oxalate,Outpatient,Outpatient Default Percent / Case Rate,301, $60.00 , $26.76 , $49.44 , See APC Packaged Rates , $42.00 , $23.40 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $46.52 , $45.11 , See APC Packaged Rates , See APC Packaged Rates , $22.87 , $22.87 , $23.46 , $23.46 , See APC Packaged Rates , $11.99 , $17.34 , $11.99 , $69.78 , $42.00
82103,5212010212,Hospital Chargemaster,Alpha-1-Antitrypsin Total,Outpatient,Outpatient Default Percent / Case Rate,301, $50.00 , $27.65 , $41.20 , See APC Packaged Rates , $35.00 , $19.50 , $72.96 , $48.96 , $46.88 , See APC Packaged Rates , See APC Packaged Rates , $32.10 , $31.13 , See APC Packaged Rates , See APC Packaged Rates , $22.86 , $22.86 , $23.45 , $23.45 , See APC Packaged Rates , $11.16 , $17.92 , $11.16 , $72.96 , $35.00
84275,5212010524,Hospital Chargemaster,Assay Of Sialic Acid,Outpatient,Outpatient Default Percent / Case Rate,301, $152.00 , $27.65 , $125.25 , See APC Packaged Rates , $106.40 , $59.28 , $72.96 , $48.96 , $46.88 , See APC Packaged Rates , See APC Packaged Rates , $30.93 , $30.00 , See APC Packaged Rates , See APC Packaged Rates , $22.86 , $22.86 , $23.45 , $23.45 , See APC Packaged Rates , $11.16 , $17.92 , $11.16 , $125.25 , $106.40
80061,5212010066,Hospital Chargemaster,Lipid Panel,Outpatient,Outpatient Default Percent / Case Rate,301, $189.00 , $30.61 , $155.74 , See APC Packaged Rates , $132.30 , $73.71 , $72.96 , $48.96 , $46.88 , See APC Packaged Rates , See APC Packaged Rates , $41.18 , $39.93 , See APC Packaged Rates , See APC Packaged Rates , $22.78 , $22.78 , $23.37 , $23.37 , See APC Packaged Rates , $11.11 , $17.86 , $11.11 , $155.74 , $132.30
82552,5212010289,Hospital Chargemaster,Assay Of Cpk In Blood,Outpatient,Outpatient Default Percent / Case Rate,301, $62.00 , $27.56 , $51.09 , See APC Packaged Rates , $43.40 , $24.18 , $72.96 , $48.96 , $46.88 , See APC Packaged Rates , See APC Packaged Rates , $45.05 , $43.68 , See APC Packaged Rates , See APC Packaged Rates , $22.78 , $22.78 , $23.37 , $23.37 , See APC Packaged Rates , $11.11 , $17.86 , $11.11 , $72.96 , $43.40
83695,5212010426,Hospital Chargemaster,Assay Of Lipoprotein(A),Outpatient,Outpatient Default Percent / Case Rate,301, $137.00 , $26.65 , $112.89 , See APC Packaged Rates , $95.90 , $53.43 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $44.44 , $43.09 , See APC Packaged Rates , See APC Packaged Rates , $22.67 , $22.67 , $23.26 , $23.26 , See APC Packaged Rates , $11.89 , $17.27 , $11.89 , $112.89 , $95.90
80162,5212010077,Hospital Chargemaster,Assay Of Digoxin Total,Outpatient,Outpatient Default Percent / Case Rate,301, $77.00 , $27.32 , $63.45 , See APC Packaged Rates , $53.90 , $30.03 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $55.83 , $54.14 , See APC Packaged Rates , See APC Packaged Rates , $22.60 , $22.60 , $23.18 , $23.18 , See APC Packaged Rates , $11.02 , $17.70 , $11.02 , $71.38 , $53.90
80175,5212010086,Hospital Chargemaster,Drug Screen Quan Lamotrigine,Outpatient,Outpatient Default Percent / Case Rate,301, $93.00 , $27.28 , $76.63 , See APC Packaged Rates , $65.10 , $36.27 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $44.44 , $43.09 , See APC Packaged Rates , See APC Packaged Rates , $22.55 , $22.55 , $23.13 , $23.13 , See APC Packaged Rates , $10.99 , $17.68 , $10.99 , $76.63 , $65.10
80177,5212010088,Hospital Chargemaster,Drug Scrn Quan Levetiracetam,Outpatient,Outpatient Default Percent / Case Rate,301, $100.00 , $27.28 , $82.40 , See APC Packaged Rates , $70.00 , $39.00 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $44.44 , $43.09 , See APC Packaged Rates , See APC Packaged Rates , $22.55 , $22.55 , $23.13 , $23.13 , See APC Packaged Rates , $10.99 , $17.68 , $10.99 , $82.40 , $70.00
80183,5212010091,Hospital Chargemaster,Drug Scrn Quant Oxcarbazepin,Outpatient,Outpatient Default Percent / Case Rate,301, $124.00 , $27.28 , $102.18 , See APC Packaged Rates , $86.80 , $48.36 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $44.44 , $43.09 , See APC Packaged Rates , See APC Packaged Rates , $22.55 , $22.55 , $23.13 , $23.13 , See APC Packaged Rates , $10.99 , $17.68 , $10.99 , $102.18 , $86.80
80185,5212010093,Hospital Chargemaster,Assay Of Phenytoin Total,Outpatient,Outpatient Default Percent / Case Rate,301, $70.00 , $27.28 , $57.68 , See APC Packaged Rates , $49.00 , $27.30 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $53.47 , $51.85 , See APC Packaged Rates , See APC Packaged Rates , $22.55 , $22.55 , $23.13 , $23.13 , See APC Packaged Rates , $10.99 , $17.68 , $10.99 , $71.38 , $49.00
82585,5212010295,Hospital Chargemaster,Assay Of Cryofibrinogen,Outpatient,Outpatient Default Percent / Case Rate,301, $92.00 , $26.19 , $75.81 , See APC Packaged Rates , $64.40 , $35.88 , $61.86 , $41.51 , $39.74 , See APC Packaged Rates , See APC Packaged Rates , $13.27 , $12.87 , See APC Packaged Rates , See APC Packaged Rates , $22.38 , $22.38 , $22.96 , $22.96 , See APC Packaged Rates , $11.73 , $16.97 , $11.73 , $75.81 , $64.40
80342,5212010133,Hospital Chargemaster,Antipsychotics Nos 1-3,Outpatient,Outpatient Default Percent / Case Rate,301, $158.00 , $59.88 , $130.19 , See APC Packaged Rates , $110.60 , $61.62 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $22.37 , $22.37 , $22.94 , $22.94 , See APC Packaged Rates , $55.30 , $- , $- , $130.19 , $110.60
83527,5212010404,Hospital Chargemaster,Assay Of Insulin,Outpatient,Outpatient Default Percent / Case Rate,301, $61.00 , $26.65 , $50.26 , See APC Packaged Rates , $42.70 , $23.79 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $34.68 , $33.63 , See APC Packaged Rates , See APC Packaged Rates , $22.03 , $22.03 , $22.59 , $22.59 , See APC Packaged Rates , $10.75 , $17.27 , $10.75 , $69.78 , $42.70
83874,5212010447,Hospital Chargemaster,Assay Of Myoglobin,Outpatient,Outpatient Default Percent / Case Rate,301, $155.00 , $26.58 , $127.72 , See APC Packaged Rates , $108.50 , $60.45 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $47.74 , $46.29 , See APC Packaged Rates , See APC Packaged Rates , $21.98 , $21.98 , $22.55 , $22.55 , See APC Packaged Rates , $10.72 , $17.22 , $10.72 , $127.72 , $108.50
82365,5212010255,Hospital Chargemaster,Calculus Spectroscopy,Outpatient,Outpatient Default Percent / Case Rate,301, $138.00 , $26.54 , $113.71 , See APC Packaged Rates , $96.60 , $53.82 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $43.38 , $42.07 , See APC Packaged Rates , See APC Packaged Rates , $21.95 , $21.95 , $22.52 , $22.52 , See APC Packaged Rates , $10.71 , $17.20 , $10.71 , $113.71 , $96.60
83497,5212010395,Hospital Chargemaster,Assay Of 5-Hiaa,Outpatient,Outpatient Default Percent / Case Rate,301, $87.00 , $26.54 , $71.69 , See APC Packaged Rates , $60.90 , $33.93 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $43.38 , $42.07 , See APC Packaged Rates , See APC Packaged Rates , $21.95 , $21.95 , $22.52 , $22.52 , See APC Packaged Rates , $10.71 , $17.20 , $10.71 , $71.69 , $60.90
82951,5212010353,Hospital Chargemaster,Glucose Tolerance Test (Gtt),Outpatient,Outpatient Default Percent / Case Rate,301, $63.00 , $29.43 , $51.91 , See APC Packaged Rates , $44.10 , $24.57 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $26.98 , $26.16 , See APC Packaged Rates , See APC Packaged Rates , $21.90 , $21.90 , $22.47 , $22.47 , See APC Packaged Rates , $10.69 , $17.16 , $10.69 , $69.78 , $44.10
83020,5212010375,Hospital Chargemaster,Hemoglobin Electrophoresis,Outpatient,Outpatient Default Percent / Case Rate,301, $189.00 , $26.48 , $155.74 , See APC Packaged Rates , $132.30 , $73.71 , $84.12 , $56.45 , $54.05 , See APC Packaged Rates , See APC Packaged Rates , $43.31 , $42.00 , See APC Packaged Rates , See APC Packaged Rates , $21.90 , $21.90 , $22.47 , $22.47 , See APC Packaged Rates , $10.69 , $17.16 , $10.69 , $155.74 , $132.30
83586,5212010410,Hospital Chargemaster,Assay 17- Ketosteroids,Outpatient,Outpatient Default Percent / Case Rate,301, $112.00 , $26.34 , $92.29 , See APC Packaged Rates , $78.40 , $43.68 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $39.12 , $37.94 , See APC Packaged Rates , See APC Packaged Rates , $21.78 , $21.78 , $22.34 , $22.34 , See APC Packaged Rates , $10.62 , $17.06 , $10.62 , $92.29 , $78.40
83625,5212010414,Hospital Chargemaster,Assay Of Ldh Enzymes,Outpatient,Outpatient Default Percent / Case Rate,301, $95.00 , $26.34 , $78.28 , See APC Packaged Rates , $66.50 , $37.05 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $43.06 , $41.75 , See APC Packaged Rates , See APC Packaged Rates , $21.77 , $21.77 , $22.33 , $22.33 , See APC Packaged Rates , $10.61 , $17.06 , $10.61 , $78.28 , $66.50
84466,5212010555,Hospital Chargemaster,Assay Of Transferrin,Outpatient,Outpatient Default Percent / Case Rate,301, $61.00 , $26.26 , $50.26 , See APC Packaged Rates , $42.70 , $23.79 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $42.96 , $41.66 , See APC Packaged Rates , See APC Packaged Rates , $21.72 , $21.72 , $22.28 , $22.28 , See APC Packaged Rates , $10.59 , $17.02 , $10.59 , $69.78 , $42.70
82415,5212010270,Hospital Chargemaster,Assay Of Chloramphenicol,Outpatient,Outpatient Default Percent / Case Rate,301, $167.00 , $26.08 , $137.61 , See APC Packaged Rates , $116.90 , $65.13 , $68.20 , $45.76 , $43.82 , See APC Packaged Rates , See APC Packaged Rates , $27.78 , $26.93 , See APC Packaged Rates , See APC Packaged Rates , $21.55 , $21.55 , $22.10 , $22.10 , See APC Packaged Rates , $10.52 , $16.90 , $10.52 , $137.61 , $116.90
83010,5212010369,Hospital Chargemaster,Assay Of Haptoglobin Quant,Outpatient,Outpatient Default Percent / Case Rate,301, $79.00 , $25.87 , $65.10 , See APC Packaged Rates , $55.30 , $30.81 , $68.20 , $45.76 , $43.82 , See APC Packaged Rates , See APC Packaged Rates , $42.28 , $41.00 , See APC Packaged Rates , See APC Packaged Rates , $21.40 , $21.40 , $21.95 , $21.95 , See APC Packaged Rates , $10.44 , $16.76 , $10.44 , $68.20 , $55.30
82370,5212010256,Hospital Chargemaster,X-Ray Assay Calculus,Outpatient,Outpatient Default Percent / Case Rate,301, $54.00 , $25.78 , $44.50 , See APC Packaged Rates , $37.80 , $21.06 , $68.20 , $45.76 , $43.82 , See APC Packaged Rates , See APC Packaged Rates , $39.66 , $38.46 , See APC Packaged Rates , See APC Packaged Rates , $21.30 , $21.30 , $21.85 , $21.85 , See APC Packaged Rates , $10.40 , $16.70 , $10.40 , $68.20 , $37.80
84119,5212010482,Hospital Chargemaster,Test Urine For Porphyrins,Outpatient,Outpatient Default Percent / Case Rate,301, $359.00 , $24.74 , $295.82 , See APC Packaged Rates , $251.30 , $140.01 , $58.68 , $39.37 , $37.70 , See APC Packaged Rates , See APC Packaged Rates , $25.48 , $24.71 , See APC Packaged Rates , See APC Packaged Rates , $21.15 , $21.15 , $21.69 , $21.69 , See APC Packaged Rates , $11.09 , $16.03 , $11.09 , $295.82 , $251.30
82525,5212010282,Hospital Chargemaster,Assay Of Copper,Outpatient,Outpatient Default Percent / Case Rate,301, $220.00 , $25.54 , $181.28 , See APC Packaged Rates , $154.00 , $85.80 , $68.20 , $45.76 , $43.82 , See APC Packaged Rates , See APC Packaged Rates , $43.17 , $41.86 , See APC Packaged Rates , See APC Packaged Rates , $21.12 , $21.12 , $21.66 , $21.66 , See APC Packaged Rates , $10.31 , $16.55 , $10.31 , $181.28 , $154.00
82375,5212010259,Hospital Chargemaster,Assay Carboxyhb Quant,Outpatient,Outpatient Default Percent / Case Rate,301, $106.00 , $25.35 , $87.34 , See APC Packaged Rates , $74.20 , $41.34 , $66.62 , $44.70 , $42.80 , See APC Packaged Rates , See APC Packaged Rates , $41.44 , $40.18 , See APC Packaged Rates , See APC Packaged Rates , $20.97 , $20.97 , $21.51 , $21.51 , See APC Packaged Rates , $10.23 , $16.43 , $10.23 , $87.34 , $74.20
82638,5212010306,Hospital Chargemaster,Assay Of Dibucaine Number,Outpatient,Outpatient Default Percent / Case Rate,301, $160.00 , $25.21 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $66.62 , $44.70 , $42.80 , See APC Packaged Rates , See APC Packaged Rates , $43.80 , $42.48 , See APC Packaged Rates , See APC Packaged Rates , $20.84 , $20.84 , $21.38 , $21.38 , See APC Packaged Rates , $10.16 , $16.33 , $10.16 , $131.84 , $112.00
83655,5212010419,Hospital Chargemaster,Assay Of Lead,Outpatient,Outpatient Default Percent / Case Rate,301, $56.00 , $27.69 , $46.14 , See APC Packaged Rates , $39.20 , $21.84 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $40.69 , $39.46 , See APC Packaged Rates , See APC Packaged Rates , $20.60 , $20.60 , $21.13 , $21.13 , See APC Packaged Rates , $10.05 , $16.14 , $10.05 , $65.04 , $39.20
84620,5212010582,Hospital Chargemaster,Xylose Tolerance Test,Outpatient,Outpatient Default Percent / Case Rate,301, $88.00 , $24.37 , $72.51 , See APC Packaged Rates , $61.60 , $34.32 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $39.85 , $38.64 , See APC Packaged Rates , See APC Packaged Rates , $20.58 , $20.58 , $21.11 , $21.11 , See APC Packaged Rates , $10.71 , $15.79 , $10.71 , $72.51 , $61.60
80338,5212010129,Hospital Chargemaster,Antidepressant Not Specified,Outpatient,Outpatient Default Percent / Case Rate,301, $264.00 , $9.26 , $217.54 , See APC Packaged Rates , $184.80 , $102.96 , $35.30 , $23.69 , $22.68 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $20.38 , $20.38 , $20.91 , $20.91 , See APC Packaged Rates , $92.40 , $- , $- , $217.54 , $184.80
80201,5212010104,Hospital Chargemaster,Assay Of Topiramate,Outpatient,Outpatient Default Percent / Case Rate,301, $80.00 , $24.52 , $65.92 , See APC Packaged Rates , $56.00 , $31.20 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $20.29 , $20.29 , $20.81 , $20.81 , See APC Packaged Rates , $9.90 , $15.89 , $- , $65.92 , $56.00
83719,5212010432,Hospital Chargemaster,Assay Of Blood Lipoprotein,Outpatient,Outpatient Default Percent / Case Rate,301, $263.00 , $23.95 , $216.71 , See APC Packaged Rates , $184.10 , $102.57 , $63.44 , $42.57 , $40.76 , See APC Packaged Rates , See APC Packaged Rates , $27.40 , $26.57 , See APC Packaged Rates , See APC Packaged Rates , $20.23 , $20.23 , $20.75 , $20.75 , See APC Packaged Rates , $10.59 , $15.52 , $10.59 , $216.71 , $184.10
82554,5212010291,Hospital Chargemaster,Creatine Isoforms,Outpatient,Outpatient Default Percent / Case Rate,301, $817.00 , $24.43 , $673.21 , See APC Packaged Rates , $571.90 , $318.63 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $25.86 , $25.07 , See APC Packaged Rates , See APC Packaged Rates , $20.20 , $20.20 , $20.72 , $20.72 , See APC Packaged Rates , $9.85 , $15.83 , $9.85 , $673.21 , $571.90
84228,5212010514,Hospital Chargemaster,Assay Of Quinine,Outpatient,Outpatient Default Percent / Case Rate,301, $122.00 , $23.95 , $100.53 , See APC Packaged Rates , $85.40 , $47.58 , $63.44 , $42.57 , $40.76 , See APC Packaged Rates , See APC Packaged Rates , $23.89 , $23.17 , See APC Packaged Rates , See APC Packaged Rates , $19.80 , $19.80 , $20.31 , $20.31 , See APC Packaged Rates , $9.65 , $15.52 , $9.65 , $100.53 , $85.40
84430,5212010542,Hospital Chargemaster,Assay Of Thiocyanate,Outpatient,Outpatient Default Percent / Case Rate,301, $184.00 , $23.95 , $151.62 , See APC Packaged Rates , $128.80 , $71.76 , $63.44 , $42.57 , $40.76 , See APC Packaged Rates , See APC Packaged Rates , $39.12 , $37.94 , See APC Packaged Rates , See APC Packaged Rates , $19.80 , $19.80 , $20.31 , $20.31 , See APC Packaged Rates , $9.65 , $15.52 , $9.65 , $151.62 , $128.80
84484,5212010561,Hospital Chargemaster,Assay Of Troponin Quant,Outpatient,Outpatient Default Percent / Case Rate,301, $101.00 , $23.09 , $83.22 , See APC Packaged Rates , $70.70 , $39.39 , $55.52 , $37.25 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $25.86 , $25.07 , See APC Packaged Rates , See APC Packaged Rates , $19.75 , $19.75 , $20.26 , $20.26 , See APC Packaged Rates , $10.35 , $14.96 , $10.35 , $83.22 , $70.70
84590,5212010578,Hospital Chargemaster,Assay Of Vitamin A,Outpatient,Outpatient Default Percent / Case Rate,301, $170.00 , $23.89 , $140.08 , See APC Packaged Rates , $119.00 , $66.30 , $63.44 , $42.57 , $40.76 , See APC Packaged Rates , See APC Packaged Rates , $29.98 , $29.07 , See APC Packaged Rates , See APC Packaged Rates , $19.75 , $19.75 , $20.26 , $20.26 , See APC Packaged Rates , $9.64 , $15.48 , $9.64 , $140.08 , $119.00
82355,5212010253,Hospital Chargemaster,Calculus Analysis Qual,Outpatient,Outpatient Default Percent / Case Rate,301, $57.00 , $23.82 , $46.97 , See APC Packaged Rates , $39.90 , $22.23 , $63.44 , $42.57 , $40.76 , See APC Packaged Rates , See APC Packaged Rates , $29.39 , $28.50 , See APC Packaged Rates , See APC Packaged Rates , $19.69 , $19.69 , $20.20 , $20.20 , See APC Packaged Rates , $9.62 , $15.43 , $9.62 , $63.44 , $39.90
82553,5212010290,Hospital Chargemaster,Creatine Mb Fraction,Outpatient,Outpatient Default Percent / Case Rate,301, $35.00 , $23.76 , $28.84 , See APC Packaged Rates , $24.50 , $13.65 , $63.44 , $42.57 , $40.76 , See APC Packaged Rates , See APC Packaged Rates , $25.86 , $25.07 , See APC Packaged Rates , See APC Packaged Rates , $19.66 , $19.66 , $20.16 , $20.16 , See APC Packaged Rates , $9.59 , $15.40 , $9.59 , $63.44 , $24.50
80373,5212010164,Hospital Chargemaster,Drug Screening Tramadol,Outpatient,Outpatient Default Percent / Case Rate,301, $121.00 , $21.85 , $99.70 , See APC Packaged Rates , $84.70 , $47.19 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $19.66 , $19.66 , $20.16 , $20.16 , See APC Packaged Rates , $42.35 , $- , $- , $106.27 , $84.70
83516,5212010399,Hospital Chargemaster,Immunoassay Nonantibody,Outpatient,Outpatient Default Percent / Case Rate,301, $55.00 , $26.37 , $45.32 , See APC Packaged Rates , $38.50 , $21.45 , $63.44 , $42.57 , $40.76 , See APC Packaged Rates , See APC Packaged Rates , $36.78 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $19.63 , $19.63 , $20.13 , $20.13 , See APC Packaged Rates , $9.56 , $15.37 , $9.56 , $63.44 , $38.50
82656,5212010309,Hospital Chargemaster,Pancreatic Elastase Fecal,Outpatient,Outpatient Default Percent / Case Rate,301, $224.00 , $23.72 , $184.58 , See APC Packaged Rates , $156.80 , $87.36 , $63.44 , $42.57 , $40.76 , See APC Packaged Rates , See APC Packaged Rates , $39.34 , $38.14 , See APC Packaged Rates , See APC Packaged Rates , $19.63 , $19.63 , $20.13 , $20.13 , See APC Packaged Rates , $9.56 , $15.37 , $9.56 , $184.58 , $156.80
84378,5212010535,Hospital Chargemaster,Sugars Single Quant,Outpatient,Outpatient Default Percent / Case Rate,301, $47.00 , $23.72 , $38.73 , See APC Packaged Rates , $32.90 , $18.33 , $61.86 , $41.51 , $39.74 , See APC Packaged Rates , See APC Packaged Rates , $39.12 , $37.94 , See APC Packaged Rates , See APC Packaged Rates , $19.61 , $19.61 , $20.12 , $20.12 , See APC Packaged Rates , $9.56 , $15.37 , $9.56 , $61.86 , $32.90
G0481,5212010791,Hospital Chargemaster,Drug test def 8-14 classes,Outpatient,Outpatient Default Percent / Case Rate,301, $240.00 , $132.00 , $197.76 , See APC Packaged Rates , $168.00 , $93.60 , $689.98 , $462.98 , $443.29 , See APC Packaged Rates , See APC Packaged Rates , $161.04 , $161.04 , See APC Packaged Rates , See APC Packaged Rates , $201.46 , $201.46 , $206.65 , $206.65 , See APC Packaged Rates , $84.00 , $187.91 , $84.00 , $689.98 , $168.00
82013,5212010199,Hospital Chargemaster,Acetylcholinesterase Assay,Outpatient,Outpatient Default Percent / Case Rate,301, $136.00 , $22.98 , $112.06 , See APC Packaged Rates , $95.20 , $53.04 , $60.28 , $40.45 , $38.73 , See APC Packaged Rates , See APC Packaged Rates , $21.90 , $21.24 , See APC Packaged Rates , See APC Packaged Rates , $19.46 , $19.46 , $19.96 , $19.96 , See APC Packaged Rates , $10.20 , $14.89 , $10.20 , $112.06 , $95.20
83525,5212010403,Hospital Chargemaster,Assay Of Insulin,Outpatient,Outpatient Default Percent / Case Rate,301, $85.00 , $23.52 , $70.04 , See APC Packaged Rates , $59.50 , $33.15 , $61.86 , $41.51 , $39.74 , See APC Packaged Rates , See APC Packaged Rates , $23.96 , $23.23 , See APC Packaged Rates , See APC Packaged Rates , $19.44 , $19.44 , $19.94 , $19.94 , See APC Packaged Rates , $9.49 , $15.24 , $9.49 , $70.04 , $59.50
84630,5212010583,Hospital Chargemaster,Assay Of Zinc,Outpatient,Outpatient Default Percent / Case Rate,301, $126.00 , $23.43 , $103.82 , See APC Packaged Rates , $88.20 , $49.14 , $61.86 , $41.51 , $39.74 , See APC Packaged Rates , See APC Packaged Rates , $38.31 , $37.14 , See APC Packaged Rates , See APC Packaged Rates , $19.38 , $19.38 , $19.88 , $19.88 , See APC Packaged Rates , $9.45 , $15.18 , $9.45 , $103.82 , $88.20
83700,5212010428,Hospital Chargemaster,Lipopro Bld Electrophoretic,Outpatient,Outpatient Default Percent / Case Rate,301, $53.00 , $23.17 , $43.67 , See APC Packaged Rates , $37.10 , $20.67 , $61.86 , $41.51 , $39.74 , See APC Packaged Rates , See APC Packaged Rates , $38.66 , $37.48 , See APC Packaged Rates , See APC Packaged Rates , $19.15 , $19.15 , $19.64 , $19.64 , See APC Packaged Rates , $9.35 , $15.01 , $9.35 , $61.86 , $37.10
83915,5212010452,Hospital Chargemaster,Assay Of Nucleotidase,Outpatient,Outpatient Default Percent / Case Rate,301, $51.00 , $22.95 , $42.02 , See APC Packaged Rates , $35.70 , $19.89 , $60.28 , $40.45 , $38.73 , See APC Packaged Rates , See APC Packaged Rates , $37.88 , $36.74 , See APC Packaged Rates , See APC Packaged Rates , $18.98 , $18.98 , $19.47 , $19.47 , See APC Packaged Rates , $9.25 , $14.87 , $9.25 , $60.28 , $35.70
83605,5212010412,Hospital Chargemaster,Assay Of Lactic Acid,Outpatient,Outpatient Default Percent / Case Rate,301, $105.00 , $24.43 , $86.52 , See APC Packaged Rates , $73.50 , $40.95 , $58.68 , $39.37 , $37.70 , See APC Packaged Rates , See APC Packaged Rates , $35.92 , $34.83 , See APC Packaged Rates , See APC Packaged Rates , $18.54 , $18.54 , $19.01 , $19.01 , See APC Packaged Rates , $9.61 , $14.24 , $9.61 , $86.52 , $73.50
80329,5212010120,Hospital Chargemaster,Analgesics Non-Opioid 1 Or 2,Outpatient,Outpatient Default Percent / Case Rate,301, $194.00 , $9.45 , $159.86 , See APC Packaged Rates , $135.80 , $75.66 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $18.32 , $18.32 , $18.79 , $18.79 , See APC Packaged Rates , $67.90 , $- , $- , $159.86 , $135.80
82390,5212010268,Hospital Chargemaster,Assay Of Ceruloplasmin,Outpatient,Outpatient Default Percent / Case Rate,301, $84.00 , $22.09 , $69.22 , See APC Packaged Rates , $58.80 , $32.76 , $58.68 , $39.37 , $37.70 , See APC Packaged Rates , See APC Packaged Rates , $26.18 , $25.39 , See APC Packaged Rates , See APC Packaged Rates , $18.27 , $18.27 , $18.74 , $18.74 , See APC Packaged Rates , $8.92 , $14.32 , $8.92 , $69.22 , $58.80
83857,5212010442,Hospital Chargemaster,Assay Of Methemalbumin,Outpatient,Outpatient Default Percent / Case Rate,301, $118.00 , $22.09 , $97.23 , See APC Packaged Rates , $82.60 , $46.02 , $58.68 , $39.37 , $37.70 , See APC Packaged Rates , See APC Packaged Rates , $24.24 , $23.51 , See APC Packaged Rates , See APC Packaged Rates , $18.27 , $18.27 , $18.74 , $18.74 , See APC Packaged Rates , $8.92 , $14.32 , $8.92 , $97.23 , $82.60
84165,5212010504,Hospital Chargemaster,Protein E-Phoresis Serum,Outpatient,Outpatient Default Percent / Case Rate,301, $120.00 , $22.09 , $98.88 , See APC Packaged Rates , $84.00 , $46.80 , $84.12 , $56.45 , $54.05 , See APC Packaged Rates , See APC Packaged Rates , $44.81 , $43.45 , See APC Packaged Rates , See APC Packaged Rates , $18.27 , $18.27 , $18.74 , $18.74 , See APC Packaged Rates , $8.92 , $14.32 , $8.92 , $98.88 , $84.00
80053,5212010064,Hospital Chargemaster,Comprehen Metabolic Panel,Outpatient,Outpatient Default Percent / Case Rate,301, $161.00 , $24.15 , $132.66 , See APC Packaged Rates , $112.70 , $62.79 , $57.10 , $38.31 , $36.68 , See APC Packaged Rates , See APC Packaged Rates , $44.44 , $43.09 , See APC Packaged Rates , See APC Packaged Rates , $17.97 , $17.97 , $18.43 , $18.43 , See APC Packaged Rates , $8.76 , $14.09 , $8.76 , $132.66 , $112.70
84510,5212010565,Hospital Chargemaster,Assay Of Tyrosine,Outpatient,Outpatient Default Percent / Case Rate,301, $117.00 , $21.41 , $96.41 , See APC Packaged Rates , $81.90 , $45.63 , $57.10 , $38.31 , $36.68 , See APC Packaged Rates , See APC Packaged Rates , $22.70 , $22.01 , See APC Packaged Rates , See APC Packaged Rates , $17.78 , $17.78 , $18.24 , $18.24 , See APC Packaged Rates , $8.83 , $13.87 , $8.83 , $96.41 , $81.90
84087,5212010476,Hospital Chargemaster,Assay Phosphohexose Enzymes,Outpatient,Outpatient Default Percent / Case Rate,301, $81.00 , $21.24 , $66.74 , See APC Packaged Rates , $56.70 , $31.59 , $55.52 , $37.25 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $29.39 , $28.50 , See APC Packaged Rates , See APC Packaged Rates , $17.72 , $17.72 , $18.18 , $18.18 , See APC Packaged Rates , $8.90 , $13.76 , $8.90 , $66.74 , $56.70
82800,5212010339,Hospital Chargemaster,Blood Ph,Outpatient,Outpatient Default Percent / Case Rate,301, $39.00 , $20.37 , $32.14 , See APC Packaged Rates , $27.30 , $15.21 , $49.18 , $33.00 , $31.60 , See APC Packaged Rates , See APC Packaged Rates , $28.50 , $27.64 , See APC Packaged Rates , See APC Packaged Rates , $17.41 , $17.41 , $17.86 , $17.86 , See APC Packaged Rates , $9.13 , $13.20 , $9.13 , $49.18 , $27.30
82180,5212010235,Hospital Chargemaster,Assay Of Ascorbic Acid,Outpatient,Outpatient Default Percent / Case Rate,301, $124.00 , $20.33 , $102.18 , See APC Packaged Rates , $86.80 , $48.36 , $53.94 , $36.19 , $34.65 , See APC Packaged Rates , See APC Packaged Rates , $17.25 , $16.72 , See APC Packaged Rates , See APC Packaged Rates , $16.81 , $16.81 , $17.25 , $17.25 , See APC Packaged Rates , $8.22 , $13.18 , $8.22 , $102.18 , $86.80
83721,5212010433,Hospital Chargemaster,Assay Of Blood Lipoprotein,Outpatient,Outpatient Default Percent / Case Rate,301, $42.00 , $21.82 , $34.61 , See APC Packaged Rates , $29.40 , $16.38 , $52.33 , $35.12 , $33.62 , See APC Packaged Rates , See APC Packaged Rates , $30.84 , $29.91 , See APC Packaged Rates , See APC Packaged Rates , $16.63 , $16.63 , $17.06 , $17.06 , See APC Packaged Rates , $8.72 , $12.72 , $8.72 , $52.33 , $29.40
83036,5212010380,Hospital Chargemaster,Glycosylated Hemoglobin Test,Outpatient,Outpatient Default Percent / Case Rate,301, $58.00 , $22.21 , $47.79 , See APC Packaged Rates , $40.60 , $22.62 , $52.33 , $35.12 , $33.62 , See APC Packaged Rates , See APC Packaged Rates , $29.39 , $28.50 , See APC Packaged Rates , See APC Packaged Rates , $16.52 , $16.52 , $16.95 , $16.95 , See APC Packaged Rates , $8.06 , $12.95 , $8.06 , $52.33 , $40.60
82085,5212010210,Hospital Chargemaster,Assay Of Aldolase,Outpatient,Outpatient Default Percent / Case Rate,301, $82.00 , $19.98 , $67.57 , See APC Packaged Rates , $57.40 , $31.98 , $52.33 , $35.12 , $33.62 , See APC Packaged Rates , See APC Packaged Rates , $39.27 , $38.07 , See APC Packaged Rates , See APC Packaged Rates , $16.52 , $16.52 , $16.95 , $16.95 , See APC Packaged Rates , $8.06 , $12.95 , $8.06 , $67.57 , $57.40
82955,5212010355,Hospital Chargemaster,Assay Of G6Pd Enzyme,Outpatient,Outpatient Default Percent / Case Rate,301, $128.00 , $19.95 , $105.47 , See APC Packaged Rates , $89.60 , $49.92 , $52.33 , $35.12 , $33.62 , See APC Packaged Rates , See APC Packaged Rates , $30.00 , $29.09 , See APC Packaged Rates , See APC Packaged Rates , $16.50 , $16.50 , $16.93 , $16.93 , See APC Packaged Rates , $8.06 , $12.92 , $8.06 , $105.47 , $89.60
84066,5212010470,Hospital Chargemaster,Assay Prostate Phosphatase,Outpatient,Outpatient Default Percent / Case Rate,301, $98.00 , $19.87 , $80.75 , See APC Packaged Rates , $68.60 , $38.22 , $52.33 , $35.12 , $33.62 , See APC Packaged Rates , See APC Packaged Rates , $36.20 , $35.10 , See APC Packaged Rates , See APC Packaged Rates , $16.44 , $16.44 , $16.87 , $16.87 , See APC Packaged Rates , $8.02 , $12.88 , $8.02 , $80.75 , $68.60
82575,5212010294,Hospital Chargemaster,Creatinine Clearance Test,Outpatient,Outpatient Default Percent / Case Rate,301, $90.00 , $19.46 , $74.16 , See APC Packaged Rates , $63.00 , $35.10 , $50.76 , $34.06 , $32.61 , See APC Packaged Rates , See APC Packaged Rates , $20.71 , $20.08 , See APC Packaged Rates , See APC Packaged Rates , $16.09 , $16.09 , $16.50 , $16.50 , See APC Packaged Rates , $7.85 , $12.61 , $7.85 , $74.16 , $63.00
82979,5212010362,Hospital Chargemaster,Assay Rbc Glutathione,Outpatient,Outpatient Default Percent / Case Rate,301, $117.00 , $19.43 , $96.41 , See APC Packaged Rates , $81.90 , $45.63 , $50.76 , $34.06 , $32.61 , See APC Packaged Rates , See APC Packaged Rates , $23.96 , $23.23 , See APC Packaged Rates , See APC Packaged Rates , $16.07 , $16.07 , $16.49 , $16.49 , See APC Packaged Rates , $7.84 , $12.59 , $7.84 , $96.41 , $81.90
84220,5212010513,Hospital Chargemaster,Assay Of Pyruvate Kinase,Outpatient,Outpatient Default Percent / Case Rate,301, $61.00 , $19.43 , $50.26 , See APC Packaged Rates , $42.70 , $23.79 , $50.76 , $34.06 , $32.61 , See APC Packaged Rates , See APC Packaged Rates , $31.73 , $30.77 , See APC Packaged Rates , See APC Packaged Rates , $16.07 , $16.07 , $16.49 , $16.49 , See APC Packaged Rates , $7.84 , $12.59 , $7.84 , $50.76 , $42.70
83670,5212010424,Hospital Chargemaster,Assay Of Lap Enzyme,Outpatient,Outpatient Default Percent / Case Rate,301, $116.00 , $18.85 , $95.58 , See APC Packaged Rates , $81.20 , $45.24 , $49.18 , $33.00 , $31.60 , See APC Packaged Rates , See APC Packaged Rates , $17.36 , $16.84 , See APC Packaged Rates , See APC Packaged Rates , $15.84 , $15.84 , $16.25 , $16.25 , See APC Packaged Rates , $8.15 , $12.22 , $8.15 , $95.58 , $81.20
82784,5212010336,Hospital Chargemaster,Assay Iga/Igd/Igg/Igm Each,Outpatient,Outpatient Default Percent / Case Rate,301, $29.00 , $19.15 , $23.90 , See APC Packaged Rates , $20.30 , $11.31 , $50.76 , $34.06 , $32.61 , See APC Packaged Rates , See APC Packaged Rates , $22.28 , $21.60 , See APC Packaged Rates , See APC Packaged Rates , $15.83 , $15.83 , $16.24 , $16.24 , See APC Packaged Rates , $7.73 , $12.41 , $7.73 , $50.76 , $20.30
82380,5212010263,Hospital Chargemaster,Assay Of Carotene,Outpatient,Outpatient Default Percent / Case Rate,301, $59.00 , $18.98 , $48.62 , See APC Packaged Rates , $41.30 , $23.01 , $50.76 , $34.06 , $32.61 , See APC Packaged Rates , See APC Packaged Rates , $31.40 , $30.45 , See APC Packaged Rates , See APC Packaged Rates , $15.69 , $15.69 , $16.09 , $16.09 , See APC Packaged Rates , $7.65 , $12.30 , $7.65 , $50.76 , $41.30
82482,5212010277,Hospital Chargemaster,Assay Rbc Cholinesterase,Outpatient,Outpatient Default Percent / Case Rate,301, $130.00 , $18.17 , $107.12 , See APC Packaged Rates , $91.00 , $50.70 , $42.84 , $28.74 , $27.52 , See APC Packaged Rates , See APC Packaged Rates , $25.86 , $25.07 , See APC Packaged Rates , See APC Packaged Rates , $15.54 , $15.54 , $15.94 , $15.94 , See APC Packaged Rates , $8.15 , $11.77 , $8.15 , $107.12 , $91.00
82810,5212010342,Hospital Chargemaster,Blood Gases O2 Sat Only,Outpatient,Outpatient Default Percent / Case Rate,301, $40.00 , $18.09 , $32.96 , See APC Packaged Rates , $28.00 , $15.60 , $47.57 , $31.92 , $30.56 , See APC Packaged Rates , See APC Packaged Rates , $29.37 , $28.48 , See APC Packaged Rates , See APC Packaged Rates , $15.47 , $15.47 , $15.87 , $15.87 , See APC Packaged Rates , $8.11 , $11.72 , $8.11 , $47.57 , $28.00
84439,5212010547,Hospital Chargemaster,Assay Of Free Thyroxine,Outpatient,Outpatient Default Percent / Case Rate,301, $90.00 , $18.56 , $74.16 , See APC Packaged Rates , $63.00 , $35.10 , $49.18 , $33.00 , $31.60 , See APC Packaged Rates , See APC Packaged Rates , $25.83 , $25.05 , See APC Packaged Rates , See APC Packaged Rates , $15.34 , $15.34 , $15.73 , $15.73 , See APC Packaged Rates , $7.48 , $12.02 , $7.48 , $74.16 , $63.00
83550,5212010407,Hospital Chargemaster,Iron Binding Test,Outpatient,Outpatient Default Percent / Case Rate,301, $58.00 , $17.98 , $47.79 , See APC Packaged Rates , $40.60 , $22.62 , $47.57 , $31.92 , $30.56 , See APC Packaged Rates , See APC Packaged Rates , $22.82 , $22.12 , See APC Packaged Rates , See APC Packaged Rates , $14.87 , $14.87 , $15.26 , $15.26 , See APC Packaged Rates , $7.25 , $11.65 , $7.25 , $47.79 , $40.60
82143,5212010226,Hospital Chargemaster,Amniotic Fluid Scan,Outpatient,Outpatient Default Percent / Case Rate,301, $52.00 , $17.32 , $42.85 , See APC Packaged Rates , $36.40 , $20.28 , $41.23 , $27.67 , $26.49 , See APC Packaged Rates , See APC Packaged Rates , $12.50 , $12.12 , See APC Packaged Rates , See APC Packaged Rates , $14.80 , $14.80 , $15.18 , $15.18 , See APC Packaged Rates , $7.76 , $11.22 , $7.76 , $42.85 , $36.40
80069,5212010067,Hospital Chargemaster,Renal Function Panel,Outpatient,Outpatient Default Percent / Case Rate,301, $75.00 , $19.85 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $47.57 , $31.92 , $30.56 , See APC Packaged Rates , See APC Packaged Rates , $36.50 , $35.40 , See APC Packaged Rates , See APC Packaged Rates , $14.77 , $14.77 , $15.15 , $15.15 , See APC Packaged Rates , $7.20 , $11.58 , $7.20 , $61.80 , $52.50
80048,5212010061,Hospital Chargemaster,Metabolic Panel Total Ca,Outpatient,Outpatient Default Percent / Case Rate,301, $78.00 , $19.33 , $64.27 , See APC Packaged Rates , $54.60 , $30.42 , $45.99 , $30.86 , $29.55 , See APC Packaged Rates , See APC Packaged Rates , $35.59 , $34.51 , See APC Packaged Rates , See APC Packaged Rates , $14.40 , $14.40 , $14.77 , $14.77 , See APC Packaged Rates , $7.03 , $11.28 , $7.03 , $64.27 , $54.60
84110,5212010480,Hospital Chargemaster,Assay Of Porphobilinogen,Outpatient,Outpatient Default Percent / Case Rate,301, $98.00 , $17.37 , $80.75 , See APC Packaged Rates , $68.60 , $38.22 , $45.99 , $30.86 , $29.55 , See APC Packaged Rates , See APC Packaged Rates , $28.41 , $27.55 , See APC Packaged Rates , See APC Packaged Rates , $14.37 , $14.37 , $14.74 , $14.74 , See APC Packaged Rates , $7.01 , $11.26 , $7.01 , $80.75 , $68.60
83718,5212010431,Hospital Chargemaster,Assay Of Lipoprotein,Outpatient,Outpatient Default Percent / Case Rate,301, $40.00 , $18.74 , $32.96 , See APC Packaged Rates , $28.00 , $15.60 , $44.41 , $29.80 , $28.54 , See APC Packaged Rates , See APC Packaged Rates , $24.24 , $23.51 , See APC Packaged Rates , See APC Packaged Rates , $13.94 , $13.94 , $14.29 , $14.29 , See APC Packaged Rates , $6.79 , $10.92 , $6.79 , $44.41 , $28.00
82010,5212010198,Hospital Chargemaster,Acetone Assay,Outpatient,Outpatient Default Percent / Case Rate,301, $29.00 , $18.69 , $23.90 , See APC Packaged Rates , $20.30 , $11.31 , $44.41 , $29.80 , $28.54 , See APC Packaged Rates , See APC Packaged Rates , $15.23 , $14.77 , See APC Packaged Rates , See APC Packaged Rates , $13.91 , $13.91 , $14.26 , $14.26 , See APC Packaged Rates , $6.78 , $10.90 , $6.78 , $44.41 , $20.30
80076,5212010069,Hospital Chargemaster,Hepatic Function Panel,Outpatient,Outpatient Default Percent / Case Rate,301, $97.00 , $16.82 , $79.93 , See APC Packaged Rates , $67.90 , $37.83 , $44.41 , $29.80 , $28.54 , See APC Packaged Rates , See APC Packaged Rates , $34.35 , $33.31 , See APC Packaged Rates , See APC Packaged Rates , $13.91 , $13.91 , $14.26 , $14.26 , See APC Packaged Rates , $6.78 , $10.90 , $6.78 , $79.93 , $67.90
82787,5212010338,Hospital Chargemaster,Igg 1 2 3 Or 4 Each,Outpatient,Outpatient Default Percent / Case Rate,301, $86.00 , $16.50 , $70.86 , See APC Packaged Rates , $60.20 , $33.54 , $42.84 , $28.74 , $27.52 , See APC Packaged Rates , See APC Packaged Rates , $41.46 , $40.21 , See APC Packaged Rates , See APC Packaged Rates , $13.64 , $13.64 , $14.00 , $14.00 , See APC Packaged Rates , $6.66 , $10.69 , $6.66 , $70.86 , $60.20
82480,5212010276,Hospital Chargemaster,Assay Serum Cholinesterase,Outpatient,Outpatient Default Percent / Case Rate,301, $97.00 , $16.21 , $79.93 , See APC Packaged Rates , $67.90 , $37.83 , $42.84 , $28.74 , $27.52 , See APC Packaged Rates , See APC Packaged Rates , $16.10 , $15.61 , See APC Packaged Rates , See APC Packaged Rates , $13.40 , $13.40 , $13.74 , $13.74 , See APC Packaged Rates , $6.54 , $10.50 , $6.54 , $79.93 , $67.90
83050,5212010383,Hospital Chargemaster,Blood Methemoglobin Assay,Outpatient,Outpatient Default Percent / Case Rate,301, $46.00 , $15.19 , $37.90 , See APC Packaged Rates , $32.20 , $17.94 , $39.65 , $26.61 , $25.48 , See APC Packaged Rates , See APC Packaged Rates , $24.64 , $23.89 , See APC Packaged Rates , See APC Packaged Rates , $12.98 , $12.98 , $13.32 , $13.32 , See APC Packaged Rates , $6.80 , $9.84 , $6.80 , $39.65 , $32.20
84311,5212010531,Hospital Chargemaster,Spectrophotometry,Outpatient,Outpatient Default Percent / Case Rate,301, $156.00 , $15.00 , $128.54 , See APC Packaged Rates , $109.20 , $60.84 , $38.07 , $25.55 , $24.46 , See APC Packaged Rates , See APC Packaged Rates , $26.98 , $26.16 , See APC Packaged Rates , See APC Packaged Rates , $12.83 , $12.83 , $13.16 , $13.16 , See APC Packaged Rates , $6.73 , $9.72 , $6.73 , $128.54 , $109.20
84703,5212010586,Hospital Chargemaster,Chorionic Gonadotropin Assay,Outpatient,Outpatient Default Percent / Case Rate,301, $103.00 , $17.21 , $84.87 , See APC Packaged Rates , $72.10 , $40.17 , $41.23 , $27.67 , $26.49 , See APC Packaged Rates , See APC Packaged Rates , $24.41 , $23.67 , See APC Packaged Rates , See APC Packaged Rates , $12.80 , $12.80 , $13.13 , $13.13 , See APC Packaged Rates , $6.25 , $10.03 , $6.25 , $84.87 , $72.10
84060,5212010469,Hospital Chargemaster,Assay Acid Phosphatase,Outpatient,Outpatient Default Percent / Case Rate,301, $65.00 , $15.20 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $39.65 , $26.61 , $25.48 , See APC Packaged Rates , See APC Packaged Rates , $22.28 , $21.60 , See APC Packaged Rates , See APC Packaged Rates , $12.67 , $12.67 , $13.00 , $13.00 , See APC Packaged Rates , $6.35 , $9.85 , $6.35 , $53.56 , $45.50
83033,5212010379,Hospital Chargemaster,Fetal Hemoglobin Assay Qual,Outpatient,Outpatient Default Percent / Case Rate,301, $83.00 , $14.82 , $68.39 , See APC Packaged Rates , $58.10 , $32.37 , $34.89 , $23.41 , $22.42 , See APC Packaged Rates , See APC Packaged Rates , $14.70 , $14.25 , See APC Packaged Rates , See APC Packaged Rates , $12.66 , $12.66 , $12.99 , $12.99 , See APC Packaged Rates , $6.64 , $9.60 , $6.64 , $68.39 , $58.10
83051,5212010384,Hospital Chargemaster,Assay Of Plasma Hemoglobin,Outpatient,Outpatient Default Percent / Case Rate,301, $34.00 , $15.04 , $28.02 , See APC Packaged Rates , $23.80 , $13.26 , $39.65 , $26.61 , $25.48 , See APC Packaged Rates , See APC Packaged Rates , $24.57 , $23.82 , See APC Packaged Rates , See APC Packaged Rates , $12.44 , $12.44 , $12.76 , $12.76 , See APC Packaged Rates , $6.07 , $9.74 , $6.07 , $39.65 , $23.80
86060,5212010610,Hospital Chargemaster,Antistreptolysin O Titer,Outpatient,Outpatient Default Percent / Case Rate,301, $112.00 , $15.02 , $92.29 , See APC Packaged Rates , $78.40 , $43.68 , $39.65 , $26.61 , $25.48 , See APC Packaged Rates , See APC Packaged Rates , $24.55 , $23.80 , See APC Packaged Rates , See APC Packaged Rates , $12.41 , $12.41 , $12.73 , $12.73 , See APC Packaged Rates , $6.07 , $9.73 , $6.07 , $92.29 , $78.40
82042,5212010205,Hospital Chargemaster,Other Source Albumin Quan Ea,Outpatient,Outpatient Default Percent / Case Rate,301, $90.00 , $14.41 , $74.16 , See APC Packaged Rates , $63.00 , $35.10 , $34.89 , $23.41 , $22.42 , See APC Packaged Rates , See APC Packaged Rates , $4.87 , $4.72 , See APC Packaged Rates , See APC Packaged Rates , $12.32 , $12.32 , $12.64 , $12.64 , See APC Packaged Rates , $6.46 , $9.34 , $4.72 , $74.16 , $63.00
82977,5212010360,Hospital Chargemaster,Assay Of Ggt,Outpatient,Outpatient Default Percent / Case Rate,301, $32.00 , $16.46 , $26.37 , See APC Packaged Rates , $22.40 , $12.48 , $39.65 , $26.61 , $25.48 , See APC Packaged Rates , See APC Packaged Rates , $21.90 , $21.24 , See APC Packaged Rates , See APC Packaged Rates , $12.24 , $12.24 , $12.56 , $12.56 , See APC Packaged Rates , $5.98 , $9.60 , $5.98 , $39.65 , $22.40
80051,5212010063,Hospital Chargemaster,Electrolyte Panel,Outpatient,Outpatient Default Percent / Case Rate,301, $83.00 , $16.04 , $68.39 , See APC Packaged Rates , $58.10 , $32.37 , $38.07 , $25.55 , $24.46 , See APC Packaged Rates , See APC Packaged Rates , $19.05 , $18.47 , See APC Packaged Rates , See APC Packaged Rates , $11.94 , $11.94 , $12.24 , $12.24 , See APC Packaged Rates , $5.82 , $9.35 , $5.82 , $68.39 , $58.10
81099,5212010196,Hospital Chargemaster,Urinalysis Test Procedure,Outpatient,Outpatient Default Percent / Case Rate,301, $391.00 , $215.05 , $322.18 , See APC Packaged Rates , $273.70 , $152.49 , $377.28 , $378.92 , $201.37 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $11.91 , $11.91 , $12.21 , $12.21 , See APC Packaged Rates , $29.36 , $- , $- , $378.92 , $273.70
84999,5212010589,Hospital Chargemaster,Clinical Chemistry Test,Outpatient,Outpatient Default Percent / Case Rate,301," $3,650.00 "," $2,007.50 "," $3,007.60 ", See APC Packaged Rates ," $2,555.00 "," $1,423.50 "," $3,521.89 "," $3,537.22 "," $1,879.82 ", See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $11.91 , $11.91 , $12.21 , $12.21 , See APC Packaged Rates , $29.36 , $- , $- ," $3,537.22 "," $2,555.00 "
83690,5212010425,Hospital Chargemaster,Assay Of Lipase,Outpatient,Outpatient Default Percent / Case Rate,301, $42.00 , $14.17 , $34.61 , See APC Packaged Rates , $29.40 , $16.38 , $38.07 , $25.55 , $24.46 , See APC Packaged Rates , See APC Packaged Rates , $16.03 , $15.54 , See APC Packaged Rates , See APC Packaged Rates , $11.72 , $11.72 , $12.02 , $12.02 , See APC Packaged Rates , $5.72 , $9.18 , $5.72 , $38.07 , $29.40
84436,5212010545,Hospital Chargemaster,Assay Of Total Thyroxine,Outpatient,Outpatient Default Percent / Case Rate,301, $85.00 , $14.13 , $70.04 , See APC Packaged Rates , $59.50 , $33.15 , $38.07 , $25.55 , $24.46 , See APC Packaged Rates , See APC Packaged Rates , $20.36 , $19.74 , See APC Packaged Rates , See APC Packaged Rates , $11.69 , $11.69 , $11.99 , $11.99 , See APC Packaged Rates , $5.71 , $9.16 , $5.71 , $70.04 , $59.50
83935,5212010458,Hospital Chargemaster,Assay Of Urine Osmolality,Outpatient,Outpatient Default Percent / Case Rate,301, $43.00 , $14.02 , $35.43 , See APC Packaged Rates , $30.10 , $16.77 , $36.50 , $24.49 , $23.45 , See APC Packaged Rates , See APC Packaged Rates , $20.71 , $20.08 , See APC Packaged Rates , See APC Packaged Rates , $11.60 , $11.60 , $11.90 , $11.90 , See APC Packaged Rates , $5.66 , $9.08 , $5.66 , $36.50 , $30.10
84545,5212010569,Hospital Chargemaster,Urea-N Clearance Test,Outpatient,Outpatient Default Percent / Case Rate,301, $25.00 , $13.61 , $20.60 , See APC Packaged Rates , $17.50 , $9.75 , $36.50 , $24.49 , $23.45 , See APC Packaged Rates , See APC Packaged Rates , $14.70 , $14.25 , See APC Packaged Rates , See APC Packaged Rates , $11.47 , $11.47 , $11.77 , $11.77 , See APC Packaged Rates , $5.98 , $8.82 , $5.98 , $36.50 , $17.50
83735,5212010436,Hospital Chargemaster,Assay Of Magnesium,Outpatient,Outpatient Default Percent / Case Rate,301, $41.00 , $13.78 , $33.78 , See APC Packaged Rates , $28.70 , $15.99 , $36.50 , $24.49 , $23.45 , See APC Packaged Rates , See APC Packaged Rates , $24.24 , $23.51 , See APC Packaged Rates , See APC Packaged Rates , $11.40 , $11.40 , $11.69 , $11.69 , See APC Packaged Rates , $5.57 , $8.93 , $5.57 , $36.50 , $28.70
80178,5212010089,Hospital Chargemaster,Assay Of Lithium,Outpatient,Outpatient Default Percent / Case Rate,301, $34.00 , $15.11 , $28.02 , See APC Packaged Rates , $23.80 , $13.26 , $36.50 , $24.49 , $23.45 , See APC Packaged Rates , See APC Packaged Rates , $23.24 , $22.53 , See APC Packaged Rates , See APC Packaged Rates , $11.24 , $11.24 , $11.53 , $11.53 , See APC Packaged Rates , $5.49 , $8.82 , $5.49 , $36.50 , $23.80
83930,5212010457,Hospital Chargemaster,Assay Of Blood Osmolality,Outpatient,Outpatient Default Percent / Case Rate,301, $39.00 , $13.61 , $32.14 , See APC Packaged Rates , $27.30 , $15.21 , $36.50 , $24.49 , $23.45 , See APC Packaged Rates , See APC Packaged Rates , $13.69 , $13.27 , See APC Packaged Rates , See APC Packaged Rates , $11.24 , $11.24 , $11.53 , $11.53 , See APC Packaged Rates , $5.49 , $8.82 , $5.49 , $36.50 , $27.30
82550,5212010288,Hospital Chargemaster,Assay Of Ck (Cpk),Outpatient,Outpatient Default Percent / Case Rate,301, $36.00 , $14.89 , $29.66 , See APC Packaged Rates , $25.20 , $14.04 , $34.89 , $23.41 , $22.42 , See APC Packaged Rates , See APC Packaged Rates , $25.95 , $25.16 , See APC Packaged Rates , See APC Packaged Rates , $11.08 , $11.08 , $11.36 , $11.36 , See APC Packaged Rates , $5.40 , $8.68 , $5.40 , $34.89 , $25.20
82150,5212010227,Hospital Chargemaster,Assay Of Amylase,Outpatient,Outpatient Default Percent / Case Rate,301, $32.00 , $14.82 , $26.37 , See APC Packaged Rates , $22.40 , $12.48 , $34.89 , $23.41 , $22.42 , See APC Packaged Rates , See APC Packaged Rates , $23.14 , $22.44 , See APC Packaged Rates , See APC Packaged Rates , $11.03 , $11.03 , $11.31 , $11.31 , See APC Packaged Rates , $5.38 , $8.64 , $5.38 , $34.89 , $22.40
83540,5212010406,Hospital Chargemaster,Assay Of Iron,Outpatient,Outpatient Default Percent / Case Rate,301, $35.00 , $13.32 , $28.84 , See APC Packaged Rates , $24.50 , $13.65 , $34.89 , $23.41 , $22.42 , See APC Packaged Rates , See APC Packaged Rates , $18.23 , $17.68 , See APC Packaged Rates , See APC Packaged Rates , $11.01 , $11.01 , $11.30 , $11.30 , See APC Packaged Rates , $5.38 , $8.63 , $5.38 , $34.89 , $24.50
82595,5212010296,Hospital Chargemaster,Assay Of Cryoglobulin,Outpatient,Outpatient Default Percent / Case Rate,301, $53.00 , $13.30 , $43.67 , See APC Packaged Rates , $37.10 , $20.67 , $34.89 , $23.41 , $22.42 , See APC Packaged Rates , See APC Packaged Rates , $21.79 , $21.12 , See APC Packaged Rates , See APC Packaged Rates , $11.00 , $11.00 , $11.28 , $11.28 , See APC Packaged Rates , $5.38 , $8.62 , $5.38 , $43.67 , $37.10
84479,5212010557,Hospital Chargemaster,Assay Of Thyroid (T3 Or T4),Outpatient,Outpatient Default Percent / Case Rate,301, $42.00 , $13.30 , $34.61 , See APC Packaged Rates , $29.40 , $16.38 , $34.89 , $23.41 , $22.42 , See APC Packaged Rates , See APC Packaged Rates , $19.49 , $18.90 , See APC Packaged Rates , See APC Packaged Rates , $11.00 , $11.00 , $11.28 , $11.28 , See APC Packaged Rates , $5.38 , $8.62 , $5.38 , $34.89 , $29.40
82930,5212010344,Hospital Chargemaster,Gastric Analy W/Ph Ea Spec,Outpatient,Outpatient Default Percent / Case Rate,301, $88.00 , $12.43 , $72.51 , See APC Packaged Rates , $61.60 , $34.32 , $30.13 , $20.22 , $19.36 , See APC Packaged Rates , See APC Packaged Rates , $18.84 , $18.27 , See APC Packaged Rates , See APC Packaged Rates , $10.63 , $10.63 , $10.90 , $10.90 , See APC Packaged Rates , $5.57 , $8.05 , $5.57 , $72.51 , $61.60
83615,5212010413,Hospital Chargemaster,Lactate (Ld) (Ldh) Enzyme,Outpatient,Outpatient Default Percent / Case Rate,301, $31.00 , $12.43 , $25.54 , See APC Packaged Rates , $21.70 , $12.09 , $33.31 , $22.35 , $21.40 , See APC Packaged Rates , See APC Packaged Rates , $22.42 , $21.74 , See APC Packaged Rates , See APC Packaged Rates , $10.28 , $10.28 , $10.54 , $10.54 , See APC Packaged Rates , $5.02 , $8.05 , $5.02 , $33.31 , $21.70
82340,5212010252,Hospital Chargemaster,Assay Of Calcium In Urine,Outpatient,Outpatient Default Percent / Case Rate,301, $37.00 , $12.41 , $30.49 , See APC Packaged Rates , $25.90 , $14.43 , $33.31 , $22.35 , $21.40 , See APC Packaged Rates , See APC Packaged Rates , $16.52 , $16.02 , See APC Packaged Rates , See APC Packaged Rates , $10.26 , $10.26 , $10.52 , $10.52 , See APC Packaged Rates , $5.01 , $8.04 , $5.01 , $33.31 , $25.90
82441,5212010274,Hospital Chargemaster,Test For Chlorohydrocarbons,Outpatient,Outpatient Default Percent / Case Rate,301, $71.00 , $12.35 , $58.50 , See APC Packaged Rates , $49.70 , $27.69 , $33.31 , $22.35 , $21.40 , See APC Packaged Rates , See APC Packaged Rates , $21.97 , $21.31 , See APC Packaged Rates , See APC Packaged Rates , $10.23 , $10.23 , $10.49 , $10.49 , See APC Packaged Rates , $4.99 , $8.00 , $4.99 , $58.50 , $49.70
83872,5212010445,Hospital Chargemaster,Assay Synovial Fluid Mucin,Outpatient,Outpatient Default Percent / Case Rate,301, $31.00 , $12.06 , $25.54 , See APC Packaged Rates , $21.70 , $12.09 , $31.73 , $21.29 , $20.39 , See APC Packaged Rates , See APC Packaged Rates , $12.47 , $12.09 , See APC Packaged Rates , See APC Packaged Rates , $9.97 , $9.97 , $10.22 , $10.22 , See APC Packaged Rates , $4.87 , $7.81 , $4.87 , $31.73 , $21.70
82043,5212010206,Hospital Chargemaster,Ur Albumin Quantitative,Outpatient,Outpatient Default Percent / Case Rate,301, $32.00 , $13.22 , $26.37 , See APC Packaged Rates , $22.40 , $12.48 , $31.73 , $21.29 , $20.39 , See APC Packaged Rates , See APC Packaged Rates , $7.39 , $7.17 , See APC Packaged Rates , See APC Packaged Rates , $9.84 , $9.84 , $10.10 , $10.10 , See APC Packaged Rates , $4.80 , $7.70 , $4.80 , $31.73 , $22.40
84478,5212010556,Hospital Chargemaster,Assay Of Triglycerides,Outpatient,Outpatient Default Percent / Case Rate,301, $41.00 , $13.13 , $33.78 , See APC Packaged Rates , $28.70 , $15.99 , $31.73 , $21.29 , $20.39 , See APC Packaged Rates , See APC Packaged Rates , $19.05 , $18.47 , See APC Packaged Rates , See APC Packaged Rates , $9.77 , $9.77 , $10.02 , $10.02 , See APC Packaged Rates , $4.76 , $7.66 , $4.76 , $33.78 , $28.70
84030,5212010467,Hospital Chargemaster,Assay Of Blood Pku,Outpatient,Outpatient Default Percent / Case Rate,301, $109.00 , $11.32 , $89.82 , See APC Packaged Rates , $76.30 , $42.51 , $30.13 , $20.22 , $19.36 , See APC Packaged Rates , See APC Packaged Rates , $12.10 , $11.73 , See APC Packaged Rates , See APC Packaged Rates , $9.35 , $9.35 , $9.59 , $9.59 , See APC Packaged Rates , $4.58 , $7.33 , $4.58 , $89.82 , $76.30
84376,5212010533,Hospital Chargemaster,Sugars Single Qual,Outpatient,Outpatient Default Percent / Case Rate,301, $39.00 , $11.32 , $32.14 , See APC Packaged Rates , $27.30 , $15.21 , $30.13 , $20.22 , $19.36 , See APC Packaged Rates , See APC Packaged Rates , $18.70 , $18.13 , See APC Packaged Rates , See APC Packaged Rates , $9.35 , $9.35 , $9.59 , $9.59 , See APC Packaged Rates , $4.58 , $7.33 , $4.58 , $32.14 , $27.30
84377,5212010534,Hospital Chargemaster,Sugars Multiple Qual,Outpatient,Outpatient Default Percent / Case Rate,301, $22.00 , $11.32 , $18.13 , See APC Packaged Rates , $15.40 , $8.58 , $30.13 , $20.22 , $19.36 , See APC Packaged Rates , See APC Packaged Rates , $18.70 , $18.13 , See APC Packaged Rates , See APC Packaged Rates , $9.35 , $9.35 , $9.59 , $9.59 , See APC Packaged Rates , $4.58 , $7.33 , $4.58 , $30.13 , $15.40
84106,5212010479,Hospital Chargemaster,Test For Porphobilinogen,Outpatient,Outpatient Default Percent / Case Rate,301, $30.00 , $10.78 , $24.72 , See APC Packaged Rates , $21.00 , $11.70 , $25.39 , $17.04 , $16.31 , See APC Packaged Rates , See APC Packaged Rates , $13.27 , $12.87 , See APC Packaged Rates , See APC Packaged Rates , $9.21 , $9.21 , $9.45 , $9.45 , See APC Packaged Rates , $4.83 , $6.98 , $4.83 , $25.39 , $21.00
84105,5212010478,Hospital Chargemaster,Assay Of Urine Phosphorus,Outpatient,Outpatient Default Percent / Case Rate,301, $45.00 , $10.70 , $37.08 , See APC Packaged Rates , $31.50 , $17.55 , $28.55 , $19.16 , $18.34 , See APC Packaged Rates , See APC Packaged Rates , $14.70 , $14.25 , See APC Packaged Rates , See APC Packaged Rates , $9.15 , $9.15 , $9.39 , $9.39 , See APC Packaged Rates , $4.80 , $6.94 , $4.80 , $37.08 , $31.50
82436,5212010272,Hospital Chargemaster,Assay Of Urine Chloride,Outpatient,Outpatient Default Percent / Case Rate,301, $25.00 , $10.65 , $20.60 , See APC Packaged Rates , $17.50 , $9.75 , $26.97 , $18.10 , $17.33 , See APC Packaged Rates , See APC Packaged Rates , $10.16 , $9.85 , See APC Packaged Rates , See APC Packaged Rates , $9.11 , $9.11 , $9.34 , $9.34 , See APC Packaged Rates , $4.78 , $6.90 , $4.78 , $26.97 , $17.50
84460,5212010554,Hospital Chargemaster,Alanine Amino (Alt) (Sgpt),Outpatient,Outpatient Default Percent / Case Rate,301, $27.00 , $12.11 , $22.25 , See APC Packaged Rates , $18.90 , $10.53 , $28.55 , $19.16 , $18.34 , See APC Packaged Rates , See APC Packaged Rates , $19.56 , $18.97 , See APC Packaged Rates , See APC Packaged Rates , $9.01 , $9.01 , $9.25 , $9.25 , See APC Packaged Rates , $4.41 , $7.07 , $4.41 , $28.55 , $18.90
82570,5212010293,Hospital Chargemaster,Assay Of Urine Creatinine,Outpatient,Outpatient Default Percent / Case Rate,301, $37.00 , $11.83 , $30.49 , See APC Packaged Rates , $25.90 , $14.43 , $28.55 , $19.16 , $18.34 , See APC Packaged Rates , See APC Packaged Rates , $17.25 , $16.72 , See APC Packaged Rates , See APC Packaged Rates , $8.81 , $8.81 , $9.04 , $9.04 , See APC Packaged Rates , $4.31 , $6.90 , $4.31 , $30.49 , $25.90
84075,5212010471,Hospital Chargemaster,Assay Alkaline Phosphatase,Outpatient,Outpatient Default Percent / Case Rate,301, $26.00 , $11.83 , $21.42 , See APC Packaged Rates , $18.20 , $10.14 , $28.55 , $19.16 , $18.34 , See APC Packaged Rates , See APC Packaged Rates , $19.16 , $18.58 , See APC Packaged Rates , See APC Packaged Rates , $8.81 , $8.81 , $9.04 , $9.04 , See APC Packaged Rates , $4.31 , $6.90 , $4.31 , $28.55 , $18.20
84450,5212010553,Hospital Chargemaster,Transferase (Ast) (Sgot),Outpatient,Outpatient Default Percent / Case Rate,301, $24.00 , $11.83 , $19.78 , See APC Packaged Rates , $16.80 , $9.36 , $28.55 , $19.16 , $18.34 , See APC Packaged Rates , See APC Packaged Rates , $17.74 , $17.20 , See APC Packaged Rates , See APC Packaged Rates , $8.81 , $8.81 , $9.04 , $9.04 , See APC Packaged Rates , $4.31 , $6.90 , $4.31 , $28.55 , $16.80
82310,5212010249,Hospital Chargemaster,Assay Of Calcium,Outpatient,Outpatient Default Percent / Case Rate,301, $23.00 , $11.80 , $18.95 , See APC Packaged Rates , $16.10 , $8.97 , $28.55 , $19.16 , $18.34 , See APC Packaged Rates , See APC Packaged Rates , $16.97 , $16.45 , See APC Packaged Rates , See APC Packaged Rates , $8.78 , $8.78 , $9.01 , $9.01 , See APC Packaged Rates , $4.28 , $6.88 , $4.28 , $28.55 , $16.10
82565,5212010292,Hospital Chargemaster,Assay Of Creatinine,Outpatient,Outpatient Default Percent / Case Rate,301, $26.00 , $11.72 , $21.42 , See APC Packaged Rates , $18.20 , $10.14 , $28.55 , $19.16 , $18.34 , See APC Packaged Rates , See APC Packaged Rates , $19.28 , $18.70 , See APC Packaged Rates , See APC Packaged Rates , $8.72 , $8.72 , $8.95 , $8.95 , See APC Packaged Rates , $4.25 , $6.83 , $4.25 , $28.55 , $18.20
84392,5212010537,Hospital Chargemaster,Assay Of Urine Sulfate,Outpatient,Outpatient Default Percent / Case Rate,301, $40.00 , $10.17 , $32.96 , See APC Packaged Rates , $28.00 , $15.60 , $25.39 , $17.04 , $16.31 , See APC Packaged Rates , See APC Packaged Rates , $12.07 , $11.71 , See APC Packaged Rates , See APC Packaged Rates , $8.69 , $8.69 , $8.91 , $8.91 , See APC Packaged Rates , $4.55 , $6.59 , $4.55 , $32.96 , $28.00
82247,5212010240,Hospital Chargemaster,Bilirubin Total,Outpatient,Outpatient Default Percent / Case Rate,301, $23.00 , $11.46 , $18.95 , See APC Packaged Rates , $16.10 , $8.97 , $26.97 , $18.10 , $17.33 , See APC Packaged Rates , See APC Packaged Rates , $17.06 , $16.54 , See APC Packaged Rates , See APC Packaged Rates , $8.54 , $8.54 , $8.76 , $8.76 , See APC Packaged Rates , $4.16 , $6.68 , $4.16 , $26.97 , $16.10
82248,5212010241,Hospital Chargemaster,Bilirubin Direct,Outpatient,Outpatient Default Percent / Case Rate,301, $23.00 , $10.32 , $18.95 , See APC Packaged Rates , $16.10 , $8.97 , $26.97 , $18.10 , $17.33 , See APC Packaged Rates , See APC Packaged Rates , $16.99 , $16.47 , See APC Packaged Rates , See APC Packaged Rates , $8.54 , $8.54 , $8.76 , $8.76 , See APC Packaged Rates , $4.16 , $6.68 , $4.16 , $26.97 , $16.10
82040,5212010204,Hospital Chargemaster,Assay Of Serum Albumin,Outpatient,Outpatient Default Percent / Case Rate,301, $16.00 , $11.32 , $13.18 , See APC Packaged Rates , $11.20 , $6.24 , $26.97 , $18.10 , $17.33 , See APC Packaged Rates , See APC Packaged Rates , $12.10 , $11.73 , See APC Packaged Rates , See APC Packaged Rates , $8.41 , $8.41 , $8.63 , $8.63 , See APC Packaged Rates , $4.11 , $6.60 , $4.11 , $26.97 , $11.20
82438,5212010273,Hospital Chargemaster,Assay Other Fluid Chlorides,Outpatient,Outpatient Default Percent / Case Rate,301, $40.00 , $10.06 , $32.96 , See APC Packaged Rates , $28.00 , $15.60 , $26.97 , $18.10 , $17.33 , See APC Packaged Rates , See APC Packaged Rates , $9.62 , $9.33 , See APC Packaged Rates , See APC Packaged Rates , $8.35 , $8.35 , $8.57 , $8.57 , See APC Packaged Rates , $4.15 , $6.52 , $4.15 , $32.96 , $28.00
84300,5212010527,Hospital Chargemaster,Assay Of Urine Sodium,Outpatient,Outpatient Default Percent / Case Rate,301, $23.00 , $10.00 , $18.95 , See APC Packaged Rates , $16.10 , $8.97 , $26.97 , $18.10 , $17.33 , See APC Packaged Rates , See APC Packaged Rates , $12.10 , $11.73 , See APC Packaged Rates , See APC Packaged Rates , $8.35 , $8.35 , $8.57 , $8.57 , See APC Packaged Rates , $4.20 , $6.48 , $4.20 , $26.97 , $16.10
82374,5212010258,Hospital Chargemaster,Assay Blood Carbon Dioxide,Outpatient,Outpatient Default Percent / Case Rate,301, $16.00 , $11.17 , $13.18 , See APC Packaged Rates , $11.20 , $6.24 , $26.97 , $18.10 , $17.33 , See APC Packaged Rates , See APC Packaged Rates , $11.96 , $11.59 , See APC Packaged Rates , See APC Packaged Rates , $8.31 , $8.31 , $8.52 , $8.52 , See APC Packaged Rates , $4.05 , $6.52 , $4.05 , $26.97 , $11.20
84302,5212010528,Hospital Chargemaster,Assay Of Sweat Sodium,Outpatient,Outpatient Default Percent / Case Rate,301, $22.00 , $10.00 , $18.13 , See APC Packaged Rates , $15.40 , $8.58 , $26.97 , $18.10 , $17.33 , See APC Packaged Rates , See APC Packaged Rates , $16.31 , $15.81 , See APC Packaged Rates , See APC Packaged Rates , $8.28 , $8.28 , $8.49 , $8.49 , See APC Packaged Rates , $4.03 , $6.48 , $4.03 , $26.97 , $15.40
84560,5212010571,Hospital Chargemaster,Assay Of Urine/Uric Acid,Outpatient,Outpatient Default Percent / Case Rate,301, $30.00 , $9.76 , $24.72 , See APC Packaged Rates , $21.00 , $11.70 , $25.39 , $17.04 , $16.31 , See APC Packaged Rates , See APC Packaged Rates , $14.53 , $14.09 , See APC Packaged Rates , See APC Packaged Rates , $8.21 , $8.21 , $8.43 , $8.43 , See APC Packaged Rates , $4.21 , $6.32 , $4.21 , $25.39 , $21.00
84295,5212010526,Hospital Chargemaster,Assay Of Serum Sodium,Outpatient,Outpatient Default Percent / Case Rate,301, $25.00 , $11.00 , $20.60 , See APC Packaged Rates , $17.50 , $9.75 , $25.39 , $17.04 , $16.31 , See APC Packaged Rates , See APC Packaged Rates , $18.37 , $17.81 , See APC Packaged Rates , See APC Packaged Rates , $8.18 , $8.18 , $8.39 , $8.39 , See APC Packaged Rates , $4.00 , $6.42 , $4.00 , $25.39 , $17.50
82950,5212010352,Hospital Chargemaster,Glucose Test,Outpatient,Outpatient Default Percent / Case Rate,301, $43.00 , $10.85 , $35.43 , See APC Packaged Rates , $30.10 , $16.77 , $25.39 , $17.04 , $16.31 , See APC Packaged Rates , See APC Packaged Rates , $14.70 , $14.25 , See APC Packaged Rates , See APC Packaged Rates , $8.08 , $8.08 , $8.28 , $8.28 , See APC Packaged Rates , $3.94 , $6.32 , $3.94 , $35.43 , $30.10
83070,5212010389,Hospital Chargemaster,Assay Of Hemosiderin Qual,Outpatient,Outpatient Default Percent / Case Rate,301, $81.00 , $9.76 , $66.74 , See APC Packaged Rates , $56.70 , $31.59 , $25.39 , $17.04 , $16.31 , See APC Packaged Rates , See APC Packaged Rates , $15.98 , $15.50 , See APC Packaged Rates , See APC Packaged Rates , $8.08 , $8.08 , $8.28 , $8.28 , See APC Packaged Rates , $3.94 , $6.32 , $3.94 , $66.74 , $56.70
84100,5212010477,Hospital Chargemaster,Assay Of Phosphorus,Outpatient,Outpatient Default Percent / Case Rate,301, $26.00 , $9.76 , $21.42 , See APC Packaged Rates , $18.20 , $10.14 , $25.39 , $17.04 , $16.31 , See APC Packaged Rates , See APC Packaged Rates , $17.13 , $16.61 , See APC Packaged Rates , See APC Packaged Rates , $8.06 , $8.06 , $8.27 , $8.27 , See APC Packaged Rates , $3.93 , $6.32 , $3.93 , $25.39 , $18.20
82948,5212010351,Hospital Chargemaster,Reagent Strip/Blood Glucose,Outpatient,Outpatient Default Percent / Case Rate,301, $13.00 , $9.33 , $10.71 , See APC Packaged Rates , $9.10 , $5.07 , $22.21 , $14.90 , $14.27 , See APC Packaged Rates , See APC Packaged Rates , $6.79 , $6.58 , See APC Packaged Rates , See APC Packaged Rates , $7.98 , $7.98 , $8.19 , $8.19 , See APC Packaged Rates , $4.19 , $6.05 , $4.19 , $22.21 , $9.10
80339,5212010130,Hospital Chargemaster,Antiepileptics Nos 1-3,Outpatient,Outpatient Default Percent / Case Rate,301, $114.00 , $14.19 , $93.94 , See APC Packaged Rates , $79.80 , $44.46 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $7.98 , $7.98 , $8.19 , $8.19 , See APC Packaged Rates , $39.90 , $- , $- , $106.27 , $79.80
84132,5212010485,Hospital Chargemaster,Assay Of Serum Potassium,Outpatient,Outpatient Default Percent / Case Rate,301, $27.00 , $10.52 , $22.25 , See APC Packaged Rates , $18.90 , $10.53 , $25.39 , $17.04 , $16.31 , See APC Packaged Rates , See APC Packaged Rates , $19.33 , $18.74 , See APC Packaged Rates , See APC Packaged Rates , $7.89 , $7.89 , $8.09 , $8.09 , See APC Packaged Rates , $3.94 , $6.13 , $3.94 , $25.39 , $18.90
82540,5212010286,Hospital Chargemaster,Assay Of Creatine,Outpatient,Outpatient Default Percent / Case Rate,301, $30.00 , $9.54 , $24.72 , See APC Packaged Rates , $21.00 , $11.70 , $25.39 , $17.04 , $16.31 , See APC Packaged Rates , See APC Packaged Rates , $19.19 , $18.61 , See APC Packaged Rates , See APC Packaged Rates , $7.89 , $7.89 , $8.09 , $8.09 , See APC Packaged Rates , $3.85 , $6.18 , $3.85 , $25.39 , $21.00
82435,5212010271,Hospital Chargemaster,Assay Of Blood Chloride,Outpatient,Outpatient Default Percent / Case Rate,301, $15.00 , $10.52 , $12.36 , See APC Packaged Rates , $10.50 , $5.85 , $25.39 , $17.04 , $16.31 , See APC Packaged Rates , See APC Packaged Rates , $11.72 , $11.37 , See APC Packaged Rates , See APC Packaged Rates , $7.83 , $7.83 , $8.03 , $8.03 , See APC Packaged Rates , $3.82 , $6.13 , $3.82 , $25.39 , $10.50
84550,5212010570,Hospital Chargemaster,Assay Of Blood/Uric Acid,Outpatient,Outpatient Default Percent / Case Rate,301, $26.00 , $10.33 , $21.42 , See APC Packaged Rates , $18.20 , $10.14 , $23.79 , $15.96 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $18.86 , $18.29 , See APC Packaged Rates , See APC Packaged Rates , $7.69 , $7.69 , $7.89 , $7.89 , See APC Packaged Rates , $3.75 , $6.02 , $3.75 , $23.79 , $18.20
82009,5212010197,Hospital Chargemaster,Test For Acetone/Ketones,Outpatient,Outpatient Default Percent / Case Rate,301, $17.00 , $9.30 , $14.01 , See APC Packaged Rates , $11.90 , $6.63 , $23.79 , $15.96 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $12.24 , $11.87 , See APC Packaged Rates , See APC Packaged Rates , $7.69 , $7.69 , $7.89 , $7.89 , See APC Packaged Rates , $3.75 , $6.02 , $3.75 , $23.79 , $11.90
84133,5212010486,Hospital Chargemaster,Assay Of Urine Potassium,Outpatient,Outpatient Default Percent / Case Rate,301, $33.00 , $8.87 , $27.19 , See APC Packaged Rates , $23.10 , $12.87 , $23.79 , $15.96 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $14.53 , $14.09 , See APC Packaged Rates , See APC Packaged Rates , $7.51 , $7.51 , $7.70 , $7.70 , See APC Packaged Rates , $3.92 , $5.75 , $3.92 , $27.19 , $23.10
82465,5212010275,Hospital Chargemaster,Assay Bld/Serum Cholesterol,Outpatient,Outpatient Default Percent / Case Rate,301, $24.00 , $9.95 , $19.78 , See APC Packaged Rates , $16.80 , $9.36 , $23.79 , $15.96 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $17.43 , $16.90 , See APC Packaged Rates , See APC Packaged Rates , $7.40 , $7.40 , $7.59 , $7.59 , See APC Packaged Rates , $3.62 , $5.81 , $3.62 , $23.79 , $16.80
84520,5212010567,Hospital Chargemaster,Assay Of Urea Nitrogen,Outpatient,Outpatient Default Percent / Case Rate,301, $20.00 , $9.04 , $16.48 , See APC Packaged Rates , $14.00 , $7.80 , $22.21 , $14.90 , $14.27 , See APC Packaged Rates , See APC Packaged Rates , $14.72 , $14.27 , See APC Packaged Rates , See APC Packaged Rates , $6.72 , $6.72 , $6.89 , $6.89 , See APC Packaged Rates , $3.28 , $5.27 , $3.28 , $22.21 , $14.00
82947,5212010350,Hospital Chargemaster,Assay Glucose Blood Quant,Outpatient,Outpatient Default Percent / Case Rate,301, $69.00 , $8.98 , $56.86 , See APC Packaged Rates , $48.30 , $26.91 , $20.63 , $13.84 , $13.25 , See APC Packaged Rates , See APC Packaged Rates , $15.75 , $15.27 , See APC Packaged Rates , See APC Packaged Rates , $6.69 , $6.69 , $6.86 , $6.86 , See APC Packaged Rates , $3.25 , $5.24 , $3.25 , $56.86 , $48.30
82945,5212010348,Hospital Chargemaster,Glucose Other Fluid,Outpatient,Outpatient Default Percent / Case Rate,301, $30.00 , $8.09 , $24.72 , See APC Packaged Rates , $21.00 , $11.70 , $20.63 , $13.84 , $13.25 , See APC Packaged Rates , See APC Packaged Rates , $13.34 , $12.93 , See APC Packaged Rates , See APC Packaged Rates , $6.69 , $6.69 , $6.86 , $6.86 , See APC Packaged Rates , $3.25 , $5.24 , $3.25 , $24.72 , $21.00
82952,5212010354,Hospital Chargemaster,Gtt-Added Samples,Outpatient,Outpatient Default Percent / Case Rate,301, $25.00 , $8.96 , $20.60 , See APC Packaged Rates , $17.50 , $9.75 , $20.63 , $13.84 , $13.25 , See APC Packaged Rates , See APC Packaged Rates , $9.66 , $9.37 , See APC Packaged Rates , See APC Packaged Rates , $6.68 , $6.68 , $6.85 , $6.85 , See APC Packaged Rates , $3.25 , $5.23 , $3.25 , $20.63 , $17.50
84157,5212010501,Hospital Chargemaster,Assay Of Protein Other,Outpatient,Outpatient Default Percent / Case Rate,301, $20.00 , $8.39 , $16.48 , See APC Packaged Rates , $14.00 , $7.80 , $20.63 , $13.84 , $13.25 , See APC Packaged Rates , See APC Packaged Rates , $12.07 , $11.71 , See APC Packaged Rates , See APC Packaged Rates , $6.37 , $6.37 , $6.53 , $6.53 , See APC Packaged Rates , $3.32 , $4.88 , $3.32 , $20.63 , $14.00
84155,5212010499,Hospital Chargemaster,Assay Of Protein Serum,Outpatient,Outpatient Default Percent / Case Rate,301, $20.00 , $8.39 , $16.48 , See APC Packaged Rates , $14.00 , $7.80 , $20.63 , $13.84 , $13.25 , See APC Packaged Rates , See APC Packaged Rates , $11.56 , $11.21 , See APC Packaged Rates , See APC Packaged Rates , $6.25 , $6.25 , $6.41 , $6.41 , See APC Packaged Rates , $3.05 , $4.88 , $3.05 , $20.63 , $14.00
84156,5212010500,Hospital Chargemaster,Assay Of Protein Urine,Outpatient,Outpatient Default Percent / Case Rate,301, $40.00 , $7.54 , $32.96 , See APC Packaged Rates , $28.00 , $15.60 , $20.63 , $13.84 , $13.25 , See APC Packaged Rates , See APC Packaged Rates , $12.07 , $11.71 , See APC Packaged Rates , See APC Packaged Rates , $6.25 , $6.25 , $6.41 , $6.41 , See APC Packaged Rates , $3.05 , $4.88 , $3.05 , $32.96 , $28.00
81050,5212010195,Hospital Chargemaster,Urinalysis Volume Measure,Outpatient,Outpatient Default Percent / Case Rate,301, $10.00 , $6.74 , $8.24 , See APC Packaged Rates , $7.00 , $3.90 , $15.87 , $10.65 , $10.19 , See APC Packaged Rates , See APC Packaged Rates , $7.16 , $6.94 , See APC Packaged Rates , See APC Packaged Rates , $5.77 , $5.77 , $5.92 , $5.92 , See APC Packaged Rates , $3.03 , $4.37 , $3.03 , $15.87 , $7.00
82962,5212010357,Hospital Chargemaster,Glucose Blood Test,Outpatient,Outpatient Default Percent / Case Rate,301, $8.00 , $6.07 , $6.59 , See APC Packaged Rates , $5.60 , $3.12 , $14.29 , $9.59 , $9.18 , See APC Packaged Rates , See APC Packaged Rates , $6.79 , $6.58 , See APC Packaged Rates , See APC Packaged Rates , $5.20 , $5.20 , $5.33 , $5.33 , See APC Packaged Rates , $2.72 , $3.94 , $2.72 , $14.29 , $5.60
81015,5212010193,Hospital Chargemaster,Microscopic Exam Of Urine,Outpatient,Outpatient Default Percent / Case Rate,301, $12.00 , $6.28 , $9.89 , See APC Packaged Rates , $8.40 , $4.68 , $15.87 , $10.65 , $10.19 , See APC Packaged Rates , See APC Packaged Rates , $7.02 , $6.81 , See APC Packaged Rates , See APC Packaged Rates , $5.18 , $5.18 , $5.32 , $5.32 , See APC Packaged Rates , $2.53 , $4.07 , $2.53 , $15.87 , $8.40
82805,5212010341,Hospital Chargemaster,Blood Gases W/O2 Saturation,Outpatient,Outpatient Default Percent / Case Rate,301, $236.00 , $145.88 , $194.46 , See APC Packaged Rates , $165.20 , $92.04 , $347.37 , $233.09 , $223.18 , See APC Packaged Rates , See APC Packaged Rates , $95.43 , $92.53 , See APC Packaged Rates , See APC Packaged Rates , $219.48 , $219.48 , $219.48 , $219.48 , See APC Packaged Rates , $65.38 , $94.52 , $65.38 , $347.37 , $165.20
80168,5212010081,Hospital Chargemaster,Assay Of Ethosuximide,Outpatient,Outpatient Default Percent / Case Rate,301, $136.00 , $33.61 , $112.06 , See APC Packaged Rates , $95.20 , $53.04 , $88.83 , $59.60 , $57.07 , See APC Packaged Rates , See APC Packaged Rates , $36.78 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $27.80 , $27.80 , $28.51 , $28.51 , See APC Packaged Rates , $13.56 , $21.78 , $13.56 , $112.06 , $95.20
80320,5212010111,Hospital Chargemaster,Drug Screen Quantalcohols,Outpatient,Outpatient Default Percent / Case Rate,301, $115.00 , $24.95 , $94.76 , See APC Packaged Rates , $80.50 , $44.85 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $17.92 , $17.92 , $18.38 , $18.38 , See APC Packaged Rates , $40.25 , $- , $- , $106.27 , $80.50
80324,5212010115,Hospital Chargemaster,Drug Screen Amphetamines 1/2,Outpatient,Outpatient Default Percent / Case Rate,301, $150.00 , $24.08 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $24.23 , $24.23 , $24.85 , $24.85 , See APC Packaged Rates , $52.50 , $- , $- , $123.60 , $105.00
80335,5212010126,Hospital Chargemaster,Antidepressant Tricyclic 1/2,Outpatient,Outpatient Default Percent / Case Rate,301, $183.00 , $37.60 , $150.79 , See APC Packaged Rates , $128.10 , $71.37 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $7.98 , $7.98 , $8.19 , $8.19 , See APC Packaged Rates , $64.05 , $- , $- , $150.79 , $128.10
80345,5212010136,Hospital Chargemaster,Drug Screening Barbiturates,Outpatient,Outpatient Default Percent / Case Rate,301, $150.00 , $29.84 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $17.41 , $17.41 , $17.86 , $17.86 , See APC Packaged Rates , $52.50 , $- , $- , $123.60 , $105.00
80346,5212010137,Hospital Chargemaster,Benzodiazepines1-12,Outpatient,Outpatient Default Percent / Case Rate,301, $125.00 , $42.67 , $103.00 , See APC Packaged Rates , $87.50 , $48.75 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.75 , $25.75 , $26.41 , $26.41 , See APC Packaged Rates , $43.75 , $- , $- , $106.27 , $87.50
80349,5212010140,Hospital Chargemaster,Cannabinoids Natural,Outpatient,Outpatient Default Percent / Case Rate,301, $150.00 , $23.71 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $21.44 , $21.44 , $21.99 , $21.99 , See APC Packaged Rates , $52.50 , $- , $- , $123.60 , $105.00
80358,5212010149,Hospital Chargemaster,Drug Screening Methadone,Outpatient,Outpatient Default Percent / Case Rate,301, $115.00 , $18.74 , $94.76 , See APC Packaged Rates , $80.50 , $44.85 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $20.97 , $20.97 , $21.51 , $21.51 , See APC Packaged Rates , $40.25 , $- , $- , $106.27 , $80.50
80360,5212010151,Hospital Chargemaster,Methylphenidate,Outpatient,Outpatient Default Percent / Case Rate,301, $117.00 , $31.48 , $96.41 , See APC Packaged Rates , $81.90 , $45.63 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $17.32 , $17.32 , $17.77 , $17.77 , See APC Packaged Rates , $40.95 , $- , $- , $106.27 , $81.90
80361,5212010152,Hospital Chargemaster,Opiates 1 Or More,Outpatient,Outpatient Default Percent / Case Rate,301, $158.00 , $25.56 , $130.19 , See APC Packaged Rates , $110.60 , $61.62 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $27.16 , $27.16 , $27.86 , $27.86 , See APC Packaged Rates , $55.30 , $- , $- , $130.19 , $110.60
80365,5212010156,Hospital Chargemaster,Drug Screening Oxycodone,Outpatient,Outpatient Default Percent / Case Rate,301, $115.00 , $15.28 , $94.76 , See APC Packaged Rates , $80.50 , $44.85 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $22.66 , $22.66 , $23.24 , $23.24 , See APC Packaged Rates , $40.25 , $- , $- , $106.27 , $80.50
80366,5212010157,Hospital Chargemaster,Drug Screening Pregabalin,Outpatient,Outpatient Default Percent / Case Rate,301, $110.00 , $23.17 , $90.64 , See APC Packaged Rates , $77.00 , $42.90 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $13.18 , $13.18 , $13.52 , $13.52 , See APC Packaged Rates , $38.50 , $- , $- , $106.27 , $77.00
80367,5212010158,Hospital Chargemaster,Drug Screening Propoxyphene,Outpatient,Outpatient Default Percent / Case Rate,301, $115.00 , $19.45 , $94.76 , See APC Packaged Rates , $80.50 , $44.85 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $20.00 , $20.00 , $20.51 , $20.51 , See APC Packaged Rates , $40.25 , $- , $- , $106.27 , $80.50
82642,5212010307,Hospital Chargemaster,Dihydrotestosterone,Outpatient,Outpatient Default Percent / Case Rate,301, $88.00 , $60.25 , $72.51 , See APC Packaged Rates , $61.60 , $34.32 , $90.08 , $60.44 , $57.87 , See APC Packaged Rates , See APC Packaged Rates , $79.93 , $77.51 , See APC Packaged Rates , See APC Packaged Rates , $48.28 , $48.28 , $49.53 , $49.53 , See APC Packaged Rates , $24.30 , $39.04 , $24.30 , $90.08 , $61.60
83919,5212010455,Hospital Chargemaster,Organic Acids Qual Each,Outpatient,Outpatient Default Percent / Case Rate,301, $49.00 , $33.85 , $40.38 , See APC Packaged Rates , $34.30 , $19.11 , $88.83 , $59.60 , $57.07 , See APC Packaged Rates , See APC Packaged Rates , $55.90 , $54.21 , See APC Packaged Rates , See APC Packaged Rates , $28.00 , $28.00 , $28.72 , $28.72 , See APC Packaged Rates , $13.65 , $21.94 , $13.65 , $88.83 , $34.30
81271,5212010599,Hospital Chargemaster,Htt Gene Detc Abnor Alleles,Outpatient,Outpatient Default Percent / Case Rate,301, $411.00 , $253.72 , $338.66 , See APC Packaged Rates , $287.70 , $160.29 , $379.35 , $254.55 , $243.72 , See APC Packaged Rates , See APC Packaged Rates , $336.61 , $326.40 , See APC Packaged Rates , See APC Packaged Rates , $216.90 , $216.90 , $222.49 , $222.49 , See APC Packaged Rates , $113.71 , $164.40 , $113.71 , $379.35 , $287.70
80145,5212010799,Hospital Chargemaster,Drug Assay Adalimumab,Outpatient,Outpatient Default Percent / Case Rate,301, $117.00 , $71.43 , $96.41 , See APC Packaged Rates , $81.90 , $45.63 , $112.89 , $113.38 , $66.89 , See APC Packaged Rates , See APC Packaged Rates , $94.77 , $91.89 , See APC Packaged Rates , See APC Packaged Rates , $68.74 , $68.74 , $70.51 , $70.51 , See APC Packaged Rates , $32.01 , $46.28 , $32.01 , $113.38 , $81.90
80235,5212010804,Hospital Chargemaster,Drug Assay Lacosamide,Outpatient,Outpatient Default Percent / Case Rate,301, $145.00 , $50.21 , $119.48 , See APC Packaged Rates , $101.50 , $56.55 , $139.91 , $140.52 , $47.01 , See APC Packaged Rates , See APC Packaged Rates , $66.62 , $64.60 , See APC Packaged Rates , See APC Packaged Rates , $48.31 , $48.31 , $49.56 , $49.56 , See APC Packaged Rates , $22.50 , $32.53 , $22.50 , $140.52 , $101.50
80179,5212010811,Hospital Chargemaster,Assay of Salicylate,Outpatient,Outpatient Default Percent / Case Rate,301, $150.00 , $82.50 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 , $144.74 , $145.37 , $77.25 , See APC Packaged Rates , See APC Packaged Rates , $100.65 , $100.65 , See APC Packaged Rates , See APC Packaged Rates , $139.50 , $139.50 , $139.50 , $139.50 , See APC Packaged Rates , $15.48 , $22.37 , $15.48 , $145.37 , $105.00
80280,5212010812,Hospital Chargemaster,Assay of Vedolizumab,Outpatient,Outpatient Default Percent / Case Rate,301, $115.00 , $71.43 , $94.76 , See APC Packaged Rates , $80.50 , $44.85 , $110.96 , $111.45 , $66.89 , See APC Packaged Rates , See APC Packaged Rates , $94.77 , $91.89 , See APC Packaged Rates , See APC Packaged Rates , $68.74 , $68.74 , $70.51 , $70.51 , See APC Packaged Rates , $32.01 , $46.28 , $32.01 , $111.45 , $80.50
80204,5212010814,Hospital Chargemaster,Assay of Methotrexate,Outpatient,Outpatient Default Percent / Case Rate,301, $171.00 , $94.05 , $140.90 , See APC Packaged Rates , $119.70 , $66.69 , $165.00 , $165.72 , $88.07 , See APC Packaged Rates , See APC Packaged Rates , $114.74 , $114.74 , See APC Packaged Rates , See APC Packaged Rates , $159.03 , $159.03 , $159.03 , $159.03 , See APC Packaged Rates , $32.01 , $46.28 , $32.01 , $165.72 , $119.70
80307,5212010821,Hospital Chargemaster,Drug Test Prsmv Chem Anlyzr,Outpatient,Outpatient Default Percent / Case Rate,301, $175.00 , $119.73 , $144.20 , See APC Packaged Rates , $122.50 , $68.25 , $315.64 , $211.79 , $202.79 , See APC Packaged Rates , See APC Packaged Rates , $196.09 , $190.14 , See APC Packaged Rates , See APC Packaged Rates , $81.72 , $81.72 , $83.82 , $83.82 , See APC Packaged Rates , $51.57 , $77.58 , $51.57 , $315.64 , $122.50
80307,5218010001,Hospital Chargemaster,Meconium 5 Panel,Outpatient,Outpatient Default Percent / Case Rate,301, $170.00 , $119.73 , $140.08 , See APC Packaged Rates , $119.00 , $66.30 , $315.64 , $211.79 , $202.79 , See APC Packaged Rates , See APC Packaged Rates , $196.09 , $190.14 , See APC Packaged Rates , See APC Packaged Rates , $81.72 , $81.72 , $83.82 , $83.82 , See APC Packaged Rates , $51.57 , $77.58 , $51.57 , $315.64 , $119.00
80307,5218010002,Hospital Chargemaster,"Amphetamine, Urine",Outpatient,Outpatient Default Percent / Case Rate,301, $30.00 , $119.73 , $24.72 , See APC Packaged Rates , $21.00 , $11.70 , $315.64 , $211.79 , $202.79 , See APC Packaged Rates , See APC Packaged Rates , $196.09 , $190.14 , See APC Packaged Rates , See APC Packaged Rates , $81.72 , $81.72 , $83.82 , $83.82 , See APC Packaged Rates , $51.57 , $77.58 , $11.70 , $315.64 , $21.00
80051,5310010053,Hospital Chargemaster,Electrolyte Panel,Outpatient,Outpatient Default Percent / Case Rate,301, $83.00 , $16.04 , $68.39 , See APC Packaged Rates , $58.10 , $32.37 , $38.07 , $25.55 , $24.46 , See APC Packaged Rates , See APC Packaged Rates , $19.05 , $18.47 , See APC Packaged Rates , See APC Packaged Rates , $11.94 , $11.94 , $12.24 , $12.24 , See APC Packaged Rates , $5.82 , $9.35 , $5.82 , $68.39 , $58.10
82330,5310010054,Hospital Chargemaster,Assay of Calcium,Outpatient,Outpatient Default Percent / Case Rate,301, $115.00 , $31.26 , $94.76 , See APC Packaged Rates , $80.50 , $44.85 , $74.54 , $50.02 , $47.89 , See APC Packaged Rates , See APC Packaged Rates , $26.63 , $25.82 , See APC Packaged Rates , See APC Packaged Rates , $23.27 , $23.27 , $23.87 , $23.87 , See APC Packaged Rates , $11.36 , $18.24 , $11.36 , $94.76 , $80.50
83605,66210053,Hospital Chargemaster,Assay Of Lactic Acid,Outpatient,Outpatient Default Percent / Case Rate,301, $35.00 , $24.43 , $28.84 , See APC Packaged Rates , $24.50 , $13.65 , $58.68 , $39.37 , $37.70 , See APC Packaged Rates , See APC Packaged Rates , $35.92 , $34.83 , See APC Packaged Rates , See APC Packaged Rates , $18.54 , $18.54 , $19.01 , $19.01 , See APC Packaged Rates , $9.61 , $14.24 , $9.61 , $58.68 , $24.50
80307,66215031,Hospital Chargemaster,Salicylate,Outpatient,Outpatient Default Percent / Case Rate,301, $49.00 , $119.73 , $40.38 , See APC Packaged Rates , $34.30 , $19.11 , $315.64 , $211.79 , $202.79 , See APC Packaged Rates , See APC Packaged Rates , $196.09 , $190.14 , See APC Packaged Rates , See APC Packaged Rates , $81.72 , $81.72 , $83.82 , $83.82 , See APC Packaged Rates , $51.57 , $77.58 , $19.11 , $315.64 , $34.30
G0480,66215084,Hospital Chargemaster,Acetominophen,Outpatient,Outpatient Default Percent / Case Rate,301, $98.00 , $53.90 , $80.75 , See APC Packaged Rates , $68.60 , $38.22 , $504.40 , $338.45 , $324.06 , See APC Packaged Rates , See APC Packaged Rates , $65.76 , $65.76 , See APC Packaged Rates , See APC Packaged Rates , $98.00 , $98.00 , $98.00 , $98.00 , See APC Packaged Rates , $34.30 , $137.32 , $34.30 , $504.40 , $68.60
G0480,66216424,Hospital Chargemaster,Alcohol,Outpatient,Outpatient Default Percent / Case Rate,301, $53.00 , $29.15 , $43.67 , See APC Packaged Rates , $37.10 , $20.67 , $504.40 , $338.45 , $324.06 , See APC Packaged Rates , See APC Packaged Rates , $35.56 , $35.56 , See APC Packaged Rates , See APC Packaged Rates , $98.00 , $98.00 , $98.00 , $98.00 , See APC Packaged Rates , $18.55 , $137.32 , $18.55 , $504.40 , $37.10
86480,5212010679,Hospital Chargemaster,Tb Test Cell Immun Measure,Outpatient,Outpatient Default Percent / Case Rate,302, $184.00 , $127.55 , $151.62 , See APC Packaged Rates , $128.80 , $71.76 , $336.27 , $225.64 , $216.04 , See APC Packaged Rates , See APC Packaged Rates , $212.75 , $206.30 , See APC Packaged Rates , See APC Packaged Rates , $105.46 , $105.46 , $108.17 , $108.17 , See APC Packaged Rates , $51.45 , $82.64 , $51.45 , $336.27 , $128.80
86360,5212010668,Hospital Chargemaster,T Cell Absolute Count/Ratio,Outpatient,Outpatient Default Percent / Case Rate,302, $140.00 , $96.67 , $115.36 , See APC Packaged Rates , $98.00 , $54.60 , $255.38 , $171.36 , $164.08 , See APC Packaged Rates , See APC Packaged Rates , $29.39 , $28.50 , See APC Packaged Rates , See APC Packaged Rates , $79.94 , $79.94 , $82.00 , $82.00 , See APC Packaged Rates , $39.00 , $62.64 , $28.50 , $255.38 , $98.00
86355,5212010664,Hospital Chargemaster,B Cells Total Count,Outpatient,Outpatient Default Percent / Case Rate,302, $113.00 , $77.64 , $93.11 , See APC Packaged Rates , $79.10 , $44.07 , $204.63 , $137.31 , $131.47 , See APC Packaged Rates , See APC Packaged Rates , $39.34 , $38.14 , See APC Packaged Rates , See APC Packaged Rates , $64.19 , $64.19 , $65.84 , $65.84 , See APC Packaged Rates , $31.31 , $50.30 , $31.31 , $204.63 , $79.10
86357,5212010666,Hospital Chargemaster,Nk Cells Total Count,Outpatient,Outpatient Default Percent / Case Rate,302, $113.00 , $77.64 , $93.11 , See APC Packaged Rates , $79.10 , $44.07 , $204.63 , $137.31 , $131.47 , See APC Packaged Rates , See APC Packaged Rates , $39.34 , $38.14 , See APC Packaged Rates , See APC Packaged Rates , $64.19 , $64.19 , $65.84 , $65.84 , See APC Packaged Rates , $31.31 , $50.30 , $31.31 , $204.63 , $79.10
86359,5212010667,Hospital Chargemaster,T Cells Total Count,Outpatient,Outpatient Default Percent / Case Rate,302, $113.00 , $77.64 , $93.11 , See APC Packaged Rates , $79.10 , $44.07 , $204.63 , $137.31 , $131.47 , See APC Packaged Rates , See APC Packaged Rates , $38.54 , $37.37 , See APC Packaged Rates , See APC Packaged Rates , $64.19 , $64.19 , $65.84 , $65.84 , See APC Packaged Rates , $31.31 , $50.30 , $31.31 , $204.63 , $79.10
86335,5212010655,Hospital Chargemaster,Immunfix E-Phorsis/Urine/Csf,Outpatient,Outpatient Default Percent / Case Rate,302, $300.00 , $60.39 , $247.20 , See APC Packaged Rates , $210.00 , $117.00 , $84.12 , $56.45 , $54.05 , See APC Packaged Rates , See APC Packaged Rates , $100.74 , $97.68 , See APC Packaged Rates , See APC Packaged Rates , $49.93 , $49.93 , $51.22 , $51.22 , See APC Packaged Rates , $24.36 , $39.13 , $24.36 , $247.20 , $210.00
86816,5212010784,Hospital Chargemaster,Hla Typing Dr/Dq,Outpatient,Outpatient Default Percent / Case Rate,302, $83.00 , $57.32 , $68.39 , See APC Packaged Rates , $58.10 , $32.37 , $150.69 , $101.11 , $96.81 , See APC Packaged Rates , See APC Packaged Rates , $97.81 , $94.84 , See APC Packaged Rates , See APC Packaged Rates , $48.31 , $48.31 , $49.56 , $49.56 , See APC Packaged Rates , $25.04 , $37.14 , $25.04 , $150.69 , $58.10
86327,5212010650,Hospital Chargemaster,Immunoelectrophoresis Assay,Outpatient,Outpatient Default Percent / Case Rate,302, $92.00 , $55.41 , $75.81 , See APC Packaged Rates , $64.40 , $35.88 , $104.36 , $70.03 , $67.05 , See APC Packaged Rates , See APC Packaged Rates , $68.54 , $66.46 , See APC Packaged Rates , See APC Packaged Rates , $47.38 , $47.38 , $48.60 , $48.60 , See APC Packaged Rates , $24.84 , $35.90 , $24.84 , $104.36 , $64.40
86356,5212010665,Hospital Chargemaster,Mononuclear Cell Antigen,Outpatient,Outpatient Default Percent / Case Rate,302, $80.00 , $55.10 , $65.92 , See APC Packaged Rates , $56.00 , $31.20 , $145.93 , $97.92 , $93.75 , See APC Packaged Rates , See APC Packaged Rates , $37.77 , $36.62 , See APC Packaged Rates , See APC Packaged Rates , $45.56 , $45.56 , $46.73 , $46.73 , See APC Packaged Rates , $22.23 , $35.70 , $22.23 , $145.93 , $56.00
86361,5212010669,Hospital Chargemaster,T Cell Absolute Count,Outpatient,Outpatient Default Percent / Case Rate,302, $135.00 , $55.10 , $111.24 , See APC Packaged Rates , $94.50 , $52.65 , $145.93 , $97.92 , $93.75 , See APC Packaged Rates , See APC Packaged Rates , $37.35 , $36.21 , See APC Packaged Rates , See APC Packaged Rates , $45.56 , $45.56 , $46.73 , $46.73 , See APC Packaged Rates , $22.23 , $35.70 , $22.23 , $145.93 , $94.50
86812,5212010783,Hospital Chargemaster,Hla Typing A B Or C,Outpatient,Outpatient Default Percent / Case Rate,302, $297.00 , $53.10 , $244.73 , See APC Packaged Rates , $207.90 , $115.83 , $139.59 , $93.66 , $89.68 , See APC Packaged Rates , See APC Packaged Rates , $91.03 , $88.26 , See APC Packaged Rates , See APC Packaged Rates , $43.92 , $43.92 , $45.05 , $45.05 , See APC Packaged Rates , $21.42 , $34.40 , $21.42 , $244.73 , $207.90
86146,5212010616,Hospital Chargemaster,Beta-2 Glycoprotein Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $78.00 , $52.37 , $64.27 , See APC Packaged Rates , $54.60 , $30.42 , $138.01 , $92.60 , $88.67 , See APC Packaged Rates , See APC Packaged Rates , $46.68 , $45.27 , See APC Packaged Rates , See APC Packaged Rates , $43.30 , $43.30 , $44.42 , $44.42 , See APC Packaged Rates , $21.12 , $33.94 , $21.12 , $138.01 , $54.60
86147,5212010617,Hospital Chargemaster,Cardiolipin Antibody Ea Ig,Outpatient,Outpatient Default Percent / Case Rate,302, $100.00 , $52.37 , $82.40 , See APC Packaged Rates , $70.00 , $39.00 , $138.01 , $92.60 , $88.67 , See APC Packaged Rates , See APC Packaged Rates , $46.24 , $44.84 , See APC Packaged Rates , See APC Packaged Rates , $43.30 , $43.30 , $44.42 , $44.42 , See APC Packaged Rates , $21.12 , $33.94 , $21.12 , $138.01 , $70.00
86332,5212010653,Hospital Chargemaster,Immune Complex Assay,Outpatient,Outpatient Default Percent / Case Rate,302, $145.00 , $50.15 , $119.48 , See APC Packaged Rates , $101.50 , $56.55 , $131.67 , $88.35 , $84.59 , See APC Packaged Rates , See APC Packaged Rates , $49.35 , $47.85 , See APC Packaged Rates , See APC Packaged Rates , $41.47 , $41.47 , $42.54 , $42.54 , See APC Packaged Rates , $20.23 , $32.50 , $20.23 , $131.67 , $101.50
86334,5212010654,Hospital Chargemaster,Immunofix E-Phoresis Serum,Outpatient,Outpatient Default Percent / Case Rate,302, $110.00 , $45.99 , $90.64 , See APC Packaged Rates , $77.00 , $42.90 , $84.12 , $56.45 , $54.05 , See APC Packaged Rates , See APC Packaged Rates , $84.59 , $82.02 , See APC Packaged Rates , See APC Packaged Rates , $38.02 , $38.02 , $39.00 , $39.00 , See APC Packaged Rates , $18.54 , $29.80 , $18.54 , $90.64 , $77.00
86341,5212010659,Hospital Chargemaster,Islet Cell Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $70.00 , $43.65 , $57.68 , See APC Packaged Rates , $49.00 , $27.30 , $107.85 , $72.37 , $69.29 , See APC Packaged Rates , See APC Packaged Rates , $48.18 , $46.72 , See APC Packaged Rates , See APC Packaged Rates , $37.32 , $37.32 , $38.28 , $38.28 , See APC Packaged Rates , $19.56 , $28.28 , $19.56 , $107.85 , $49.00
86337,5212010657,Hospital Chargemaster,Insulin Antibodies,Outpatient,Outpatient Default Percent / Case Rate,302, $252.00 , $44.06 , $207.65 , See APC Packaged Rates , $176.40 , $98.28 , $115.80 , $77.70 , $74.40 , See APC Packaged Rates , See APC Packaged Rates , $43.97 , $42.63 , See APC Packaged Rates , See APC Packaged Rates , $36.42 , $36.42 , $37.36 , $37.36 , See APC Packaged Rates , $17.77 , $28.55 , $17.77 , $207.65 , $176.40
86300,5212010638,Hospital Chargemaster,Immunoassay Tumor Ca 15-3,Outpatient,Outpatient Default Percent / Case Rate,302, $160.00 , $42.84 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $112.62 , $75.56 , $72.35 , See APC Packaged Rates , See APC Packaged Rates , $70.67 , $68.52 , See APC Packaged Rates , See APC Packaged Rates , $35.41 , $35.41 , $36.32 , $36.32 , See APC Packaged Rates , $17.28 , $27.76 , $17.28 , $131.84 , $112.00
86301,5212010639,Hospital Chargemaster,Immunoassay Tumor Ca 19-9,Outpatient,Outpatient Default Percent / Case Rate,302, $160.00 , $42.84 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $112.62 , $75.56 , $72.35 , See APC Packaged Rates , See APC Packaged Rates , $68.54 , $66.46 , See APC Packaged Rates , See APC Packaged Rates , $35.41 , $35.41 , $36.32 , $36.32 , See APC Packaged Rates , $17.28 , $27.76 , $17.28 , $131.84 , $112.00
86304,5212010640,Hospital Chargemaster,Immunoassay Tumor Ca 125,Outpatient,Outpatient Default Percent / Case Rate,302, $175.00 , $42.84 , $144.20 , See APC Packaged Rates , $122.50 , $68.25 , $112.62 , $75.56 , $72.35 , See APC Packaged Rates , See APC Packaged Rates , $70.67 , $68.52 , See APC Packaged Rates , See APC Packaged Rates , $35.41 , $35.41 , $36.32 , $36.32 , See APC Packaged Rates , $17.28 , $27.76 , $17.28 , $144.20 , $122.50
86305,5212010641,Hospital Chargemaster,Human Epididymis Protein 4,Outpatient,Outpatient Default Percent / Case Rate,302, $88.00 , $42.84 , $72.51 , See APC Packaged Rates , $61.60 , $34.32 , $112.62 , $75.56 , $72.35 , See APC Packaged Rates , See APC Packaged Rates , $68.54 , $66.46 , See APC Packaged Rates , See APC Packaged Rates , $35.41 , $35.41 , $36.32 , $36.32 , See APC Packaged Rates , $17.28 , $27.76 , $17.28 , $112.62 , $61.60
86316,5212010645,Hospital Chargemaster,Immunoassay Tumor Other,Outpatient,Outpatient Default Percent / Case Rate,302, $91.00 , $42.84 , $74.98 , See APC Packaged Rates , $63.70 , $35.49 , $112.62 , $75.56 , $72.35 , See APC Packaged Rates , See APC Packaged Rates , $69.99 , $67.87 , See APC Packaged Rates , See APC Packaged Rates , $35.41 , $35.41 , $36.32 , $36.32 , See APC Packaged Rates , $17.28 , $27.76 , $17.28 , $112.62 , $63.70
86162,5212010626,Hospital Chargemaster,Complement Total (Ch50),Outpatient,Outpatient Default Percent / Case Rate,302, $84.00 , $41.82 , $69.22 , See APC Packaged Rates , $58.80 , $32.76 , $111.04 , $74.51 , $71.34 , See APC Packaged Rates , See APC Packaged Rates , $63.34 , $61.42 , See APC Packaged Rates , See APC Packaged Rates , $34.58 , $34.58 , $35.47 , $35.47 , See APC Packaged Rates , $16.87 , $27.10 , $16.87 , $111.04 , $58.80
86580,5212010685,Hospital Chargemaster,Tb Intradermal Test,Outpatient,Outpatient Default Percent / Case Rate,302, $35.00 , $31.80 , $28.84 , $29.53 , $24.50 , $13.65 , $18.97 , $12.73 , $12.19 , $29.53 , $29.53 , $25.18 , $24.41 , $31.01 , $30.12 , $35.00 , $35.00 , $35.00 , $35.00 , $29.53 , $8.41 , $20.60 , $8.41 , $35.00 , $24.50
86689,5212010727,Hospital Chargemaster,Htlv/Hiv Confirmj Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $198.00 , $39.84 , $163.15 , See APC Packaged Rates , $138.60 , $77.22 , $104.70 , $70.25 , $67.26 , See APC Packaged Rates , See APC Packaged Rates , $65.10 , $63.12 , See APC Packaged Rates , See APC Packaged Rates , $32.93 , $32.93 , $33.78 , $33.78 , See APC Packaged Rates , $16.07 , $25.81 , $16.07 , $163.15 , $138.60
86696,5212010731,Hospital Chargemaster,Herpes Simplex Type 2 Test,Outpatient,Outpatient Default Percent / Case Rate,302, $100.00 , $39.84 , $82.40 , See APC Packaged Rates , $70.00 , $39.00 , $104.70 , $70.25 , $67.26 , See APC Packaged Rates , See APC Packaged Rates , $65.73 , $63.74 , See APC Packaged Rates , See APC Packaged Rates , $32.93 , $32.93 , $33.78 , $33.78 , See APC Packaged Rates , $16.07 , $25.81 , $16.07 , $104.70 , $70.00
86757,5212010757,Hospital Chargemaster,Rickettsia Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $88.00 , $39.84 , $72.51 , See APC Packaged Rates , $61.60 , $34.32 , $104.70 , $70.25 , $67.26 , See APC Packaged Rates , See APC Packaged Rates , $63.72 , $61.78 , See APC Packaged Rates , See APC Packaged Rates , $32.93 , $32.93 , $33.78 , $33.78 , See APC Packaged Rates , $16.07 , $25.81 , $16.07 , $104.70 , $61.60
86022,5212010779,Hospital Chargemaster,Platelet Antibodies,Outpatient,Outpatient Default Percent / Case Rate,302, $200.00 , $37.80 , $164.80 , See APC Packaged Rates , $140.00 , $78.00 , $99.93 , $67.06 , $64.20 , See APC Packaged Rates , See APC Packaged Rates , $61.75 , $59.88 , See APC Packaged Rates , See APC Packaged Rates , $31.26 , $31.26 , $32.06 , $32.06 , See APC Packaged Rates , $15.24 , $24.49 , $15.24 , $164.80 , $140.00
86665,5212010717,Hospital Chargemaster,Epstein-Barr Capsid Vca,Outpatient,Outpatient Default Percent / Case Rate,302, $270.00 , $37.34 , $222.48 , See APC Packaged Rates , $189.00 , $105.30 , $98.35 , $66.00 , $63.19 , See APC Packaged Rates , See APC Packaged Rates , $48.06 , $46.61 , See APC Packaged Rates , See APC Packaged Rates , $30.87 , $30.87 , $31.67 , $31.67 , See APC Packaged Rates , $15.05 , $24.19 , $15.05 , $222.48 , $189.00
86235,5212010632,Hospital Chargemaster,Nuclear Antigen Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $83.00 , $36.91 , $68.39 , See APC Packaged Rates , $58.10 , $32.37 , $96.75 , $64.92 , $62.16 , See APC Packaged Rates , See APC Packaged Rates , $60.30 , $58.47 , See APC Packaged Rates , See APC Packaged Rates , $30.52 , $30.52 , $31.30 , $31.30 , See APC Packaged Rates , $14.87 , $23.92 , $14.87 , $96.75 , $58.10
86692,5212010728,Hospital Chargemaster,Hepatitis Delta Agent Antbdy,Outpatient,Outpatient Default Percent / Case Rate,302, $109.00 , $35.32 , $89.82 , See APC Packaged Rates , $76.30 , $42.51 , $93.59 , $62.80 , $60.13 , See APC Packaged Rates , See APC Packaged Rates , $56.86 , $55.14 , See APC Packaged Rates , See APC Packaged Rates , $29.20 , $29.20 , $29.95 , $29.95 , See APC Packaged Rates , $14.24 , $22.88 , $14.24 , $93.59 , $76.30
86618,5212010697,Hospital Chargemaster,Lyme Disease Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $150.00 , $38.93 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 , $91.99 , $61.72 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $34.40 , $33.35 , See APC Packaged Rates , See APC Packaged Rates , $28.96 , $28.96 , $29.71 , $29.71 , See APC Packaged Rates , $14.14 , $22.70 , $14.14 , $123.60 , $105.00
86382,5212010672,Hospital Chargemaster,Neutralization Test Viral,Outpatient,Outpatient Default Percent / Case Rate,302," $1,000.00 ", $34.80 , $824.00 , See APC Packaged Rates , $700.00 , $390.00 , $91.99 , $61.72 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $56.86 , $55.14 , See APC Packaged Rates , See APC Packaged Rates , $28.78 , $28.78 , $29.52 , $29.52 , See APC Packaged Rates , $14.03 , $22.55 , $14.03 , $824.00 , $700.00
86645,5212010708,Hospital Chargemaster,Cmv Antibody Igm,Outpatient,Outpatient Default Percent / Case Rate,302, $110.00 , $34.67 , $90.64 , See APC Packaged Rates , $77.00 , $42.90 , $91.99 , $61.72 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $48.06 , $46.61 , See APC Packaged Rates , See APC Packaged Rates , $28.67 , $28.67 , $29.41 , $29.41 , See APC Packaged Rates , $13.98 , $22.46 , $13.98 , $91.99 , $77.00
86788,5212010769,Hospital Chargemaster,West Nile Virus Ab Igm,Outpatient,Outpatient Default Percent / Case Rate,302, $67.00 , $34.67 , $55.21 , See APC Packaged Rates , $46.90 , $26.13 , $91.99 , $61.72 , $59.10 , See APC Packaged Rates , See APC Packaged Rates , $49.07 , $47.58 , See APC Packaged Rates , See APC Packaged Rates , $28.67 , $28.67 , $29.41 , $29.41 , See APC Packaged Rates , $13.98 , $22.46 , $13.98 , $91.99 , $46.90
86318,5212010647,Hospital Chargemaster,Immunoassay Infectious Agent,Outpatient,Outpatient Default Percent / Case Rate,302, $105.00 , $33.50 , $86.52 , See APC Packaged Rates , $73.50 , $40.95 , $79.30 , $53.21 , $50.95 , See APC Packaged Rates , See APC Packaged Rates , $54.43 , $52.78 , See APC Packaged Rates , See APC Packaged Rates , $28.64 , $28.64 , $29.38 , $29.38 , See APC Packaged Rates , $15.02 , $21.71 , $15.02 , $86.52 , $73.50
86148,5212010618,Hospital Chargemaster,Anti-Phospholipid Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $90.00 , $33.06 , $74.16 , See APC Packaged Rates , $63.00 , $35.10 , $87.25 , $58.55 , $56.06 , See APC Packaged Rates , See APC Packaged Rates , $57.80 , $56.04 , See APC Packaged Rates , See APC Packaged Rates , $27.33 , $27.33 , $28.04 , $28.04 , See APC Packaged Rates , $13.35 , $21.42 , $13.35 , $87.25 , $63.00
86800,5212010774,Hospital Chargemaster,Thyroglobulin Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $113.00 , $32.72 , $93.11 , See APC Packaged Rates , $79.10 , $44.07 , $85.65 , $57.47 , $55.02 , See APC Packaged Rates , See APC Packaged Rates , $49.82 , $48.31 , See APC Packaged Rates , See APC Packaged Rates , $27.07 , $27.07 , $27.77 , $27.77 , See APC Packaged Rates , $13.20 , $21.20 , $13.20 , $93.11 , $79.10
86684,5212010724,Hospital Chargemaster,Hemophilus Influenza Antibdy,Outpatient,Outpatient Default Percent / Case Rate,302, $170.00 , $32.60 , $140.08 , See APC Packaged Rates , $119.00 , $66.30 , $85.65 , $57.47 , $55.02 , See APC Packaged Rates , See APC Packaged Rates , $29.32 , $28.43 , See APC Packaged Rates , See APC Packaged Rates , $26.95 , $26.95 , $27.64 , $27.64 , See APC Packaged Rates , $13.15 , $21.12 , $13.15 , $140.08 , $119.00
86677,5212010722,Hospital Chargemaster,Helicobacter Pylori Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $151.00 , $31.21 , $124.42 , See APC Packaged Rates , $105.70 , $58.89 , $79.30 , $53.21 , $50.95 , See APC Packaged Rates , See APC Packaged Rates , $48.79 , $47.31 , See APC Packaged Rates , See APC Packaged Rates , $26.67 , $26.67 , $27.36 , $27.36 , See APC Packaged Rates , $13.98 , $20.22 , $13.98 , $124.42 , $105.70
86336,5212010656,Hospital Chargemaster,Inhibina,Outpatient,Outpatient Default Percent / Case Rate,302, $150.00 , $32.08 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 , $84.07 , $56.41 , $54.01 , See APC Packaged Rates , See APC Packaged Rates , $52.28 , $50.69 , See APC Packaged Rates , See APC Packaged Rates , $26.52 , $26.52 , $27.20 , $27.20 , See APC Packaged Rates , $12.94 , $20.78 , $12.94 , $123.60 , $105.00
86617,5212010696,Hospital Chargemaster,Lyme Disease Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $60.00 , $31.87 , $49.44 , See APC Packaged Rates , $42.00 , $23.40 , $84.07 , $56.41 , $54.01 , See APC Packaged Rates , See APC Packaged Rates , $52.09 , $50.51 , See APC Packaged Rates , See APC Packaged Rates , $26.36 , $26.36 , $27.04 , $27.04 , See APC Packaged Rates , $12.86 , $20.65 , $12.86 , $84.07 , $42.00
86804,5212010776,Hospital Chargemaster,Hep C Ab Test Confirm,Outpatient,Outpatient Default Percent / Case Rate,302, $350.00 , $31.87 , $288.40 , See APC Packaged Rates , $245.00 , $136.50 , $84.07 , $56.41 , $54.01 , See APC Packaged Rates , See APC Packaged Rates , $65.10 , $63.12 , See APC Packaged Rates , See APC Packaged Rates , $26.36 , $26.36 , $27.04 , $27.04 , See APC Packaged Rates , $12.86 , $20.65 , $12.86 , $288.40 , $245.00
86713,5212010743,Hospital Chargemaster,Legionella Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $57.00 , $31.48 , $46.97 , See APC Packaged Rates , $39.90 , $22.23 , $82.49 , $55.35 , $53.00 , See APC Packaged Rates , See APC Packaged Rates , $51.48 , $49.92 , See APC Packaged Rates , See APC Packaged Rates , $26.03 , $26.03 , $26.70 , $26.70 , See APC Packaged Rates , $12.70 , $20.40 , $12.70 , $82.49 , $39.90
86664,5212010716,Hospital Chargemaster,Epstein-Barr Nuclear Antigen,Outpatient,Outpatient Default Percent / Case Rate,302, $101.00 , $31.47 , $83.22 , See APC Packaged Rates , $70.70 , $39.39 , $82.49 , $55.35 , $53.00 , See APC Packaged Rates , See APC Packaged Rates , $48.06 , $46.61 , See APC Packaged Rates , See APC Packaged Rates , $26.01 , $26.01 , $26.68 , $26.68 , See APC Packaged Rates , $12.69 , $20.39 , $12.69 , $83.22 , $70.70
86648,5212010709,Hospital Chargemaster,Diphtheria Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $97.00 , $31.30 , $79.93 , See APC Packaged Rates , $67.90 , $37.83 , $82.49 , $55.35 , $53.00 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $25.87 , $25.87 , $26.54 , $26.54 , See APC Packaged Rates , $12.63 , $20.28 , $12.63 , $82.49 , $67.90
86340,5212010658,Hospital Chargemaster,Intrinsic Factor Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $86.00 , $31.02 , $70.86 , See APC Packaged Rates , $60.20 , $33.54 , $82.49 , $55.35 , $53.00 , See APC Packaged Rates , See APC Packaged Rates , $42.66 , $41.36 , See APC Packaged Rates , See APC Packaged Rates , $25.66 , $25.66 , $26.32 , $26.32 , See APC Packaged Rates , $12.51 , $20.10 , $12.51 , $82.49 , $60.20
86720,5212010745,Hospital Chargemaster,Leptospira Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $130.00 , $30.00 , $107.12 , See APC Packaged Rates , $91.00 , $50.70 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $25.64 , $25.64 , $26.30 , $26.30 , See APC Packaged Rates , $13.45 , $19.44 , $13.45 , $107.12 , $91.00
86606,5212010691,Hospital Chargemaster,Aspergillus Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $55.00 , $30.98 , $45.32 , See APC Packaged Rates , $38.50 , $21.45 , $82.49 , $55.35 , $53.00 , See APC Packaged Rates , See APC Packaged Rates , $49.58 , $48.08 , See APC Packaged Rates , See APC Packaged Rates , $25.61 , $25.61 , $26.27 , $26.27 , See APC Packaged Rates , $12.49 , $20.08 , $12.49 , $82.49 , $38.50
86021,5212010778,Hospital Chargemaster,Wbc Antibody Identification,Outpatient,Outpatient Default Percent / Case Rate,302, $133.00 , $30.98 , $109.59 , See APC Packaged Rates , $93.10 , $51.87 , $82.49 , $55.35 , $53.00 , See APC Packaged Rates , See APC Packaged Rates , $50.61 , $49.08 , See APC Packaged Rates , See APC Packaged Rates , $25.61 , $25.61 , $26.27 , $26.27 , See APC Packaged Rates , $12.49 , $20.08 , $12.49 , $109.59 , $93.10
86747,5212010753,Hospital Chargemaster,Parvovirus Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $122.00 , $30.93 , $100.53 , See APC Packaged Rates , $85.40 , $47.58 , $80.88 , $54.27 , $51.96 , See APC Packaged Rates , See APC Packaged Rates , $34.40 , $33.35 , See APC Packaged Rates , See APC Packaged Rates , $25.58 , $25.58 , $26.24 , $26.24 , See APC Packaged Rates , $12.48 , $20.04 , $12.48 , $100.53 , $85.40
86317,5212010646,Hospital Chargemaster,Immunoassay Infectious Agent,Outpatient,Outpatient Default Percent / Case Rate,302, $75.00 , $30.84 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $80.88 , $54.27 , $51.96 , See APC Packaged Rates , See APC Packaged Rates , $34.05 , $33.01 , See APC Packaged Rates , See APC Packaged Rates , $25.50 , $25.50 , $26.16 , $26.16 , See APC Packaged Rates , $12.44 , $19.98 , $12.44 , $80.88 , $52.50
86774,5212010763,Hospital Chargemaster,Tetanus Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $110.00 , $30.45 , $90.64 , See APC Packaged Rates , $77.00 , $42.90 , $80.88 , $54.27 , $51.96 , See APC Packaged Rates , See APC Packaged Rates , $34.40 , $33.35 , See APC Packaged Rates , See APC Packaged Rates , $25.18 , $25.18 , $25.83 , $25.83 , See APC Packaged Rates , $12.28 , $19.73 , $12.28 , $90.64 , $77.00
86674,5212010721,Hospital Chargemaster,Giardia Lamblia Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $94.00 , $30.28 , $77.46 , See APC Packaged Rates , $65.80 , $36.66 , $79.30 , $53.21 , $50.95 , See APC Packaged Rates , See APC Packaged Rates , $34.40 , $33.35 , See APC Packaged Rates , See APC Packaged Rates , $25.04 , $25.04 , $25.69 , $25.69 , See APC Packaged Rates , $12.22 , $19.62 , $12.22 , $79.30 , $65.80
86376,5212010671,Hospital Chargemaster,Microsomal Antibody Each,Outpatient,Outpatient Default Percent / Case Rate,302, $124.00 , $29.95 , $102.18 , See APC Packaged Rates , $86.80 , $48.36 , $79.30 , $53.21 , $50.95 , See APC Packaged Rates , See APC Packaged Rates , $46.36 , $44.95 , See APC Packaged Rates , See APC Packaged Rates , $24.75 , $24.75 , $25.39 , $25.39 , See APC Packaged Rates , $12.08 , $19.40 , $12.08 , $102.18 , $86.80
86641,5212010706,Hospital Chargemaster,Cryptococcus Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $43.00 , $29.65 , $35.43 , See APC Packaged Rates , $30.10 , $16.77 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $24.52 , $24.52 , $25.15 , $25.15 , See APC Packaged Rates , $11.97 , $19.21 , $11.97 , $77.73 , $30.10
86778,5212010765,Hospital Chargemaster,Toxoplasma Antibody Igm,Outpatient,Outpatient Default Percent / Case Rate,302, $169.00 , $29.65 , $139.26 , See APC Packaged Rates , $118.30 , $65.91 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $34.40 , $33.35 , See APC Packaged Rates , See APC Packaged Rates , $24.50 , $24.50 , $25.13 , $25.13 , See APC Packaged Rates , $11.97 , $19.21 , $11.97 , $139.26 , $118.30
86644,5212010707,Hospital Chargemaster,Cmv Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $52.00 , $29.61 , $42.85 , See APC Packaged Rates , $36.40 , $20.28 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $39.73 , $38.53 , See APC Packaged Rates , See APC Packaged Rates , $24.49 , $24.49 , $25.12 , $25.12 , See APC Packaged Rates , $11.94 , $19.19 , $11.94 , $77.73 , $36.40
86694,5212010729,Hospital Chargemaster,Herpes Simplex Nes Antbdy,Outpatient,Outpatient Default Percent / Case Rate,302, $175.00 , $29.61 , $144.20 , See APC Packaged Rates , $122.50 , $68.25 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $39.73 , $38.53 , See APC Packaged Rates , See APC Packaged Rates , $24.49 , $24.49 , $25.12 , $25.12 , See APC Packaged Rates , $11.94 , $19.19 , $11.94 , $144.20 , $122.50
86762,5212010759,Hospital Chargemaster,Rubella Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $220.00 , $29.61 , $181.28 , See APC Packaged Rates , $154.00 , $85.80 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $39.73 , $38.53 , See APC Packaged Rates , See APC Packaged Rates , $24.49 , $24.49 , $25.12 , $25.12 , See APC Packaged Rates , $11.94 , $19.19 , $11.94 , $181.28 , $154.00
86777,5212010764,Hospital Chargemaster,Toxoplasma Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $127.00 , $29.61 , $104.65 , See APC Packaged Rates , $88.90 , $49.53 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $39.73 , $38.53 , See APC Packaged Rates , See APC Packaged Rates , $24.49 , $24.49 , $25.12 , $25.12 , See APC Packaged Rates , $11.94 , $19.19 , $11.94 , $104.65 , $88.90
86789,5212010770,Hospital Chargemaster,West Nile Virus Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $68.00 , $29.61 , $56.03 , See APC Packaged Rates , $47.60 , $26.52 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $49.42 , $47.92 , See APC Packaged Rates , See APC Packaged Rates , $24.49 , $24.49 , $25.12 , $25.12 , See APC Packaged Rates , $11.94 , $19.19 , $11.94 , $77.73 , $47.60
86803,5212010775,Hospital Chargemaster,Hepatitis C Ab Test,Outpatient,Outpatient Default Percent / Case Rate,302, $116.00 , $32.61 , $95.58 , See APC Packaged Rates , $81.20 , $45.24 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $60.02 , $58.20 , See APC Packaged Rates , See APC Packaged Rates , $24.27 , $24.27 , $24.90 , $24.90 , See APC Packaged Rates , $11.85 , $19.02 , $11.85 , $95.58 , $81.20
86329,5212010651,Hospital Chargemaster,Immunodiffusion Nes,Outpatient,Outpatient Default Percent / Case Rate,302, $110.00 , $28.91 , $90.64 , See APC Packaged Rates , $77.00 , $42.90 , $76.15 , $51.10 , $48.92 , See APC Packaged Rates , See APC Packaged Rates , $47.22 , $45.79 , See APC Packaged Rates , See APC Packaged Rates , $23.90 , $23.90 , $24.52 , $24.52 , See APC Packaged Rates , $11.66 , $18.73 , $11.66 , $90.64 , $77.00
86688,5212010726,Hospital Chargemaster,Htlv-Ii Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $105.00 , $28.82 , $86.52 , See APC Packaged Rates , $73.50 , $40.95 , $76.15 , $51.10 , $48.92 , See APC Packaged Rates , See APC Packaged Rates , $26.98 , $26.16 , See APC Packaged Rates , See APC Packaged Rates , $23.83 , $23.83 , $24.44 , $24.44 , See APC Packaged Rates , $11.62 , $18.67 , $11.62 , $86.52 , $73.50
86225,5212010630,Hospital Chargemaster,Dna Antibody Native,Outpatient,Outpatient Default Percent / Case Rate,302, $67.00 , $28.28 , $55.21 , See APC Packaged Rates , $46.90 , $26.13 , $74.54 , $50.02 , $47.89 , See APC Packaged Rates , See APC Packaged Rates , $48.91 , $47.42 , See APC Packaged Rates , See APC Packaged Rates , $23.38 , $23.38 , $23.98 , $23.98 , See APC Packaged Rates , $11.40 , $18.32 , $11.40 , $74.54 , $46.90
86710,5212010742,Hospital Chargemaster,Influenza Virus Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $71.00 , $27.89 , $58.50 , See APC Packaged Rates , $49.70 , $27.69 , $72.96 , $48.96 , $46.88 , See APC Packaged Rates , See APC Packaged Rates , $25.41 , $24.64 , See APC Packaged Rates , See APC Packaged Rates , $23.06 , $23.06 , $23.65 , $23.65 , See APC Packaged Rates , $11.25 , $18.07 , $11.25 , $72.96 , $49.70
86702,5212010734,Hospital Chargemaster,Hiv-2 Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $138.00 , $27.82 , $113.71 , See APC Packaged Rates , $96.60 , $53.82 , $72.96 , $48.96 , $46.88 , See APC Packaged Rates , See APC Packaged Rates , $28.15 , $27.30 , See APC Packaged Rates , See APC Packaged Rates , $23.00 , $23.00 , $23.59 , $23.59 , See APC Packaged Rates , $11.22 , $18.02 , $11.22 , $113.71 , $96.60
86619,5212010698,Hospital Chargemaster,Borrelia Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $280.00 , $27.52 , $230.72 , See APC Packaged Rates , $196.00 , $109.20 , $72.96 , $48.96 , $46.88 , See APC Packaged Rates , See APC Packaged Rates , $32.83 , $31.83 , See APC Packaged Rates , See APC Packaged Rates , $22.77 , $22.77 , $23.35 , $23.35 , See APC Packaged Rates , $11.11 , $17.83 , $11.11 , $230.72 , $196.00
86215,5212010629,Hospital Chargemaster,Deoxyribonuclease Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $176.00 , $27.26 , $145.02 , See APC Packaged Rates , $123.20 , $68.64 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $36.78 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $22.53 , $22.53 , $23.11 , $23.11 , See APC Packaged Rates , $10.99 , $17.66 , $10.99 , $145.02 , $123.20
86780,5212010766,Hospital Chargemaster,Treponema Pallidum,Outpatient,Outpatient Default Percent / Case Rate,302, $61.00 , $30.26 , $50.26 , See APC Packaged Rates , $42.70 , $23.79 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $43.59 , $42.27 , See APC Packaged Rates , See APC Packaged Rates , $22.52 , $22.52 , $23.10 , $23.10 , See APC Packaged Rates , $10.99 , $17.65 , $10.99 , $71.38 , $42.70
86738,5212010750,Hospital Chargemaster,Mycoplasma Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $150.00 , $27.24 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $25.41 , $24.64 , See APC Packaged Rates , See APC Packaged Rates , $22.52 , $22.52 , $23.10 , $23.10 , See APC Packaged Rates , $10.99 , $17.65 , $10.99 , $123.60 , $105.00
86615,5212010695,Hospital Chargemaster,Bordetella Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $160.00 , $27.13 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $44.34 , $43.00 , See APC Packaged Rates , See APC Packaged Rates , $22.44 , $22.44 , $23.02 , $23.02 , See APC Packaged Rates , $10.94 , $17.58 , $10.94 , $131.84 , $112.00
86651,5212010710,Hospital Chargemaster,Encephalitis Californ Antbdy,Outpatient,Outpatient Default Percent / Case Rate,302, $100.00 , $27.13 , $82.40 , See APC Packaged Rates , $70.00 , $39.00 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $44.34 , $43.00 , See APC Packaged Rates , See APC Packaged Rates , $22.44 , $22.44 , $23.02 , $23.02 , See APC Packaged Rates , $10.94 , $17.58 , $10.94 , $82.40 , $70.00
86652,5212010711,Hospital Chargemaster,Encephaltis East Eqne Anbdy,Outpatient,Outpatient Default Percent / Case Rate,302, $100.00 , $27.13 , $82.40 , See APC Packaged Rates , $70.00 , $39.00 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $44.34 , $43.00 , See APC Packaged Rates , See APC Packaged Rates , $22.44 , $22.44 , $23.02 , $23.02 , See APC Packaged Rates , $10.94 , $17.58 , $10.94 , $82.40 , $70.00
86653,5212010712,Hospital Chargemaster,Encephaltis St Louis Antbody,Outpatient,Outpatient Default Percent / Case Rate,302, $100.00 , $27.13 , $82.40 , See APC Packaged Rates , $70.00 , $39.00 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $44.34 , $43.00 , See APC Packaged Rates , See APC Packaged Rates , $22.44 , $22.44 , $23.02 , $23.02 , See APC Packaged Rates , $10.94 , $17.58 , $10.94 , $82.40 , $70.00
86654,5212010713,Hospital Chargemaster,Encephaltis West Eqne Antbdy,Outpatient,Outpatient Default Percent / Case Rate,302, $100.00 , $27.13 , $82.40 , See APC Packaged Rates , $70.00 , $39.00 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $44.34 , $43.00 , See APC Packaged Rates , See APC Packaged Rates , $22.44 , $22.44 , $23.02 , $23.02 , See APC Packaged Rates , $10.94 , $17.58 , $10.94 , $82.40 , $70.00
86695,5212010730,Hospital Chargemaster,Herpes Simplex Type 1 Test,Outpatient,Outpatient Default Percent / Case Rate,302, $75.00 , $27.13 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $44.34 , $43.00 , See APC Packaged Rates , See APC Packaged Rates , $22.44 , $22.44 , $23.02 , $23.02 , See APC Packaged Rates , $10.94 , $17.58 , $10.94 , $71.38 , $52.50
86723,5212010746,Hospital Chargemaster,Listeria Monocytogenes,Outpatient,Outpatient Default Percent / Case Rate,302, $160.00 , $27.13 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $22.44 , $22.44 , $23.02 , $23.02 , See APC Packaged Rates , $10.94 , $17.58 , $10.94 , $131.84 , $112.00
86768,5212010761,Hospital Chargemaster,Salmonella Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $47.00 , $27.13 , $38.73 , See APC Packaged Rates , $32.90 , $18.33 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $34.40 , $33.35 , See APC Packaged Rates , See APC Packaged Rates , $22.44 , $22.44 , $23.02 , $23.02 , See APC Packaged Rates , $10.94 , $17.58 , $10.94 , $71.38 , $32.90
86793,5212010772,Hospital Chargemaster,Yersinia Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $130.00 , $27.13 , $107.12 , See APC Packaged Rates , $91.00 , $50.70 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $22.44 , $22.44 , $23.02 , $23.02 , See APC Packaged Rates , $10.94 , $17.58 , $10.94 , $107.12 , $91.00
86668,5212010719,Hospital Chargemaster,Francisella Tularensis,Outpatient,Outpatient Default Percent / Case Rate,302, $101.00 , $26.22 , $83.22 , See APC Packaged Rates , $70.70 , $39.39 , $61.86 , $41.51 , $39.74 , See APC Packaged Rates , See APC Packaged Rates , $24.62 , $23.87 , See APC Packaged Rates , See APC Packaged Rates , $22.41 , $22.41 , $22.99 , $22.99 , See APC Packaged Rates , $11.75 , $16.99 , $11.75 , $83.22 , $70.70
86625,5212010700,Hospital Chargemaster,Campylobacter Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $147.00 , $27.00 , $121.13 , See APC Packaged Rates , $102.90 , $57.33 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $22.32 , $22.32 , $22.89 , $22.89 , See APC Packaged Rates , $10.89 , $17.50 , $10.89 , $121.13 , $102.90
86663,5212010715,Hospital Chargemaster,Epstein-Barr Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $101.00 , $27.00 , $83.22 , See APC Packaged Rates , $70.70 , $39.39 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $44.11 , $42.77 , See APC Packaged Rates , See APC Packaged Rates , $22.32 , $22.32 , $22.89 , $22.89 , See APC Packaged Rates , $10.89 , $17.50 , $10.89 , $83.22 , $70.70
86735,5212010749,Hospital Chargemaster,Mumps Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $100.00 , $26.85 , $82.40 , See APC Packaged Rates , $70.00 , $39.00 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $43.88 , $42.54 , See APC Packaged Rates , See APC Packaged Rates , $22.20 , $22.20 , $22.77 , $22.77 , See APC Packaged Rates , $10.83 , $17.40 , $10.83 , $82.40 , $70.00
86658,5212010714,Hospital Chargemaster,Enterovirus Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $371.00 , $26.80 , $305.70 , See APC Packaged Rates , $259.70 , $144.69 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $35.10 , $34.04 , See APC Packaged Rates , See APC Packaged Rates , $22.17 , $22.17 , $22.74 , $22.74 , See APC Packaged Rates , $10.81 , $17.36 , $10.81 , $305.70 , $259.70
86682,5212010723,Hospital Chargemaster,Helminth Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $190.00 , $26.76 , $156.56 , See APC Packaged Rates , $133.00 , $74.10 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $22.13 , $22.13 , $22.70 , $22.70 , See APC Packaged Rates , $10.80 , $17.34 , $10.80 , $156.56 , $133.00
86141,5212010615,Hospital Chargemaster,C-Reactive Protein Hs,Outpatient,Outpatient Default Percent / Case Rate,302, $60.00 , $26.65 , $49.44 , See APC Packaged Rates , $42.00 , $23.40 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $43.95 , $42.61 , See APC Packaged Rates , See APC Packaged Rates , $22.03 , $22.03 , $22.59 , $22.59 , See APC Packaged Rates , $10.75 , $17.27 , $10.75 , $69.78 , $42.00
86200,5212010628,Hospital Chargemaster,Ccp Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $90.00 , $26.65 , $74.16 , See APC Packaged Rates , $63.00 , $35.10 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $44.44 , $43.09 , See APC Packaged Rates , See APC Packaged Rates , $22.03 , $22.03 , $22.59 , $22.59 , See APC Packaged Rates , $10.75 , $17.27 , $10.75 , $74.16 , $63.00
86612,5212010694,Hospital Chargemaster,Blastomyces Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $60.00 , $26.56 , $49.44 , See APC Packaged Rates , $42.00 , $23.40 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $43.38 , $42.07 , See APC Packaged Rates , See APC Packaged Rates , $21.95 , $21.95 , $22.52 , $22.52 , See APC Packaged Rates , $10.71 , $17.21 , $10.71 , $69.78 , $42.00
86609,5212010692,Hospital Chargemaster,Bacterium Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $228.00 , $26.50 , $187.87 , See APC Packaged Rates , $159.60 , $88.92 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $21.92 , $21.92 , $22.48 , $22.48 , See APC Packaged Rates , $10.69 , $17.17 , $10.69 , $187.87 , $159.60
86765,5212010760,Hospital Chargemaster,Rubeola Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $130.00 , $26.50 , $107.12 , See APC Packaged Rates , $91.00 , $50.70 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $34.40 , $33.35 , See APC Packaged Rates , See APC Packaged Rates , $21.92 , $21.92 , $22.48 , $22.48 , See APC Packaged Rates , $10.69 , $17.17 , $10.69 , $107.12 , $91.00
86787,5212010768,Hospital Chargemaster,Varicella-Zoster Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $135.00 , $26.50 , $111.24 , See APC Packaged Rates , $94.50 , $52.65 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $43.36 , $42.04 , See APC Packaged Rates , See APC Packaged Rates , $21.92 , $21.92 , $22.48 , $22.48 , See APC Packaged Rates , $10.69 , $17.17 , $10.69 , $111.24 , $94.50
86790,5212010771,Hospital Chargemaster,Virus Antibody Nos,Outpatient,Outpatient Default Percent / Case Rate,302, $114.00 , $26.50 , $93.94 , See APC Packaged Rates , $79.80 , $44.46 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $21.92 , $21.92 , $22.48 , $22.48 , See APC Packaged Rates , $10.69 , $17.17 , $10.69 , $93.94 , $79.80
86603,5212010690,Hospital Chargemaster,Adenovirus Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $164.00 , $26.48 , $135.14 , See APC Packaged Rates , $114.80 , $63.96 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $35.10 , $34.04 , See APC Packaged Rates , See APC Packaged Rates , $21.90 , $21.90 , $22.47 , $22.47 , See APC Packaged Rates , $10.69 , $17.16 , $10.69 , $135.14 , $114.80
86727,5212010747,Hospital Chargemaster,Lymph Choriomeningitis Ab,Outpatient,Outpatient Default Percent / Case Rate,302, $193.00 , $26.48 , $159.03 , See APC Packaged Rates , $135.10 , $75.27 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $35.10 , $34.04 , See APC Packaged Rates , See APC Packaged Rates , $21.90 , $21.90 , $22.47 , $22.47 , See APC Packaged Rates , $10.69 , $17.16 , $10.69 , $159.03 , $135.10
86698,5212010732,Hospital Chargemaster,Histoplasma Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $75.00 , $25.71 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $68.20 , $45.76 , $43.82 , See APC Packaged Rates , See APC Packaged Rates , $42.05 , $40.77 , See APC Packaged Rates , See APC Packaged Rates , $21.83 , $21.83 , $22.39 , $22.39 , See APC Packaged Rates , $11.44 , $16.66 , $11.44 , $68.20 , $52.50
86632,5212010703,Hospital Chargemaster,Chlamydia Igm Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $164.00 , $26.09 , $135.14 , See APC Packaged Rates , $114.80 , $63.96 , $68.20 , $45.76 , $43.82 , See APC Packaged Rates , See APC Packaged Rates , $42.71 , $41.41 , See APC Packaged Rates , See APC Packaged Rates , $21.58 , $21.58 , $22.14 , $22.14 , See APC Packaged Rates , $10.52 , $16.91 , $10.52 , $135.14 , $114.80
86384,5212010673,Hospital Chargemaster,Nitroblue Tetrazolium Dye,Outpatient,Outpatient Default Percent / Case Rate,302, $141.00 , $25.21 , $116.18 , See APC Packaged Rates , $98.70 , $54.99 , $61.86 , $41.51 , $39.74 , See APC Packaged Rates , See APC Packaged Rates , $29.39 , $28.50 , See APC Packaged Rates , See APC Packaged Rates , $21.55 , $21.55 , $22.10 , $22.10 , See APC Packaged Rates , $11.30 , $16.33 , $11.30 , $116.18 , $98.70
86784,5212010767,Hospital Chargemaster,Trichinella Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $190.00 , $25.85 , $156.56 , See APC Packaged Rates , $133.00 , $74.10 , $68.20 , $45.76 , $43.82 , See APC Packaged Rates , See APC Packaged Rates , $42.26 , $40.98 , See APC Packaged Rates , See APC Packaged Rates , $21.38 , $21.38 , $21.93 , $21.93 , See APC Packaged Rates , $10.42 , $16.75 , $10.42 , $156.56 , $133.00
86343,5212010660,Hospital Chargemaster,Leukocyte Histamine Release,Outpatient,Outpatient Default Percent / Case Rate,302, $150.00 , $25.63 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 , $68.20 , $45.76 , $43.82 , See APC Packaged Rates , See APC Packaged Rates , $41.91 , $40.64 , See APC Packaged Rates , See APC Packaged Rates , $21.20 , $21.20 , $21.74 , $21.74 , See APC Packaged Rates , $10.34 , $16.61 , $10.34 , $123.60 , $105.00
86023,5212010780,Hospital Chargemaster,Immunoglobulin Assay,Outpatient,Outpatient Default Percent / Case Rate,302, $108.00 , $25.63 , $88.99 , See APC Packaged Rates , $75.60 , $42.12 , $68.20 , $45.76 , $43.82 , See APC Packaged Rates , See APC Packaged Rates , $41.89 , $40.62 , See APC Packaged Rates , See APC Packaged Rates , $21.20 , $21.20 , $21.74 , $21.74 , See APC Packaged Rates , $10.34 , $16.61 , $10.34 , $88.99 , $75.60
86708,5212010740,Hospital Chargemaster,Hepatitis A Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $72.00 , $25.48 , $59.33 , See APC Packaged Rates , $50.40 , $28.08 , $66.62 , $44.70 , $42.80 , See APC Packaged Rates , See APC Packaged Rates , $52.09 , $50.51 , See APC Packaged Rates , See APC Packaged Rates , $21.07 , $21.07 , $21.62 , $21.62 , See APC Packaged Rates , $10.28 , $16.51 , $10.28 , $66.62 , $50.40
86753,5212010755,Hospital Chargemaster,Protozoa Antibody Nos,Outpatient,Outpatient Default Percent / Case Rate,302, $130.00 , $25.48 , $107.12 , See APC Packaged Rates , $91.00 , $50.70 , $66.62 , $44.70 , $42.80 , See APC Packaged Rates , See APC Packaged Rates , $24.24 , $23.51 , See APC Packaged Rates , See APC Packaged Rates , $21.07 , $21.07 , $21.62 , $21.62 , See APC Packaged Rates , $10.28 , $16.51 , $10.28 , $107.12 , $91.00
86671,5212010720,Hospital Chargemaster,Fungus Nes Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $78.00 , $25.22 , $64.27 , See APC Packaged Rates , $54.60 , $30.42 , $66.62 , $44.70 , $42.80 , See APC Packaged Rates , See APC Packaged Rates , $32.83 , $31.83 , See APC Packaged Rates , See APC Packaged Rates , $20.86 , $20.86 , $21.39 , $21.39 , See APC Packaged Rates , $10.16 , $16.34 , $10.16 , $66.62 , $54.60
86717,5212010744,Hospital Chargemaster,Leishmania Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $37.00 , $25.21 , $30.49 , See APC Packaged Rates , $25.90 , $14.43 , $66.62 , $44.70 , $42.80 , See APC Packaged Rates , See APC Packaged Rates , $24.24 , $23.51 , See APC Packaged Rates , See APC Packaged Rates , $20.84 , $20.84 , $21.38 , $21.38 , See APC Packaged Rates , $10.16 , $16.33 , $10.16 , $66.62 , $25.90
86638,5212010705,Hospital Chargemaster,Q Fever Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $56.00 , $24.95 , $46.14 , See APC Packaged Rates , $39.20 , $21.84 , $66.62 , $44.70 , $42.80 , See APC Packaged Rates , See APC Packaged Rates , $40.76 , $39.53 , See APC Packaged Rates , See APC Packaged Rates , $20.63 , $20.63 , $21.16 , $21.16 , See APC Packaged Rates , $10.06 , $16.16 , $10.06 , $66.62 , $39.20
86226,5212010631,Hospital Chargemaster,Dna Antibody Single Strand,Outpatient,Outpatient Default Percent / Case Rate,302, $235.00 , $24.91 , $193.64 , See APC Packaged Rates , $164.50 , $91.65 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $28.90 , $28.02 , See APC Packaged Rates , See APC Packaged Rates , $20.60 , $20.60 , $21.13 , $21.13 , See APC Packaged Rates , $10.05 , $16.14 , $10.05 , $193.64 , $164.50
86038,5212010781,Hospital Chargemaster,Antinuclear Antibodies,Outpatient,Outpatient Default Percent / Case Rate,302, $61.00 , $24.87 , $50.26 , See APC Packaged Rates , $42.70 , $23.79 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $36.60 , $35.49 , See APC Packaged Rates , See APC Packaged Rates , $20.57 , $20.57 , $21.10 , $21.10 , See APC Packaged Rates , $10.03 , $16.12 , $10.03 , $65.04 , $42.70
86704,5212010736,Hospital Chargemaster,HEp B Core Antibody Total,Outpatient,Outpatient Default Percent / Case Rate,302, $70.00 , $24.80 , $57.68 , See APC Packaged Rates , $49.00 , $27.30 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $50.68 , $49.15 , See APC Packaged Rates , See APC Packaged Rates , $20.50 , $20.50 , $21.03 , $21.03 , See APC Packaged Rates , $10.00 , $16.07 , $10.00 , $65.04 , $49.00
86255,5212010633,Hospital Chargemaster,Fluorescent Antibody Screen,Outpatient,Outpatient Default Percent / Case Rate,302, $52.00 , $24.80 , $42.85 , See APC Packaged Rates , $36.40 , $20.28 , $84.12 , $56.45 , $54.05 , See APC Packaged Rates , See APC Packaged Rates , $21.97 , $21.31 , See APC Packaged Rates , See APC Packaged Rates , $20.50 , $20.50 , $21.03 , $21.03 , See APC Packaged Rates , $10.00 , $16.07 , $10.00 , $84.12 , $36.40
86256,5212010634,Hospital Chargemaster,Fluorescent Antibody Titer,Outpatient,Outpatient Default Percent / Case Rate,302, $89.00 , $24.80 , $73.34 , See APC Packaged Rates , $62.30 , $34.71 , $84.12 , $56.45 , $54.05 , See APC Packaged Rates , See APC Packaged Rates , $25.41 , $24.64 , See APC Packaged Rates , See APC Packaged Rates , $20.50 , $20.50 , $21.03 , $21.03 , See APC Packaged Rates , $10.00 , $16.07 , $10.00 , $84.12 , $62.30
86628,5212010701,Hospital Chargemaster,Candida Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $239.00 , $24.71 , $196.94 , See APC Packaged Rates , $167.30 , $93.21 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $20.43 , $20.43 , $20.95 , $20.95 , See APC Packaged Rates , $9.98 , $16.01 , $9.98 , $196.94 , $167.30
86160,5212010624,Hospital Chargemaster,Complement Antigen,Outpatient,Outpatient Default Percent / Case Rate,302, $98.00 , $24.69 , $80.75 , See APC Packaged Rates , $68.60 , $38.22 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $39.87 , $38.66 , See APC Packaged Rates , See APC Packaged Rates , $20.41 , $20.41 , $20.94 , $20.94 , See APC Packaged Rates , $9.96 , $16.00 , $9.96 , $80.75 , $68.60
86161,5212010625,Hospital Chargemaster,Complement/Function Activity,Outpatient,Outpatient Default Percent / Case Rate,302, $105.00 , $24.69 , $86.52 , See APC Packaged Rates , $73.50 , $40.95 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $39.87 , $38.66 , See APC Packaged Rates , See APC Packaged Rates , $20.41 , $20.41 , $20.94 , $20.94 , See APC Packaged Rates , $9.96 , $16.00 , $9.96 , $86.52 , $73.50
86331,5212010652,Hospital Chargemaster,Immunodiffusion Ouchterlony,Outpatient,Outpatient Default Percent / Case Rate,302, $94.00 , $24.65 , $77.46 , See APC Packaged Rates , $65.80 , $36.66 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $20.38 , $20.38 , $20.91 , $20.91 , See APC Packaged Rates , $9.94 , $15.97 , $9.94 , $77.46 , $65.80
86631,5212010702,Hospital Chargemaster,Chlamydia Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $164.00 , $24.34 , $135.14 , See APC Packaged Rates , $114.80 , $63.96 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $20.12 , $20.12 , $20.64 , $20.64 , See APC Packaged Rates , $9.81 , $15.77 , $9.81 , $135.14 , $114.80
86705,5212010737,Hospital Chargemaster,Hep B Core Antibody Igm,Outpatient,Outpatient Default Percent / Case Rate,302, $68.00 , $24.22 , $56.03 , See APC Packaged Rates , $47.60 , $26.52 , $63.44 , $42.57 , $40.76 , See APC Packaged Rates , See APC Packaged Rates , $49.49 , $47.99 , See APC Packaged Rates , See APC Packaged Rates , $20.03 , $20.03 , $20.54 , $20.54 , See APC Packaged Rates , $9.76 , $15.70 , $9.76 , $63.44 , $47.60
86707,5212010739,Hospital Chargemaster,Hepatitis Be Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $91.00 , $23.80 , $74.98 , See APC Packaged Rates , $63.70 , $35.49 , $63.44 , $42.57 , $40.76 , See APC Packaged Rates , See APC Packaged Rates , $48.60 , $47.13 , See APC Packaged Rates , See APC Packaged Rates , $19.67 , $19.67 , $20.18 , $20.18 , See APC Packaged Rates , $9.61 , $15.42 , $9.61 , $74.98 , $63.70
86635,5212010704,Hospital Chargemaster,Coccidioides Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $96.00 , $23.61 , $79.10 , See APC Packaged Rates , $67.20 , $37.44 , $61.86 , $41.51 , $39.74 , See APC Packaged Rates , See APC Packaged Rates , $38.56 , $37.39 , See APC Packaged Rates , See APC Packaged Rates , $19.52 , $19.52 , $20.02 , $20.02 , See APC Packaged Rates , $9.53 , $15.30 , $9.53 , $79.10 , $67.20
86709,5212010741,Hospital Chargemaster,Hepatitis A Igm Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $118.00 , $23.17 , $97.23 , See APC Packaged Rates , $82.60 , $46.02 , $61.86 , $41.51 , $39.74 , See APC Packaged Rates , See APC Packaged Rates , $47.31 , $45.88 , See APC Packaged Rates , See APC Packaged Rates , $19.15 , $19.15 , $19.64 , $19.64 , See APC Packaged Rates , $9.35 , $15.01 , $9.35 , $97.23 , $82.60
86039,5212010782,Hospital Chargemaster,Antinuclear Antibodies (Ana),Outpatient,Outpatient Default Percent / Case Rate,302, $128.00 , $22.96 , $105.47 , See APC Packaged Rates , $89.60 , $49.92 , $60.28 , $40.45 , $38.73 , See APC Packaged Rates , See APC Packaged Rates , $40.46 , $39.23 , See APC Packaged Rates , See APC Packaged Rates , $19.00 , $19.00 , $19.49 , $19.49 , See APC Packaged Rates , $9.25 , $14.88 , $9.25 , $105.47 , $89.60
86403,5212010675,Hospital Chargemaster,Particle Agglut Antbdy Scrn,Outpatient,Outpatient Default Percent / Case Rate,302, $74.00 , $21.37 , $60.98 , See APC Packaged Rates , $51.80 , $28.86 , $55.52 , $37.25 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $34.26 , $33.22 , See APC Packaged Rates , See APC Packaged Rates , $18.27 , $18.27 , $18.74 , $18.74 , See APC Packaged Rates , $9.58 , $13.85 , $9.58 , $60.98 , $51.80
86706,5212010738,Hospital Chargemaster,Hep B Surface Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $69.00 , $22.09 , $56.86 , See APC Packaged Rates , $48.30 , $26.91 , $58.68 , $39.37 , $37.70 , See APC Packaged Rates , See APC Packaged Rates , $45.14 , $43.77 , See APC Packaged Rates , See APC Packaged Rates , $18.27 , $18.27 , $18.74 , $18.74 , See APC Packaged Rates , $8.92 , $14.32 , $8.92 , $58.68 , $48.30
86406,5212010676,Hospital Chargemaster,Particle Agglut Antbdy Titr,Outpatient,Outpatient Default Percent / Case Rate,302, $35.00 , $21.89 , $28.84 , See APC Packaged Rates , $24.50 , $13.65 , $57.10 , $38.31 , $36.68 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $18.10 , $18.10 , $18.57 , $18.57 , See APC Packaged Rates , $8.84 , $14.18 , $8.84 , $57.10 , $24.50
86602,5212010689,Hospital Chargemaster,Antinomyces Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $60.00 , $20.95 , $49.44 , See APC Packaged Rates , $42.00 , $23.40 , $55.52 , $37.25 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $19.94 , $19.33 , See APC Packaged Rates , See APC Packaged Rates , $17.32 , $17.32 , $17.77 , $17.77 , See APC Packaged Rates , $8.45 , $13.57 , $8.45 , $55.52 , $42.00
86611,5212010693,Hospital Chargemaster,Bartonella Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $30.00 , $20.95 , $24.72 , See APC Packaged Rates , $21.00 , $11.70 , $55.52 , $37.25 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $33.13 , $32.13 , See APC Packaged Rates , See APC Packaged Rates , $17.32 , $17.32 , $17.77 , $17.77 , See APC Packaged Rates , $8.45 , $13.57 , $8.45 , $55.52 , $21.00
86666,5212010718,Hospital Chargemaster,Ehrlichia Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $90.00 , $20.95 , $74.16 , See APC Packaged Rates , $63.00 , $35.10 , $55.52 , $37.25 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $33.13 , $32.13 , See APC Packaged Rates , See APC Packaged Rates , $17.32 , $17.32 , $17.77 , $17.77 , See APC Packaged Rates , $8.45 , $13.57 , $8.45 , $74.16 , $63.00
86171,5212010627,Hospital Chargemaster,Complement Fixation Each,Outpatient,Outpatient Default Percent / Case Rate,302, $544.00 , $20.59 , $448.26 , See APC Packaged Rates , $380.80 , $212.16 , $53.94 , $36.19 , $34.65 , See APC Packaged Rates , See APC Packaged Rates , $29.27 , $28.39 , See APC Packaged Rates , See APC Packaged Rates , $17.03 , $17.03 , $17.47 , $17.47 , See APC Packaged Rates , $8.32 , $13.34 , $8.32 , $448.26 , $380.80
86344,5212010661,Hospital Chargemaster,Leukocyte Phagocytosis,Outpatient,Outpatient Default Percent / Case Rate,302, $32.00 , $19.24 , $26.37 , See APC Packaged Rates , $22.40 , $12.48 , $45.99 , $30.86 , $29.55 , See APC Packaged Rates , See APC Packaged Rates , $23.42 , $22.71 , See APC Packaged Rates , See APC Packaged Rates , $16.44 , $16.44 , $16.87 , $16.87 , See APC Packaged Rates , $8.62 , $12.47 , $8.62 , $45.99 , $22.40
86622,5212010699,Hospital Chargemaster,Brucella Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $92.00 , $18.37 , $75.81 , See APC Packaged Rates , $64.40 , $35.88 , $49.18 , $33.00 , $31.60 , See APC Packaged Rates , See APC Packaged Rates , $29.23 , $28.34 , See APC Packaged Rates , See APC Packaged Rates , $15.20 , $15.20 , $15.59 , $15.59 , See APC Packaged Rates , $7.40 , $11.90 , $7.40 , $75.81 , $64.40
86701,5212010733,Hospital Chargemaster,Hiv-1Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $91.00 , $20.32 , $74.98 , See APC Packaged Rates , $63.70 , $35.49 , $47.57 , $31.92 , $30.56 , See APC Packaged Rates , See APC Packaged Rates , $28.17 , $27.32 , See APC Packaged Rates , See APC Packaged Rates , $15.12 , $15.12 , $15.51 , $15.51 , See APC Packaged Rates , $7.38 , $11.84 , $7.38 , $74.98 , $63.70
86687,5212010725,Hospital Chargemaster,Htlv-I Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $91.00 , $17.26 , $74.98 , See APC Packaged Rates , $63.70 , $35.49 , $45.99 , $30.86 , $29.55 , See APC Packaged Rates , See APC Packaged Rates , $28.15 , $27.30 , See APC Packaged Rates , See APC Packaged Rates , $14.55 , $14.55 , $14.93 , $14.93 , See APC Packaged Rates , $7.55 , $11.18 , $7.55 , $74.98 , $63.70
86280,5212010636,Hospital Chargemaster,Hemagglutination Inhibition,Outpatient,Outpatient Default Percent / Case Rate,302, $160.00 , $16.85 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $44.41 , $29.80 , $28.54 , See APC Packaged Rates , See APC Packaged Rates , $27.54 , $26.71 , See APC Packaged Rates , See APC Packaged Rates , $13.94 , $13.94 , $14.29 , $14.29 , See APC Packaged Rates , $6.79 , $10.92 , $6.79 , $131.84 , $112.00
86157,5212010623,Hospital Chargemaster,Cold Agglutinin Titer,Outpatient,Outpatient Default Percent / Case Rate,302, $36.00 , $16.59 , $29.66 , See APC Packaged Rates , $25.20 , $14.04 , $44.41 , $29.80 , $28.54 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $13.72 , $13.72 , $14.07 , $14.07 , See APC Packaged Rates , $6.69 , $10.75 , $6.69 , $44.41 , $25.20
86156,5212010622,Hospital Chargemaster,Cold Agglutinin Screen,Outpatient,Outpatient Default Percent / Case Rate,302, $30.00 , $14.95 , $24.72 , See APC Packaged Rates , $21.00 , $11.70 , $36.50 , $24.49 , $23.45 , See APC Packaged Rates , See APC Packaged Rates , $18.37 , $17.81 , See APC Packaged Rates , See APC Packaged Rates , $12.78 , $12.78 , $13.11 , $13.11 , See APC Packaged Rates , $6.70 , $9.68 , $6.70 , $36.50 , $21.00
86309,5212010643,Hospital Chargemaster,Heterophile Antibody Titer,Outpatient,Outpatient Default Percent / Case Rate,302, $28.00 , $13.30 , $23.07 , See APC Packaged Rates , $19.60 , $10.92 , $34.89 , $23.41 , $22.42 , See APC Packaged Rates , See APC Packaged Rates , $20.71 , $20.08 , See APC Packaged Rates , See APC Packaged Rates , $11.00 , $11.00 , $11.28 , $11.28 , See APC Packaged Rates , $5.38 , $8.62 , $5.38 , $34.89 , $19.60
86430,5212010677,Hospital Chargemaster,Rheumatoid Factor Test Qual,Outpatient,Outpatient Default Percent / Case Rate,302, $43.00 , $11.67 , $35.43 , See APC Packaged Rates , $30.10 , $16.77 , $30.13 , $20.22 , $19.36 , See APC Packaged Rates , See APC Packaged Rates , $15.75 , $15.27 , See APC Packaged Rates , See APC Packaged Rates , $9.83 , $9.83 , $10.08 , $10.08 , See APC Packaged Rates , $5.10 , $7.56 , $5.10 , $35.43 , $30.10
86431,5212010678,Hospital Chargemaster,Rheumatoid Factor Quant,Outpatient,Outpatient Default Percent / Case Rate,302, $81.00 , $11.67 , $66.74 , See APC Packaged Rates , $56.70 , $31.59 , $30.13 , $20.22 , $19.36 , See APC Packaged Rates , See APC Packaged Rates , $15.75 , $15.27 , See APC Packaged Rates , See APC Packaged Rates , $9.64 , $9.64 , $9.89 , $9.89 , See APC Packaged Rates , $4.71 , $7.56 , $4.71 , $66.74 , $56.70
86003,5212010777,Hospital Chargemaster,Allg Spec Ige Crude Xtrc Ea,Outpatient,Outpatient Default Percent / Case Rate,302, $44.00 , $10.74 , $36.26 , See APC Packaged Rates , $30.80 , $17.16 , $28.55 , $19.16 , $18.34 , See APC Packaged Rates , See APC Packaged Rates , $12.17 , $11.80 , See APC Packaged Rates , See APC Packaged Rates , $8.88 , $8.88 , $9.10 , $9.10 , See APC Packaged Rates , $4.33 , $6.96 , $4.33 , $36.26 , $30.80
86308,5212010642,Hospital Chargemaster,Heterophile Antibody Screen,Outpatient,Outpatient Default Percent / Case Rate,302, $142.00 , $11.83 , $117.01 , See APC Packaged Rates , $99.40 , $55.38 , $28.55 , $19.16 , $18.34 , See APC Packaged Rates , See APC Packaged Rates , $16.15 , $15.66 , See APC Packaged Rates , See APC Packaged Rates , $8.81 , $8.81 , $9.04 , $9.04 , See APC Packaged Rates , $4.31 , $6.90 , $4.31 , $117.01 , $99.40
86140,5212010614,Hospital Chargemaster,C-Reactive Protein,Outpatient,Outpatient Default Percent / Case Rate,302, $44.00 , $10.65 , $36.26 , See APC Packaged Rates , $30.80 , $17.16 , $28.55 , $19.16 , $18.34 , See APC Packaged Rates , See APC Packaged Rates , $14.53 , $14.09 , See APC Packaged Rates , See APC Packaged Rates , $8.81 , $8.81 , $9.04 , $9.04 , See APC Packaged Rates , $4.31 , $6.90 , $4.31 , $36.26 , $30.80
86593,5212010688,Hospital Chargemaster,Syphilis Test Non-Trep Quant,Outpatient,Outpatient Default Percent / Case Rate,302, $24.00 , $9.06 , $19.78 , See APC Packaged Rates , $16.80 , $9.36 , $23.79 , $15.96 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $17.25 , $16.72 , See APC Packaged Rates , See APC Packaged Rates , $7.49 , $7.49 , $7.68 , $7.68 , See APC Packaged Rates , $3.65 , $5.87 , $3.65 , $23.79 , $16.80
86592,5212010687,Hospital Chargemaster,Syphilis Test Non-Trep Qual,Outpatient,Outpatient Default Percent / Case Rate,302, $40.00 , $8.80 , $32.96 , See APC Packaged Rates , $28.00 , $15.60 , $23.79 , $15.96 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $12.10 , $11.73 , See APC Packaged Rates , See APC Packaged Rates , $7.26 , $7.26 , $7.45 , $7.45 , See APC Packaged Rates , $3.55 , $5.70 , $3.55 , $32.96 , $28.00
86849,5212010785,Hospital Chargemaster,Immunology Procedure,Outpatient,Outpatient Default Percent / Case Rate,302, $738.00 , $405.90 , $608.11 , See APC Packaged Rates , $516.60 , $287.82 , $712.10 , $715.20 , $380.08 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $686.34 , $686.34 , $686.34 , $686.34 , See APC Packaged Rates , $29.36 , $- , $- , $715.20 , $516.60
86769,5212010796,Hospital Chargemaster,Sars-Cov-2-Covid-19 Antibody,Outpatient,Outpatient Default Percent / Case Rate,302, $120.00 , $66.00 , $98.88 , See APC Packaged Rates , $84.00 , $46.80 , $115.79 , $116.29 , $61.80 , See APC Packaged Rates , See APC Packaged Rates , $98.58 , $95.59 , See APC Packaged Rates , See APC Packaged Rates , $58.10 , $58.10 , $62.28 , $62.28 , See APC Packaged Rates , $42.00 , $50.56 , $42.00 , $116.29 , $84.00
86008,5212010800,Hospital Chargemaster,Allg Spec Ige Recomb Ea,Outpatient,Outpatient Default Percent / Case Rate,302, $44.00 , $36.91 , $36.26 , See APC Packaged Rates , $30.80 , $17.16 , $96.75 , $64.92 , $62.16 , See APC Packaged Rates , See APC Packaged Rates , $54.41 , $52.75 , See APC Packaged Rates , See APC Packaged Rates , $30.52 , $30.52 , $31.30 , $31.30 , See APC Packaged Rates , $14.87 , $23.92 , $14.87 , $96.75 , $30.80
85097,5214010020,Hospital Chargemaster,Bone Marrow Interpretation,Outpatient,Outpatient Default Percent / Case Rate,305, $98.00 ," $1,033.64 ", $80.75 , $783.46 , $68.60 , $38.22 ," $1,767.29 "," $1,185.85 "," $1,135.43 ", $783.46 , $783.46 , $- , $- , $822.63 , $799.13 , $98.00 , $98.00 , $98.00 , $98.00 , $783.46 , $40.84 , $669.74 , $- ," $1,767.29 ", $68.60
85397,5214010063,Hospital Chargemaster,Clotting Funct Activity,Outpatient,Outpatient Default Percent / Case Rate,305, $168.00 , $57.15 , $138.43 , See APC Packaged Rates , $117.60 , $65.52 , $136.40 , $91.53 , $87.63 , See APC Packaged Rates , See APC Packaged Rates , $75.56 , $73.27 , See APC Packaged Rates , See APC Packaged Rates , $48.85 , $48.85 , $50.11 , $50.11 , See APC Packaged Rates , $25.62 , $37.03 , $25.62 , $138.43 , $117.60
85576,5214010083,Hospital Chargemaster,Blood Platelet Aggregation,Outpatient,Outpatient Default Percent / Case Rate,305, $739.00 , $49.12 , $608.94 , See APC Packaged Rates , $517.30 , $288.21 , $84.12 , $56.45 , $54.05 , See APC Packaged Rates , See APC Packaged Rates , $72.26 , $70.07 , See APC Packaged Rates , See APC Packaged Rates , $39.44 , $39.44 , $40.45 , $40.45 , See APC Packaged Rates , $20.67 , $29.89 , $20.67 , $608.94 , $517.30
85245,5214010029,Hospital Chargemaster,Clot Factor Viii Vw Ristoctn,Outpatient,Outpatient Default Percent / Case Rate,305, $106.00 , $47.21 , $87.34 , See APC Packaged Rates , $74.20 , $41.34 , $125.30 , $84.07 , $80.50 , See APC Packaged Rates , See APC Packaged Rates , $77.20 , $74.85 , See APC Packaged Rates , See APC Packaged Rates , $39.02 , $39.02 , $40.03 , $40.03 , See APC Packaged Rates , $19.04 , $30.59 , $19.04 , $125.30 , $74.20
85246,5214010030,Hospital Chargemaster,Clot Factor Viii Vw Antigen,Outpatient,Outpatient Default Percent / Case Rate,305, $112.00 , $47.21 , $92.29 , See APC Packaged Rates , $78.40 , $43.68 , $125.30 , $84.07 , $80.50 , See APC Packaged Rates , See APC Packaged Rates , $77.20 , $74.85 , See APC Packaged Rates , See APC Packaged Rates , $39.02 , $39.02 , $40.03 , $40.03 , See APC Packaged Rates , $19.04 , $30.59 , $19.04 , $125.30 , $78.40
85247,5214010031,Hospital Chargemaster,Clot Factor Viii Multimetric,Outpatient,Outpatient Default Percent / Case Rate,305, $197.00 , $47.21 , $162.33 , See APC Packaged Rates , $137.90 , $76.83 , $125.30 , $84.07 , $80.50 , See APC Packaged Rates , See APC Packaged Rates , $77.20 , $74.85 , See APC Packaged Rates , See APC Packaged Rates , $39.02 , $39.02 , $40.03 , $40.03 , See APC Packaged Rates , $19.04 , $30.59 , $19.04 , $162.33 , $137.90
85280,5214010035,Hospital Chargemaster,Clot Factor Xii Hageman,Outpatient,Outpatient Default Percent / Case Rate,305, $200.00 , $39.82 , $164.80 , See APC Packaged Rates , $140.00 , $78.00 , $104.70 , $70.25 , $67.26 , See APC Packaged Rates , See APC Packaged Rates , $65.08 , $63.10 , See APC Packaged Rates , See APC Packaged Rates , $32.92 , $32.92 , $33.76 , $33.76 , See APC Packaged Rates , $16.07 , $25.80 , $16.07 , $164.80 , $140.00
85250,5214010032,Hospital Chargemaster,Clot Factor Ix Ptc/Chrstmas,Outpatient,Outpatient Default Percent / Case Rate,305, $224.00 , $39.19 , $184.58 , See APC Packaged Rates , $156.80 , $87.36 , $103.09 , $69.17 , $66.23 , See APC Packaged Rates , See APC Packaged Rates , $64.05 , $62.10 , See APC Packaged Rates , See APC Packaged Rates , $32.39 , $32.39 , $33.23 , $33.23 , See APC Packaged Rates , $15.81 , $25.39 , $15.81 , $184.58 , $156.80
85292,5214010038,Hospital Chargemaster,Clot Factor Fletcher Fact,Outpatient,Outpatient Default Percent / Case Rate,305, $88.00 , $38.97 , $72.51 , See APC Packaged Rates , $61.60 , $34.32 , $103.09 , $69.17 , $66.23 , See APC Packaged Rates , See APC Packaged Rates , $63.69 , $61.76 , See APC Packaged Rates , See APC Packaged Rates , $32.21 , $32.21 , $33.04 , $33.04 , See APC Packaged Rates , $15.71 , $25.25 , $15.71 , $103.09 , $61.60
85549,5214010080,Hospital Chargemaster,Muramidase,Outpatient,Outpatient Default Percent / Case Rate,305, $301.00 , $38.58 , $248.02 , See APC Packaged Rates , $210.70 , $117.39 , $101.51 , $68.11 , $65.22 , See APC Packaged Rates , See APC Packaged Rates , $51.22 , $49.67 , See APC Packaged Rates , See APC Packaged Rates , $31.90 , $31.90 , $32.72 , $32.72 , See APC Packaged Rates , $15.56 , $25.00 , $15.56 , $248.02 , $210.70
85597,5214010084,Hospital Chargemaster,Phospholipid Pltlt Neutraliz,Outpatient,Outpatient Default Percent / Case Rate,305, $61.00 , $36.98 , $50.26 , See APC Packaged Rates , $42.70 , $23.79 , $98.35 , $66.00 , $63.19 , See APC Packaged Rates , See APC Packaged Rates , $19.54 , $18.95 , See APC Packaged Rates , See APC Packaged Rates , $30.58 , $30.58 , $31.37 , $31.37 , See APC Packaged Rates , $14.93 , $23.96 , $14.93 , $98.35 , $42.70
85598,5214010085,Hospital Chargemaster,Hexagnal Phosph Pltlt Neutrl,Outpatient,Outpatient Default Percent / Case Rate,305, $61.00 , $36.98 , $50.26 , See APC Packaged Rates , $42.70 , $23.79 , $98.35 , $66.00 , $63.19 , See APC Packaged Rates , See APC Packaged Rates , $16.15 , $15.66 , See APC Packaged Rates , See APC Packaged Rates , $30.58 , $30.58 , $31.37 , $31.37 , See APC Packaged Rates , $14.93 , $23.96 , $14.93 , $98.35 , $42.70
85230,5214010026,Hospital Chargemaster,Clot Factor Vii Proconvertin,Outpatient,Outpatient Default Percent / Case Rate,305, $293.00 , $36.84 , $241.43 , See APC Packaged Rates , $205.10 , $114.27 , $96.75 , $64.92 , $62.16 , See APC Packaged Rates , See APC Packaged Rates , $60.23 , $58.40 , See APC Packaged Rates , See APC Packaged Rates , $30.46 , $30.46 , $31.24 , $31.24 , See APC Packaged Rates , $14.86 , $23.87 , $14.86 , $241.43 , $205.10
85240,5214010027,Hospital Chargemaster,Clot Factor Viii Ahg 1 Stage,Outpatient,Outpatient Default Percent / Case Rate,305, $96.00 , $36.84 , $79.10 , See APC Packaged Rates , $67.20 , $37.44 , $96.75 , $64.92 , $62.16 , See APC Packaged Rates , See APC Packaged Rates , $60.23 , $58.40 , See APC Packaged Rates , See APC Packaged Rates , $30.46 , $30.46 , $31.24 , $31.24 , See APC Packaged Rates , $14.86 , $23.87 , $14.86 , $96.75 , $67.20
85260,5214010033,Hospital Chargemaster,Clot Factor X Stuart-Power,Outpatient,Outpatient Default Percent / Case Rate,305, $266.00 , $36.84 , $219.18 , See APC Packaged Rates , $186.20 , $103.74 , $96.75 , $64.92 , $62.16 , See APC Packaged Rates , See APC Packaged Rates , $60.23 , $58.40 , See APC Packaged Rates , See APC Packaged Rates , $30.46 , $30.46 , $31.24 , $31.24 , See APC Packaged Rates , $14.86 , $23.87 , $14.86 , $219.18 , $186.20
85270,5214010034,Hospital Chargemaster,Clot Factor Xi Pta,Outpatient,Outpatient Default Percent / Case Rate,305, $200.00 , $36.84 , $164.80 , See APC Packaged Rates , $140.00 , $78.00 , $96.75 , $64.92 , $62.16 , See APC Packaged Rates , See APC Packaged Rates , $60.23 , $58.40 , See APC Packaged Rates , See APC Packaged Rates , $30.46 , $30.46 , $31.24 , $31.24 , See APC Packaged Rates , $14.86 , $23.87 , $14.86 , $164.80 , $140.00
85220,5214010025,Hospital Chargemaster,Blooc Clot Factor V Test,Outpatient,Outpatient Default Percent / Case Rate,305, $122.00 , $36.32 , $100.53 , See APC Packaged Rates , $85.40 , $47.58 , $95.17 , $63.86 , $61.14 , See APC Packaged Rates , See APC Packaged Rates , $59.34 , $57.54 , See APC Packaged Rates , See APC Packaged Rates , $30.03 , $30.03 , $30.80 , $30.80 , See APC Packaged Rates , $14.64 , $23.53 , $14.64 , $100.53 , $85.40
85290,5214010036,Hospital Chargemaster,Clot Factor Xiii Fibrin Stab,Outpatient,Outpatient Default Percent / Case Rate,305, $158.00 , $33.61 , $130.19 , See APC Packaged Rates , $110.60 , $61.62 , $88.83 , $59.60 , $57.07 , See APC Packaged Rates , See APC Packaged Rates , $54.94 , $53.28 , See APC Packaged Rates , See APC Packaged Rates , $27.80 , $27.80 , $28.51 , $28.51 , See APC Packaged Rates , $13.56 , $21.78 , $13.56 , $130.19 , $110.60
85306,5214010045,Hospital Chargemaster,Clot Inhibit Prot S Free,Outpatient,Outpatient Default Percent / Case Rate,305, $104.00 , $31.54 , $85.70 , See APC Packaged Rates , $72.80 , $40.56 , $82.49 , $55.35 , $53.00 , See APC Packaged Rates , See APC Packaged Rates , $48.53 , $47.06 , See APC Packaged Rates , See APC Packaged Rates , $26.07 , $26.07 , $26.74 , $26.74 , See APC Packaged Rates , $12.71 , $20.44 , $12.71 , $85.70 , $72.80
85307,5214010046,Hospital Chargemaster,Assay Activated Protein C,Outpatient,Outpatient Default Percent / Case Rate,305, $67.00 , $31.54 , $55.21 , See APC Packaged Rates , $46.90 , $26.13 , $82.49 , $55.35 , $53.00 , See APC Packaged Rates , See APC Packaged Rates , $48.53 , $47.06 , See APC Packaged Rates , See APC Packaged Rates , $26.07 , $26.07 , $26.74 , $26.74 , See APC Packaged Rates , $12.71 , $20.44 , $12.71 , $82.49 , $46.90
85303,5214010043,Hospital Chargemaster,Clot Inhibit Prot C Activity,Outpatient,Outpatient Default Percent / Case Rate,305, $213.00 , $28.47 , $175.51 , See APC Packaged Rates , $149.10 , $83.07 , $74.54 , $50.02 , $47.89 , See APC Packaged Rates , See APC Packaged Rates , $50.47 , $48.94 , See APC Packaged Rates , See APC Packaged Rates , $23.53 , $23.53 , $24.14 , $24.14 , See APC Packaged Rates , $11.49 , $18.44 , $11.49 , $175.51 , $149.10
85520,5214010074,Hospital Chargemaster,Heparin Assay,Outpatient,Outpatient Default Percent / Case Rate,305, $162.00 , $26.95 , $133.49 , See APC Packaged Rates , $113.40 , $63.18 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $44.02 , $42.68 , See APC Packaged Rates , See APC Packaged Rates , $22.27 , $22.27 , $22.85 , $22.85 , See APC Packaged Rates , $10.87 , $17.46 , $10.87 , $133.49 , $113.40
85210,5214010024,Hospital Chargemaster,Clot Factor Ii Prothrom Spec,Outpatient,Outpatient Default Percent / Case Rate,305, $140.00 , $26.72 , $115.36 , See APC Packaged Rates , $98.00 , $54.60 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $43.69 , $42.36 , See APC Packaged Rates , See APC Packaged Rates , $22.09 , $22.09 , $22.66 , $22.66 , See APC Packaged Rates , $10.78 , $17.32 , $10.78 , $115.36 , $98.00
85335,5214010047,Hospital Chargemaster,Factor Inhibitor Test,Outpatient,Outpatient Default Percent / Case Rate,305, $143.00 , $26.48 , $117.83 , See APC Packaged Rates , $100.10 , $55.77 , $69.78 , $46.82 , $44.83 , See APC Packaged Rates , See APC Packaged Rates , $43.31 , $42.00 , See APC Packaged Rates , See APC Packaged Rates , $21.90 , $21.90 , $22.47 , $22.47 , See APC Packaged Rates , $10.69 , $17.16 , $10.69 , $117.83 , $100.10
85302,5214010042,Hospital Chargemaster,Clot Inhibit Prot C Antigen,Outpatient,Outpatient Default Percent / Case Rate,305, $229.00 , $24.72 , $188.70 , See APC Packaged Rates , $160.30 , $89.31 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $50.52 , $48.99 , See APC Packaged Rates , See APC Packaged Rates , $20.44 , $20.44 , $20.97 , $20.97 , See APC Packaged Rates , $9.98 , $16.02 , $9.98 , $188.70 , $160.30
85300,5214010040,Hospital Chargemaster,Antithrombin Iii Activity,Outpatient,Outpatient Default Percent / Case Rate,305, $503.00 , $24.39 , $414.47 , See APC Packaged Rates , $352.10 , $196.17 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $39.85 , $38.64 , See APC Packaged Rates , See APC Packaged Rates , $20.17 , $20.17 , $20.68 , $20.68 , See APC Packaged Rates , $9.83 , $15.80 , $9.83 , $414.47 , $352.10
85810,5214010099,Hospital Chargemaster,Blood Viscosity Examination,Outpatient,Outpatient Default Percent / Case Rate,305, $112.00 , $24.02 , $92.29 , See APC Packaged Rates , $78.40 , $43.68 , $63.44 , $42.57 , $40.76 , See APC Packaged Rates , See APC Packaged Rates , $34.54 , $33.49 , See APC Packaged Rates , See APC Packaged Rates , $19.86 , $19.86 , $20.37 , $20.37 , See APC Packaged Rates , $9.70 , $15.56 , $9.70 , $92.29 , $78.40
85305,5214010044,Hospital Chargemaster,Clot Inhibit Prot S Total,Outpatient,Outpatient Default Percent / Case Rate,305, $319.00 , $23.89 , $262.86 , See APC Packaged Rates , $223.30 , $124.41 , $63.44 , $42.57 , $40.76 , See APC Packaged Rates , See APC Packaged Rates , $48.74 , $47.26 , See APC Packaged Rates , See APC Packaged Rates , $19.75 , $19.75 , $20.26 , $20.26 , See APC Packaged Rates , $9.64 , $15.48 , $9.64 , $262.86 , $223.30
85170,5214010022,Hospital Chargemaster,Blood Clot Retraction,Outpatient,Outpatient Default Percent / Case Rate,305, $19.00 , $30.19 , $15.66 , See APC Packaged Rates , $13.30 , $7.41 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $12.17 , $11.80 , See APC Packaged Rates , See APC Packaged Rates , $19.00 , $19.00 , $19.00 , $19.00 , See APC Packaged Rates , $13.54 , $19.56 , $7.41 , $71.38 , $13.30
85301,5214010041,Hospital Chargemaster,Antithrombin Iii Antigen,Outpatient,Outpatient Default Percent / Case Rate,305, $61.00 , $22.24 , $50.26 , See APC Packaged Rates , $42.70 , $23.79 , $58.68 , $39.37 , $37.70 , See APC Packaged Rates , See APC Packaged Rates , $45.49 , $44.11 , See APC Packaged Rates , See APC Packaged Rates , $18.40 , $18.40 , $18.87 , $18.87 , See APC Packaged Rates , $8.97 , $14.41 , $8.97 , $58.68 , $42.70
85421,5214010068,Hospital Chargemaster,Fibrinolytic Plasminogen,Outpatient,Outpatient Default Percent / Case Rate,305, $164.00 , $20.96 , $135.14 , See APC Packaged Rates , $114.80 , $63.96 , $55.52 , $37.25 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $26.18 , $25.39 , See APC Packaged Rates , See APC Packaged Rates , $17.32 , $17.32 , $17.77 , $17.77 , See APC Packaged Rates , $8.45 , $13.58 , $8.45 , $135.14 , $114.80
85379,5214010057,Hospital Chargemaster,Fibrin Degradation Quant,Outpatient,Outpatient Default Percent / Case Rate,305, $168.00 , $20.95 , $138.43 , See APC Packaged Rates , $117.60 , $65.52 , $55.52 , $37.25 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $25.23 , $24.46 , See APC Packaged Rates , See APC Packaged Rates , $17.32 , $17.32 , $17.77 , $17.77 , See APC Packaged Rates , $8.45 , $13.57 , $8.45 , $138.43 , $117.60
85635,5214010090,Hospital Chargemaster,Reptilase Test,Outpatient,Outpatient Default Percent / Case Rate,305, $67.00 , $20.26 , $55.21 , See APC Packaged Rates , $46.90 , $26.13 , $53.94 , $36.19 , $34.65 , See APC Packaged Rates , See APC Packaged Rates , $33.13 , $32.13 , See APC Packaged Rates , See APC Packaged Rates , $16.75 , $16.75 , $17.18 , $17.18 , See APC Packaged Rates , $8.17 , $13.13 , $8.17 , $55.21 , $46.90
85613,5214010089,Hospital Chargemaster,Russell Viper Venom Diluted,Outpatient,Outpatient Default Percent / Case Rate,305, $59.00 , $19.71 , $48.62 , See APC Packaged Rates , $41.30 , $23.01 , $52.33 , $35.12 , $33.62 , See APC Packaged Rates , See APC Packaged Rates , $19.56 , $18.97 , See APC Packaged Rates , See APC Packaged Rates , $16.30 , $16.30 , $16.72 , $16.72 , See APC Packaged Rates , $7.96 , $12.77 , $7.96 , $52.33 , $41.30
85384,5214010059,Hospital Chargemaster,Fibrinogen Activity,Outpatient,Outpatient Default Percent / Case Rate,305, $61.00 , $18.00 , $50.26 , See APC Packaged Rates , $42.70 , $23.79 , $45.99 , $30.86 , $29.55 , See APC Packaged Rates , See APC Packaged Rates , $32.95 , $31.95 , See APC Packaged Rates , See APC Packaged Rates , $15.38 , $15.38 , $15.78 , $15.78 , See APC Packaged Rates , $8.07 , $11.66 , $8.07 , $50.26 , $42.70
85475,5214010073,Hospital Chargemaster,Hemolysin Acid,Outpatient,Outpatient Default Percent / Case Rate,305, $49.00 , $18.26 , $40.38 , See APC Packaged Rates , $34.30 , $19.11 , $47.57 , $31.92 , $30.56 , See APC Packaged Rates , See APC Packaged Rates , $18.37 , $17.81 , See APC Packaged Rates , See APC Packaged Rates , $15.09 , $15.09 , $15.48 , $15.48 , See APC Packaged Rates , $7.37 , $11.83 , $7.37 , $47.57 , $34.30
85461,5214010072,Hospital Chargemaster,Hemoglobin Fetal,Outpatient,Outpatient Default Percent / Case Rate,305, $58.00 , $17.33 , $47.79 , See APC Packaged Rates , $40.60 , $22.62 , $41.23 , $27.67 , $26.49 , See APC Packaged Rates , See APC Packaged Rates , $22.32 , $21.65 , See APC Packaged Rates , See APC Packaged Rates , $14.81 , $14.81 , $15.19 , $15.19 , See APC Packaged Rates , $7.76 , $11.23 , $7.76 , $47.79 , $40.60
85540,5214010078,Hospital Chargemaster,Wbc Alkaline Phosphatase,Outpatient,Outpatient Default Percent / Case Rate,305, $45.00 , $17.71 , $37.08 , See APC Packaged Rates , $31.50 , $17.55 , $45.99 , $30.86 , $29.55 , See APC Packaged Rates , See APC Packaged Rates , $24.24 , $23.51 , See APC Packaged Rates , See APC Packaged Rates , $14.63 , $14.63 , $15.00 , $15.00 , See APC Packaged Rates , $7.14 , $11.47 , $7.14 , $45.99 , $31.50
85025,5214010009,Hospital Chargemaster,Complete Cbc W/Auto Diff Wbc,Outpatient,Outpatient Default Percent / Case Rate,305, $35.00 , $15.98 , $28.84 , See APC Packaged Rates , $24.50 , $13.65 , $42.84 , $28.74 , $27.52 , See APC Packaged Rates , See APC Packaged Rates , $19.56 , $18.97 , See APC Packaged Rates , See APC Packaged Rates , $13.21 , $13.21 , $13.55 , $13.55 , See APC Packaged Rates , $6.45 , $10.36 , $6.45 , $42.84 , $24.50
85460,5214010071,Hospital Chargemaster,Hemoglobin Fetal,Outpatient,Outpatient Default Percent / Case Rate,305, $41.00 , $15.91 , $33.78 , See APC Packaged Rates , $28.70 , $15.99 , $41.23 , $27.67 , $26.49 , See APC Packaged Rates , See APC Packaged Rates , $19.54 , $18.95 , See APC Packaged Rates , See APC Packaged Rates , $13.15 , $13.15 , $13.49 , $13.49 , See APC Packaged Rates , $6.41 , $10.31 , $6.41 , $41.23 , $28.70
85410,5214010065,Hospital Chargemaster,Fibrinolytic Antiplasmin,Outpatient,Outpatient Default Percent / Case Rate,305, $173.00 , $15.85 , $142.55 , See APC Packaged Rates , $121.10 , $67.47 , $41.23 , $27.67 , $26.49 , See APC Packaged Rates , See APC Packaged Rates , $25.95 , $25.16 , See APC Packaged Rates , See APC Packaged Rates , $13.11 , $13.11 , $13.44 , $13.44 , See APC Packaged Rates , $6.40 , $10.27 , $6.40 , $142.55 , $121.10
85555,5214010081,Hospital Chargemaster,Rbc Osmotic Fragility,Outpatient,Outpatient Default Percent / Case Rate,305, $138.00 , $13.83 , $113.71 , See APC Packaged Rates , $96.60 , $53.82 , $36.50 , $24.49 , $23.45 , See APC Packaged Rates , See APC Packaged Rates , $19.56 , $18.97 , See APC Packaged Rates , See APC Packaged Rates , $11.83 , $11.83 , $12.13 , $12.13 , See APC Packaged Rates , $6.20 , $8.96 , $6.20 , $113.71 , $96.60
85362,5214010053,Hospital Chargemaster,Fibrin Degradation Products,Outpatient,Outpatient Default Percent / Case Rate,305, $36.00 , $14.17 , $29.66 , See APC Packaged Rates , $25.20 , $14.04 , $38.07 , $25.55 , $24.46 , See APC Packaged Rates , See APC Packaged Rates , $19.16 , $18.58 , See APC Packaged Rates , See APC Packaged Rates , $11.72 , $11.72 , $12.02 , $12.02 , See APC Packaged Rates , $5.72 , $9.18 , $5.72 , $38.07 , $25.20
85999,5214010100,Hospital Chargemaster,Hematology Procedure,Outpatient,Outpatient Default Percent / Case Rate,305, $12.00 , $6.60 , $9.89 , See APC Packaged Rates , $8.40 , $4.68 , $11.58 , $11.63 , $6.18 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $11.91 , $11.91 , $12.00 , $12.00 , See APC Packaged Rates , $29.36 , $- , $- , $29.36 , $8.40
85004,5214010002,Hospital Chargemaster,Automated Diff Wbc Count,Outpatient,Outpatient Default Percent / Case Rate,305, $21.00 , $13.30 , $17.30 , See APC Packaged Rates , $14.70 , $8.19 , $34.89 , $23.41 , $22.42 , See APC Packaged Rates , See APC Packaged Rates , $7.68 , $7.44 , See APC Packaged Rates , See APC Packaged Rates , $11.00 , $11.00 , $11.28 , $11.28 , See APC Packaged Rates , $5.38 , $8.62 , $5.38 , $34.89 , $14.70
85027,5214010010,Hospital Chargemaster,Complete Cbc Automated,Outpatient,Outpatient Default Percent / Case Rate,305, $25.00 , $13.30 , $20.60 , See APC Packaged Rates , $17.50 , $9.75 , $34.89 , $23.41 , $22.42 , See APC Packaged Rates , See APC Packaged Rates , $19.49 , $18.90 , See APC Packaged Rates , See APC Packaged Rates , $11.00 , $11.00 , $11.28 , $11.28 , See APC Packaged Rates , $5.38 , $8.62 , $5.38 , $34.89 , $17.50
85732,5214010098,Hospital Chargemaster,Thromboplastin Time Partial,Outpatient,Outpatient Default Percent / Case Rate,305, $96.00 , $13.30 , $79.10 , See APC Packaged Rates , $67.20 , $37.44 , $34.89 , $23.41 , $22.42 , See APC Packaged Rates , See APC Packaged Rates , $19.96 , $19.35 , See APC Packaged Rates , See APC Packaged Rates , $11.00 , $11.00 , $11.28 , $11.28 , See APC Packaged Rates , $5.38 , $8.62 , $5.38 , $79.10 , $67.20
85730,5214010097,Hospital Chargemaster,Thromboplastin Time Partial,Outpatient,Outpatient Default Percent / Case Rate,305, $29.00 , $12.35 , $23.90 , See APC Packaged Rates , $20.30 , $11.31 , $33.31 , $22.35 , $21.40 , See APC Packaged Rates , See APC Packaged Rates , $20.36 , $19.74 , See APC Packaged Rates , See APC Packaged Rates , $10.23 , $10.23 , $10.49 , $10.49 , See APC Packaged Rates , $4.99 , $8.00 , $4.99 , $33.31 , $20.30
85670,5214010094,Hospital Chargemaster,Thrombin Time Plasma,Outpatient,Outpatient Default Percent / Case Rate,305, $63.00 , $11.87 , $51.91 , See APC Packaged Rates , $44.10 , $24.57 , $31.73 , $21.29 , $20.39 , See APC Packaged Rates , See APC Packaged Rates , $19.40 , $18.81 , See APC Packaged Rates , See APC Packaged Rates , $9.81 , $9.81 , $10.07 , $10.07 , See APC Packaged Rates , $4.79 , $7.69 , $4.79 , $51.91 , $44.10
85660,5214010093,Hospital Chargemaster,Rbc Sickle Cell Test,Outpatient,Outpatient Default Percent / Case Rate,305, $78.00 , $11.33 , $64.27 , See APC Packaged Rates , $54.60 , $30.42 , $30.13 , $20.22 , $19.36 , See APC Packaged Rates , See APC Packaged Rates , $17.15 , $16.63 , See APC Packaged Rates , See APC Packaged Rates , $9.37 , $9.37 , $9.61 , $9.61 , See APC Packaged Rates , $4.58 , $7.34 , $4.58 , $64.27 , $54.60
85002,5214010001,Hospital Chargemaster,Bleeding Time Test,Outpatient,Outpatient Default Percent / Case Rate,305, $28.00 , $9.28 , $23.07 , See APC Packaged Rates , $19.60 , $10.92 , $23.79 , $15.96 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $14.06 , $13.64 , See APC Packaged Rates , See APC Packaged Rates , $7.80 , $7.80 , $8.00 , $8.00 , See APC Packaged Rates , $4.00 , $6.01 , $4.00 , $23.79 , $19.60
85049,5214010017,Hospital Chargemaster,Automated Platelet Count,Outpatient,Outpatient Default Percent / Case Rate,305, $20.00 , $9.20 , $16.48 , See APC Packaged Rates , $14.00 , $7.80 , $23.79 , $15.96 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $14.72 , $14.27 , See APC Packaged Rates , See APC Packaged Rates , $7.61 , $7.61 , $7.81 , $7.81 , See APC Packaged Rates , $3.72 , $5.96 , $3.72 , $23.79 , $14.00
85348,5214010051,Hospital Chargemaster,Coagulation Time Otr Method,Outpatient,Outpatient Default Percent / Case Rate,305, $200.00 , $8.32 , $164.80 , See APC Packaged Rates , $140.00 , $78.00 , $20.63 , $13.84 , $13.25 , See APC Packaged Rates , See APC Packaged Rates , $8.21 , $7.96 , See APC Packaged Rates , See APC Packaged Rates , $7.11 , $7.11 , $7.29 , $7.29 , See APC Packaged Rates , $3.73 , $5.39 , $3.73 , $164.80 , $140.00
85610,5214010086,Hospital Chargemaster,Prothrombin Time,Outpatient,Outpatient Default Percent / Case Rate,305, $26.00 , $8.98 , $21.42 , See APC Packaged Rates , $18.20 , $10.14 , $20.63 , $13.84 , $13.25 , See APC Packaged Rates , See APC Packaged Rates , $13.36 , $12.96 , See APC Packaged Rates , See APC Packaged Rates , $6.83 , $6.83 , $7.01 , $7.01 , See APC Packaged Rates , $3.56 , $5.24 , $3.56 , $21.42 , $18.20
85045,5214010014,Hospital Chargemaster,Automated Reticulocyte Count,Outpatient,Outpatient Default Percent / Case Rate,305, $25.00 , $8.22 , $20.60 , See APC Packaged Rates , $17.50 , $9.75 , $22.21 , $14.90 , $14.27 , See APC Packaged Rates , See APC Packaged Rates , $14.30 , $13.86 , See APC Packaged Rates , See APC Packaged Rates , $6.80 , $6.80 , $6.97 , $6.97 , See APC Packaged Rates , $3.31 , $5.33 , $3.31 , $22.21 , $17.50
85651,5214010091,Hospital Chargemaster,Rbc Sed Rate Nonautomated,Outpatient,Outpatient Default Percent / Case Rate,305, $35.00 , $7.91 , $28.84 , See APC Packaged Rates , $24.50 , $13.65 , $19.02 , $12.76 , $12.22 , See APC Packaged Rates , See APC Packaged Rates , $13.46 , $13.05 , See APC Packaged Rates , See APC Packaged Rates , $6.77 , $6.77 , $6.94 , $6.94 , See APC Packaged Rates , $3.55 , $5.12 , $3.55 , $28.84 , $24.50
85611,5214010087,Hospital Chargemaster,Prothrombin Test,Outpatient,Outpatient Default Percent / Case Rate,305, $26.00 , $8.11 , $21.42 , See APC Packaged Rates , $18.20 , $10.14 , $22.21 , $14.90 , $14.27 , See APC Packaged Rates , See APC Packaged Rates , $14.72 , $14.27 , See APC Packaged Rates , See APC Packaged Rates , $6.71 , $6.71 , $6.88 , $6.88 , See APC Packaged Rates , $3.27 , $5.26 , $3.27 , $22.21 , $18.20
85007,5214010003,Hospital Chargemaster,Bl Smear W/Diff Wbc Count,Outpatient,Outpatient Default Percent / Case Rate,305, $24.00 , $7.07 , $19.78 , See APC Packaged Rates , $16.80 , $9.36 , $19.02 , $12.76 , $12.22 , See APC Packaged Rates , See APC Packaged Rates , $8.54 , $8.28 , See APC Packaged Rates , See APC Packaged Rates , $6.01 , $6.01 , $6.17 , $6.17 , See APC Packaged Rates , $3.15 , $4.58 , $3.15 , $19.78 , $16.80
85652,5214010092,Hospital Chargemaster,Rbc Sed Rate Automated,Outpatient,Outpatient Default Percent / Case Rate,305, $35.00 , $5.56 , $28.84 , See APC Packaged Rates , $24.50 , $13.65 , $14.29 , $9.59 , $9.18 , See APC Packaged Rates , See APC Packaged Rates , $7.84 , $7.60 , See APC Packaged Rates , See APC Packaged Rates , $4.58 , $4.58 , $4.70 , $4.70 , See APC Packaged Rates , $2.25 , $3.60 , $2.25 , $28.84 , $24.50
85048,5214010016,Hospital Chargemaster,Automated Leukocyte Count,Outpatient,Outpatient Default Percent / Case Rate,305, $9.00 , $5.22 , $7.42 , See APC Packaged Rates , $6.30 , $3.51 , $14.29 , $9.59 , $9.18 , See APC Packaged Rates , See APC Packaged Rates , $6.69 , $6.49 , See APC Packaged Rates , See APC Packaged Rates , $4.32 , $4.32 , $4.43 , $4.43 , See APC Packaged Rates , $2.10 , $3.38 , $2.10 , $14.29 , $6.30
85014,5214010007,Hospital Chargemaster,Hematocrit,Outpatient,Outpatient Default Percent / Case Rate,305, $20.00 , $5.43 , $16.48 , See APC Packaged Rates , $14.00 , $7.80 , $12.68 , $8.51 , $8.15 , See APC Packaged Rates , See APC Packaged Rates , $8.03 , $7.78 , See APC Packaged Rates , See APC Packaged Rates , $4.03 , $4.03 , $4.13 , $4.13 , See APC Packaged Rates , $1.97 , $3.16 , $1.97 , $16.48 , $14.00
85018,5214010008,Hospital Chargemaster,Hemoglobin,Outpatient,Outpatient Default Percent / Case Rate,305, $20.00 , $5.43 , $16.48 , See APC Packaged Rates , $14.00 , $7.80 , $12.68 , $8.51 , $8.15 , See APC Packaged Rates , See APC Packaged Rates , $6.69 , $6.49 , See APC Packaged Rates , See APC Packaged Rates , $4.03 , $4.03 , $4.13 , $4.13 , See APC Packaged Rates , $1.97 , $3.16 , $1.97 , $16.48 , $14.00
87903,5213010212,Hospital Chargemaster,Phenotype Dna Hiv W/Culture,Outpatient,Outpatient Default Percent / Case Rate,306," $1,455.00 "," $1,005.54 "," $1,198.92 ", See APC Packaged Rates ," $1,018.50 ", $567.45 ," $2,655.25 "," $1,781.67 "," $1,705.92 ", See APC Packaged Rates , See APC Packaged Rates ," $1,659.18 "," $1,608.83 ", See APC Packaged Rates , See APC Packaged Rates , $831.43 , $831.43 , $852.83 , $852.83 , See APC Packaged Rates , $405.58 , $651.54 , $405.58 ," $2,655.25 "," $1,018.50 "
87507,5213010135,Hospital Chargemaster,Iadna-Dna/Rna Probe Tq 12-25,Outpatient,Outpatient Default Percent / Case Rate,306," $1,390.00 ", $857.64 ," $1,145.36 ", See APC Packaged Rates , $973.00 , $542.10 ," $2,265.04 "," $1,519.84 "," $1,455.22 ", See APC Packaged Rates , See APC Packaged Rates , $711.01 , $689.44 , See APC Packaged Rates , See APC Packaged Rates , $709.14 , $709.14 , $727.40 , $727.40 , See APC Packaged Rates , $345.93 , $555.71 , $345.93 ," $2,265.04 ", $973.00
87901,5213010210,Hospital Chargemaster,Genotype Dna Hiv Reverse T,Outpatient,Outpatient Default Percent / Case Rate,306, $766.00 , $529.76 , $631.18 , See APC Packaged Rates , $536.20 , $298.74 ," $1,399.01 ", $938.74 , $898.82 , See APC Packaged Rates , See APC Packaged Rates , $279.37 , $270.90 , See APC Packaged Rates , See APC Packaged Rates , $438.03 , $438.03 , $449.31 , $449.31 , See APC Packaged Rates , $213.67 , $343.26 , $213.67 ," $1,399.01 ", $536.20
87902,5213010211,Hospital Chargemaster,Genotype Dna/Rna Hep C,Outpatient,Outpatient Default Percent / Case Rate,306, $766.00 , $529.76 , $631.18 , See APC Packaged Rates , $536.20 , $298.74 ," $1,399.01 ", $938.74 , $898.82 , See APC Packaged Rates , See APC Packaged Rates , $279.37 , $270.90 , See APC Packaged Rates , See APC Packaged Rates , $438.03 , $438.03 , $449.31 , $449.31 , See APC Packaged Rates , $213.67 , $343.26 , $213.67 ," $1,399.01 ", $536.20
87900,5213010209,Hospital Chargemaster,Phenotype Infect Agent Drug,Outpatient,Outpatient Default Percent / Case Rate,306, $615.00 , $268.23 , $506.76 , See APC Packaged Rates , $430.50 , $239.85 , $709.03 , $475.76 , $455.53 , See APC Packaged Rates , See APC Packaged Rates , $447.45 , $433.88 , See APC Packaged Rates , See APC Packaged Rates , $221.78 , $221.78 , $227.49 , $227.49 , See APC Packaged Rates , $108.19 , $173.80 , $108.19 , $709.03 , $430.50
87906,5213010215,Hospital Chargemaster,Genotype Dna/Rna Hiv,Outpatient,Outpatient Default Percent / Case Rate,306, $383.00 , $264.89 , $315.59 , See APC Packaged Rates , $268.10 , $149.37 , $699.50 , $469.37 , $449.41 , See APC Packaged Rates , See APC Packaged Rates , $142.23 , $137.91 , See APC Packaged Rates , See APC Packaged Rates , $219.02 , $219.02 , $224.66 , $224.66 , See APC Packaged Rates , $106.84 , $171.64 , $106.84 , $699.50 , $268.10
87502,5213010131,Hospital Chargemaster,Influenza Dna Amp Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $284.00 , $194.57 , $234.02 , See APC Packaged Rates , $198.80 , $110.76 , $463.17 , $310.79 , $297.57 , See APC Packaged Rates , See APC Packaged Rates , $194.36 , $188.46 , See APC Packaged Rates , See APC Packaged Rates , $151.68 , $151.68 , $155.59 , $155.59 , See APC Packaged Rates , $79.52 , $114.96 , $79.52 , $463.17 , $198.80
87536,5213010155,Hospital Chargemaster,Hiv-1 Quant&Revrse Trnscrpj,Outpatient,Outpatient Default Percent / Case Rate,306, $491.00 , $175.11 , $404.58 , See APC Packaged Rates , $343.70 , $191.49 , $463.17 , $310.79 , $297.57 , See APC Packaged Rates , See APC Packaged Rates , $357.72 , $346.86 , See APC Packaged Rates , See APC Packaged Rates , $144.79 , $144.79 , $148.52 , $148.52 , See APC Packaged Rates , $70.64 , $113.46 , $70.64 , $463.17 , $343.70
U0003,5213010228,Hospital Chargemaster,Sars-Cov2 Covid19 Amp Prb thr,Outpatient,Outpatient Default Percent / Case Rate,306, $125.00 , $138.92 , $103.00 , See APC Packaged Rates , $87.50 , $48.75 , $120.61 , $121.14 , $130.08 , See APC Packaged Rates , See APC Packaged Rates , $83.88 , $83.88 , See APC Packaged Rates , See APC Packaged Rates , $125.00 , $125.00 , $125.00 , $125.00 , See APC Packaged Rates , $43.75 , Not Applicable , $43.75 , $138.92 , $87.50
87801,5213010197,Hospital Chargemaster,Detect Agnt Mult Dna Ampli,Outpatient,Outpatient Default Percent / Case Rate,306, $209.00 , $144.44 , $172.22 , See APC Packaged Rates , $146.30 , $81.51 , $380.68 , $255.44 , $244.58 , See APC Packaged Rates , See APC Packaged Rates , $88.43 , $85.75 , See APC Packaged Rates , See APC Packaged Rates , $119.44 , $119.44 , $122.52 , $122.52 , See APC Packaged Rates , $58.26 , $93.59 , $58.26 , $380.68 , $146.30
87497,5213010127,Hospital Chargemaster,Cytomeg Dna Quant,Outpatient,Outpatient Default Percent / Case Rate,306, $262.00 , $88.16 , $215.89 , See APC Packaged Rates , $183.40 , $102.18 , $233.18 , $156.46 , $149.81 , See APC Packaged Rates , See APC Packaged Rates , $180.09 , $174.62 , See APC Packaged Rates , See APC Packaged Rates , $72.88 , $72.88 , $74.76 , $74.76 , See APC Packaged Rates , $35.56 , $57.12 , $35.56 , $233.18 , $183.40
87522,5213010143,Hospital Chargemaster,Hepatitis C Revrs Trnscrpj,Outpatient,Outpatient Default Percent / Case Rate,306, $175.00 , $88.16 , $144.20 , See APC Packaged Rates , $122.50 , $68.25 , $233.18 , $156.46 , $149.81 , See APC Packaged Rates , See APC Packaged Rates , $180.09 , $174.62 , See APC Packaged Rates , See APC Packaged Rates , $72.88 , $72.88 , $74.76 , $74.76 , See APC Packaged Rates , $35.56 , $57.12 , $35.56 , $233.18 , $122.50
87530,5213010149,Hospital Chargemaster,Hsv Dna Quant,Outpatient,Outpatient Default Percent / Case Rate,306, $490.00 , $88.16 , $403.76 , See APC Packaged Rates , $343.00 , $191.10 , $233.18 , $156.46 , $149.81 , See APC Packaged Rates , See APC Packaged Rates , $180.09 , $174.62 , See APC Packaged Rates , See APC Packaged Rates , $72.88 , $72.88 , $74.76 , $74.76 , See APC Packaged Rates , $35.56 , $57.12 , $35.56 , $403.76 , $343.00
87799,5213010195,Hospital Chargemaster,Detect Agent Nos Dna Quant,Outpatient,Outpatient Default Percent / Case Rate,306, $275.00 , $88.16 , $226.60 , See APC Packaged Rates , $192.50 , $107.25 , $233.18 , $156.46 , $149.81 , See APC Packaged Rates , See APC Packaged Rates , $180.09 , $174.62 , See APC Packaged Rates , See APC Packaged Rates , $72.88 , $72.88 , $74.76 , $74.76 , See APC Packaged Rates , $35.56 , $57.12 , $35.56 , $233.18 , $192.50
87556,5213010166,Hospital Chargemaster,M.Tuberculo Dna Amp Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $203.00 , $77.19 , $167.27 , See APC Packaged Rates , $142.10 , $79.17 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $147.54 , $143.06 , See APC Packaged Rates , See APC Packaged Rates , $65.99 , $65.99 , $67.69 , $67.69 , See APC Packaged Rates , $34.59 , $50.02 , $34.59 , $190.34 , $142.10
87625,5213010179,Hospital Chargemaster,Hpv Types 16 & 18 Only,Outpatient,Outpatient Default Percent / Case Rate,306, $220.00 , $75.10 , $181.28 , See APC Packaged Rates , $154.00 , $85.80 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $87.09 , $84.45 , See APC Packaged Rates , See APC Packaged Rates , $64.20 , $64.20 , $65.86 , $65.86 , See APC Packaged Rates , $33.66 , $48.66 , $33.66 , $190.34 , $154.00
87187,5213010045,Hospital Chargemaster,Microbe Susceptible Mlc,Outpatient,Outpatient Default Percent / Case Rate,306, $154.00 , $74.39 , $126.90 , See APC Packaged Rates , $107.80 , $60.06 , $176.05 , $118.13 , $113.11 , See APC Packaged Rates , See APC Packaged Rates , $34.87 , $33.81 , See APC Packaged Rates , See APC Packaged Rates , $63.60 , $63.60 , $65.24 , $65.24 , See APC Packaged Rates , $33.34 , $48.20 , $33.34 , $176.05 , $107.80
87493,5213010124,Hospital Chargemaster,C Diff Amplified Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $105.00 , $72.21 , $86.52 , See APC Packaged Rates , $73.50 , $40.95 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $85.78 , $83.18 , See APC Packaged Rates , See APC Packaged Rates , $60.57 , $60.57 , $62.13 , $62.13 , See APC Packaged Rates , $30.94 , $46.79 , $30.94 , $190.34 , $73.50
87471,5213010110,Hospital Chargemaster,Bartonella Dna Amp Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $219.00 , $72.21 , $180.46 , See APC Packaged Rates , $153.30 , $85.41 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $147.54 , $143.06 , See APC Packaged Rates , See APC Packaged Rates , $59.71 , $59.71 , $61.25 , $61.25 , See APC Packaged Rates , $29.13 , $46.79 , $29.13 , $190.34 , $153.30
87476,5213010113,Hospital Chargemaster,Lyme Dis Dna Amp Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $374.00 , $72.21 , $308.18 , See APC Packaged Rates , $261.80 , $145.86 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $147.54 , $143.06 , See APC Packaged Rates , See APC Packaged Rates , $59.71 , $59.71 , $61.25 , $61.25 , See APC Packaged Rates , $29.13 , $46.79 , $29.13 , $308.18 , $261.80
87481,5213010115,Hospital Chargemaster,Candida Dna Amp Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $230.00 , $72.21 , $189.52 , See APC Packaged Rates , $161.00 , $89.70 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $147.54 , $143.06 , See APC Packaged Rates , See APC Packaged Rates , $59.71 , $59.71 , $61.25 , $61.25 , See APC Packaged Rates , $29.13 , $46.79 , $29.13 , $190.34 , $161.00
87491,5213010122,Hospital Chargemaster,Chylmd Trach Dna Amp Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $203.00 , $72.21 , $167.27 , See APC Packaged Rates , $142.10 , $79.17 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $147.54 , $143.06 , See APC Packaged Rates , See APC Packaged Rates , $59.71 , $59.71 , $61.25 , $61.25 , See APC Packaged Rates , $29.13 , $46.79 , $29.13 , $190.34 , $142.10
87496,5213010126,Hospital Chargemaster,Cytomeg Dna Amp Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $414.00 , $72.21 , $341.14 , See APC Packaged Rates , $289.80 , $161.46 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $147.54 , $143.06 , See APC Packaged Rates , See APC Packaged Rates , $59.71 , $59.71 , $61.25 , $61.25 , See APC Packaged Rates , $29.13 , $46.79 , $29.13 , $341.14 , $289.80
87498,5213010128,Hospital Chargemaster,Enterovirus Probe&Revrs Trns,Outpatient,Outpatient Default Percent / Case Rate,306, $190.00 , $72.21 , $156.56 , See APC Packaged Rates , $133.00 , $74.10 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $89.41 , $86.70 , See APC Packaged Rates , See APC Packaged Rates , $59.71 , $59.71 , $61.25 , $61.25 , See APC Packaged Rates , $29.13 , $46.79 , $29.13 , $190.34 , $133.00
87521,5213010142,Hospital Chargemaster,Hepatitis C Probe&Rvrs Trnsc,Outpatient,Outpatient Default Percent / Case Rate,306, $431.00 , $72.21 , $355.14 , See APC Packaged Rates , $301.70 , $168.09 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $147.54 , $143.06 , See APC Packaged Rates , See APC Packaged Rates , $59.71 , $59.71 , $61.25 , $61.25 , See APC Packaged Rates , $29.13 , $46.79 , $29.13 , $355.14 , $301.70
87529,5213010148,Hospital Chargemaster,Hsv Dna Amp Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $202.00 , $72.21 , $166.45 , See APC Packaged Rates , $141.40 , $78.78 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $147.54 , $143.06 , See APC Packaged Rates , See APC Packaged Rates , $59.71 , $59.71 , $61.25 , $61.25 , See APC Packaged Rates , $29.13 , $46.79 , $29.13 , $190.34 , $141.40
87535,5213010154,Hospital Chargemaster,Hiv-1 Probe&Reverse Trnscrpj,Outpatient,Outpatient Default Percent / Case Rate,306, $250.00 , $72.21 , $206.00 , See APC Packaged Rates , $175.00 , $97.50 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $147.54 , $143.06 , See APC Packaged Rates , See APC Packaged Rates , $59.71 , $59.71 , $61.25 , $61.25 , See APC Packaged Rates , $29.13 , $46.79 , $29.13 , $206.00 , $175.00
87538,5213010157,Hospital Chargemaster,Hiv-2 Probe&Revrse Trnscripj,Outpatient,Outpatient Default Percent / Case Rate,306, $207.00 , $72.21 , $170.57 , See APC Packaged Rates , $144.90 , $80.73 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $147.54 , $143.06 , See APC Packaged Rates , See APC Packaged Rates , $59.71 , $59.71 , $61.25 , $61.25 , See APC Packaged Rates , $29.13 , $46.79 , $29.13 , $190.34 , $144.90
87591,5213010175,Hospital Chargemaster,N.Gonorrhoeae Dna Amp Prob,Outpatient,Outpatient Default Percent / Case Rate,306, $203.00 , $72.21 , $167.27 , See APC Packaged Rates , $142.10 , $79.17 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $147.54 , $143.06 , See APC Packaged Rates , See APC Packaged Rates , $59.71 , $59.71 , $61.25 , $61.25 , See APC Packaged Rates , $29.13 , $46.79 , $29.13 , $190.34 , $142.10
87624,5213010178,Hospital Chargemaster,Hpv High-Risk Types,Outpatient,Outpatient Default Percent / Case Rate,306, $203.00 , $72.21 , $167.27 , See APC Packaged Rates , $142.10 , $79.17 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $87.09 , $84.45 , See APC Packaged Rates , See APC Packaged Rates , $59.71 , $59.71 , $61.25 , $61.25 , See APC Packaged Rates , $29.13 , $46.79 , $29.13 , $190.34 , $142.10
87661,5213010191,Hospital Chargemaster,Trichomonas Vaginalis Amplif,Outpatient,Outpatient Default Percent / Case Rate,306, $143.00 , $72.21 , $117.83 , See APC Packaged Rates , $100.10 , $55.77 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $87.31 , $84.66 , See APC Packaged Rates , See APC Packaged Rates , $59.71 , $59.71 , $61.25 , $61.25 , See APC Packaged Rates , $29.13 , $46.79 , $29.13 , $190.34 , $100.10
87798,5213010194,Hospital Chargemaster,Detect Agent Nos Dna Amp,Outpatient,Outpatient Default Percent / Case Rate,306, $203.00 , $72.21 , $167.27 , See APC Packaged Rates , $142.10 , $79.17 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $147.54 , $143.06 , See APC Packaged Rates , See APC Packaged Rates , $59.71 , $59.71 , $61.25 , $61.25 , See APC Packaged Rates , $29.13 , $46.79 , $29.13 , $190.34 , $142.10
87255,5213010060,Hospital Chargemaster,Genet Virus Isolate Hsv,Outpatient,Outpatient Default Percent / Case Rate,306, $192.00 , $69.67 , $158.21 , See APC Packaged Rates , $134.40 , $74.88 , $184.00 , $123.46 , $118.21 , See APC Packaged Rates , See APC Packaged Rates , $113.70 , $110.25 , See APC Packaged Rates , See APC Packaged Rates , $57.62 , $57.62 , $59.10 , $59.10 , See APC Packaged Rates , $28.10 , $45.14 , $28.10 , $184.00 , $134.40
87520,5213010141,Hospital Chargemaster,Hepatitis C Rna Dir Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $124.00 , $57.82 , $102.18 , See APC Packaged Rates , $86.80 , $48.36 , $138.01 , $92.60 , $88.67 , See APC Packaged Rates , See APC Packaged Rates , $84.29 , $81.73 , See APC Packaged Rates , See APC Packaged Rates , $49.42 , $49.42 , $50.69 , $50.69 , See APC Packaged Rates , $25.91 , $37.46 , $25.91 , $138.01 , $86.80
87252,5213010057,Hospital Chargemaster,Virus Inoculation Tissue,Outpatient,Outpatient Default Percent / Case Rate,306, $145.00 , $53.65 , $119.48 , See APC Packaged Rates , $101.50 , $56.55 , $141.16 , $94.72 , $90.69 , See APC Packaged Rates , See APC Packaged Rates , $57.87 , $56.11 , See APC Packaged Rates , See APC Packaged Rates , $44.35 , $44.35 , $45.49 , $45.49 , See APC Packaged Rates , $21.64 , $34.76 , $21.64 , $141.16 , $101.50
87904,5213010213,Hospital Chargemaster,Phenotype Dna Hiv W/Clt Add,Outpatient,Outpatient Default Percent / Case Rate,306, $400.00 , $53.65 , $329.60 , See APC Packaged Rates , $280.00 , $156.00 , $141.16 , $94.72 , $90.69 , See APC Packaged Rates , See APC Packaged Rates , $88.50 , $85.81 , See APC Packaged Rates , See APC Packaged Rates , $44.35 , $44.35 , $45.49 , $45.49 , See APC Packaged Rates , $21.64 , $34.76 , $21.64 , $329.60 , $280.00
87560,5213010168,Hospital Chargemaster,M.Avium-Intra Dna Dir Prob,Outpatient,Outpatient Default Percent / Case Rate,306, $116.00 , $50.54 , $95.58 , See APC Packaged Rates , $81.20 , $45.24 , $120.56 , $80.90 , $77.46 , See APC Packaged Rates , See APC Packaged Rates , $84.29 , $81.73 , See APC Packaged Rates , See APC Packaged Rates , $43.21 , $43.21 , $44.32 , $44.32 , See APC Packaged Rates , $22.66 , $32.75 , $22.66 , $120.56 , $81.20
87590,5213010174,Hospital Chargemaster,N.Gonorrhoeae Dna Dir Prob,Outpatient,Outpatient Default Percent / Case Rate,306, $116.00 , $49.78 , $95.58 , See APC Packaged Rates , $81.20 , $45.24 , $118.96 , $79.82 , $76.43 , See APC Packaged Rates , See APC Packaged Rates , $84.29 , $81.73 , See APC Packaged Rates , See APC Packaged Rates , $42.56 , $42.56 , $43.66 , $43.66 , See APC Packaged Rates , $22.31 , $32.26 , $22.31 , $118.96 , $81.20
87390,5213010100,Hospital Chargemaster,Hiv-1 Ag Ia,Outpatient,Outpatient Default Percent / Case Rate,306, $146.00 , $44.56 , $120.30 , See APC Packaged Rates , $102.20 , $56.94 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $74.15 , $71.90 , See APC Packaged Rates , See APC Packaged Rates , $38.09 , $38.09 , $39.07 , $39.07 , See APC Packaged Rates , $19.97 , $28.87 , $19.97 , $120.30 , $102.20
87490,5213010121,Hospital Chargemaster,Chylmd Trach Dna Dir Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $116.00 , $42.13 , $95.58 , See APC Packaged Rates , $81.20 , $45.24 , $109.46 , $73.45 , $70.32 , See APC Packaged Rates , See APC Packaged Rates , $84.29 , $81.73 , See APC Packaged Rates , See APC Packaged Rates , $36.02 , $36.02 , $36.95 , $36.95 , See APC Packaged Rates , $18.88 , $27.30 , $18.88 , $109.46 , $81.20
87253,5213010058,Hospital Chargemaster,Virus Inoculate Tissue Addl,Outpatient,Outpatient Default Percent / Case Rate,306, $150.00 , $41.58 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 , $109.46 , $73.45 , $70.32 , See APC Packaged Rates , See APC Packaged Rates , $67.93 , $65.87 , See APC Packaged Rates , See APC Packaged Rates , $34.38 , $34.38 , $35.26 , $35.26 , See APC Packaged Rates , $16.77 , $26.94 , $16.77 , $123.60 , $105.00
87480,5213010114,Hospital Chargemaster,Candida Dna Dir Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $55.00 , $41.26 , $45.32 , See APC Packaged Rates , $38.50 , $21.45 , $109.46 , $73.45 , $70.32 , See APC Packaged Rates , See APC Packaged Rates , $84.29 , $81.73 , See APC Packaged Rates , See APC Packaged Rates , $34.12 , $34.12 , $35.00 , $35.00 , See APC Packaged Rates , $16.63 , $26.74 , $16.63 , $109.46 , $38.50
87510,5213010136,Hospital Chargemaster,Gardner Vag Dna Dir Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $55.00 , $41.26 , $45.32 , See APC Packaged Rates , $38.50 , $21.45 , $109.46 , $73.45 , $70.32 , See APC Packaged Rates , See APC Packaged Rates , $84.29 , $81.73 , See APC Packaged Rates , See APC Packaged Rates , $34.12 , $34.12 , $35.00 , $35.00 , See APC Packaged Rates , $16.63 , $26.74 , $16.63 , $109.46 , $38.50
87528,5213010147,Hospital Chargemaster,Hsv Dna Dir Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $116.00 , $41.26 , $95.58 , See APC Packaged Rates , $81.20 , $45.24 , $109.46 , $73.45 , $70.32 , See APC Packaged Rates , See APC Packaged Rates , $84.29 , $81.73 , See APC Packaged Rates , See APC Packaged Rates , $34.12 , $34.12 , $35.00 , $35.00 , See APC Packaged Rates , $16.63 , $26.74 , $16.63 , $109.46 , $81.20
87580,5213010171,Hospital Chargemaster,M.Pneumon Dna Dir Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $200.00 , $41.26 , $164.80 , See APC Packaged Rates , $140.00 , $78.00 , $109.46 , $73.45 , $70.32 , See APC Packaged Rates , See APC Packaged Rates , $84.29 , $81.73 , See APC Packaged Rates , See APC Packaged Rates , $34.12 , $34.12 , $35.00 , $35.00 , See APC Packaged Rates , $16.63 , $26.74 , $16.63 , $164.80 , $140.00
87660,5213010190,Hospital Chargemaster,Trichomonas Vagin Dir Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $55.00 , $41.26 , $45.32 , See APC Packaged Rates , $38.50 , $21.45 , $109.46 , $73.45 , $70.32 , See APC Packaged Rates , See APC Packaged Rates , $66.03 , $64.03 , See APC Packaged Rates , See APC Packaged Rates , $34.12 , $34.12 , $35.00 , $35.00 , See APC Packaged Rates , $16.63 , $26.74 , $16.63 , $109.46 , $38.50
87230,5213010055,Hospital Chargemaster,Assay Toxin Or Antitoxin,Outpatient,Outpatient Default Percent / Case Rate,306, $261.00 , $40.61 , $215.06 , See APC Packaged Rates , $182.70 , $101.79 , $107.85 , $72.37 , $69.29 , See APC Packaged Rates , See APC Packaged Rates , $65.71 , $63.71 , See APC Packaged Rates , See APC Packaged Rates , $33.58 , $33.58 , $34.44 , $34.44 , See APC Packaged Rates , $16.39 , $26.32 , $16.39 , $215.06 , $182.70
87110,5213010023,Hospital Chargemaster,Chlamydia Culture,Outpatient,Outpatient Default Percent / Case Rate,306, $95.00 , $40.32 , $78.28 , See APC Packaged Rates , $66.50 , $37.05 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $65.89 , $63.90 , See APC Packaged Rates , See APC Packaged Rates , $33.33 , $33.33 , $34.19 , $34.19 , See APC Packaged Rates , $16.27 , $26.12 , $16.27 , $106.27 , $66.50
87254,5213010059,Hospital Chargemaster,Virus Inoculation Shell Via,Outpatient,Outpatient Default Percent / Case Rate,306, $92.00 , $40.24 , $75.81 , See APC Packaged Rates , $64.40 , $35.88 , $106.27 , $71.31 , $68.28 , See APC Packaged Rates , See APC Packaged Rates , $16.61 , $16.11 , See APC Packaged Rates , See APC Packaged Rates , $33.29 , $33.29 , $34.14 , $34.14 , See APC Packaged Rates , $16.23 , $26.08 , $16.11 , $106.27 , $64.40
87209,5213010052,Hospital Chargemaster,Smear Complex Stain,Outpatient,Outpatient Default Percent / Case Rate,306, $85.00 , $36.98 , $70.04 , See APC Packaged Rates , $59.50 , $33.15 , $98.35 , $66.00 , $63.19 , See APC Packaged Rates , See APC Packaged Rates , $61.71 , $59.83 , See APC Packaged Rates , See APC Packaged Rates , $30.58 , $30.58 , $31.37 , $31.37 , See APC Packaged Rates , $14.93 , $23.96 , $14.93 , $98.35 , $59.50
87389,5213010099,Hospital Chargemaster,Hiv-1 Ag W/Hiv-1 & Hiv-2 Ab,Outpatient,Outpatient Default Percent / Case Rate,306, $30.00 , $55.06 , $24.72 , See APC Packaged Rates , $21.00 , $11.70 , $130.06 , $87.27 , $83.56 , See APC Packaged Rates , See APC Packaged Rates , $78.23 , $75.85 , See APC Packaged Rates , See APC Packaged Rates , $30.00 , $30.00 , $30.00 , $30.00 , See APC Packaged Rates , $19.98 , $32.10 , $11.70 , $130.06 , $21.00
87804,5213010200,Hospital Chargemaster,Influenza Assay W/Optic,Outpatient,Outpatient Default Percent / Case Rate,306, $94.00 , $30.65 , $77.46 , See APC Packaged Rates , $65.80 , $36.66 , $72.96 , $48.96 , $46.88 , See APC Packaged Rates , See APC Packaged Rates , $38.91 , $37.73 , See APC Packaged Rates , See APC Packaged Rates , $26.20 , $26.20 , $26.87 , $26.87 , See APC Packaged Rates , $13.74 , $19.86 , $13.74 , $77.46 , $65.80
87109,5213010022,Hospital Chargemaster,Mycoplasma,Outpatient,Outpatient Default Percent / Case Rate,306, $450.00 , $31.67 , $370.80 , See APC Packaged Rates , $315.00 , $175.50 , $84.07 , $56.41 , $54.01 , See APC Packaged Rates , See APC Packaged Rates , $51.74 , $50.17 , See APC Packaged Rates , See APC Packaged Rates , $26.18 , $26.18 , $26.85 , $26.85 , See APC Packaged Rates , $12.77 , $20.52 , $12.77 , $370.80 , $315.00
87880,5213010207,Hospital Chargemaster,Strep A Assay W/Optic,Outpatient,Outpatient Default Percent / Case Rate,306, $65.00 , $30.61 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $72.96 , $48.96 , $46.88 , See APC Packaged Rates , See APC Packaged Rates , $50.43 , $48.90 , See APC Packaged Rates , See APC Packaged Rates , $26.16 , $26.16 , $26.84 , $26.84 , See APC Packaged Rates , $13.72 , $19.84 , $13.72 , $72.96 , $45.50
87197,5213010048,Hospital Chargemaster,Bactericidal Level Serum,Outpatient,Outpatient Default Percent / Case Rate,306, $124.00 , $30.91 , $102.18 , See APC Packaged Rates , $86.80 , $48.36 , $80.88 , $54.27 , $51.96 , See APC Packaged Rates , See APC Packaged Rates , $50.52 , $48.99 , See APC Packaged Rates , See APC Packaged Rates , $25.56 , $25.56 , $26.22 , $26.22 , See APC Packaged Rates , $12.46 , $20.03 , $12.46 , $102.18 , $86.80
87299,5213010079,Hospital Chargemaster,Antibody Detection Nos If,Outpatient,Outpatient Default Percent / Case Rate,306, $78.00 , $29.82 , $64.27 , See APC Packaged Rates , $54.60 , $30.42 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $50.43 , $48.90 , See APC Packaged Rates , See APC Packaged Rates , $25.49 , $25.49 , $26.14 , $26.14 , See APC Packaged Rates , $13.37 , $19.32 , $13.37 , $71.38 , $54.60
87899,5213010208,Hospital Chargemaster,Agent Nos Assay W/Optic,Outpatient,Outpatient Default Percent / Case Rate,306, $48.00 , $29.76 , $39.55 , See APC Packaged Rates , $33.60 , $18.72 , $71.38 , $47.90 , $45.86 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.44 , $25.44 , $26.10 , $26.10 , See APC Packaged Rates , $13.35 , $19.28 , $- , $71.38 , $33.60
87278,5213010072,Hospital Chargemaster,Legion Pneumophilia Ag If,Outpatient,Outpatient Default Percent / Case Rate,306, $89.00 , $28.89 , $73.34 , See APC Packaged Rates , $62.30 , $34.71 , $68.20 , $45.76 , $43.82 , See APC Packaged Rates , See APC Packaged Rates , $50.43 , $48.90 , See APC Packaged Rates , See APC Packaged Rates , $24.70 , $24.70 , $25.34 , $25.34 , See APC Packaged Rates , $12.95 , $18.72 , $12.95 , $73.34 , $62.30
87338,5213010092,Hospital Chargemaster,Hpylori Stool Ia,Outpatient,Outpatient Default Percent / Case Rate,306, $180.00 , $32.89 , $148.32 , See APC Packaged Rates , $126.00 , $70.20 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $85.04 , $82.46 , See APC Packaged Rates , See APC Packaged Rates , $24.47 , $24.47 , $25.10 , $25.10 , See APC Packaged Rates , $11.94 , $19.18 , $11.94 , $148.32 , $126.00
87320,5213010083,Hospital Chargemaster,Chylmd Trach Ag Ia,Outpatient,Outpatient Default Percent / Case Rate,306, $69.00 , $27.78 , $56.86 , See APC Packaged Rates , $48.30 , $26.91 , $66.62 , $44.70 , $42.80 , See APC Packaged Rates , See APC Packaged Rates , $50.43 , $48.90 , See APC Packaged Rates , See APC Packaged Rates , $23.75 , $23.75 , $24.36 , $24.36 , See APC Packaged Rates , $12.45 , $18.00 , $12.45 , $66.62 , $48.30
87118,5213010025,Hospital Chargemaster,Mycobacteric Identification,Outpatient,Outpatient Default Percent / Case Rate,306, $51.00 , $27.06 , $42.02 , See APC Packaged Rates , $35.70 , $19.89 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $36.81 , $35.69 , See APC Packaged Rates , See APC Packaged Rates , $23.13 , $23.13 , $23.73 , $23.73 , See APC Packaged Rates , $12.14 , $17.53 , $12.14 , $65.04 , $35.70
87400,5213010102,Hospital Chargemaster,Influenza A/B Ag Ia,Outpatient,Outpatient Default Percent / Case Rate,306, $53.00 , $26.17 , $43.67 , See APC Packaged Rates , $37.10 , $20.67 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $38.91 , $37.73 , See APC Packaged Rates , See APC Packaged Rates , $22.37 , $22.37 , $22.94 , $22.94 , See APC Packaged Rates , $11.72 , $16.96 , $11.72 , $65.04 , $37.10
87280,5213010074,Hospital Chargemaster,Respiratory Syncytial Ag If,Outpatient,Outpatient Default Percent / Case Rate,306, $210.00 , $24.85 , $173.04 , See APC Packaged Rates , $147.00 , $81.90 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $50.43 , $48.90 , See APC Packaged Rates , See APC Packaged Rates , $21.24 , $21.24 , $21.79 , $21.79 , See APC Packaged Rates , $11.13 , $16.10 , $11.13 , $173.04 , $147.00
87290,5213010078,Hospital Chargemaster,Varicella Zoster Ag If,Outpatient,Outpatient Default Percent / Case Rate,306, $72.00 , $24.85 , $59.33 , See APC Packaged Rates , $50.40 , $28.08 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $50.43 , $48.90 , See APC Packaged Rates , See APC Packaged Rates , $21.24 , $21.24 , $21.79 , $21.79 , See APC Packaged Rates , $11.13 , $16.10 , $11.13 , $65.04 , $50.40
87385,5213010098,Hospital Chargemaster,Histoplasma Capsul Ag Ia,Outpatient,Outpatient Default Percent / Case Rate,306, $160.00 , $24.67 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $50.43 , $48.90 , See APC Packaged Rates , See APC Packaged Rates , $20.98 , $20.98 , $21.52 , $21.52 , See APC Packaged Rates , $10.99 , $15.98 , $10.99 , $131.84 , $112.00
87807,5213010202,Hospital Chargemaster,Rsv Assay W/Optic,Outpatient,Outpatient Default Percent / Case Rate,306, $85.00 , $27.41 , $70.04 , See APC Packaged Rates , $59.50 , $33.15 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $39.34 , $38.14 , See APC Packaged Rates , See APC Packaged Rates , $20.84 , $20.84 , $21.38 , $21.38 , See APC Packaged Rates , $10.88 , $15.98 , $10.88 , $70.04 , $59.50
87802,5213010198,Hospital Chargemaster,Strep B Assay W/Optic,Outpatient,Outpatient Default Percent / Case Rate,306, $45.00 , $24.67 , $37.08 , See APC Packaged Rates , $31.50 , $17.55 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $38.91 , $37.73 , See APC Packaged Rates , See APC Packaged Rates , $20.69 , $20.69 , $21.22 , $21.22 , See APC Packaged Rates , $10.57 , $15.98 , $10.57 , $65.04 , $31.50
87449,5213010107,Hospital Chargemaster,Ag Detect Nos Ia Mult,Outpatient,Outpatient Default Percent / Case Rate,306, $69.00 , $27.41 , $56.86 , See APC Packaged Rates , $48.30 , $26.91 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $50.43 , $48.90 , See APC Packaged Rates , See APC Packaged Rates , $20.40 , $20.40 , $20.92 , $20.92 , See APC Packaged Rates , $9.94 , $15.98 , $9.94 , $65.04 , $48.30
87265,5213010062,Hospital Chargemaster,Pertussis Ag If,Outpatient,Outpatient Default Percent / Case Rate,306, $160.00 , $24.67 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $50.43 , $48.90 , See APC Packaged Rates , See APC Packaged Rates , $20.40 , $20.40 , $20.92 , $20.92 , See APC Packaged Rates , $9.94 , $15.98 , $9.94 , $131.84 , $112.00
87272,5213010067,Hospital Chargemaster,Cryptosporidium Ag If,Outpatient,Outpatient Default Percent / Case Rate,306, $69.00 , $24.67 , $56.86 , See APC Packaged Rates , $48.30 , $26.91 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $50.43 , $48.90 , See APC Packaged Rates , See APC Packaged Rates , $20.40 , $20.40 , $20.92 , $20.92 , See APC Packaged Rates , $9.94 , $15.98 , $9.94 , $65.04 , $48.30
87273,5213010068,Hospital Chargemaster,Herpes Simplex 2 Ag If,Outpatient,Outpatient Default Percent / Case Rate,306, $53.00 , $24.67 , $43.67 , See APC Packaged Rates , $37.10 , $20.67 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $38.91 , $37.73 , See APC Packaged Rates , See APC Packaged Rates , $20.40 , $20.40 , $20.92 , $20.92 , See APC Packaged Rates , $9.94 , $15.98 , $9.94 , $65.04 , $37.10
87274,5213010069,Hospital Chargemaster,Herpes Simplex 1 Ag If,Outpatient,Outpatient Default Percent / Case Rate,306, $118.00 , $24.67 , $97.23 , See APC Packaged Rates , $82.60 , $46.02 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $50.43 , $48.90 , See APC Packaged Rates , See APC Packaged Rates , $20.40 , $20.40 , $20.92 , $20.92 , See APC Packaged Rates , $9.94 , $15.98 , $9.94 , $97.23 , $82.60
87305,5213010082,Hospital Chargemaster,Aspergillus Ag Ia,Outpatient,Outpatient Default Percent / Case Rate,306, $54.00 , $24.67 , $44.50 , See APC Packaged Rates , $37.80 , $21.06 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $39.34 , $38.14 , See APC Packaged Rates , See APC Packaged Rates , $20.40 , $20.40 , $20.92 , $20.92 , See APC Packaged Rates , $9.94 , $15.98 , $9.94 , $65.04 , $37.80
87324,5213010084,Hospital Chargemaster,Clostridium Ag Ia,Outpatient,Outpatient Default Percent / Case Rate,306, $69.00 , $24.67 , $56.86 , See APC Packaged Rates , $48.30 , $26.91 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $50.43 , $48.90 , See APC Packaged Rates , See APC Packaged Rates , $20.40 , $20.40 , $20.92 , $20.92 , See APC Packaged Rates , $9.94 , $15.98 , $9.94 , $65.04 , $48.30
87329,5213010087,Hospital Chargemaster,Giardia Ag Ia,Outpatient,Outpatient Default Percent / Case Rate,306, $98.00 , $24.67 , $80.75 , See APC Packaged Rates , $68.60 , $38.22 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $37.72 , $36.58 , See APC Packaged Rates , See APC Packaged Rates , $20.40 , $20.40 , $20.92 , $20.92 , See APC Packaged Rates , $9.94 , $15.98 , $9.94 , $80.75 , $68.60
87337,5213010091,Hospital Chargemaster,Entamoeb Hist Group Ag Ia,Outpatient,Outpatient Default Percent / Case Rate,306, $53.00 , $24.67 , $43.67 , See APC Packaged Rates , $37.10 , $20.67 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $38.91 , $37.73 , See APC Packaged Rates , See APC Packaged Rates , $20.40 , $20.40 , $20.92 , $20.92 , See APC Packaged Rates , $9.94 , $15.98 , $9.94 , $65.04 , $37.10
87425,5213010104,Hospital Chargemaster,Rotavirus Ag Ia,Outpatient,Outpatient Default Percent / Case Rate,306, $111.00 , $24.67 , $91.46 , See APC Packaged Rates , $77.70 , $43.29 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $50.43 , $48.90 , See APC Packaged Rates , See APC Packaged Rates , $20.40 , $20.40 , $20.92 , $20.92 , See APC Packaged Rates , $9.94 , $15.98 , $9.94 , $91.46 , $77.70
87427,5213010105,Hospital Chargemaster,Shiga-Like Toxin Ag Ia,Outpatient,Outpatient Default Percent / Case Rate,306, $64.00 , $24.67 , $52.74 , See APC Packaged Rates , $44.80 , $24.96 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $38.91 , $37.73 , See APC Packaged Rates , See APC Packaged Rates , $20.40 , $20.40 , $20.92 , $20.92 , See APC Packaged Rates , $9.94 , $15.98 , $9.94 , $65.04 , $44.80
87350,5213010096,Hospital Chargemaster,Hepatitis Be Ag Ia,Outpatient,Outpatient Default Percent / Case Rate,306, $90.00 , $23.72 , $74.16 , See APC Packaged Rates , $63.00 , $35.10 , $61.86 , $41.51 , $39.74 , See APC Packaged Rates , See APC Packaged Rates , $48.44 , $46.97 , See APC Packaged Rates , See APC Packaged Rates , $19.61 , $19.61 , $20.12 , $20.12 , See APC Packaged Rates , $9.56 , $15.37 , $9.56 , $74.16 , $63.00
87116,5213010024,Hospital Chargemaster,Mycobacteria Culture,Outpatient,Outpatient Default Percent / Case Rate,306, $100.00 , $22.22 , $82.40 , See APC Packaged Rates , $70.00 , $39.00 , $58.68 , $39.37 , $37.70 , See APC Packaged Rates , See APC Packaged Rates , $36.32 , $35.21 , See APC Packaged Rates , See APC Packaged Rates , $18.38 , $18.38 , $18.85 , $18.85 , See APC Packaged Rates , $8.96 , $14.40 , $8.96 , $82.40 , $70.00
87340,5213010094,Hospital Chargemaster,Hepatitis B Surface Ag Ia,Outpatient,Outpatient Default Percent / Case Rate,306, $77.00 , $21.26 , $63.45 , See APC Packaged Rates , $53.90 , $30.03 , $55.52 , $37.25 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $43.41 , $42.09 , See APC Packaged Rates , See APC Packaged Rates , $17.58 , $17.58 , $18.03 , $18.03 , See APC Packaged Rates , $8.57 , $13.78 , $8.57 , $63.45 , $53.90
87341,5213010095,Hospital Chargemaster,Hepatitis B Surface Ag Ia,Outpatient,Outpatient Default Percent / Case Rate,306, $77.00 , $21.26 , $63.45 , See APC Packaged Rates , $53.90 , $30.03 , $55.52 , $37.25 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $35.05 , $33.99 , See APC Packaged Rates , See APC Packaged Rates , $17.58 , $17.58 , $18.03 , $18.03 , See APC Packaged Rates , $8.57 , $13.78 , $8.57 , $63.45 , $53.90
87040,5213010004,Hospital Chargemaster,Blood Culture For Bacteria,Outpatient,Outpatient Default Percent / Case Rate,306, $78.00 , $21.24 , $64.27 , See APC Packaged Rates , $54.60 , $30.42 , $55.52 , $37.25 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $34.75 , $33.69 , See APC Packaged Rates , See APC Packaged Rates , $17.57 , $17.57 , $18.02 , $18.02 , See APC Packaged Rates , $8.57 , $13.76 , $8.57 , $64.27 , $54.60
87106,5213010020,Hospital Chargemaster,Fungi Identification Yeast,Outpatient,Outpatient Default Percent / Case Rate,306, $48.00 , $21.24 , $39.55 , See APC Packaged Rates , $33.60 , $18.72 , $55.52 , $37.25 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $34.75 , $33.69 , See APC Packaged Rates , See APC Packaged Rates , $17.57 , $17.57 , $18.02 , $18.02 , See APC Packaged Rates , $8.57 , $13.76 , $8.57 , $55.52 , $33.60
87107,5213010021,Hospital Chargemaster,Fungi Identification Mold,Outpatient,Outpatient Default Percent / Case Rate,306, $48.00 , $21.24 , $39.55 , See APC Packaged Rates , $33.60 , $18.72 , $55.52 , $37.25 , $35.67 , See APC Packaged Rates , See APC Packaged Rates , $35.05 , $33.99 , See APC Packaged Rates , See APC Packaged Rates , $17.57 , $17.57 , $18.02 , $18.02 , See APC Packaged Rates , $8.57 , $13.76 , $8.57 , $55.52 , $33.60
87450,5213010108,Hospital Chargemaster,Ag Detect Nos Ia Single,Outpatient,Outpatient Default Percent / Case Rate,306, $68.00 , $37.40 , $56.03 , See APC Packaged Rates , $47.60 , $26.52 , $52.33 , $35.12 , $33.62 , See APC Packaged Rates , See APC Packaged Rates , $45.63 , $45.63 , See APC Packaged Rates , See APC Packaged Rates , $16.32 , $16.32 , $16.74 , $16.74 , See APC Packaged Rates , $23.80 , Not Applicable , $16.32 , $56.03 , $47.60
87075,5213010010,Hospital Chargemaster,Cultr Bacteria Except Blood,Outpatient,Outpatient Default Percent / Case Rate,306, $83.00 , $19.48 , $68.39 , See APC Packaged Rates , $58.10 , $32.37 , $50.76 , $34.06 , $32.61 , See APC Packaged Rates , See APC Packaged Rates , $24.62 , $23.87 , See APC Packaged Rates , See APC Packaged Rates , $16.10 , $16.10 , $16.52 , $16.52 , See APC Packaged Rates , $7.86 , $12.62 , $7.86 , $68.39 , $58.10
87046,5213010006,Hospital Chargemaster,Stool Cultr Aerobic Bact Ea,Outpatient,Outpatient Default Percent / Case Rate,306, $48.00 , $19.43 , $39.55 , See APC Packaged Rates , $33.60 , $18.72 , $50.76 , $34.06 , $32.61 , See APC Packaged Rates , See APC Packaged Rates , $8.00 , $7.76 , See APC Packaged Rates , See APC Packaged Rates , $16.07 , $16.07 , $16.49 , $16.49 , See APC Packaged Rates , $7.84 , $12.59 , $7.76 , $50.76 , $33.60
87177,5213010040,Hospital Chargemaster,Ova And Parasites Smears,Outpatient,Outpatient Default Percent / Case Rate,306, $85.00 , $18.32 , $70.04 , See APC Packaged Rates , $59.50 , $33.15 , $47.57 , $31.92 , $30.56 , See APC Packaged Rates , See APC Packaged Rates , $19.05 , $18.47 , See APC Packaged Rates , See APC Packaged Rates , $15.15 , $15.15 , $15.54 , $15.54 , See APC Packaged Rates , $7.39 , $11.87 , $7.39 , $70.04 , $59.50
87186,5213010044,Hospital Chargemaster,Microbe Susceptible Mic,Outpatient,Outpatient Default Percent / Case Rate,306, $48.00 , $17.80 , $39.55 , See APC Packaged Rates , $33.60 , $18.72 , $47.57 , $31.92 , $30.56 , See APC Packaged Rates , See APC Packaged Rates , $24.24 , $23.51 , See APC Packaged Rates , See APC Packaged Rates , $14.71 , $14.71 , $15.08 , $15.08 , See APC Packaged Rates , $7.18 , $11.53 , $7.18 , $47.57 , $33.60
87070,5213010007,Hospital Chargemaster,Culture Othr Specimn Aerobic,Outpatient,Outpatient Default Percent / Case Rate,306, $59.00 , $17.72 , $48.62 , See APC Packaged Rates , $41.30 , $23.01 , $47.57 , $31.92 , $30.56 , See APC Packaged Rates , See APC Packaged Rates , $28.97 , $28.09 , See APC Packaged Rates , See APC Packaged Rates , $14.66 , $14.66 , $15.04 , $15.04 , See APC Packaged Rates , $7.15 , $11.48 , $7.15 , $48.62 , $41.30
87088,5213010016,Hospital Chargemaster,Urine Bacteria Culture,Outpatient,Outpatient Default Percent / Case Rate,306, $59.00 , $16.65 , $48.62 , See APC Packaged Rates , $41.30 , $23.01 , $44.41 , $29.80 , $28.54 , See APC Packaged Rates , See APC Packaged Rates , $27.19 , $26.37 , See APC Packaged Rates , See APC Packaged Rates , $13.77 , $13.77 , $14.12 , $14.12 , See APC Packaged Rates , $6.71 , $10.79 , $6.71 , $48.62 , $41.30
87077,5213010012,Hospital Chargemaster,Culture Aerobic Identify,Outpatient,Outpatient Default Percent / Case Rate,306, $46.00 , $18.46 , $37.90 , See APC Packaged Rates , $32.20 , $17.94 , $44.41 , $29.80 , $28.54 , See APC Packaged Rates , See APC Packaged Rates , $17.74 , $17.20 , See APC Packaged Rates , See APC Packaged Rates , $13.74 , $13.74 , $14.09 , $14.09 , See APC Packaged Rates , $6.70 , $10.76 , $6.70 , $44.41 , $32.20
87076,5213010011,Hospital Chargemaster,Culture Anaerobe Ident Each,Outpatient,Outpatient Default Percent / Case Rate,306, $130.00 , $16.61 , $107.12 , See APC Packaged Rates , $91.00 , $50.70 , $44.41 , $29.80 , $28.54 , See APC Packaged Rates , See APC Packaged Rates , $43.31 , $42.00 , See APC Packaged Rates , See APC Packaged Rates , $13.74 , $13.74 , $14.09 , $14.09 , See APC Packaged Rates , $6.70 , $10.76 , $6.70 , $107.12 , $91.00
87101,5213010017,Hospital Chargemaster,Skin Fungi Culture,Outpatient,Outpatient Default Percent / Case Rate,306, $32.00 , $15.85 , $26.37 , See APC Packaged Rates , $22.40 , $12.48 , $41.23 , $27.67 , $26.49 , See APC Packaged Rates , See APC Packaged Rates , $17.57 , $17.04 , See APC Packaged Rates , See APC Packaged Rates , $13.11 , $13.11 , $13.44 , $13.44 , See APC Packaged Rates , $6.40 , $10.27 , $6.40 , $41.23 , $22.40
87184,5213010042,Hospital Chargemaster,Microbe Susceptible Disk,Outpatient,Outpatient Default Percent / Case Rate,306, $41.00 , $14.19 , $33.78 , See APC Packaged Rates , $28.70 , $15.99 , $38.07 , $25.55 , $24.46 , See APC Packaged Rates , See APC Packaged Rates , $24.43 , $23.69 , See APC Packaged Rates , See APC Packaged Rates , $11.97 , $11.97 , $12.28 , $12.28 , See APC Packaged Rates , $6.20 , $9.19 , $6.20 , $38.07 , $28.70
87015,5213010003,Hospital Chargemaster,Specimen Infect Agnt Concntj,Outpatient,Outpatient Default Percent / Case Rate,306, $105.00 , $13.74 , $86.52 , See APC Packaged Rates , $73.50 , $40.95 , $36.50 , $24.49 , $23.45 , See APC Packaged Rates , See APC Packaged Rates , $22.44 , $21.76 , See APC Packaged Rates , See APC Packaged Rates , $11.35 , $11.35 , $11.64 , $11.64 , See APC Packaged Rates , $5.54 , $8.90 , $5.54 , $86.52 , $73.50
87081,5213010013,Hospital Chargemaster,Culture Screen Only,Outpatient,Outpatient Default Percent / Case Rate,306, $31.00 , $13.63 , $25.54 , See APC Packaged Rates , $21.70 , $12.09 , $36.50 , $24.49 , $23.45 , See APC Packaged Rates , See APC Packaged Rates , $22.30 , $21.62 , See APC Packaged Rates , See APC Packaged Rates , $11.28 , $11.28 , $11.57 , $11.57 , See APC Packaged Rates , $5.50 , $8.83 , $5.50 , $36.50 , $21.70
87207,5213010051,Hospital Chargemaster,Smear Special Stain,Outpatient,Outpatient Default Percent / Case Rate,306, $52.00 , $12.33 , $42.85 , See APC Packaged Rates , $36.40 , $20.28 , $84.12 , $56.45 , $54.05 , See APC Packaged Rates , See APC Packaged Rates , $14.53 , $14.09 , See APC Packaged Rates , See APC Packaged Rates , $10.20 , $10.20 , $10.46 , $10.46 , See APC Packaged Rates , $4.97 , $7.99 , $4.97 , $84.12 , $36.40
87140,5213010026,Hospital Chargemaster,Culture Type Immunofluoresc,Outpatient,Outpatient Default Percent / Case Rate,306, $37.00 , $11.46 , $30.49 , See APC Packaged Rates , $25.90 , $14.43 , $30.13 , $20.22 , $19.36 , See APC Packaged Rates , See APC Packaged Rates , $15.02 , $14.57 , See APC Packaged Rates , See APC Packaged Rates , $9.48 , $9.48 , $9.72 , $9.72 , See APC Packaged Rates , $4.62 , $7.43 , $4.62 , $30.49 , $25.90
87210,5213010053,Hospital Chargemaster,Smear Wet Mount Saline/Ink,Outpatient,Outpatient Default Percent / Case Rate,306, $52.00 , $10.78 , $42.85 , See APC Packaged Rates , $36.40 , $20.28 , $25.39 , $17.04 , $16.31 , See APC Packaged Rates , See APC Packaged Rates , $13.81 , $13.39 , See APC Packaged Rates , See APC Packaged Rates , $9.21 , $9.21 , $9.45 , $9.45 , See APC Packaged Rates , $4.83 , $6.98 , $4.83 , $42.85 , $36.40
87206,5213010050,Hospital Chargemaster,Smear Fluorescent/Acid Stai,Outpatient,Outpatient Default Percent / Case Rate,306, $42.00 , $11.09 , $34.61 , See APC Packaged Rates , $29.40 , $16.38 , $28.55 , $19.16 , $18.34 , See APC Packaged Rates , See APC Packaged Rates , $18.06 , $17.52 , See APC Packaged Rates , See APC Packaged Rates , $9.17 , $9.17 , $9.40 , $9.40 , See APC Packaged Rates , $4.47 , $7.19 , $4.47 , $34.61 , $29.40
87147,5213010028,Hospital Chargemaster,Culture Type Immunologic,Outpatient,Outpatient Default Percent / Case Rate,306, $26.00 , $10.65 , $21.42 , See APC Packaged Rates , $18.20 , $10.14 , $28.55 , $19.16 , $18.34 , See APC Packaged Rates , See APC Packaged Rates , $13.27 , $12.87 , See APC Packaged Rates , See APC Packaged Rates , $8.81 , $8.81 , $9.04 , $9.04 , See APC Packaged Rates , $4.31 , $6.90 , $4.31 , $28.55 , $18.20
87169,5213010037,Hospital Chargemaster,Macroscopic Exam Parasite,Outpatient,Outpatient Default Percent / Case Rate,306, $20.00 , $8.80 , $16.48 , See APC Packaged Rates , $14.00 , $7.80 , $23.79 , $15.96 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $14.51 , $14.07 , See APC Packaged Rates , See APC Packaged Rates , $7.28 , $7.28 , $7.46 , $7.46 , See APC Packaged Rates , $3.57 , $5.70 , $3.57 , $23.79 , $14.00
87168,5213010036,Hospital Chargemaster,Macroscopic Exam Arthropod,Outpatient,Outpatient Default Percent / Case Rate,306, $42.00 , $8.80 , $34.61 , See APC Packaged Rates , $29.40 , $16.38 , $23.79 , $15.96 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $14.51 , $14.07 , See APC Packaged Rates , See APC Packaged Rates , $7.26 , $7.26 , $7.45 , $7.45 , See APC Packaged Rates , $3.55 , $5.70 , $3.55 , $34.61 , $29.40
87172,5213010038,Hospital Chargemaster,Pinworm Exam,Outpatient,Outpatient Default Percent / Case Rate,306, $45.00 , $8.80 , $37.08 , See APC Packaged Rates , $31.50 , $17.55 , $23.79 , $15.96 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $14.51 , $14.07 , See APC Packaged Rates , See APC Packaged Rates , $7.26 , $7.26 , $7.45 , $7.45 , See APC Packaged Rates , $3.55 , $5.70 , $3.55 , $37.08 , $31.50
87205,5213010049,Hospital Chargemaster,Smear Gram Stain,Outpatient,Outpatient Default Percent / Case Rate,306, $22.00 , $8.80 , $18.13 , See APC Packaged Rates , $15.40 , $8.58 , $23.79 , $15.96 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $9.85 , $9.55 , See APC Packaged Rates , See APC Packaged Rates , $7.26 , $7.26 , $7.45 , $7.45 , See APC Packaged Rates , $3.55 , $5.70 , $3.55 , $23.79 , $15.40
87220,5213010054,Hospital Chargemaster,Tissue Exam For Fungi,Outpatient,Outpatient Default Percent / Case Rate,306, $33.00 , $8.80 , $27.19 , See APC Packaged Rates , $23.10 , $12.87 , $23.79 , $15.96 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $11.72 , $11.37 , See APC Packaged Rates , See APC Packaged Rates , $7.26 , $7.26 , $7.45 , $7.45 , See APC Packaged Rates , $3.55 , $5.70 , $3.55 , $27.19 , $23.10
86711,5213010001,Hospital Chargemaster,John Cunningham Antibody,Outpatient,Outpatient Default Percent / Case Rate,306, $51.00 , $31.28 , $42.02 , See APC Packaged Rates , $35.70 , $19.89 , $77.73 , $52.15 , $49.94 , See APC Packaged Rates , See APC Packaged Rates , $48.60 , $47.13 , See APC Packaged Rates , See APC Packaged Rates , $47.43 , $47.43 , $47.43 , $47.43 , See APC Packaged Rates , $14.02 , $20.27 , $14.02 , $77.73 , $35.70
87653,5213010189,Hospital Chargemaster,Strep B Dna Amp Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $120.00 , $72.21 , $98.88 , See APC Packaged Rates , $84.00 , $46.80 , $190.34 , $127.72 , $122.29 , See APC Packaged Rates , See APC Packaged Rates , $89.41 , $86.70 , See APC Packaged Rates , See APC Packaged Rates , $111.60 , $111.60 , $111.60 , $111.60 , See APC Packaged Rates , $29.13 , $46.79 , $29.13 , $190.34 , $84.00
87086,5213010015,Hospital Chargemaster,Urine Culture/Colony Count,Outpatient,Outpatient Default Percent / Case Rate,306, $24.00 , $16.61 , $19.78 , See APC Packaged Rates , $16.80 , $9.36 , $44.41 , $29.80 , $28.54 , See APC Packaged Rates , See APC Packaged Rates , $27.17 , $26.34 , See APC Packaged Rates , See APC Packaged Rates , $13.74 , $13.74 , $14.09 , $14.09 , See APC Packaged Rates , $6.70 , $10.76 , $6.70 , $44.41 , $16.80
87328,5213010086,Hospital Chargemaster,Cryptosporidium Ag Ia,Outpatient,Outpatient Default Percent / Case Rate,306, $42.00 , $25.59 , $34.61 , See APC Packaged Rates , $29.40 , $16.38 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $50.43 , $48.90 , See APC Packaged Rates , See APC Packaged Rates , $21.87 , $21.87 , $22.44 , $22.44 , See APC Packaged Rates , $11.47 , $16.58 , $11.47 , $65.04 , $29.40
87635,5213010227,Hospital Chargemaster,Sars-Cov-2 Covid-19 Amp Prb,Outpatient,Outpatient Default Percent / Case Rate,306, $120.00 , $66.00 , $98.88 , See APC Packaged Rates , $84.00 , $46.80 , $115.79 , $116.29 , $61.80 , See APC Packaged Rates , See APC Packaged Rates , $120.07 , $116.42 , See APC Packaged Rates , See APC Packaged Rates , $70.75 , $70.75 , $75.84 , $75.84 , See APC Packaged Rates , $42.00 , $61.57 , $42.00 , $120.07 , $84.00
U0005,5213010230,Hospital Chargemaster,Sars-Cov2 Covid19 Amp High Thr,Outpatient,Outpatient Default Percent / Case Rate,306, $25.00 , $13.75 , $20.60 , See APC Packaged Rates , $17.50 , $9.75 , $24.12 , $24.23 , $12.88 , See APC Packaged Rates , See APC Packaged Rates , $16.78 , $16.78 , See APC Packaged Rates , See APC Packaged Rates , $23.25 , $23.25 , $23.25 , $23.25 , See APC Packaged Rates , $8.75 , Not Applicable , $8.75 , $24.23 , $17.50
87563,5213010231,Hospital Chargemaster,M. Genitalium Amp Probe,Outpatient,Outpatient Default Percent / Case Rate,306, $105.00 , $72.21 , $86.52 , See APC Packaged Rates , $73.50 , $40.95 , $101.31 , $101.76 , $67.62 , See APC Packaged Rates , See APC Packaged Rates , $86.21 , $83.59 , See APC Packaged Rates , See APC Packaged Rates , $62.54 , $62.54 , $64.15 , $64.15 , See APC Packaged Rates , $29.13 , $42.11 , $29.13 , $101.76 , $73.50
87076,66240051,Hospital Chargemaster,Anaerobic Bacteria,Outpatient,Outpatient Default Percent / Case Rate,306, $60.00 , $16.61 , $49.44 , See APC Packaged Rates , $42.00 , $23.40 , $44.41 , $29.80 , $28.54 , See APC Packaged Rates , See APC Packaged Rates , $43.31 , $42.00 , See APC Packaged Rates , See APC Packaged Rates , $13.74 , $13.74 , $14.09 , $14.09 , See APC Packaged Rates , $6.70 , $10.76 , $6.70 , $49.44 , $42.00
87070,66245615,Hospital Chargemaster,"Throat, Beta Screen",Outpatient,Outpatient Default Percent / Case Rate,306, $85.00 , $17.72 , $70.04 , See APC Packaged Rates , $59.50 , $33.15 , $47.57 , $31.92 , $30.56 , See APC Packaged Rates , See APC Packaged Rates , $28.97 , $28.09 , See APC Packaged Rates , See APC Packaged Rates , $14.66 , $14.66 , $15.04 , $15.04 , See APC Packaged Rates , $7.15 , $11.48 , $7.15 , $70.04 , $59.50
87070,66245661,Hospital Chargemaster,Bronchial Washing Culture,Outpatient,Outpatient Default Percent / Case Rate,306, $40.00 , $17.72 , $32.96 , See APC Packaged Rates , $28.00 , $15.60 , $47.57 , $31.92 , $30.56 , See APC Packaged Rates , See APC Packaged Rates , $28.97 , $28.09 , See APC Packaged Rates , See APC Packaged Rates , $14.66 , $14.66 , $15.04 , $15.04 , See APC Packaged Rates , $7.15 , $11.48 , $7.15 , $47.57 , $28.00
81025,5217010006,Hospital Chargemaster,Urine Pregnancy Test,Outpatient,Outpatient Default Percent / Case Rate,307, $84.00 , $15.95 , $69.22 , See APC Packaged Rates , $58.80 , $32.76 , $38.07 , $25.55 , $24.46 , See APC Packaged Rates , See APC Packaged Rates , $21.27 , $20.63 , See APC Packaged Rates , See APC Packaged Rates , $13.63 , $13.63 , $13.98 , $13.98 , See APC Packaged Rates , $7.15 , $10.33 , $7.15 , $69.22 , $58.80
84583,5217010014,Hospital Chargemaster,Assay Of Urine Urobilinogen,Outpatient,Outpatient Default Percent / Case Rate,307, $26.00 , $11.20 , $21.42 , See APC Packaged Rates , $18.20 , $10.14 , $26.97 , $18.10 , $17.33 , See APC Packaged Rates , See APC Packaged Rates , $12.10 , $11.73 , See APC Packaged Rates , See APC Packaged Rates , $9.58 , $9.58 , $9.83 , $9.83 , See APC Packaged Rates , $5.02 , $7.26 , $5.02 , $26.97 , $18.20
84540,5217010013,Hospital Chargemaster,Assay Of Urine/Urea-N,Outpatient,Outpatient Default Percent / Case Rate,307, $40.00 , $10.30 , $32.96 , See APC Packaged Rates , $28.00 , $15.60 , $25.39 , $17.04 , $16.31 , See APC Packaged Rates , See APC Packaged Rates , $12.10 , $11.73 , See APC Packaged Rates , See APC Packaged Rates , $8.80 , $8.80 , $9.03 , $9.03 , See APC Packaged Rates , $4.61 , $6.67 , $4.61 , $32.96 , $28.00
82705,5217010010,Hospital Chargemaster,Fats/Lipids Feces Qual,Outpatient,Outpatient Default Percent / Case Rate,307, $30.00 , $10.48 , $24.72 , See APC Packaged Rates , $21.00 , $11.70 , $26.97 , $18.10 , $17.33 , See APC Packaged Rates , See APC Packaged Rates , $17.13 , $16.61 , See APC Packaged Rates , See APC Packaged Rates , $8.68 , $8.68 , $8.90 , $8.90 , See APC Packaged Rates , $4.24 , $6.79 , $4.24 , $26.97 , $21.00
82271,5217010008,Hospital Chargemaster,Occult Blood Other Sources,Outpatient,Outpatient Default Percent / Case Rate,307, $16.00 , $9.85 , $13.18 , See APC Packaged Rates , $11.20 , $6.24 , $23.79 , $15.96 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $11.16 , $10.82 , See APC Packaged Rates , See APC Packaged Rates , $8.43 , $8.43 , $8.65 , $8.65 , See APC Packaged Rates , $4.42 , $6.38 , $4.42 , $23.79 , $11.20
82270,5217010007,Hospital Chargemaster,Occult Blood Feces,Outpatient,Outpatient Default Percent / Case Rate,307, $10.00 , $8.11 , $8.24 , See APC Packaged Rates , $7.00 , $3.90 , $19.02 , $12.76 , $12.22 , See APC Packaged Rates , See APC Packaged Rates , $7.23 , $7.01 , See APC Packaged Rates , See APC Packaged Rates , $6.94 , $6.94 , $7.12 , $7.12 , See APC Packaged Rates , $3.64 , $5.26 , $3.64 , $19.02 , $7.00
82272,5217010009,Hospital Chargemaster,Occult Bld Feces 1-3 Tests,Outpatient,Outpatient Default Percent / Case Rate,307, $16.00 , $7.83 , $13.18 , See APC Packaged Rates , $11.20 , $6.24 , $19.02 , $12.76 , $12.22 , See APC Packaged Rates , See APC Packaged Rates , $11.16 , $10.82 , See APC Packaged Rates , See APC Packaged Rates , $6.69 , $6.69 , $6.86 , $6.86 , See APC Packaged Rates , $3.51 , $5.08 , $3.51 , $19.02 , $11.20
81000,5217010001,Hospital Chargemaster,Urinalysis Nonauto W/Scope,Outpatient,Outpatient Default Percent / Case Rate,307, $25.00 , $7.45 , $20.60 , See APC Packaged Rates , $17.50 , $9.75 , $17.44 , $11.71 , $11.21 , See APC Packaged Rates , See APC Packaged Rates , $10.74 , $10.41 , See APC Packaged Rates , See APC Packaged Rates , $6.37 , $6.37 , $6.53 , $6.53 , See APC Packaged Rates , $3.33 , $4.82 , $3.33 , $20.60 , $17.50
83986,5217010011,Hospital Chargemaster,Assay Ph Body Fluid Nos,Outpatient,Outpatient Default Percent / Case Rate,307, $41.00 , $8.19 , $33.78 , See APC Packaged Rates , $28.70 , $15.99 , $19.02 , $12.76 , $12.22 , See APC Packaged Rates , See APC Packaged Rates , $12.05 , $11.69 , See APC Packaged Rates , See APC Packaged Rates , $6.09 , $6.09 , $6.25 , $6.25 , See APC Packaged Rates , $2.97 , $4.78 , $2.97 , $33.78 , $28.70
81002,5217010003,Hospital Chargemaster,Urinalysis Nonauto W/O Scope,Outpatient,Outpatient Default Percent / Case Rate,307, $10.00 , $6.44 , $8.24 , See APC Packaged Rates , $7.00 , $3.90 , $15.87 , $10.65 , $10.19 , See APC Packaged Rates , See APC Packaged Rates , $7.49 , $7.26 , See APC Packaged Rates , See APC Packaged Rates , $5.51 , $5.51 , $5.65 , $5.65 , See APC Packaged Rates , $2.88 , $4.18 , $2.88 , $15.87 , $7.00
81001,5217010002,Hospital Chargemaster,Urinalysis Auto W/Scope,Outpatient,Outpatient Default Percent / Case Rate,307, $25.00 , $6.52 , $20.60 , See APC Packaged Rates , $17.50 , $9.75 , $17.44 , $11.71 , $11.21 , See APC Packaged Rates , See APC Packaged Rates , $10.74 , $10.41 , See APC Packaged Rates , See APC Packaged Rates , $5.40 , $5.40 , $5.54 , $5.54 , See APC Packaged Rates , $2.63 , $4.22 , $2.63 , $20.60 , $17.50
84315,5217010012,Hospital Chargemaster,Body Fluid Specific Gravity,Outpatient,Outpatient Default Percent / Case Rate,307, $35.00 , $6.07 , $28.84 , See APC Packaged Rates , $24.50 , $13.65 , $14.29 , $9.59 , $9.18 , See APC Packaged Rates , See APC Packaged Rates , $8.42 , $8.17 , See APC Packaged Rates , See APC Packaged Rates , $5.20 , $5.20 , $5.33 , $5.33 , See APC Packaged Rates , $2.72 , $3.94 , $2.72 , $28.84 , $24.50
81003,5217010004,Hospital Chargemaster,Urinalysis Auto W/O Scope,Outpatient,Outpatient Default Percent / Case Rate,307, $23.00 , $5.13 , $18.95 , See APC Packaged Rates , $16.10 , $8.97 , $12.68 , $8.51 , $8.15 , See APC Packaged Rates , See APC Packaged Rates , $7.42 , $7.19 , See APC Packaged Rates , See APC Packaged Rates , $3.81 , $3.81 , $3.91 , $3.91 , See APC Packaged Rates , $1.86 , $2.99 , $1.86 , $18.95 , $16.10
81005,5217010005,Hospital Chargemaster,Urinalysis,Outpatient,Outpatient Default Percent / Case Rate,307, $35.00 , $4.46 , $28.84 , See APC Packaged Rates , $24.50 , $13.65 , $11.10 , $7.45 , $7.13 , See APC Packaged Rates , See APC Packaged Rates , $6.58 , $6.38 , See APC Packaged Rates , See APC Packaged Rates , $3.69 , $3.69 , $3.79 , $3.79 , See APC Packaged Rates , $1.80 , $2.89 , $1.80 , $28.84 , $24.50
81404,5213010220,Hospital Chargemaster,Mopath Procedure Level 5,Outpatient,Outpatient Default Percent / Case Rate,309, $700.00 , $508.99 , $576.80 , See APC Packaged Rates , $490.00 , $273.00 ," $1,210.25 ", $812.08 , $777.55 , See APC Packaged Rates , See APC Packaged Rates , $469.70 , $469.70 , See APC Packaged Rates , See APC Packaged Rates , $435.13 , $435.13 , $446.33 , $446.33 , See APC Packaged Rates , $228.10 , $329.80 , $228.10 ," $1,210.25 ", $490.00
81403,5213010219,Hospital Chargemaster,Mopath Procedure Level 4,Outpatient,Outpatient Default Percent / Case Rate,309, $550.00 , $342.99 , $453.20 , See APC Packaged Rates , $385.00 , $214.50 , $815.30 , $547.07 , $523.81 , See APC Packaged Rates , See APC Packaged Rates , $369.05 , $369.05 , See APC Packaged Rates , See APC Packaged Rates , $293.23 , $293.23 , $300.78 , $300.78 , See APC Packaged Rates , $153.71 , $222.24 , $153.71 , $815.30 , $385.00
89321,5213010225,Hospital Chargemaster,Semen Anal Sperm Detection,Outpatient,Outpatient Default Percent / Case Rate,309, $250.00 , $27.56 , $206.00 , See APC Packaged Rates , $175.00 , $97.50 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $40.93 , $39.68 , See APC Packaged Rates , See APC Packaged Rates , $20.50 , $20.50 , $21.03 , $21.03 , See APC Packaged Rates , $10.00 , $16.07 , $10.00 , $206.00 , $175.00
89060,5213010223,Hospital Chargemaster,Exam Synovial Fluid Crystals,Outpatient,Outpatient Default Percent / Case Rate,309, $384.00 , $14.72 , $316.42 , See APC Packaged Rates , $268.80 , $149.76 , $84.12 , $56.45 , $54.05 , See APC Packaged Rates , See APC Packaged Rates , $15.80 , $15.32 , See APC Packaged Rates , See APC Packaged Rates , $12.24 , $12.24 , $12.56 , $12.56 , See APC Packaged Rates , $6.08 , $9.54 , $6.08 , $316.42 , $268.80
89190,5213010224,Hospital Chargemaster,Nasal Smear For Eosinophils,Outpatient,Outpatient Default Percent / Case Rate,309, $28.00 , $10.72 , $23.07 , See APC Packaged Rates , $19.60 , $10.92 , $25.39 , $17.04 , $16.31 , See APC Packaged Rates , See APC Packaged Rates , $12.19 , $11.82 , See APC Packaged Rates , See APC Packaged Rates , $9.17 , $9.17 , $9.40 , $9.40 , See APC Packaged Rates , $4.80 , $6.95 , $4.80 , $25.39 , $19.60
89055,5213010222,Hospital Chargemaster,Leukocyte Assessment Fecal,Outpatient,Outpatient Default Percent / Case Rate,309, $29.00 , $8.80 , $23.90 , See APC Packaged Rates , $20.30 , $11.31 , $23.79 , $15.96 , $15.28 , See APC Packaged Rates , See APC Packaged Rates , $14.06 , $13.64 , See APC Packaged Rates , See APC Packaged Rates , $7.26 , $7.26 , $7.45 , $7.45 , See APC Packaged Rates , $3.55 , $5.70 , $3.55 , $23.90 , $20.30
81479,5213010221,Hospital Chargemaster,Unlisted Molecular Pathology,Outpatient,Outpatient Default Percent / Case Rate,309, $164.00 , $90.20 , $135.14 , See APC Packaged Rates , $114.80 , $63.96 , $240.82 , $161.59 , $154.72 , See APC Packaged Rates , See APC Packaged Rates , $110.04 , $110.04 , See APC Packaged Rates , See APC Packaged Rates , $152.52 , $152.52 , $152.52 , $152.52 , See APC Packaged Rates , $139.48 , $- , $- , $240.82 , $114.80
88333,5219010010,Hospital Chargemaster,Intraop Cyto Path Consult 1,Outpatient,Outpatient Default Percent / Case Rate,310, $748.00 ," $1,033.64 ", $616.35 , $783.46 , $523.60 , $291.72 ," $1,767.29 "," $1,185.85 "," $1,135.43 ", $783.46 , $783.46 , $56.86 , $55.14 , $822.63 , $799.13 , $748.00 , $748.00 , $748.00 , $748.00 , $783.46 , $28.09 , $669.74 , $28.09 ," $1,767.29 ", $523.60
81301,5219010001,Hospital Chargemaster,Microsatellite Instability,Outpatient,Outpatient Default Percent / Case Rate,310, $900.00 , $645.53 , $741.60 , See APC Packaged Rates , $630.00 , $351.00 ," $1,573.48 "," $1,055.81 "," $1,010.92 ", See APC Packaged Rates , See APC Packaged Rates , $603.90 , $603.90 , See APC Packaged Rates , See APC Packaged Rates , $551.86 , $551.86 , $566.07 , $566.07 , See APC Packaged Rates , $289.29 , $418.27 , $289.29 ," $1,573.48 ", $630.00
88262,5219010008,Hospital Chargemaster,Chromosome Analysis 15-20,Outpatient,Outpatient Default Percent / Case Rate,310, $720.00 , $256.48 , $593.28 , See APC Packaged Rates , $504.00 , $280.80 , $677.30 , $454.47 , $435.14 , See APC Packaged Rates , See APC Packaged Rates , $524.00 , $508.10 , See APC Packaged Rates , See APC Packaged Rates , $212.41 , $212.41 , $217.88 , $217.88 , See APC Packaged Rates , $104.15 , $166.19 , $104.15 , $677.30 , $504.00
88230,5219010007,Hospital Chargemaster,Tissue Culture Lymphocyte,Outpatient,Outpatient Default Percent / Case Rate,310, $464.00 , $239.72 , $382.34 , See APC Packaged Rates , $324.80 , $180.96 , $632.88 , $424.66 , $406.61 , See APC Packaged Rates , See APC Packaged Rates , $85.64 , $83.05 , See APC Packaged Rates , See APC Packaged Rates , $198.21 , $198.21 , $203.32 , $203.32 , See APC Packaged Rates , $96.68 , $155.33 , $83.05 , $632.88 , $324.80
88342,5219010013,Hospital Chargemaster,Immunohisto Antb 1St Stain,Outpatient,Outpatient Default Percent / Case Rate,310, $192.00 , $268.04 , $158.21 , $178.30 , $134.40 , $74.88 , $458.30 , $307.52 , $294.44 , $178.30 , $178.30 , $140.03 , $135.78 , $187.22 , $181.87 , $192.00 , $192.00 , $192.00 , $192.00 , $178.30 , $58.79 , $173.68 , $58.79 , $458.30 , $134.40
88184,5219010003,Hospital Chargemaster,Flowcytometry/ Tc 1 Marker,Outpatient,Outpatient Default Percent / Case Rate,310, $191.00 , $507.86 , $157.38 , $348.19 , $133.70 , $74.49 , $868.33 , $582.65 , $557.88 , $348.19 , $348.19 , $138.69 , $134.48 , $365.60 , $355.15 , $191.00 , $191.00 , $191.00 , $191.00 , $348.19 , $57.92 , $329.06 , $57.92 , $868.33 , $133.70
88188,5219010005,Hospital Chargemaster,Flowcytometry/Read 9-15,Outpatient,Outpatient Default Percent / Case Rate,310, $640.00 , $122.14 , $527.36 , See APC Packaged Rates , $448.00 , $249.60 , $297.83 , $199.85 , $191.35 , See APC Packaged Rates , See APC Packaged Rates , $218.77 , $212.13 , See APC Packaged Rates , See APC Packaged Rates , $62.85 , $62.85 , $64.47 , $64.47 , See APC Packaged Rates , $52.13 , $79.14 , $52.13 , $527.36 , $448.00
88189,5219010006,Hospital Chargemaster,Flowcytometry/Read 16 & >,Outpatient,Outpatient Default Percent / Case Rate,310, $396.00 , $163.53 , $326.30 , See APC Packaged Rates , $277.20 , $154.44 , $396.69 , $266.18 , $254.86 , See APC Packaged Rates , See APC Packaged Rates , $288.22 , $279.47 , See APC Packaged Rates , See APC Packaged Rates , $62.85 , $62.85 , $64.47 , $64.47 , See APC Packaged Rates , $70.66 , $105.96 , $62.85 , $396.69 , $277.20
88280,5219010009,Hospital Chargemaster,Chromosome Karyotype Study,Outpatient,Outpatient Default Percent / Case Rate,310, $150.00 , $61.99 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 , $147.50 , $98.98 , $94.77 , See APC Packaged Rates , See APC Packaged Rates , $105.49 , $102.29 , See APC Packaged Rates , See APC Packaged Rates , $52.99 , $52.99 , $54.36 , $54.36 , See APC Packaged Rates , $27.79 , $40.16 , $27.79 , $147.50 , $105.00
89051,5219010014,Hospital Chargemaster,Body Fluid Cell Count,Outpatient,Outpatient Default Percent / Case Rate,310, $67.00 , $11.33 , $55.21 , See APC Packaged Rates , $46.90 , $26.13 , $30.13 , $20.22 , $19.36 , See APC Packaged Rates , See APC Packaged Rates , $18.53 , $17.97 , See APC Packaged Rates , See APC Packaged Rates , $9.41 , $9.41 , $9.66 , $9.66 , See APC Packaged Rates , $4.64 , $7.34 , $4.64 , $55.21 , $46.90
88334,5219010011,Hospital Chargemaster,Intraop Cyto Path Consult 2,Outpatient,Outpatient Default Percent / Case Rate,310, $56.00 , $- , $46.14 , See APC Packaged Rates , $39.20 , $21.84 , $83.54 , $56.06 , $53.67 , See APC Packaged Rates , See APC Packaged Rates , $34.80 , $33.74 , See APC Packaged Rates , See APC Packaged Rates , $52.08 , $52.08 , $52.08 , $52.08 , See APC Packaged Rates , $15.92 , $20.33 , $- , $83.54 , $39.20
88185,5219010004,Hospital Chargemaster,Flowcytometry/Tc Add-On,Outpatient,Outpatient Default Percent / Case Rate,310, $117.00 , $- , $96.41 , See APC Packaged Rates , $81.90 , $45.63 , $122.67 , $82.31 , $78.81 , See APC Packaged Rates , See APC Packaged Rates , $68.02 , $65.96 , See APC Packaged Rates , See APC Packaged Rates , $108.81 , $108.81 , $108.81 , $108.81 , See APC Packaged Rates , $19.12 , $29.84 , $- , $122.67 , $81.90
88141,5219010002,Hospital Chargemaster,Cytopath C/V Interpret,Outpatient,Outpatient Default Percent / Case Rate,310, $60.00 , $- , $49.44 , See APC Packaged Rates , $42.00 , $23.40 , $150.38 , $100.91 , $96.62 , See APC Packaged Rates , See APC Packaged Rates , $60.56 , $58.72 , See APC Packaged Rates , See APC Packaged Rates , $55.80 , $55.80 , $55.80 , $55.80 , See APC Packaged Rates , $18.25 , $38.93 , $- , $150.38 , $42.00
88341,5219010012,Hospital Chargemaster,Immunohisto Antb Addl Slide,Outpatient,Outpatient Default Percent / Case Rate,310, $200.00 , $- , $164.80 , See APC Packaged Rates , $140.00 , $78.00 , $318.21 , $213.52 , $204.44 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $186.00 , $186.00 , $186.00 , $186.00 , See APC Packaged Rates , $54.15 , $77.41 , $- , $318.21 , $140.00
81377,5218010005,Hospital Chargemaster,Celiac HLA Reflex to Ab Combo,Outpatient,Outpatient Default Percent / Case Rate,310, $294.00 , $188.92 , $242.26 , See APC Packaged Rates , $205.80 , $114.66 , $499.64 , $335.26 , $321.00 , See APC Packaged Rates , See APC Packaged Rates , $197.27 , $197.27 , See APC Packaged Rates , See APC Packaged Rates , $157.37 , $157.37 , $161.42 , $161.42 , See APC Packaged Rates , $78.64 , $122.41 , $78.64 , $499.64 , $205.80
81383,5218010006,Hospital Chargemaster,Celiac HLA Reflex to Ab Combo,Outpatient,Outpatient Default Percent / Case Rate,310, $325.00 , $224.57 , $267.80 , See APC Packaged Rates , $227.50 , $126.75 , $593.23 , $398.06 , $381.13 , See APC Packaged Rates , See APC Packaged Rates , $218.08 , $218.08 , See APC Packaged Rates , See APC Packaged Rates , $185.68 , $185.68 , $190.46 , $190.46 , See APC Packaged Rates , $90.57 , $145.51 , $90.57 , $593.23 , $227.50
88187,5218010007,Hospital Chargemaster,Flowcytometry/Read 2-8,Outpatient,Outpatient Default Percent / Case Rate,310, $431.00 , $72.08 , $355.14 , See APC Packaged Rates , $301.70 , $168.09 , $175.17 , $117.54 , $112.54 , See APC Packaged Rates , See APC Packaged Rates , $175.31 , $169.99 , See APC Packaged Rates , See APC Packaged Rates , $62.85 , $62.85 , $64.47 , $64.47 , See APC Packaged Rates , $30.41 , $46.70 , $30.41 , $355.14 , $301.70
88237,5220010010,Hospital Chargemaster,Tissue Culture Bone Marrow,Outpatient,Outpatient Default Percent / Case Rate,311, $376.00 , $266.23 , $309.82 , See APC Packaged Rates , $263.20 , $146.64 , $686.82 , $460.86 , $441.26 , See APC Packaged Rates , See APC Packaged Rates , $85.64 , $83.05 , See APC Packaged Rates , See APC Packaged Rates , $227.59 , $227.59 , $233.45 , $233.45 , See APC Packaged Rates , $119.32 , $172.50 , $83.05 , $686.82 , $263.20
88172,5220010007,Hospital Chargemaster,Cytp Dx Eval Fna 1St Ea Site,Outpatient,Outpatient Default Percent / Case Rate,311, $126.00 , $268.04 , $103.82 , $178.30 , $88.20 , $49.14 , $458.30 , $307.52 , $294.44 , $178.30 , $178.30 , $44.41 , $43.07 , $187.22 , $181.87 , $126.00 , $126.00 , $126.00 , $126.00 , $178.30 , $16.51 , $173.68 , $16.51 , $458.30 , $88.20
88112,5220010003,Hospital Chargemaster,Cytopath Cell Enhance Tech,Outpatient,Outpatient Default Percent / Case Rate,311, $104.00 , $94.41 , $85.70 , $59.41 , $72.80 , $40.56 , $161.43 , $108.32 , $103.72 , $59.41 , $59.41 , $69.78 , $69.78 , $62.38 , $60.60 , $95.25 , $95.25 , $97.70 , $97.70 , $59.41 , $33.02 , $61.18 , $33.02 , $161.43 , $72.80
88173,5220010008,Hospital Chargemaster,Cytopath Eval Fna Report,Outpatient,Outpatient Default Percent / Case Rate,311, $163.00 , $94.41 , $134.31 , $59.41 , $114.10 , $63.57 , $161.43 , $108.32 , $103.72 , $59.41 , $59.41 , $52.93 , $51.32 , $62.38 , $60.60 , $95.25 , $95.25 , $97.70 , $97.70 , $59.41 , $70.95 , $61.18 , $51.32 , $161.43 , $114.10
88275,5220010014,Hospital Chargemaster,Cytogenetics 100-300,Outpatient,Outpatient Default Percent / Case Rate,311, $216.00 , $94.80 , $177.98 , See APC Packaged Rates , $151.20 , $84.24 , $225.23 , $151.13 , $144.70 , See APC Packaged Rates , See APC Packaged Rates , $168.83 , $163.71 , See APC Packaged Rates , See APC Packaged Rates , $81.05 , $81.05 , $83.13 , $83.13 , See APC Packaged Rates , $42.49 , $61.43 , $42.49 , $225.23 , $151.20
88274,5220010013,Hospital Chargemaster,Cytogenetics 25-99,Outpatient,Outpatient Default Percent / Case Rate,311, $201.00 , $78.49 , $165.62 , See APC Packaged Rates , $140.70 , $78.39 , $188.76 , $126.66 , $121.27 , See APC Packaged Rates , See APC Packaged Rates , $146.32 , $141.88 , See APC Packaged Rates , See APC Packaged Rates , $67.10 , $67.10 , $68.82 , $68.82 , See APC Packaged Rates , $35.18 , $50.86 , $35.18 , $188.76 , $140.70
88104,5220010001,Hospital Chargemaster,Cytopath Fl Nongyn Smears,Outpatient,Outpatient Default Percent / Case Rate,311, $97.00 , $59.49 , $79.93 , $40.47 , $67.90 , $37.83 , $101.71 , $68.24 , $65.34 , $40.47 , $40.47 , $27.40 , $26.57 , $42.49 , $41.28 , $63.27 , $63.27 , $64.89 , $64.89 , $40.47 , $33.02 , $38.54 , $26.57 , $101.71 , $67.90
88108,5220010002,Hospital Chargemaster,Cytopath Concentrate Tech,Outpatient,Outpatient Default Percent / Case Rate,311, $122.00 , $59.49 , $100.53 , $40.47 , $85.40 , $47.58 , $101.71 , $68.24 , $65.34 , $40.47 , $40.47 , $29.84 , $28.93 , $42.49 , $41.28 , $63.27 , $63.27 , $64.89 , $64.89 , $40.47 , $34.17 , $38.54 , $28.93 , $101.71 , $85.40
88289,5220010015,Hospital Chargemaster,Chromosome Study Additional,Outpatient,Outpatient Default Percent / Case Rate,311, $432.00 , $70.86 , $355.97 , See APC Packaged Rates , $302.40 , $168.48 , $187.16 , $125.58 , $120.24 , See APC Packaged Rates , See APC Packaged Rates , $115.78 , $112.27 , See APC Packaged Rates , See APC Packaged Rates , $58.59 , $58.59 , $60.10 , $60.10 , See APC Packaged Rates , $28.58 , $45.91 , $28.58 , $355.97 , $302.40
88273,5220010012,Hospital Chargemaster,Cytogenetics 10-30,Outpatient,Outpatient Default Percent / Case Rate,311, $283.00 , $66.12 , $233.19 , See APC Packaged Rates , $198.10 , $110.37 , $174.47 , $117.07 , $112.09 , See APC Packaged Rates , See APC Packaged Rates , $135.06 , $130.97 , See APC Packaged Rates , See APC Packaged Rates , $55.73 , $55.73 , $57.16 , $57.16 , See APC Packaged Rates , $28.89 , $42.84 , $28.89 , $233.19 , $198.10
88271,5220010011,Hospital Chargemaster,Cytogenetics Dna Probe,Outpatient,Outpatient Default Percent / Case Rate,311, $134.00 , $44.08 , $110.42 , See APC Packaged Rates , $93.80 , $52.26 , $115.80 , $77.70 , $74.40 , See APC Packaged Rates , See APC Packaged Rates , $90.04 , $87.31 , See APC Packaged Rates , See APC Packaged Rates , $36.44 , $36.44 , $37.38 , $37.38 , See APC Packaged Rates , $17.77 , $28.56 , $17.77 , $115.80 , $93.80
88142,5220010005,Hospital Chargemaster,Cytopath C/V Thin Layer,Outpatient,Outpatient Default Percent / Case Rate,311, $134.00 , $41.69 , $110.42 , See APC Packaged Rates , $93.80 , $52.26 , $109.46 , $73.45 , $70.32 , See APC Packaged Rates , See APC Packaged Rates , $97.37 , $94.41 , See APC Packaged Rates , See APC Packaged Rates , $34.47 , $34.47 , $35.36 , $35.36 , See APC Packaged Rates , $16.81 , $27.01 , $16.81 , $110.42 , $93.80
88177,5220010009,Hospital Chargemaster,Cytp Fna Eval Ea Addl,Outpatient,Outpatient Default Percent / Case Rate,311, $35.00 , $- , $28.84 , See APC Packaged Rates , $24.50 , $13.65 , $35.55 , $23.86 , $22.84 , See APC Packaged Rates , See APC Packaged Rates , $17.18 , $16.65 , See APC Packaged Rates , See APC Packaged Rates , $32.55 , $32.55 , $32.55 , $32.55 , See APC Packaged Rates , $6.08 , $8.65 , $- , $35.55 , $24.50
88291,5220010016,Hospital Chargemaster,Cyto/Molecular Report,Outpatient,Outpatient Default Percent / Case Rate,311, $127.00 , $62.75 , $104.65 , See APC Packaged Rates , $88.90 , $49.53 , $155.31 , $104.22 , $99.78 , See APC Packaged Rates , See APC Packaged Rates , $16.45 , $15.95 , See APC Packaged Rates , See APC Packaged Rates , $118.11 , $118.11 , $118.11 , $118.11 , See APC Packaged Rates , $28.09 , $40.66 , $15.95 , $155.31 , $88.90
88175,5218010004,Hospital Chargemaster,Cytopath c/v auto fluid redo,Outpatient,Outpatient Default Percent / Case Rate,311, $120.00 , $54.52 , $98.88 , See APC Packaged Rates , $84.00 , $46.80 , $144.35 , $96.86 , $92.74 , See APC Packaged Rates , See APC Packaged Rates , $87.24 , $84.59 , See APC Packaged Rates , See APC Packaged Rates , $45.13 , $45.13 , $46.29 , $46.29 , See APC Packaged Rates , $22.09 , $35.33 , $22.09 , $144.35 , $84.00
88161,5220010006,Hospital Chargemaster,Cytopath Smear Other Source,Outpatient,Outpatient Default Percent / Case Rate,311, $42.00 , $59.49 , $34.61 , $29.53 , $29.40 , $16.38 , $101.71 , $68.24 , $65.34 , $29.53 , $29.53 , $24.97 , $24.21 , $31.01 , $30.12 , $42.00 , $42.00 , $42.00 , $42.00 , $29.53 , $38.52 , $38.54 , $16.38 , $101.71 , $29.40
88348,5215010018,Hospital Chargemaster,Electron Microscopy,Outpatient,Outpatient Default Percent / Case Rate,312," $1,363.00 "," $1,033.64 "," $1,123.11 ", $783.46 , $954.10 , $531.57 ," $1,767.29 "," $1,185.85 "," $1,135.43 ", $783.46 , $783.46 , $161.90 , $156.99 , $822.63 , $799.13 ," $1,044.55 "," $1,044.55 "," $1,071.44 "," $1,071.44 ", $783.46 , $294.24 , $669.74 , $156.99 ," $1,767.29 ", $954.10
88309,5215010007,Hospital Chargemaster,Tissue Exam By Pathologist,Outpatient,Outpatient Default Percent / Case Rate,312, $748.00 ," $1,033.64 ", $616.35 , $783.46 , $523.60 , $291.72 ," $1,767.29 "," $1,185.85 "," $1,135.43 ", $783.46 , $783.46 , $118.71 , $115.11 , $822.63 , $799.13 , $748.00 , $748.00 , $748.00 , $748.00 , $783.46 , $244.71 , $669.74 , $115.11 ," $1,767.29 ", $523.60
88307,5215010006,Hospital Chargemaster,Tissue Exam By Pathologist,Outpatient,Outpatient Default Percent / Case Rate,312, $445.00 , $507.86 , $366.68 , $348.19 , $311.50 , $173.55 , $868.33 , $582.65 , $557.88 , $348.19 , $348.19 , $95.61 , $92.71 , $365.60 , $355.15 , $391.55 , $391.55 , $401.63 , $401.63 , $348.19 , $171.75 , $329.06 , $92.71 , $868.33 , $311.50
88344,5215010017,Hospital Chargemaster,Immunohisto Antibody Slide,Outpatient,Outpatient Default Percent / Case Rate,312, $300.00 , $507.86 , $247.20 , $348.19 , $210.00 , $117.00 , $868.33 , $582.65 , $557.88 , $348.19 , $348.19 , $- , $- , $365.60 , $355.15 , $300.00 , $300.00 , $300.00 , $300.00 , $348.19 , $116.13 , $329.06 , $- , $868.33 , $210.00
88365,5215010020,Hospital Chargemaster,Insitu Hybridization (Fish),Outpatient,Outpatient Default Percent / Case Rate,312, $255.00 , $268.04 , $210.12 , $178.30 , $178.50 , $99.45 , $458.30 , $307.52 , $294.44 , $178.30 , $178.30 , $46.85 , $45.43 , $187.22 , $181.87 , $247.22 , $247.22 , $253.58 , $253.58 , $178.30 , $117.87 , $173.68 , $45.43 , $458.30 , $178.50
88233,5215010001,Hospital Chargemaster,Tissue Culture Skin/Biopsy,Outpatient,Outpatient Default Percent / Case Rate,312, $520.00 , $289.58 , $428.48 , See APC Packaged Rates , $364.00 , $202.80 , $764.55 , $513.01 , $491.20 , See APC Packaged Rates , See APC Packaged Rates , $295.61 , $286.64 , See APC Packaged Rates , See APC Packaged Rates , $239.44 , $239.44 , $245.60 , $245.60 , See APC Packaged Rates , $116.80 , $187.63 , $116.80 , $764.55 , $364.00
88331,5215010015,Hospital Chargemaster,Path Consult Intraop 1 Bloc,Outpatient,Outpatient Default Percent / Case Rate,312, $200.00 , $268.04 , $164.80 , $178.30 , $140.00 , $78.00 , $458.30 , $307.52 , $294.44 , $178.30 , $178.30 , $34.70 , $33.65 , $187.22 , $181.87 , $200.00 , $200.00 , $200.00 , $200.00 , $178.30 , $35.04 , $173.68 , $33.65 , $458.30 , $140.00
88360,5215010019,Hospital Chargemaster,Tumor Immunohistochem/Manual,Outpatient,Outpatient Default Percent / Case Rate,312, $182.00 , $268.04 , $149.97 , $178.30 , $127.40 , $70.98 , $458.30 , $307.52 , $294.44 , $178.30 , $178.30 , $132.47 , $128.45 , $187.22 , $181.87 , $182.00 , $182.00 , $182.00 , $182.00 , $178.30 , $68.64 , $173.68 , $68.64 , $458.30 , $127.40
88319,5215010011,Hospital Chargemaster,Enzyme Histochemistry,Outpatient,Outpatient Default Percent / Case Rate,312, $179.00 ," $1,033.64 ", $147.50 , $783.46 , $125.30 , $69.81 ," $1,767.29 "," $1,185.85 "," $1,135.43 ", $783.46 , $783.46 , $29.84 , $28.93 , $822.63 , $799.13 , $179.00 , $179.00 , $179.00 , $179.00 , $783.46 , $85.44 , $669.74 , $28.93 ," $1,767.29 ", $125.30
88323,5215010012,Hospital Chargemaster,Microslide Consultation,Outpatient,Outpatient Default Percent / Case Rate,312, $188.00 , $94.41 , $154.91 , $59.41 , $131.60 , $73.32 , $161.43 , $108.32 , $103.72 , $59.41 , $59.41 , $69.43 , $67.32 , $62.38 , $60.60 , $95.49 , $95.49 , $97.95 , $97.95 , $59.41 , $22.59 , $61.18 , $22.59 , $161.43 , $131.60
88304,5215010004,Hospital Chargemaster,Tissue Exam By Pathologist,Outpatient,Outpatient Default Percent / Case Rate,312, $220.00 , $94.41 , $181.28 , $59.41 , $154.00 , $85.80 , $161.43 , $108.32 , $103.72 , $59.41 , $59.41 , $42.00 , $40.73 , $62.38 , $60.60 , $95.25 , $95.25 , $97.70 , $97.70 , $59.41 , $25.48 , $61.18 , $25.48 , $181.28 , $154.00
88305,5215010005,Hospital Chargemaster,Tissue Exam By Patholgst Prost,Outpatient,Outpatient Default Percent / Case Rate,312, $266.00 , $94.41 , $219.18 , $59.41 , $186.20 , $103.74 , $161.43 , $108.32 , $103.72 , $59.41 , $59.41 , $64.56 , $62.60 , $62.38 , $60.60 , $95.25 , $95.25 , $97.70 , $97.70 , $59.41 , $28.09 , $61.18 , $28.09 , $219.18 , $186.20
88312,5215010009,Hospital Chargemaster,Special Stains Group 1,Outpatient,Outpatient Default Percent / Case Rate,312, $139.00 , $94.41 , $114.54 , $59.41 , $97.30 , $54.21 , $161.43 , $108.32 , $103.72 , $59.41 , $59.41 , $14.58 , $14.14 , $62.38 , $60.60 , $95.25 , $95.25 , $97.70 , $97.70 , $59.41 , $71.53 , $61.18 , $14.14 , $161.43 , $97.30
88305,5215010022,Hospital Chargemaster,Tissue Exam by Pathologist,Outpatient,Outpatient Default Percent / Case Rate,312, $266.00 , $94.41 , $219.18 , $59.41 , $186.20 , $103.74 , $161.43 , $108.32 , $103.72 , $59.41 , $59.41 , $64.56 , $62.60 , $62.38 , $60.60 , $95.25 , $95.25 , $97.70 , $97.70 , $59.41 , $28.09 , $61.18 , $28.09 , $219.18 , $186.20
88313,5215010010,Hospital Chargemaster,Special Stains Group 2,Outpatient,Outpatient Default Percent / Case Rate,312, $117.00 , $59.49 , $96.41 , $40.47 , $81.90 , $45.63 , $101.71 , $68.24 , $65.34 , $40.47 , $40.47 , $12.17 , $11.80 , $42.49 , $41.28 , $63.27 , $63.27 , $64.89 , $64.89 , $40.47 , $57.63 , $38.54 , $11.80 , $101.71 , $81.90
88329,5215010014,Hospital Chargemaster,Path Consult Introp,Outpatient,Outpatient Default Percent / Case Rate,312, $114.00 , $59.49 , $93.94 , $40.47 , $79.80 , $44.46 , $101.71 , $68.24 , $65.34 , $40.47 , $40.47 , $39.57 , $38.37 , $42.49 , $41.28 , $62.99 , $62.99 , $64.61 , $64.61 , $40.47 , $29.83 , $38.54 , $29.83 , $101.71 , $79.80
88302,5215010003,Hospital Chargemaster,Tissue Exam By Pathologist,Outpatient,Outpatient Default Percent / Case Rate,312, $140.00 , $59.49 , $115.36 , $29.53 , $98.00 , $54.60 , $101.71 , $68.24 , $65.34 , $29.53 , $29.53 , $29.84 , $28.93 , $31.01 , $30.12 , $47.93 , $47.93 , $49.16 , $49.16 , $29.53 , $20.85 , $38.54 , $20.85 , $115.36 , $98.00
88300,5215010002,Hospital Chargemaster,Surgical Path Gross,Outpatient,Outpatient Default Percent / Case Rate,312, $65.00 , $31.80 , $53.56 , $29.53 , $45.50 , $25.35 , $54.36 , $36.47 , $34.92 , $29.53 , $29.53 , $12.17 , $11.80 , $31.01 , $30.12 , $46.61 , $46.61 , $47.81 , $47.81 , $29.53 , $9.27 , $20.60 , $9.27 , $54.36 , $45.50
88311,5215010008,Hospital Chargemaster,Decalcify Tissue,Outpatient,Outpatient Default Percent / Case Rate,312, $107.00 , $- , $88.17 , See APC Packaged Rates , $74.90 , $41.73 , $44.28 , $29.71 , $28.45 , See APC Packaged Rates , See APC Packaged Rates , $12.17 , $11.80 , See APC Packaged Rates , See APC Packaged Rates , $99.51 , $99.51 , $99.51 , $99.51 , See APC Packaged Rates , $7.24 , $10.81 , $- , $99.51 , $74.90
88332,5215010016,Hospital Chargemaster,Path Consult Intraop Addl,Outpatient,Outpatient Default Percent / Case Rate,312, $200.00 , $- , $164.80 , See APC Packaged Rates , $140.00 , $78.00 , $108.27 , $72.65 , $69.56 , See APC Packaged Rates , See APC Packaged Rates , $34.70 , $33.65 , See APC Packaged Rates , See APC Packaged Rates , $186.00 , $186.00 , $186.00 , $186.00 , See APC Packaged Rates , $19.98 , $26.38 , $- , $186.00 , $140.00
74249,5110010102,Hospital Chargemaster,Contrast x-ray UP GI sm int,Outpatient,Outpatient Default Percent / Case Rate,320, $542.00 , $298.10 , $446.61 , See APC Packaged Rates , $379.40 , $211.38 , $522.98 , $525.25 , $279.14 , See APC Packaged Rates , See APC Packaged Rates , $363.68 , $363.68 , See APC Packaged Rates , See APC Packaged Rates , $504.06 , $504.06 , $504.06 , $504.06 , See APC Packaged Rates , $189.70 , Not Applicable , $189.70 , $525.25 , $379.40
75822,5110010125,Hospital Chargemaster,Vein x-ray arms/leg bilat,Outpatient,Outpatient Default Percent / Case Rate,320," $2,445.00 "," $1,344.75 "," $2,014.68 "," $1,681.14 "," $1,711.50 ", $953.55 ," $2,775.15 "," $2,176.10 "," $2,168.59 "," $1,681.14 "," $1,681.14 ", $- , $- ," $1,765.20 "," $1,714.76 "," $2,349.54 "," $2,349.54 "," $2,410.03 "," $2,410.03 "," $1,681.14 "," $3,621.49 "," $1,640.45 ", $- ," $3,621.49 "," $1,711.50 "
75820,5110010124,Hospital Chargemaster,Vein x-ray arm/leg unilat,Outpatient,Outpatient Default Percent / Case Rate,320," $1,841.00 "," $1,012.55 "," $1,516.98 "," $1,681.14 "," $1,288.70 ", $717.99 ," $1,573.32 "," $1,233.69 "," $1,229.44 "," $1,681.14 "," $1,681.14 ", $- , $- ," $1,765.20 "," $1,714.76 "," $1,607.54 "," $1,607.54 "," $1,648.93 "," $1,648.93 "," $1,681.14 "," $3,621.49 ", $930.02 , $- ," $3,621.49 "," $1,288.70 "
75820,5110040124,Hospital Chargemaster,Vein x-ray arm/leg unilat LT,Outpatient,Outpatient Default Percent / Case Rate,320," $1,841.00 "," $1,012.55 "," $1,516.98 "," $1,681.14 "," $1,288.70 ", $717.99 ," $1,573.32 "," $1,233.69 "," $1,229.44 "," $1,681.14 "," $1,681.14 ", $- , $- ," $1,765.20 "," $1,714.76 "," $1,607.54 "," $1,607.54 "," $1,648.93 "," $1,648.93 "," $1,681.14 "," $3,621.49 ", $930.02 , $- ," $3,621.49 "," $1,288.70 "
75820,5110050124,Hospital Chargemaster,Vein x-ray arm/leg unilat RT,Outpatient,Outpatient Default Percent / Case Rate,320," $1,841.00 "," $1,012.55 "," $1,516.98 "," $1,681.14 "," $1,288.70 ", $717.99 ," $1,573.32 "," $1,233.69 "," $1,229.44 "," $1,681.14 "," $1,681.14 ", $- , $- ," $1,765.20 "," $1,714.76 "," $1,607.54 "," $1,607.54 "," $1,648.93 "," $1,648.93 "," $1,681.14 "," $3,621.49 ", $930.02 , $- ," $3,621.49 "," $1,288.70 "
72265,5110010051,Hospital Chargemaster,Myelography l-s spine,Outpatient,Outpatient Default Percent / Case Rate,320," $1,327.00 ", $729.85 ," $1,093.45 ", $855.31 , $928.90 , $517.53 ," $1,755.36 "," $1,376.44 "," $1,371.70 ", $855.31 , $855.31 , $- , $- , $898.07 , $872.41 ," $1,246.82 "," $1,246.82 "," $1,278.92 "," $1,278.92 ", $855.31 ," $1,841.93 "," $1,037.63 ", $- ," $1,841.93 ", $928.90
73040,5110010057,Hospital Chargemaster,"Contrast x-ray of shoulder""",Outpatient,Outpatient Default Percent / Case Rate,320, $876.00 , $481.80 , $721.82 , $440.24 , $613.20 , $341.64 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $613.20
73580,5110010082,Hospital Chargemaster,Contrast x-ray of knee joint,Outpatient,Outpatient Default Percent / Case Rate,320, $739.00 , $406.45 , $608.94 , $440.24 , $517.30 , $288.21 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $517.30
73040,5110040057,Hospital Chargemaster,Contrast x-ray of shoulder LT,Outpatient,Outpatient Default Percent / Case Rate,320, $876.00 , $481.80 , $721.82 , $440.24 , $613.20 , $341.64 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $613.20
73580,5110040082,Hospital Chargemaster,Contrast x-ray knee joint LT,Outpatient,Outpatient Default Percent / Case Rate,320, $739.00 , $406.45 , $608.94 , $440.24 , $517.30 , $288.21 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $517.30
73085,5110040138,Hospital Chargemaster,Contrast x-ray of elbow Left,Outpatient,Outpatient Default Percent / Case Rate,320, $739.00 , $406.45 , $608.94 , $440.24 , $517.30 , $288.21 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $517.30
73040,5110050057,Hospital Chargemaster,Contrast x-ray of shoulder RT,Outpatient,Outpatient Default Percent / Case Rate,320, $876.00 , $481.80 , $721.82 , $440.24 , $613.20 , $341.64 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $613.20
73580,5110050082,Hospital Chargemaster,Contrast x-ray knee joint RT,Outpatient,Outpatient Default Percent / Case Rate,320, $739.00 , $406.45 , $608.94 , $440.24 , $517.30 , $288.21 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $517.30
73085,5110050138,Hospital Chargemaster,Contrast x-ray of elbow Right,Outpatient,Outpatient Default Percent / Case Rate,320, $739.00 , $406.45 , $608.94 , $440.24 , $517.30 , $288.21 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $517.30
76098,5110010130,Hospital Chargemaster,X-ray surgical specimen,Outpatient,Outpatient Default Percent / Case Rate,320, $709.00 , $389.95 , $584.22 , $577.66 , $496.30 , $276.51 ," $1,262.41 ", $989.90 , $986.49 , $577.66 , $577.66 , $51.43 , $49.87 , $606.54 , $589.21 , $709.00 , $709.00 , $709.00 , $709.00 , $577.66 ," $1,243.67 ", $746.24 , $49.87 ," $1,262.41 ", $496.30
76080,5110010129,Hospital Chargemaster,X-ray of fistula,Outpatient,Outpatient Default Percent / Case Rate,320, $697.00 , $383.35 , $574.33 , $577.66 , $487.90 , $271.83 ," $1,262.41 ", $989.90 , $986.49 , $577.66 , $577.66 , $- , $- , $606.54 , $589.21 , $697.00 , $697.00 , $697.00 , $697.00 , $577.66 ," $1,243.67 ", $746.24 , $- ," $1,262.41 ", $487.90
74420,5110010115,Hospital Chargemaster,Contrst x-ray urinary tract,Outpatient,Outpatient Default Percent / Case Rate,320, $572.00 , $314.60 , $471.33 , $440.24 , $400.40 , $223.08 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $319.90 , $310.19 , $462.26 , $449.05 , $572.00 , $572.00 , $572.00 , $572.00 , $440.24 , $948.09 , $578.82 , $223.08 , $979.20 , $400.40
74425,5110010116,Hospital Chargemaster,Contrst x-ray urinary tract,Outpatient,Outpatient Default Percent / Case Rate,320, $572.00 , $314.60 , $471.33 , $440.24 , $400.40 , $223.08 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $572.00 , $572.00 , $572.00 , $572.00 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $400.40
74430,5110010117,Hospital Chargemaster,Contrast x-ray bladder,Outpatient,Outpatient Default Percent / Case Rate,320, $572.00 , $314.60 , $471.33 , $440.24 , $400.40 , $223.08 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $572.00 , $572.00 , $572.00 , $572.00 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $400.40
74455,5110010118,Hospital Chargemaster,X-ray urethra/bladder,Outpatient,Outpatient Default Percent / Case Rate,320, $572.00 , $314.60 , $471.33 , $275.09 , $400.40 , $223.08 , $585.06 , $458.77 , $457.19 , $275.09 , $275.09 , $- , $- , $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $592.70 , $345.84 , $- , $592.70 , $400.40
70390,5110010022,Hospital Chargemaster,X-ray of salivary duct,Outpatient,Outpatient Default Percent / Case Rate,320, $697.00 , $383.35 , $574.33 , $275.09 , $487.90 , $271.83 , $585.06 , $458.77 , $457.19 , $275.09 , $275.09 , $- , $- , $288.84 , $280.59 , $439.48 , $439.48 , $450.79 , $450.79 , $275.09 , $592.70 , $345.84 , $- , $592.70 , $487.90
74740,5110010119,Hospital Chargemaster,X-ray female genital tract,Outpatient,Outpatient Default Percent / Case Rate,320, $697.00 , $383.35 , $574.33 , $275.09 , $487.90 , $271.83 , $585.06 , $458.77 , $457.19 , $275.09 , $275.09 , $- , $- , $288.84 , $280.59 , $439.48 , $439.48 , $450.79 , $450.79 , $275.09 , $592.70 , $345.84 , $- , $592.70 , $487.90
74280,5110010106,Hospital Chargemaster,Contrast x-ray colon air contr,Outpatient,Outpatient Default Percent / Case Rate,320, $444.00 , $244.20 , $365.86 , $213.55 , $310.80 , $173.16 , $511.92 , $401.42 , $400.03 , $213.55 , $213.55 , $272.07 , $263.82 , $224.23 , $217.82 , $339.82 , $339.82 , $348.57 , $348.57 , $213.55 , $459.86 , $302.61 , $173.16 , $511.92 , $310.80
74400,5110010112,Hospital Chargemaster,Contrst x-ray urinary tract,Outpatient,Outpatient Default Percent / Case Rate,320, $572.00 , $314.60 , $471.33 , $213.55 , $400.40 , $223.08 , $511.92 , $401.42 , $400.03 , $213.55 , $213.55 , $204.84 , $198.63 , $224.23 , $217.82 , $339.82 , $339.82 , $348.57 , $348.57 , $213.55 , $459.86 , $302.61 , $198.63 , $511.92 , $400.40
74410,5110010113,Hospital Chargemaster,Contrst x-ray urinary tract,Outpatient,Outpatient Default Percent / Case Rate,320, $572.00 , $314.60 , $471.33 , $213.55 , $400.40 , $223.08 , $511.92 , $401.42 , $400.03 , $213.55 , $213.55 , $237.39 , $230.19 , $224.23 , $217.82 , $339.82 , $339.82 , $348.57 , $348.57 , $213.55 , $459.86 , $302.61 , $213.55 , $511.92 , $400.40
74270,5110010105,Hospital Chargemaster,Contrast x-ray colon enema,Outpatient,Outpatient Default Percent / Case Rate,320, $341.00 , $187.55 , $280.98 , $213.55 , $238.70 , $132.99 , $511.92 , $401.42 , $400.03 , $213.55 , $213.55 , $207.28 , $200.99 , $224.23 , $217.82 , $329.13 , $329.13 , $337.60 , $337.60 , $213.55 , $459.86 , $302.61 , $132.99 , $511.92 , $238.70
76000,5110010127,Hospital Chargemaster,Fluoroscopy <1 hr phys/qhp,Outpatient,Outpatient Default Percent / Case Rate,320, $333.00 , $183.15 , $274.39 , $275.09 , $233.10 , $129.87 , $585.06 , $458.77 , $457.19 , $275.09 , $275.09 , $- , $- , $288.84 , $280.59 , $333.00 , $333.00 , $333.00 , $333.00 , $275.09 , $592.70 , $345.84 , $- , $592.70 , $233.10
74246,5110010100,Hospital Chargemaster,Contrast x-ray UP GI w/o KUB,Outpatient,Outpatient Default Percent / Case Rate,320, $330.00 , $181.50 , $271.92 , $213.55 , $231.00 , $128.70 , $511.92 , $401.42 , $400.03 , $213.55 , $213.55 , $200.26 , $194.18 , $224.23 , $217.82 , $329.13 , $329.13 , $330.00 , $330.00 , $213.55 , $459.86 , $302.61 , $128.70 , $511.92 , $231.00
74290,5110010107,Hospital Chargemaster,Contrast x-ray gallbladder,Outpatient,Outpatient Default Percent / Case Rate,320, $364.00 , $200.20 , $299.94 , $213.55 , $254.80 , $141.96 , $511.92 , $401.42 , $400.03 , $213.55 , $213.55 , $89.81 , $87.08 , $224.23 , $217.82 , $308.49 , $308.49 , $316.43 , $316.43 , $213.55 , $459.86 , $302.61 , $87.08 , $511.92 , $254.80
74220,5110010097,Hospital Chargemaster,Contrast x-ray esophagus,Outpatient,Outpatient Default Percent / Case Rate,320, $294.00 , $161.70 , $242.26 , $213.55 , $205.80 , $114.66 , $511.92 , $401.42 , $400.03 , $213.55 , $213.55 , $143.96 , $139.59 , $224.23 , $217.82 , $294.00 , $294.00 , $294.00 , $294.00 , $213.55 , $459.86 , $302.61 , $114.66 , $511.92 , $205.80
74250,5110010103,Hospital Chargemaster,X-ray of small bowel,Outpatient,Outpatient Default Percent / Case Rate,320, $526.00 , $289.30 , $433.42 , $213.55 , $368.20 , $205.14 , $285.50 , $223.87 , $223.10 , $213.55 , $213.55 , $158.25 , $153.45 , $224.23 , $217.82 , $282.52 , $282.52 , $289.79 , $289.79 , $213.55 , $459.86 , $168.77 , $153.45 , $459.86 , $368.20
72084,5110010042,Hospital Chargemaster,X-ray entire spi 6/> vw,Outpatient,Outpatient Default Percent / Case Rate,320, $470.00 , $258.50 , $387.28 , $130.16 , $329.00 , $183.30 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $158.09 , $153.29 , $136.66 , $132.76 , $247.22 , $247.22 , $253.58 , $253.58 , $130.16 , $280.65 , $168.77 , $130.16 , $387.28 , $329.00
73523,5110010075,Hospital Chargemaster,X-ray hips bi 5/> views,Outpatient,Outpatient Default Percent / Case Rate,320, $470.00 , $258.50 , $387.28 , $130.16 , $329.00 , $183.30 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $105.58 , $102.38 , $136.66 , $132.76 , $247.22 , $247.22 , $253.58 , $253.58 , $130.16 , $280.65 , $168.77 , $102.38 , $387.28 , $329.00
74230,5110010098,Hospital Chargemaster,Cine/vid x-ray throat/esoph,Outpatient,Outpatient Default Percent / Case Rate,320, $250.00 , $137.50 , $206.00 , $213.55 , $175.00 , $97.50 , $285.50 , $223.87 , $223.10 , $213.55 , $213.55 , $158.25 , $153.45 , $224.23 , $217.82 , $250.00 , $250.00 , $250.00 , $250.00 , $213.55 , $459.86 , $168.77 , $97.50 , $459.86 , $175.00
70150,5110010008,Hospital Chargemaster,X-ray of facial bone 3+ views,Outpatient,Outpatient Default Percent / Case Rate,320, $288.00 , $158.40 , $237.31 , $130.16 , $201.60 , $112.32 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $95.89 , $92.98 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $92.98 , $285.50 , $201.60
70260,5110010017,Hospital Chargemaster,X-ray of skull >4 views,Outpatient,Outpatient Default Percent / Case Rate,320, $566.00 , $311.30 , $466.38 , $130.16 , $396.20 , $220.74 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $108.97 , $105.67 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $105.67 , $466.38 , $396.20
72050,5110010035,Hospital Chargemaster,X-ray neck spine 4/5vws,Outpatient,Outpatient Default Percent / Case Rate,320, $534.00 , $293.70 , $440.02 , $130.16 , $373.80 , $208.26 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $108.97 , $105.67 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $105.67 , $440.02 , $373.80
72052,5110010036,Hospital Chargemaster,X-ray neck spine 6/>vws,Outpatient,Outpatient Default Percent / Case Rate,320, $600.00 , $330.00 , $494.40 , $130.16 , $420.00 , $234.00 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $137.87 , $133.69 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $130.16 , $494.40 , $420.00
72070,5110010037,Hospital Chargemaster,X-ray thorac spine 2vws,Outpatient,Outpatient Default Percent / Case Rate,320, $237.00 , $130.35 , $195.29 , $130.16 , $165.90 , $92.43 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $79.12 , $76.71 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $76.71 , $285.50 , $165.90
72082,5110010041,Hospital Chargemaster,X-ray entire spi 2/3 vw,Outpatient,Outpatient Default Percent / Case Rate,320, $245.00 , $134.75 , $201.88 , $130.16 , $171.50 , $95.55 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $120.58 , $116.92 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $95.55 , $285.50 , $171.50
72110,5110010044,Hospital Chargemaster,X-ray l-2 spine 4/>vws,Outpatient,Outpatient Default Percent / Case Rate,320, $534.00 , $293.70 , $440.02 , $130.16 , $373.80 , $208.26 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $111.41 , $108.03 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $108.03 , $440.02 , $373.80
72114,5110010045,Hospital Chargemaster,X-ray l-s spine bending,Outpatient,Outpatient Default Percent / Case Rate,320, $362.00 , $199.10 , $298.29 , $130.16 , $253.40 , $141.18 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $143.96 , $139.59 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $130.16 , $298.29 , $253.40
72202,5110010049,Hospital Chargemaster,X-ray si joints 3/> vws,Outpatient,Outpatient Default Percent / Case Rate,320, $220.00 , $121.00 , $181.28 , $130.16 , $154.00 , $85.80 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $75.47 , $73.18 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $73.18 , $285.50 , $154.00
73120,5110010067,Hospital Chargemaster,X-ray of hand 2 views,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $130.16 , $178.50 , $99.45 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $59.95 , $58.13 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $58.13 , $285.50 , $178.50
73503,5110010072,Hospital Chargemaster,X-ray hip uni 4/> views,Outpatient,Outpatient Default Percent / Case Rate,320, $245.00 , $134.75 , $201.88 , $130.16 , $171.50 , $95.55 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $97.13 , $94.19 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $94.19 , $285.50 , $171.50
73521,5110010073,Hospital Chargemaster,X-ray hips bi 2 views,Outpatient,Outpatient Default Percent / Case Rate,320, $245.00 , $134.75 , $201.88 , $130.16 , $171.50 , $95.55 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $72.75 , $70.54 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $70.54 , $285.50 , $171.50
73522,5110010074,Hospital Chargemaster,X-ray hips bi 3-4 views,Outpatient,Outpatient Default Percent / Case Rate,320, $245.00 , $134.75 , $201.88 , $130.16 , $171.50 , $95.55 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $87.77 , $85.11 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $85.11 , $285.50 , $171.50
76100,5110010131,Hospital Chargemaster,X-ray of body section,Outpatient,Outpatient Default Percent / Case Rate,320, $439.00 , $241.45 , $361.74 , $130.16 , $307.30 , $171.21 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $152.19 , $147.58 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $130.16 , $361.74 , $307.30
77075,5110010150,Hospital Chargemaster,X-Rays Bone Survey Complete,Outpatient,Outpatient Default Percent / Case Rate,320, $805.00 , $442.75 , $663.32 , $130.16 , $563.50 , $313.95 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $175.01 , $169.70 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $130.16 , $663.32 , $563.50
73120,5110040067,Hospital Chargemaster,X-ray of hand 2 views LT,Outpatient,Outpatient Default Percent / Case Rate,320, $125.00 , $68.75 , $103.00 , $130.16 , $87.50 , $48.75 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $59.95 , $58.13 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $48.75 , $285.50 , $87.50
73503,5110040072,Hospital Chargemaster,X-ray hip uni 4/> views LT,Outpatient,Outpatient Default Percent / Case Rate,320, $215.00 , $118.25 , $177.16 , $130.16 , $150.50 , $83.85 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $97.13 , $94.19 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $83.85 , $285.50 , $150.50
73120,5110050067,Hospital Chargemaster,X-ray of hand 2 views RT,Outpatient,Outpatient Default Percent / Case Rate,320, $125.00 , $68.75 , $103.00 , $130.16 , $87.50 , $48.75 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $59.95 , $58.13 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $48.75 , $285.50 , $87.50
73503,5110050072,Hospital Chargemaster,X-ray hip uni 4/> views RT,Outpatient,Outpatient Default Percent / Case Rate,320, $215.00 , $118.25 , $177.16 , $130.16 , $150.50 , $83.85 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $97.13 , $94.19 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $83.85 , $285.50 , $150.50
77080,5150010009,Hospital Chargemaster,DXA Bone Density Axial,Outpatient,Outpatient Default Percent / Case Rate,320, $517.00 , $284.35 , $426.01 , $130.16 , $361.90 , $201.63 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $376.69 , $365.26 , $136.66 , $132.76 , $206.18 , $206.18 , $211.49 , $211.49 , $130.16 , $280.65 , $168.77 , $130.16 , $426.01 , $361.90
70110,5110010003,Hospital Chargemaster,X-ray of jaw 4/> views,Outpatient,Outpatient Default Percent / Case Rate,320, $344.00 , $189.20 , $283.46 , $130.16 , $240.80 , $134.16 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $75.47 , $73.18 , $136.66 , $132.76 , $206.18 , $206.18 , $211.49 , $211.49 , $130.16 , $280.65 , $168.77 , $73.18 , $285.50 , $240.80
70130,5110010005,Hospital Chargemaster,X-ray of mastoids 3+ views,Outpatient,Outpatient Default Percent / Case Rate,320, $421.00 , $231.55 , $346.90 , $130.16 , $294.70 , $164.19 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $95.89 , $92.98 , $136.66 , $132.76 , $194.00 , $194.00 , $198.99 , $198.99 , $130.16 , $280.65 , $168.77 , $92.98 , $346.90 , $294.70
70250,5110010016,Hospital Chargemaster,X-ray of skull < 4 views,Outpatient,Outpatient Default Percent / Case Rate,320, $302.00 , $166.10 , $248.85 , $130.16 , $211.40 , $117.78 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $75.47 , $73.18 , $136.66 , $132.76 , $194.00 , $194.00 , $198.99 , $198.99 , $130.16 , $280.65 , $168.77 , $73.18 , $285.50 , $211.40
72100,5110010043,Hospital Chargemaster,X-ray l-s spine 2/3 vws,Outpatient,Outpatient Default Percent / Case Rate,320, $293.00 , $161.15 , $241.43 , $130.16 , $205.10 , $114.27 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $81.55 , $79.07 , $136.66 , $132.76 , $194.00 , $194.00 , $198.99 , $198.99 , $130.16 , $280.65 , $168.77 , $79.07 , $285.50 , $205.10
73564,5110010081,Hospital Chargemaster,X-ray knee 4 +,Outpatient,Outpatient Default Percent / Case Rate,320, $346.00 , $190.30 , $285.10 , $130.16 , $242.20 , $134.94 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $75.47 , $73.18 , $136.66 , $132.76 , $194.00 , $194.00 , $198.99 , $198.99 , $130.16 , $280.65 , $168.77 , $73.18 , $285.50 , $242.20
73564,5110040081,Hospital Chargemaster,X-ray knee 4 + LT,Outpatient,Outpatient Default Percent / Case Rate,320, $346.00 , $190.30 , $285.10 , $130.16 , $242.20 , $134.94 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $75.47 , $73.18 , $136.66 , $132.76 , $194.00 , $194.00 , $198.99 , $198.99 , $130.16 , $280.65 , $168.77 , $73.18 , $285.50 , $242.20
73564,5110050081,Hospital Chargemaster,X-ray knee 4 + RT,Outpatient,Outpatient Default Percent / Case Rate,320, $346.00 , $190.30 , $285.10 , $130.16 , $242.20 , $134.94 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $75.47 , $73.18 , $136.66 , $132.76 , $194.00 , $194.00 , $198.99 , $198.99 , $130.16 , $280.65 , $168.77 , $73.18 , $285.50 , $242.20
70120,5110010004,Hospital Chargemaster,X-ray of mastoid<3 views,Outpatient,Outpatient Default Percent / Case Rate,320, $323.00 , $177.65 , $266.15 , $130.16 , $226.10 , $125.97 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $75.47 , $73.18 , $136.66 , $132.76 , $193.86 , $193.86 , $198.85 , $198.85 , $130.16 , $280.65 , $168.77 , $73.18 , $285.50 , $226.10
73010,5110010054,Hospital Chargemaster,"X-ray of shoulder blade""",Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $130.16 , $178.50 , $99.45 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $63.60 , $61.67 , $136.66 , $132.76 , $193.86 , $193.86 , $198.85 , $198.85 , $130.16 , $280.65 , $168.77 , $61.67 , $285.50 , $178.50
77073,5110010135,Hospital Chargemaster,X-rays bone length studies,Outpatient,Outpatient Default Percent / Case Rate,320, $305.00 , $167.75 , $251.32 , $130.16 , $213.50 , $118.95 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $95.89 , $92.98 , $136.66 , $132.76 , $193.86 , $193.86 , $198.85 , $198.85 , $130.16 , $280.65 , $168.77 , $92.98 , $285.50 , $213.50
73010,5110040054,Hospital Chargemaster,X-ray of shoulder blade LT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $130.16 , $178.50 , $99.45 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $63.60 , $61.67 , $136.66 , $132.76 , $193.86 , $193.86 , $198.85 , $198.85 , $130.16 , $280.65 , $168.77 , $61.67 , $285.50 , $178.50
73010,5110050054,Hospital Chargemaster,X-ray of shoulder blade RT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $130.16 , $178.50 , $99.45 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $63.60 , $61.67 , $136.66 , $132.76 , $193.86 , $193.86 , $198.85 , $198.85 , $130.16 , $280.65 , $168.77 , $61.67 , $285.50 , $178.50
72170,5110010047,Hospital Chargemaster,X-ray of pelvis,Outpatient,Outpatient Default Percent / Case Rate,320, $196.00 , $107.80 , $161.50 , $130.16 , $137.20 , $76.44 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $63.60 , $61.67 , $136.66 , $132.76 , $196.00 , $196.00 , $196.00 , $196.00 , $130.16 , $280.65 , $168.77 , $61.67 , $285.50 , $137.20
73092,5110010063,Hospital Chargemaster,X-ray Of Arm Infant,Outpatient,Outpatient Default Percent / Case Rate,320, $196.00 , $107.80 , $161.50 , $130.16 , $137.20 , $76.44 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $59.95 , $58.13 , $136.66 , $132.76 , $196.00 , $196.00 , $196.00 , $196.00 , $130.16 , $280.65 , $168.77 , $58.13 , $285.50 , $137.20
73092,5110040063,Hospital Chargemaster,X-ray of arm infant LT,Outpatient,Outpatient Default Percent / Case Rate,320, $196.00 , $107.80 , $161.50 , $130.16 , $137.20 , $76.44 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $59.95 , $58.13 , $136.66 , $132.76 , $196.00 , $196.00 , $196.00 , $196.00 , $130.16 , $280.65 , $168.77 , $58.13 , $285.50 , $137.20
73092,5110050063,Hospital Chargemaster,X-ray of arm infant RT,Outpatient,Outpatient Default Percent / Case Rate,320, $196.00 , $107.80 , $161.50 , $130.16 , $137.20 , $76.44 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $59.95 , $58.13 , $136.66 , $132.76 , $196.00 , $196.00 , $196.00 , $196.00 , $130.16 , $280.65 , $168.77 , $58.13 , $285.50 , $137.20
72072,5110010038,Hospital Chargemaster,X-ray thorac spine 3vws,Outpatient,Outpatient Default Percent / Case Rate,320, $193.00 , $106.15 , $159.03 , $130.16 , $135.10 , $75.27 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $89.81 , $87.08 , $136.66 , $132.76 , $193.00 , $193.00 , $193.00 , $193.00 , $130.16 , $280.65 , $168.77 , $75.27 , $285.50 , $135.10
74022,5110010095,Hospital Chargemaster,X-ray series abdomen,Outpatient,Outpatient Default Percent / Case Rate,320, $193.00 , $106.15 , $159.03 , $130.16 , $135.10 , $75.27 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $89.81 , $87.08 , $136.66 , $132.76 , $193.00 , $193.00 , $193.00 , $193.00 , $130.16 , $280.65 , $168.77 , $75.27 , $285.50 , $135.10
77074,5110010136,Hospital Chargemaster,X-rays bone survey limited,Outpatient,Outpatient Default Percent / Case Rate,320, $193.00 , $106.15 , $159.03 , $130.16 , $135.10 , $75.27 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $121.14 , $117.47 , $136.66 , $132.76 , $193.00 , $193.00 , $193.00 , $193.00 , $130.16 , $280.65 , $168.77 , $75.27 , $285.50 , $135.10
74019,5110010093,Hospital Chargemaster,X-ray abdomen 2 views,Outpatient,Outpatient Default Percent / Case Rate,320, $272.00 , $149.60 , $224.13 , $130.16 , $190.40 , $106.08 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $57.56 , $55.82 , $136.66 , $132.76 , $184.09 , $184.09 , $188.83 , $188.83 , $130.16 , $280.65 , $168.77 , $55.82 , $285.50 , $190.40
72190,5110010139,Hospital Chargemaster,X-Ray Exam of Pelvis,Outpatient,Outpatient Default Percent / Case Rate,320, $181.00 , $99.55 , $149.14 , $130.16 , $126.70 , $70.59 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $81.55 , $79.07 , $136.66 , $132.76 , $181.00 , $181.00 , $181.00 , $181.00 , $130.16 , $280.65 , $168.77 , $70.59 , $285.50 , $126.70
72120,5110010046,Hospital Chargemaster,X-ray bend only l-s spine,Outpatient,Outpatient Default Percent / Case Rate,320, $178.00 , $97.90 , $146.67 , $130.16 , $124.60 , $69.42 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $108.97 , $105.67 , $136.66 , $132.76 , $178.00 , $178.00 , $178.00 , $178.00 , $130.16 , $280.65 , $168.77 , $69.42 , $285.50 , $124.60
70200,5110010012,Hospital Chargemaster,X-ray of eye sockets 4+ views,Outpatient,Outpatient Default Percent / Case Rate,320, $170.00 , $93.50 , $140.08 , $130.16 , $119.00 , $66.30 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $95.89 , $92.98 , $136.66 , $132.76 , $170.00 , $170.00 , $170.00 , $170.00 , $130.16 , $280.65 , $168.77 , $66.30 , $285.50 , $119.00
70134,5110010006,Hospital Chargemaster,X-ray of middle ear,Outpatient,Outpatient Default Percent / Case Rate,320, $156.00 , $85.80 , $128.54 , $577.66 , $109.20 , $60.84 ," $1,262.41 ", $989.90 , $986.49 , $577.66 , $577.66 , $89.81 , $87.08 , $606.54 , $589.21 , $156.00 , $156.00 , $156.00 , $156.00 , $577.66 ," $1,243.67 ", $746.24 , $60.84 ," $1,262.41 ", $109.20
77072,5110010134,Hospital Chargemaster,X-rays for bone age,Outpatient,Outpatient Default Percent / Case Rate,320, $153.00 , $84.15 , $126.07 , $130.16 , $107.10 , $59.67 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $63.60 , $61.67 , $136.66 , $132.76 , $153.00 , $153.00 , $153.00 , $153.00 , $130.16 , $280.65 , $168.77 , $59.67 , $285.50 , $107.10
70220,5110010014,Hospital Chargemaster,X-ray of sinusse 3 + views,Outpatient,Outpatient Default Percent / Case Rate,320, $344.00 , $189.20 , $283.46 , $96.70 , $240.80 , $134.16 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $95.89 , $92.98 , $101.54 , $98.64 , $147.96 , $147.96 , $151.77 , $151.77 , $96.70 , $208.36 , $93.45 , $92.98 , $283.46 , $240.80
73080,5110010061,Hospital Chargemaster,X-ray of elbow 3 + views,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $147.96 , $147.96 , $151.77 , $151.77 , $96.70 , $208.36 , $93.45 , $67.32 , $210.12 , $178.50
73090,5110010062,Hospital Chargemaster,"X-ray of forearm""",Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $147.96 , $147.96 , $151.77 , $151.77 , $96.70 , $208.36 , $93.45 , $61.67 , $210.12 , $178.50
73130,5110010068,Hospital Chargemaster,X-ray of hand 3 + views,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $64.82 , $62.85 , $101.54 , $98.64 , $147.96 , $147.96 , $151.77 , $151.77 , $96.70 , $208.36 , $93.45 , $62.85 , $210.12 , $178.50
73610,5110010086,Hospital Chargemaster,X-ray of ankle 3 + views,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $64.82 , $62.85 , $101.54 , $98.64 , $147.96 , $147.96 , $151.77 , $151.77 , $96.70 , $208.36 , $93.45 , $62.85 , $210.12 , $178.50
73080,5110030061,Hospital Chargemaster,X-ray of elbow 3 + views RT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $147.96 , $147.96 , $151.77 , $151.77 , $96.70 , $208.36 , $93.45 , $67.32 , $210.12 , $178.50
73080,5110040061,Hospital Chargemaster,X-ray of elbow 3 + views LT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $147.96 , $147.96 , $151.77 , $151.77 , $96.70 , $208.36 , $93.45 , $67.32 , $210.12 , $178.50
73090,5110040062,Hospital Chargemaster,X-ray of forearm LT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $147.96 , $147.96 , $151.77 , $151.77 , $96.70 , $208.36 , $93.45 , $61.67 , $210.12 , $178.50
73130,5110040068,Hospital Chargemaster,X-ray of hand 3 + views LT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $64.82 , $62.85 , $101.54 , $98.64 , $147.96 , $147.96 , $151.77 , $151.77 , $96.70 , $208.36 , $93.45 , $62.85 , $210.12 , $178.50
73610,5110040086,Hospital Chargemaster,X-ray of ankle 3 + views LT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $64.82 , $62.85 , $101.54 , $98.64 , $147.96 , $147.96 , $151.77 , $151.77 , $96.70 , $208.36 , $93.45 , $62.85 , $210.12 , $178.50
73090,5110050062,Hospital Chargemaster,X-ray of forearm RT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $147.96 , $147.96 , $151.77 , $151.77 , $96.70 , $208.36 , $93.45 , $61.67 , $210.12 , $178.50
73130,5110050068,Hospital Chargemaster,X-ray of hand 3 + views RT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $64.82 , $62.85 , $101.54 , $98.64 , $147.96 , $147.96 , $151.77 , $151.77 , $96.70 , $208.36 , $93.45 , $62.85 , $210.12 , $178.50
73610,5110050086,Hospital Chargemaster,X-ray of ankle 3 + views RT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $64.82 , $62.85 , $101.54 , $98.64 , $147.96 , $147.96 , $151.77 , $151.77 , $96.70 , $208.36 , $93.45 , $62.85 , $210.12 , $178.50
74018,5110010092,Hospital Chargemaster,X-ray abdomen 1 view,Outpatient,Outpatient Default Percent / Case Rate,320, $245.00 , $134.75 , $201.88 , $96.70 , $171.50 , $95.55 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $48.13 , $46.67 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $46.67 , $208.36 , $171.50
70100,5110010002,Hospital Chargemaster,X-ray of jaw <4views,Outpatient,Outpatient Default Percent / Case Rate,320, $323.00 , $177.65 , $266.15 , $96.70 , $226.10 , $125.97 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $61.67 , $266.15 , $226.10
70140,5110010007,Hospital Chargemaster,X-ray of facial bone< 3 views,Outpatient,Outpatient Default Percent / Case Rate,320, $267.00 , $146.85 , $220.01 , $96.70 , $186.90 , $104.13 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $75.47 , $73.18 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $73.18 , $220.01 , $186.90
70160,5110010009,Hospital Chargemaster,X-ray of nasal bones,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $61.67 , $210.12 , $178.50
70328,5110010018,Hospital Chargemaster,X-ray of jaw joint unilat,Outpatient,Outpatient Default Percent / Case Rate,320, $201.00 , $110.55 , $165.62 , $96.70 , $140.70 , $78.39 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $58.13 , $208.36 , $140.70
70330,5110010019,Hospital Chargemaster,X-ray of jaw joint bilat,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $101.93 , $98.84 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $93.45 , $210.12 , $178.50
70360,5110010020,Hospital Chargemaster,X-ray of neck soft tissue,Outpatient,Outpatient Default Percent / Case Rate,320, $156.00 , $85.80 , $128.54 , $96.70 , $109.20 , $60.84 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $51.43 , $49.87 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $49.87 , $208.36 , $109.20
72040,5110010034,Hospital Chargemaster,X-ray neck spine 2-3 vw,Outpatient,Outpatient Default Percent / Case Rate,320, $281.00 , $154.55 , $231.54 , $96.70 , $196.70 , $109.59 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $73.03 , $70.82 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $70.82 , $231.54 , $196.70
72080,5110010039,Hospital Chargemaster,X-ray thoracolmb 2/> vw,Outpatient,Outpatient Default Percent / Case Rate,320, $534.00 , $293.70 , $440.02 , $96.70 , $373.80 , $208.26 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $81.55 , $79.07 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $79.07 , $440.02 , $373.80
72081,5110010040,Hospital Chargemaster,X-ray entire spi 1 vw,Outpatient,Outpatient Default Percent / Case Rate,320, $149.00 , $81.95 , $122.78 , $96.70 , $104.30 , $58.11 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $66.20 , $64.19 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $58.11 , $208.36 , $104.30
72220,5110010050,Hospital Chargemaster,X-ray sacrum tailbone,Outpatient,Outpatient Default Percent / Case Rate,320, $281.00 , $154.55 , $231.54 , $96.70 , $196.70 , $109.59 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $67.32 , $231.54 , $196.70
73000,5110010053,Hospital Chargemaster,"X-ray of collar bone""",Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $61.67 , $210.12 , $178.50
73030,5110010056,Hospital Chargemaster,X-ray of shoulder 2 + views,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $67.32 , $210.12 , $178.50
73050,5110010058,Hospital Chargemaster,X-ray of shoulders bilat,Outpatient,Outpatient Default Percent / Case Rate,320, $301.00 , $165.55 , $248.02 , $96.70 , $210.70 , $117.39 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $81.55 , $79.07 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $79.07 , $248.02 , $210.70
73110,5110010065,Hospital Chargemaster,X-ray of wrist 3 + views,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $64.82 , $62.85 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $62.85 , $210.12 , $178.50
73140,5110010069,Hospital Chargemaster,X-ray of finger(s),Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $51.43 , $49.87 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $49.87 , $210.12 , $178.50
73502,5110010071,Hospital Chargemaster,X-ray hip uni 2-3 views,Outpatient,Outpatient Default Percent / Case Rate,320, $171.00 , $94.05 , $140.90 , $96.70 , $119.70 , $66.69 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $78.39 , $76.01 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $66.69 , $208.36 , $119.70
73551,5110010077,Hospital Chargemaster,X-ray of femur 1,Outpatient,Outpatient Default Percent / Case Rate,320, $149.00 , $81.95 , $122.78 , $96.70 , $104.30 , $58.11 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $50.24 , $48.72 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $48.72 , $208.36 , $104.30
73552,5110010078,Hospital Chargemaster,X-ray of femur 2/>,Outpatient,Outpatient Default Percent / Case Rate,320, $214.00 , $117.70 , $176.34 , $96.70 , $149.80 , $83.46 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.62 , $57.81 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $57.81 , $208.36 , $149.80
73560,5110010079,Hospital Chargemaster,X-ray of knee 1 or 2,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $61.67 , $210.12 , $178.50
73562,5110010080,Hospital Chargemaster,X-ray of knee 3,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $67.32 , $210.12 , $178.50
73590,5110010083,Hospital Chargemaster,"X-ray of lower leg""",Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $61.67 , $210.12 , $178.50
73630,5110010089,Hospital Chargemaster,X-ray of foot 3 + views,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $64.82 , $62.85 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $62.85 , $210.12 , $178.50
73650,5110010090,Hospital Chargemaster,"X-ray of heel""",Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $57.52 , $55.77 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $55.77 , $210.12 , $178.50
73660,5110010091,Hospital Chargemaster,"X-ray of toe(s)""",Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $51.43 , $49.87 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $49.87 , $210.12 , $178.50
73565,5110010140,Hospital Chargemaster,X-Ray Exam of Knees,Outpatient,Outpatient Default Percent / Case Rate,320, $152.00 , $83.60 , $125.25 , $96.70 , $106.40 , $59.28 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $58.13 , $208.36 , $106.40
70328,5110040018,Hospital Chargemaster,X-ray of jaw joint unilat LT,Outpatient,Outpatient Default Percent / Case Rate,320, $201.00 , $110.55 , $165.62 , $96.70 , $140.70 , $78.39 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $58.13 , $208.36 , $140.70
73000,5110040053,Hospital Chargemaster,X-ray of collar bone LT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $61.67 , $210.12 , $178.50
73030,5110040056,Hospital Chargemaster,X-ray of shoulder 2+ views LT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $67.32 , $210.12 , $178.50
73110,5110040065,Hospital Chargemaster,X-ray of wrist 3 + views LT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $64.82 , $62.85 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $62.85 , $210.12 , $178.50
73140,5110040069,Hospital Chargemaster,X-ray of finger(s) LT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $51.43 , $49.87 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $49.87 , $210.12 , $178.50
73502,5110040071,Hospital Chargemaster,X-ray hip uni 2-3 views LT,Outpatient,Outpatient Default Percent / Case Rate,320, $171.00 , $94.05 , $140.90 , $96.70 , $119.70 , $66.69 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $78.39 , $76.01 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $66.69 , $208.36 , $119.70
73551,5110040077,Hospital Chargemaster,X-ray of femur 1 LT,Outpatient,Outpatient Default Percent / Case Rate,320, $149.00 , $81.95 , $122.78 , $96.70 , $104.30 , $58.11 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $50.24 , $48.72 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $48.72 , $208.36 , $104.30
73552,5110040078,Hospital Chargemaster,X-ray of femur 2/> LT,Outpatient,Outpatient Default Percent / Case Rate,320, $214.00 , $117.70 , $176.34 , $96.70 , $149.80 , $83.46 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.62 , $57.81 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $57.81 , $208.36 , $149.80
73560,5110040079,Hospital Chargemaster,X-ray of knee 1 or 2 LT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $61.67 , $210.12 , $178.50
73562,5110040080,Hospital Chargemaster,X-ray of knee 3 LT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $67.32 , $210.12 , $178.50
73590,5110040083,Hospital Chargemaster,X-ray of lower leg LT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $61.67 , $210.12 , $178.50
73630,5110040089,Hospital Chargemaster,X-ray of foot 3 + views LT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $64.82 , $62.85 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $62.85 , $210.12 , $178.50
73650,5110040090,Hospital Chargemaster,X-ray of heel LT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $57.52 , $55.77 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $55.77 , $210.12 , $178.50
73660,5110040091,Hospital Chargemaster,X-ray of toe(s) LT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $51.43 , $49.87 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $49.87 , $210.12 , $178.50
70328,5110050018,Hospital Chargemaster,X-ray of jaw joint unilat RT,Outpatient,Outpatient Default Percent / Case Rate,320, $201.00 , $110.55 , $165.62 , $96.70 , $140.70 , $78.39 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $58.13 , $208.36 , $140.70
73000,5110050053,Hospital Chargemaster,X-ray of collar bone RT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $61.67 , $210.12 , $178.50
73030,5110050056,Hospital Chargemaster,X-ray of shoulder 2+ views RT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $67.32 , $210.12 , $178.50
73110,5110050065,Hospital Chargemaster,X-ray of wrist 3 + views RT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $64.82 , $62.85 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $62.85 , $210.12 , $178.50
73140,5110050069,Hospital Chargemaster,X-ray of finger(s) RT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $51.43 , $49.87 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $49.87 , $210.12 , $178.50
73502,5110050071,Hospital Chargemaster,X-ray hip uni 2-3 views RT,Outpatient,Outpatient Default Percent / Case Rate,320, $171.00 , $94.05 , $140.90 , $96.70 , $119.70 , $66.69 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $78.39 , $76.01 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $66.69 , $208.36 , $119.70
73551,5110050077,Hospital Chargemaster,X-ray of femur 1 RT,Outpatient,Outpatient Default Percent / Case Rate,320, $149.00 , $81.95 , $122.78 , $96.70 , $104.30 , $58.11 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $50.24 , $48.72 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $48.72 , $208.36 , $104.30
73552,5110050078,Hospital Chargemaster,X-ray of femur 2/> RT,Outpatient,Outpatient Default Percent / Case Rate,320, $214.00 , $117.70 , $176.34 , $96.70 , $149.80 , $83.46 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.62 , $57.81 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $57.81 , $208.36 , $149.80
73560,5110050079,Hospital Chargemaster,X-ray of knee 1 or 2 RT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $61.67 , $210.12 , $178.50
73562,5110050080,Hospital Chargemaster,X-ray of knee 3 RT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $67.32 , $210.12 , $178.50
73590,5110050083,Hospital Chargemaster,X-ray of lower leg RT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $61.67 , $210.12 , $178.50
73630,5110050089,Hospital Chargemaster,X-ray of foot 3 + views RT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $64.82 , $62.85 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $62.85 , $210.12 , $178.50
73650,5110050090,Hospital Chargemaster,X-ray of heel RT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $57.52 , $55.77 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $55.77 , $210.12 , $178.50
73660,5110050091,Hospital Chargemaster,X-ray of toe(s) RT,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $51.43 , $49.87 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $49.87 , $210.12 , $178.50
73000,5110060053,Hospital Chargemaster,X-Ray of Collar Bone Bilat,Outpatient,Outpatient Default Percent / Case Rate,320, $255.00 , $140.25 , $210.12 , $96.70 , $178.50 , $99.45 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $61.67 , $210.12 , $178.50
77081,5150010010,Hospital Chargemaster,DXA Bone Density peripheral,Outpatient,Outpatient Default Percent / Case Rate,320, $253.00 , $139.15 , $208.47 , $96.70 , $177.10 , $98.67 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $184.46 , $178.87 , $101.54 , $98.64 , $140.84 , $140.84 , $144.46 , $144.46 , $96.70 , $208.36 , $93.45 , $93.45 , $208.47 , $177.10
72020,5110010033,Hospital Chargemaster,X-ray of spine 1 view,Outpatient,Outpatient Default Percent / Case Rate,320, $140.00 , $77.00 , $115.36 , $96.70 , $98.00 , $54.60 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $51.43 , $49.87 , $101.54 , $98.64 , $140.00 , $140.00 , $140.00 , $140.00 , $96.70 , $208.36 , $93.45 , $49.87 , $208.36 , $98.00
73592,5110010084,Hospital Chargemaster,"X-ray of leg infant""",Outpatient,Outpatient Default Percent / Case Rate,320, $136.00 , $74.80 , $112.06 , $96.70 , $95.20 , $53.04 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $136.00 , $136.00 , $136.00 , $136.00 , $96.70 , $208.36 , $93.45 , $53.04 , $208.36 , $95.20
73592,5110040084,Hospital Chargemaster,X-ray of leg infant LT,Outpatient,Outpatient Default Percent / Case Rate,320, $136.00 , $74.80 , $112.06 , $96.70 , $95.20 , $53.04 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $136.00 , $136.00 , $136.00 , $136.00 , $96.70 , $208.36 , $93.45 , $53.04 , $208.36 , $95.20
73592,5110050084,Hospital Chargemaster,X-ray of leg infant RT,Outpatient,Outpatient Default Percent / Case Rate,320, $136.00 , $74.80 , $112.06 , $96.70 , $95.20 , $53.04 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $136.00 , $136.00 , $136.00 , $136.00 , $96.70 , $208.36 , $93.45 , $53.04 , $208.36 , $95.20
73501,5110010070,Hospital Chargemaster,X-ray hip uni 1 view,Outpatient,Outpatient Default Percent / Case Rate,320, $130.00 , $71.50 , $107.12 , $96.70 , $91.00 , $50.70 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $52.11 , $50.53 , $101.54 , $98.64 , $130.00 , $130.00 , $130.00 , $130.00 , $96.70 , $208.36 , $93.45 , $50.53 , $208.36 , $91.00
73501,5110040070,Hospital Chargemaster,X-ray hip uni 1 view LT,Outpatient,Outpatient Default Percent / Case Rate,320, $130.00 , $71.50 , $107.12 , $96.70 , $91.00 , $50.70 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $52.11 , $50.53 , $101.54 , $98.64 , $130.00 , $130.00 , $130.00 , $130.00 , $96.70 , $208.36 , $93.45 , $50.53 , $208.36 , $91.00
73501,5110050070,Hospital Chargemaster,X-ray hip uni 1 view RT,Outpatient,Outpatient Default Percent / Case Rate,320, $130.00 , $71.50 , $107.12 , $96.70 , $91.00 , $50.70 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $52.11 , $50.53 , $101.54 , $98.64 , $130.00 , $130.00 , $130.00 , $130.00 , $96.70 , $208.36 , $93.45 , $50.53 , $208.36 , $91.00
70210,5110010013,Hospital Chargemaster,X-ray of sinuses<3 views,Outpatient,Outpatient Default Percent / Case Rate,320, $128.00 , $70.40 , $105.47 , $96.70 , $89.60 , $49.92 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $75.47 , $73.18 , $101.54 , $98.64 , $128.00 , $128.00 , $128.00 , $128.00 , $96.70 , $208.36 , $93.45 , $49.92 , $208.36 , $89.60
73070,5110010060,Hospital Chargemaster,X-ray of elbow 2 views,Outpatient,Outpatient Default Percent / Case Rate,320, $128.00 , $70.40 , $105.47 , $96.70 , $89.60 , $49.92 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $128.00 , $128.00 , $128.00 , $128.00 , $96.70 , $208.36 , $93.45 , $49.92 , $208.36 , $89.60
73070,5110040060,Hospital Chargemaster,X-ray of elbow 2 views LT,Outpatient,Outpatient Default Percent / Case Rate,320, $128.00 , $70.40 , $105.47 , $96.70 , $89.60 , $49.92 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $128.00 , $128.00 , $128.00 , $128.00 , $96.70 , $208.36 , $93.45 , $49.92 , $208.36 , $89.60
73070,5110050060,Hospital Chargemaster,X-ray of elbow 2 views RT,Outpatient,Outpatient Default Percent / Case Rate,320, $128.00 , $70.40 , $105.47 , $96.70 , $89.60 , $49.92 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $128.00 , $128.00 , $128.00 , $128.00 , $96.70 , $208.36 , $93.45 , $49.92 , $208.36 , $89.60
73620,5110010088,Hospital Chargemaster,X-ray of foot 2 views,Outpatient,Outpatient Default Percent / Case Rate,320, $126.00 , $69.30 , $103.82 , $96.70 , $88.20 , $49.14 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $126.00 , $126.00 , $126.00 , $126.00 , $96.70 , $208.36 , $93.45 , $49.14 , $208.36 , $88.20
73620,5110040088,Hospital Chargemaster,X-ray of foot 2 views LT,Outpatient,Outpatient Default Percent / Case Rate,320, $126.00 , $69.30 , $103.82 , $96.70 , $88.20 , $49.14 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $126.00 , $126.00 , $126.00 , $126.00 , $96.70 , $208.36 , $93.45 , $49.14 , $208.36 , $88.20
73620,5110050088,Hospital Chargemaster,X-ray of foot 2 views RT,Outpatient,Outpatient Default Percent / Case Rate,320, $126.00 , $69.30 , $103.82 , $96.70 , $88.20 , $49.14 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $126.00 , $126.00 , $126.00 , $126.00 , $96.70 , $208.36 , $93.45 , $49.14 , $208.36 , $88.20
73020,5110010055,Hospital Chargemaster,X-ray of shoulder 1 view,Outpatient,Outpatient Default Percent / Case Rate,320, $125.00 , $68.75 , $103.00 , $96.70 , $87.50 , $48.75 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $57.52 , $55.77 , $101.54 , $98.64 , $125.00 , $125.00 , $125.00 , $125.00 , $96.70 , $208.36 , $93.45 , $48.75 , $208.36 , $87.50
73100,5110010064,Hospital Chargemaster,X-ray of wrist 2 views,Outpatient,Outpatient Default Percent / Case Rate,320, $125.00 , $68.75 , $103.00 , $96.70 , $87.50 , $48.75 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $125.00 , $125.00 , $125.00 , $125.00 , $96.70 , $208.36 , $93.45 , $48.75 , $208.36 , $87.50
73020,5110040055,Hospital Chargemaster,X-ray of shoulder 1 view LT,Outpatient,Outpatient Default Percent / Case Rate,320, $125.00 , $68.75 , $103.00 , $96.70 , $87.50 , $48.75 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $57.52 , $55.77 , $101.54 , $98.64 , $125.00 , $125.00 , $125.00 , $125.00 , $96.70 , $208.36 , $93.45 , $48.75 , $208.36 , $87.50
73100,5110040064,Hospital Chargemaster,X-ray of wrist 2 views LT,Outpatient,Outpatient Default Percent / Case Rate,320, $125.00 , $68.75 , $103.00 , $96.70 , $87.50 , $48.75 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $125.00 , $125.00 , $125.00 , $125.00 , $96.70 , $208.36 , $93.45 , $48.75 , $208.36 , $87.50
73020,5110050055,Hospital Chargemaster,X-ray of shoulder 1 view RT,Outpatient,Outpatient Default Percent / Case Rate,320, $125.00 , $68.75 , $103.00 , $96.70 , $87.50 , $48.75 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $57.52 , $55.77 , $101.54 , $98.64 , $125.00 , $125.00 , $125.00 , $125.00 , $96.70 , $208.36 , $93.45 , $48.75 , $208.36 , $87.50
73100,5110050064,Hospital Chargemaster,X-ray of wrist 2 views RT,Outpatient,Outpatient Default Percent / Case Rate,320, $125.00 , $68.75 , $103.00 , $96.70 , $87.50 , $48.75 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $125.00 , $125.00 , $125.00 , $125.00 , $96.70 , $208.36 , $93.45 , $48.75 , $208.36 , $87.50
72200,5110010048,Hospital Chargemaster,X-ray si joints,Outpatient,Outpatient Default Percent / Case Rate,320, $125.00 , $68.75 , $103.00 , $130.16 , $87.50 , $48.75 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $63.60 , $61.67 , $136.66 , $132.76 , $125.00 , $125.00 , $125.00 , $125.00 , $130.16 , $280.65 , $168.77 , $48.75 , $285.50 , $87.50
73060,5110010059,Hospital Chargemaster,"X-ray of humerus""",Outpatient,Outpatient Default Percent / Case Rate,320, $123.00 , $67.65 , $101.35 , $96.70 , $86.10 , $47.97 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $123.00 , $123.00 , $123.00 , $123.00 , $96.70 , $208.36 , $93.45 , $47.97 , $208.36 , $86.10
73060,5110040059,Hospital Chargemaster,X-ray of humerus LT,Outpatient,Outpatient Default Percent / Case Rate,320, $123.00 , $67.65 , $101.35 , $96.70 , $86.10 , $47.97 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $123.00 , $123.00 , $123.00 , $123.00 , $96.70 , $208.36 , $93.45 , $47.97 , $208.36 , $86.10
73060,5110050059,Hospital Chargemaster,X-ray of humerus RT,Outpatient,Outpatient Default Percent / Case Rate,320, $123.00 , $67.65 , $101.35 , $96.70 , $86.10 , $47.97 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $123.00 , $123.00 , $123.00 , $123.00 , $96.70 , $208.36 , $93.45 , $47.97 , $208.36 , $86.10
76010,5110010128,Hospital Chargemaster,X-ray nose to rectum,Outpatient,Outpatient Default Percent / Case Rate,320, $116.00 , $63.80 , $95.58 , $96.70 , $81.20 , $45.24 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $63.60 , $61.67 , $101.54 , $98.64 , $116.00 , $116.00 , $116.00 , $116.00 , $96.70 , $208.36 , $93.45 , $45.24 , $208.36 , $81.20
73600,5110010085,Hospital Chargemaster,X-ray of ankle 2 views,Outpatient,Outpatient Default Percent / Case Rate,320, $114.00 , $62.70 , $93.94 , $96.70 , $79.80 , $44.46 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $114.00 , $114.00 , $114.00 , $114.00 , $96.70 , $208.36 , $93.45 , $44.46 , $208.36 , $79.80
73600,5110040085,Hospital Chargemaster,X-ray of ankle 2 views LT,Outpatient,Outpatient Default Percent / Case Rate,320, $114.00 , $62.70 , $93.94 , $96.70 , $79.80 , $44.46 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $114.00 , $114.00 , $114.00 , $114.00 , $96.70 , $208.36 , $93.45 , $44.46 , $208.36 , $79.80
73600,5110050085,Hospital Chargemaster,X-ray of ankle 2 views RT,Outpatient,Outpatient Default Percent / Case Rate,320, $114.00 , $62.70 , $93.94 , $96.70 , $79.80 , $44.46 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $114.00 , $114.00 , $114.00 , $114.00 , $96.70 , $208.36 , $93.45 , $44.46 , $208.36 , $79.80
74300,5110010108,Hospital Chargemaster,X-ray bile ducts/pancreas,Outpatient,Outpatient Default Percent / Case Rate,320, $230.00 , $126.50 , $189.52 , See APC Packaged Rates , $161.00 , $89.70 , $182.71 , $143.27 , $142.78 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $213.90 , $213.90 , $213.90 , $213.90 , See APC Packaged Rates , $80.50 , $- , $- , $213.90 , $161.00
75984,5110010126,Hospital Chargemaster,Xray control catheter change,Outpatient,Outpatient Default Percent / Case Rate,320, $662.00 , $364.10 , $545.49 , See APC Packaged Rates , $463.40 , $258.18 , $270.54 , $212.14 , $211.41 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $615.66 , $615.66 , $615.66 , $615.66 , See APC Packaged Rates , $231.70 , $- , $- , $615.66 , $463.40
74328,5110010109,Hospital Chargemaster,X-ray bile duct endoscopy,Outpatient,Outpatient Default Percent / Case Rate,320, $171.00 , $94.05 , $140.90 , See APC Packaged Rates , $119.70 , $66.69 , $415.31 , $325.66 , $324.54 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $159.03 , $159.03 , $159.03 , $159.03 , See APC Packaged Rates , $59.85 , $- , $- , $415.31 , $119.70
74330,5110010110,Hospital Chargemaster,X-ray bile/panc endoscopy,Outpatient,Outpatient Default Percent / Case Rate,320, $256.00 , $140.80 , $210.94 , See APC Packaged Rates , $179.20 , $99.84 , $590.63 , $463.14 , $461.54 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $238.08 , $238.08 , $238.08 , $238.08 , See APC Packaged Rates , $89.60 , $- , $- , $590.63 , $179.20
74021,5110010094,Hospital Chargemaster,X-ray abdomen 3+ views,Outpatient,Outpatient Default Percent / Case Rate,320, $272.00 , $149.60 , $224.13 , $130.16 , $190.40 , $106.08 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $66.99 , $64.96 , $136.66 , $132.76 , $184.09 , $184.09 , $188.83 , $188.83 , $130.16 , $280.65 , $168.77 , $64.96 , $285.50 , $190.40
74241,5110010099,Hospital Chargemaster,X-ray upper gi delay w/kub,Outpatient,Outpatient Default Percent / Case Rate,320, $553.00 , $304.15 , $455.67 , See APC Packaged Rates , $387.10 , $215.67 , $533.59 , $535.91 , $284.81 , See APC Packaged Rates , See APC Packaged Rates , $371.06 , $371.06 , See APC Packaged Rates , See APC Packaged Rates , $514.29 , $514.29 , $514.29 , $514.29 , See APC Packaged Rates , $193.55 , Not Applicable , $193.55 , $535.91 , $387.10
74247,5110010101,Hospital Chargemaster,Contrast x-ray UP GI w KUB,Outpatient,Outpatient Default Percent / Case Rate,320, $352.00 , $193.60 , $290.05 , See APC Packaged Rates , $246.40 , $137.28 , $339.64 , $341.12 , $181.29 , See APC Packaged Rates , See APC Packaged Rates , $236.19 , $236.19 , See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , Not Applicable , $123.20 , $341.12 , $246.40
74230,5110010141,Hospital Chargemaster,X-Ray Xm Swlng Funcj C+,Outpatient,Outpatient Default Percent / Case Rate,320, $250.00 , $137.50 , $206.00 , $213.55 , $175.00 , $97.50 , $285.50 , $223.87 , $223.10 , $213.55 , $213.55 , $158.25 , $153.45 , $224.23 , $217.82 , $250.00 , $250.00 , $250.00 , $250.00 , $213.55 , $459.86 , $168.77 , $97.50 , $459.86 , $175.00
74240,5110010142,Hospital Chargemaster,X-Ray Xm Upr GI Trc 1 Cntrst,Outpatient,Outpatient Default Percent / Case Rate,320, $420.00 , $231.00 , $346.08 , $213.55 , $294.00 , $163.80 , $511.92 , $401.42 , $400.03 , $213.55 , $213.55 , $177.44 , $172.06 , $224.23 , $217.82 , $329.13 , $329.13 , $337.60 , $337.60 , $213.55 , $459.86 , $302.61 , $163.80 , $511.92 , $294.00
77001,5110010149,Hospital Chargemaster,Fluoroguide For Vein Device,Outpatient,Outpatient Default Percent / Case Rate,320, $237.00 , $130.35 , $195.29 , See APC Packaged Rates , $165.90 , $92.43 , $287.63 , $225.54 , $224.76 , See APC Packaged Rates , See APC Packaged Rates , $172.15 , $166.93 , See APC Packaged Rates , See APC Packaged Rates , $220.41 , $220.41 , $220.41 , $220.41 , See APC Packaged Rates , $82.95 , $- , $- , $287.63 , $165.90
74248,5110010151,Hospital Chargemaster,X-Ray Sm Int F-Thru Std,Outpatient,Outpatient Default Percent / Case Rate,320, $212.00 , $116.60 , $174.69 , See APC Packaged Rates , $148.40 , $82.68 , $191.66 , $150.28 , $149.77 , See APC Packaged Rates , See APC Packaged Rates , $125.47 , $121.66 , See APC Packaged Rates , See APC Packaged Rates , $197.16 , $197.16 , $197.16 , $197.16 , See APC Packaged Rates , $74.20 , $- , $- , $197.16 , $148.40
74450,5110010152,Hospital Chargemaster,X-Ray Urethra/Bladder,Outpatient,Outpatient Default Percent / Case Rate,320, $572.00 , $314.60 , $471.33 , $275.09 , $400.40 , $223.08 , $585.06 , $458.77 , $457.19 , $275.09 , $275.09 , $- , $- , $288.84 , $280.59 , $439.48 , $439.48 , $450.79 , $450.79 , $275.09 , $592.70 , $345.84 , $- , $592.70 , $400.40
77002,5110010157,Hospital Chargemaster,Needle Localization By Xray,Outpatient,Outpatient Default Percent / Case Rate,320, $282.00 , $155.10 , $232.37 , See APC Packaged Rates , $197.40 , $109.98 , $294.75 , $231.12 , $230.33 , See APC Packaged Rates , See APC Packaged Rates , $158.25 , $153.45 , See APC Packaged Rates , See APC Packaged Rates , $262.26 , $262.26 , $262.26 , $262.26 , See APC Packaged Rates , $98.70 , $- , $- , $294.75 , $197.40
77071,5110010160,Hospital Chargemaster,Stress Views any Joint,Outpatient,Outpatient Default Percent / Case Rate,320, $125.00 , $68.75 , $103.00 , $96.70 , $87.50 , $48.75 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.72 , $57.90 , $101.54 , $98.64 , $125.00 , $125.00 , $125.00 , $125.00 , $96.70 , $208.36 , $93.45 , $48.75 , $208.36 , $87.50
73592,5110060084,Hospital Chargemaster,X-Ray of Leg Infant Bilat,Outpatient,Outpatient Default Percent / Case Rate,320, $204.00 , $112.20 , $168.10 , $96.70 , $142.80 , $79.56 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $59.95 , $58.13 , $101.54 , $98.64 , $136.00 , $136.00 , $136.00 , $136.00 , $96.70 , $208.36 , $93.45 , $58.13 , $208.36 , $142.80
73115,5110010066,Hospital Chargemaster,"Contrast x-ray of wrist""",Outpatient,Outpatient Default Percent / Case Rate,322, $739.00 , $406.45 , $608.94 , $440.24 , $517.30 , $288.21 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $517.30
73525,5110010076,Hospital Chargemaster,Contrast x-ray of hip,Outpatient,Outpatient Default Percent / Case Rate,322, $739.00 , $406.45 , $608.94 , $440.24 , $517.30 , $288.21 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $517.30
73115,5110040066,Hospital Chargemaster,Contrast x-ray of wrist LT,Outpatient,Outpatient Default Percent / Case Rate,322, $739.00 , $406.45 , $608.94 , $440.24 , $517.30 , $288.21 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $517.30
73525,5110040076,Hospital Chargemaster,Contrast x-ray of hip LT,Outpatient,Outpatient Default Percent / Case Rate,322, $739.00 , $406.45 , $608.94 , $440.24 , $517.30 , $288.21 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $517.30
73115,5110050066,Hospital Chargemaster,Contrast x-ray of wrist RT,Outpatient,Outpatient Default Percent / Case Rate,322, $739.00 , $406.45 , $608.94 , $440.24 , $517.30 , $288.21 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $517.30
73525,5110050076,Hospital Chargemaster,Contrast x-ray of hip RT,Outpatient,Outpatient Default Percent / Case Rate,322, $739.00 , $406.45 , $608.94 , $440.24 , $517.30 , $288.21 , $979.20 , $767.83 , $765.18 , $440.24 , $440.24 , $- , $- , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $948.09 , $578.82 , $- , $979.20 , $517.30
71111,5110010030,Hospital Chargemaster,X-ray ribs/chest4/> vws,Outpatient,Outpatient Default Percent / Case Rate,324, $890.00 , $489.50 , $733.36 , $130.16 , $623.00 , $347.10 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $108.97 , $105.67 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $280.65 , $168.77 , $105.67 , $733.36 , $623.00
71101,5110010028,Hospital Chargemaster,X-ray unilat ribs/chest,Outpatient,Outpatient Default Percent / Case Rate,324, $610.00 , $335.50 , $502.64 , $130.16 , $427.00 , $237.90 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $81.55 , $79.07 , $136.66 , $132.76 , $206.18 , $206.18 , $211.49 , $211.49 , $130.16 , $280.65 , $168.77 , $79.07 , $502.64 , $427.00
71101,5110040028,Hospital Chargemaster,X-ray unilat ribs/chest LT,Outpatient,Outpatient Default Percent / Case Rate,324, $610.00 , $335.50 , $502.64 , $130.16 , $427.00 , $237.90 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $81.55 , $79.07 , $136.66 , $132.76 , $206.18 , $206.18 , $211.49 , $211.49 , $130.16 , $280.65 , $168.77 , $79.07 , $502.64 , $427.00
71101,5110050028,Hospital Chargemaster,X-ray unilat ribs/chest RT,Outpatient,Outpatient Default Percent / Case Rate,324, $610.00 , $335.50 , $502.64 , $130.16 , $427.00 , $237.90 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $81.55 , $79.07 , $136.66 , $132.76 , $206.18 , $206.18 , $211.49 , $211.49 , $130.16 , $280.65 , $168.77 , $79.07 , $502.64 , $427.00
71110,5110010029,Hospital Chargemaster,X-ray ribs bil 3 views,Outpatient,Outpatient Default Percent / Case Rate,324, $193.00 , $106.15 , $159.03 , $130.16 , $135.10 , $75.27 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $95.89 , $92.98 , $136.66 , $132.76 , $193.00 , $193.00 , $193.00 , $193.00 , $130.16 , $280.65 , $168.77 , $75.27 , $285.50 , $135.10
71048,5110010026,Hospital Chargemaster,X-ray chest 4+ views,Outpatient,Outpatient Default Percent / Case Rate,324, $275.00 , $151.25 , $226.60 , $130.16 , $192.50 , $107.25 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $67.93 , $65.87 , $136.66 , $132.76 , $184.09 , $184.09 , $188.83 , $188.83 , $130.16 , $280.65 , $168.77 , $65.87 , $285.50 , $192.50
71045,5110010023,Hospital Chargemaster,X-ray chest 1 view,Outpatient,Outpatient Default Percent / Case Rate,324, $205.00 , $112.75 , $168.92 , $96.70 , $143.50 , $79.95 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $28.31 , $27.45 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $27.45 , $208.36 , $143.50
71046,5110010024,Hospital Chargemaster,X-ray chest 2 views,Outpatient,Outpatient Default Percent / Case Rate,324, $205.00 , $112.75 , $168.92 , $96.70 , $143.50 , $79.95 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $51.88 , $50.30 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $50.30 , $208.36 , $143.50
71047,5110010025,Hospital Chargemaster,X-ray chest 3 views,Outpatient,Outpatient Default Percent / Case Rate,324, $148.00 , $81.40 , $121.95 , $96.70 , $103.60 , $57.72 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $66.06 , $64.05 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $57.72 , $208.36 , $103.60
71100,5110010027,Hospital Chargemaster,X-ray ribs uni 2 views,Outpatient,Outpatient Default Percent / Case Rate,324, $401.00 , $220.55 , $330.42 , $96.70 , $280.70 , $156.39 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $67.32 , $330.42 , $280.70
71120,5110010031,Hospital Chargemaster,X-ray breastbone 2/>vws,Outpatient,Outpatient Default Percent / Case Rate,324, $160.00 , $88.00 , $131.84 , $96.70 , $112.00 , $62.40 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $79.12 , $76.71 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $62.40 , $208.36 , $112.00
71100,5110040027,Hospital Chargemaster,X-ray ribs uni 2 views LT,Outpatient,Outpatient Default Percent / Case Rate,324, $401.00 , $220.55 , $330.42 , $96.70 , $280.70 , $156.39 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $67.32 , $330.42 , $280.70
71100,5110050027,Hospital Chargemaster,X-ray ribs uni 2 views RT,Outpatient,Outpatient Default Percent / Case Rate,324, $401.00 , $220.55 , $330.42 , $96.70 , $280.70 , $156.39 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $69.43 , $67.32 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $208.36 , $93.45 , $67.32 , $330.42 , $280.70
71130,5110010032,Hospital Chargemaster,X-ray strenoclavic jt 3/>vws,Outpatient,Outpatient Default Percent / Case Rate,324, $141.00 , $77.55 , $116.18 , $96.70 , $98.70 , $54.99 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $85.20 , $82.61 , $101.54 , $98.64 , $141.00 , $141.00 , $141.00 , $141.00 , $96.70 , $208.36 , $93.45 , $54.99 , $208.36 , $98.70
96409,5810010007,Hospital Chargemaster,Chemo iv push sngl drug,Outpatient,Outpatient Default Percent / Case Rate,331, $430.00 , $236.50 , $354.32 , $244.57 , $301.00 , $167.70 , $459.57 , $359.18 , $393.42 , $244.57 , $244.57 , $313.14 , $303.64 , $256.80 , $249.46 , $300.73 , $300.73 , $308.47 , $308.47 , $244.57 , $241.02 , $- , $- , $459.57 , $301.00
96401,5810010003,Hospital Chargemaster,Chemo anti-neopl sq/im,Outpatient,Outpatient Default Percent / Case Rate,331, $216.00 , $118.80 , $177.98 , $74.12 , $151.20 , $84.24 , $146.70 , $114.66 , $125.59 , $74.12 , $74.12 , $169.53 , $164.39 , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $241.02 , $- , $- , $241.02 , $151.20
96402,5810010004,Hospital Chargemaster,Chemo hormon antineopl sq/im,Outpatient,Outpatient Default Percent / Case Rate,331, $116.00 , $63.80 , $95.58 , $74.12 , $81.20 , $45.24 , $146.70 , $114.66 , $125.59 , $74.12 , $74.12 , $90.30 , $87.56 , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $241.02 , $- , $- , $241.02 , $81.20
96411,5810010008,Hospital Chargemaster,Chemo iv push addl drug,Outpatient,Outpatient Default Percent / Case Rate,331, $247.00 , $135.85 , $203.53 , $74.12 , $172.90 , $96.33 , $146.70 , $114.66 , $125.59 , $74.12 , $74.12 , $180.16 , $174.69 , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $241.02 , $- , $- , $241.02 , $172.90
96405,5810010005,Hospital Chargemaster,Chemo intralesional up to 7,Outpatient,Outpatient Default Percent / Case Rate,331, $- , $- , $- , $74.12 , $- , $- , $146.70 , $114.66 , $125.59 , $74.12 , $74.12 , $91.26 , $88.49 , $77.83 , $75.60 , $- , $- , $- , $- , $74.12 , $241.02 , $- , $- , $241.02 , $-
96406,5810010006,Hospital Chargemaster,Chemo intralesional over 7,Outpatient,Outpatient Default Percent / Case Rate,331, $- , $- , $- , $244.57 , $- , $- , $459.57 , $359.18 , $393.42 , $244.57 , $244.57 , $139.93 , $135.69 , $256.80 , $249.46 , $- , $- , $- , $- , $244.57 , $241.02 , $- , $- , $459.57 , $-
96413,5810010009,Hospital Chargemaster,Chemo iv infusion 1 hr,Outpatient,Outpatient Default Percent / Case Rate,335, $639.00 , $351.45 , $526.54 , $381.19 , $447.30 , $249.21 , $708.04 , $553.37 , $606.14 , $381.19 , $381.19 , $442.70 , $429.27 , $400.25 , $388.81 , $480.87 , $480.87 , $493.26 , $493.26 , $381.19 , $241.02 , $- , $- , $708.04 , $447.30
96415,5810010010,Hospital Chargemaster,Chemo iv infusion addl hr,Outpatient,Outpatient Default Percent / Case Rate,335, $326.00 , $179.30 , $268.62 , $74.12 , $228.20 , $127.14 , $146.70 , $114.66 , $125.59 , $74.12 , $74.12 , $97.62 , $94.66 , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $241.02 , $- , $- , $268.62 , $228.20
96417,5810010012,Hospital Chargemaster,Chemo iv infus each addl seq,Outpatient,Outpatient Default Percent / Case Rate,335, $296.00 , $162.80 , $243.90 , $74.12 , $207.20 , $115.44 , $146.70 , $114.66 , $125.59 , $74.12 , $74.12 , $215.12 , $208.59 , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $241.02 , $- , $- , $243.90 , $207.20
96549,5810010017,Hospital Chargemaster,Chemotherapy unspecified,Outpatient,Outpatient Default Percent / Case Rate,335, $95.00 , $52.25 , $78.28 , $47.84 , $66.50 , $37.05 , $91.67 , $92.06 , $48.93 , $47.84 , $47.84 , $- , $- , $50.23 , $48.80 , $61.50 , $61.50 , $63.08 , $63.08 , $47.84 , $241.02 , $- , $- , $241.02 , $66.50
96416,5810010011,Hospital Chargemaster,Chemo prolong infuse w/pump,Outpatient,Outpatient Default Percent / Case Rate,335, $655.00 , $360.25 , $539.72 , $381.19 , $458.50 , $255.45 , $708.04 , $553.37 , $606.14 , $381.19 , $381.19 , $476.63 , $462.17 , $400.25 , $388.81 , $480.87 , $480.87 , $493.26 , $493.26 , $381.19 , $241.02 , $- , $- , $708.04 , $458.50
78806,5155010121,Hospital Chargemaster,Abscess Imaging Whole Body,Outpatient,Outpatient Default Percent / Case Rate,341," $1,440.00 ", $792.00 ," $1,186.56 ", See APC Packaged Rates ," $1,008.00 ", $561.60 ," $1,389.46 "," $1,395.50 ", $741.63 , See APC Packaged Rates , See APC Packaged Rates , $966.24 , $966.24 , See APC Packaged Rates , See APC Packaged Rates ," $1,339.20 "," $1,339.20 "," $1,339.20 "," $1,339.20 ", See APC Packaged Rates , $314.36 , Not Applicable , $314.36 ," $1,395.50 "," $1,008.00 "
78452,5155010064,Hospital Chargemaster,Ht Muscle Image Spect Mult,Outpatient,Outpatient Default Percent / Case Rate,341," $4,158.00 "," $2,286.90 "," $3,426.19 "," $1,562.28 "," $2,910.60 "," $1,621.62 "," $4,975.37 "," $2,575.55 "," $2,527.75 "," $1,562.28 "," $1,562.28 ", $816.52 , $791.74 ," $1,640.39 "," $1,593.53 "," $2,503.10 "," $2,503.10 "," $2,567.54 "," $2,567.54 "," $1,562.28 ", $314.36 ," $1,844.07 ", $314.36 ," $4,975.37 "," $2,910.60 "
78453,5155010065,Hospital Chargemaster,Ht Muscle Image Planar Sing,Outpatient,Outpatient Default Percent / Case Rate,341," $1,874.00 "," $1,030.70 "," $1,544.18 "," $1,562.28 "," $1,311.80 ", $730.86 ," $4,975.37 "," $2,575.55 "," $2,527.75 "," $1,562.28 "," $1,562.28 ", $393.89 , $381.94 ," $1,640.39 "," $1,593.53 "," $1,874.00 "," $1,874.00 "," $1,874.00 "," $1,874.00 "," $1,562.28 ", $314.36 ," $1,844.07 ", $314.36 ," $4,975.37 "," $1,311.80 "
78451,5155010063,Hospital Chargemaster,Ht Muscle Image Spect Sing,Outpatient,Outpatient Default Percent / Case Rate,341," $1,855.00 "," $1,020.25 "," $1,528.52 "," $1,562.28 "," $1,298.50 ", $723.45 ," $4,975.37 "," $2,575.55 "," $2,527.75 "," $1,562.28 "," $1,562.28 ", $422.32 , $409.51 ," $1,640.39 "," $1,593.53 "," $1,855.00 "," $1,855.00 "," $1,855.00 "," $1,855.00 "," $1,562.28 ", $314.36 ," $1,844.07 ", $314.36 ," $4,975.37 "," $1,298.50 "
78708,5155010107,Hospital Chargemaster,K Flow/Funct Image W/Drug,Outpatient,Outpatient Default Percent / Case Rate,341," $1,016.00 ", $558.80 , $837.18 , $585.03 , $711.20 , $396.24 ," $1,155.90 ", $906.38 , $903.26 , $585.03 , $585.03 , $543.23 , $526.75 , $614.28 , $596.73 , $939.30 , $939.30 , $963.48 , $963.48 , $585.03 , $314.36 , $683.28 , $314.36 ," $1,155.90 ", $711.20
78582,5155010085,Hospital Chargemaster,Lung Ventilat&Perfus Imaging,Outpatient,Outpatient Default Percent / Case Rate,341," $2,011.00 "," $1,106.05 "," $1,657.06 ", $585.03 ," $1,407.70 ", $784.29 ," $1,155.90 ", $906.38 , $903.26 , $585.03 , $585.03 , $708.95 , $687.44 , $614.28 , $596.73 , $939.30 , $939.30 , $963.48 , $963.48 , $585.03 , $314.36 , $683.28 , $314.36 ," $1,657.06 "," $1,407.70 "
78803,5155010118,Hospital Chargemaster,Tumor Imaging (3D),Outpatient,Outpatient Default Percent / Case Rate,341," $1,076.00 ", $591.80 , $886.62 ," $1,562.28 ", $753.20 , $419.64 ," $1,155.90 ", $906.38 , $903.26 ," $1,562.28 "," $1,562.28 ", $796.42 , $772.25 ," $1,640.39 "," $1,593.53 ", $939.30 , $939.30 , $963.48 , $963.48 ," $1,562.28 ", $314.36 , $683.28 , $314.36 ," $1,640.39 ", $753.20
78606,5155010092,Hospital Chargemaster,Brain Image W/Flow 4 + Views,Outpatient,Outpatient Default Percent / Case Rate,341," $1,243.00 ", $683.65 ," $1,024.23 ", $585.03 , $870.10 , $484.77 ," $1,155.90 ", $906.38 , $903.26 , $585.03 , $585.03 , $470.18 , $455.91 , $614.28 , $596.73 , $939.30 , $939.30 , $963.48 , $963.48 , $585.03 , $314.36 , $683.28 , $314.36 ," $1,155.90 ", $870.10
78610,5155010096,Hospital Chargemaster,Brain Flow Imaging Only,Outpatient,Outpatient Default Percent / Case Rate,341," $1,148.00 ", $631.40 , $945.95 , $585.03 , $803.60 , $447.72 ," $1,155.90 ", $906.38 , $903.26 , $585.03 , $585.03 , $191.74 , $185.92 , $614.28 , $596.73 , $932.49 , $932.49 , $956.49 , $956.49 , $585.03 , $314.36 , $683.28 , $185.92 ," $1,155.90 ", $803.60
78227,5155010034,Hospital Chargemaster,Hepatobil Syst Image W/Drug,Outpatient,Outpatient Default Percent / Case Rate,341," $1,293.00 ", $711.15 ," $1,065.43 ", $585.03 , $905.10 , $504.27 ," $1,155.90 ", $906.38 , $903.26 , $585.03 , $585.03 , $764.92 , $741.71 , $614.28 , $596.73 , $932.49 , $932.49 , $956.49 , $956.49 , $585.03 , $314.36 , $683.28 , $314.36 ," $1,155.90 ", $905.10
78195,5155010026,Hospital Chargemaster,Lymph System Imaging,Outpatient,Outpatient Default Percent / Case Rate,341, $746.00 , $410.30 , $614.70 , $585.03 , $522.20 , $290.94 ," $1,155.90 ", $906.38 , $903.26 , $585.03 , $585.03 , $495.14 , $480.12 , $614.28 , $596.73 , $746.00 , $746.00 , $746.00 , $746.00 , $585.03 , $314.36 , $683.28 , $290.94 ," $1,155.90 ", $522.20
78014,5155010003,Hospital Chargemaster,Thyroid Imaging W/Blood Flow,Outpatient,Outpatient Default Percent / Case Rate,341, $751.00 , $413.05 , $618.82 , $450.66 , $525.70 , $292.89 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $570.14 , $552.84 , $473.19 , $459.67 , $720.40 , $720.40 , $738.95 , $738.95 , $450.66 , $314.36 , $530.24 , $292.89 , $897.01 , $525.70
78597,5155010086,Hospital Chargemaster,Lung Perfusion Differential,Outpatient,Outpatient Default Percent / Case Rate,341, $785.00 , $431.75 , $646.84 , $450.66 , $549.50 , $306.15 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $423.19 , $410.35 , $473.19 , $459.67 , $720.40 , $720.40 , $738.95 , $738.95 , $450.66 , $314.36 , $530.24 , $306.15 , $897.01 , $549.50
78215,5155010031,Hospital Chargemaster,Liver And Spleen Imaging,Outpatient,Outpatient Default Percent / Case Rate,341, $992.00 , $545.60 , $817.41 , $450.66 , $694.40 , $386.88 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $356.34 , $345.52 , $473.19 , $459.67 , $720.40 , $720.40 , $738.95 , $738.95 , $450.66 , $314.36 , $530.24 , $314.36 , $897.01 , $694.40
78761,5155010113,Hospital Chargemaster,Testicular Imaging W/Flow,Outpatient,Outpatient Default Percent / Case Rate,341, $909.00 , $499.95 , $749.02 , $450.66 , $636.30 , $354.51 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $388.63 , $376.84 , $473.19 , $459.67 , $720.40 , $720.40 , $738.95 , $738.95 , $450.66 , $314.36 , $530.24 , $314.36 , $897.01 , $636.30
78701,5155010105,Hospital Chargemaster,Kidney Imaging With Flow,Outpatient,Outpatient Default Percent / Case Rate,341, $909.00 , $499.95 , $749.02 , $450.66 , $636.30 , $354.51 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $431.85 , $418.74 , $473.19 , $459.67 , $720.40 , $720.40 , $738.95 , $738.95 , $450.66 , $314.36 , $530.24 , $314.36 , $897.01 , $636.30
78306,5155010053,Hospital Chargemaster,Bone Imaging Whole Body,Outpatient,Outpatient Default Percent / Case Rate,341, $774.00 , $425.70 , $637.78 , $450.66 , $541.80 , $301.86 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $519.20 , $503.45 , $473.19 , $459.67 , $720.40 , $720.40 , $738.95 , $738.95 , $450.66 , $314.36 , $530.24 , $301.86 , $897.01 , $541.80
78315,5155010054,Hospital Chargemaster,Bone Imaging 3 Phase,Outpatient,Outpatient Default Percent / Case Rate,341, $797.00 , $438.35 , $656.73 , $450.66 , $557.90 , $310.83 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $580.34 , $562.73 , $473.19 , $459.67 , $720.40 , $720.40 , $738.95 , $738.95 , $450.66 , $314.36 , $530.24 , $310.83 , $897.01 , $557.90
78226,5155010033,Hospital Chargemaster,Hepatobiliary System Imaging,Outpatient,Outpatient Default Percent / Case Rate,341," $1,293.00 ", $711.15 ," $1,065.43 ", $450.66 , $905.10 , $504.27 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $764.92 , $741.71 , $473.19 , $459.67 , $720.40 , $720.40 , $738.95 , $738.95 , $450.66 , $314.36 , $530.24 , $314.36 ," $1,065.43 ", $905.10
78278,5155010046,Hospital Chargemaster,Acute Gi Blood Loss Imaging,Outpatient,Outpatient Default Percent / Case Rate,341, $907.00 , $498.85 , $747.37 , $450.66 , $634.90 , $353.73 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $592.25 , $574.28 , $473.19 , $459.67 , $720.40 , $720.40 , $738.95 , $738.95 , $450.66 , $314.36 , $530.24 , $314.36 , $897.01 , $634.90
78466,5155010071,Hospital Chargemaster,Heart Infarct Image,Outpatient,Outpatient Default Percent / Case Rate,341, $817.00 , $449.35 , $673.21 , $450.66 , $571.90 , $318.63 ," $1,430.61 ", $740.57 , $726.82 , $450.66 , $450.66 , $319.90 , $310.19 , $473.19 , $459.67 , $720.40 , $720.40 , $738.95 , $738.95 , $450.66 , $314.36 , $530.24 , $310.19 ," $1,430.61 ", $571.90
78472,5155010074,Hospital Chargemaster,Gated Heart Planar Single,Outpatient,Outpatient Default Percent / Case Rate,341, $921.00 , $506.55 , $758.90 , $450.66 , $644.70 , $359.19 ," $1,430.61 ", $740.57 , $726.82 , $450.66 , $450.66 , $670.15 , $649.82 , $473.19 , $459.67 , $720.40 , $720.40 , $738.95 , $738.95 , $450.66 , $314.36 , $530.24 , $314.36 ," $1,430.61 ", $644.70
78445,5155010062,Hospital Chargemaster,Vascular Flow Imaging,Outpatient,Outpatient Default Percent / Case Rate,341, $729.00 , $400.95 , $600.70 , $450.66 , $510.30 , $284.31 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $225.51 , $218.66 , $473.19 , $459.67 , $720.40 , $720.40 , $729.00 , $729.00 , $450.66 , $314.36 , $530.24 , $218.66 , $897.01 , $510.30
78300,5155010051,Hospital Chargemaster,Bone Imaging Limited Area,Outpatient,Outpatient Default Percent / Case Rate,341, $714.00 , $392.70 , $588.34 , $450.66 , $499.80 , $278.46 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $303.15 , $293.95 , $473.19 , $459.67 , $714.00 , $714.00 , $714.00 , $714.00 , $450.66 , $314.36 , $530.24 , $278.46 , $897.01 , $499.80
78262,5155010040,Hospital Chargemaster,Gastroesophageal Reflux Exam,Outpatient,Outpatient Default Percent / Case Rate,341, $710.00 , $390.50 , $585.04 , $450.66 , $497.00 , $276.90 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $516.77 , $501.09 , $473.19 , $459.67 , $710.00 , $710.00 , $710.00 , $710.00 , $450.66 , $314.36 , $530.24 , $276.90 , $897.01 , $497.00
78264,5155010041,Hospital Chargemaster,Gastric Emptying Imag Study,Outpatient,Outpatient Default Percent / Case Rate,341, $689.00 , $378.95 , $567.74 , $450.66 , $482.30 , $268.71 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $501.23 , $486.02 , $473.19 , $459.67 , $689.00 , $689.00 , $689.00 , $689.00 , $450.66 , $314.36 , $530.24 , $268.71 , $897.01 , $482.30
78012,5155010001,Hospital Chargemaster,Thyroid Uptake Measurement,Outpatient,Outpatient Default Percent / Case Rate,341, $681.00 , $374.55 , $561.14 , $450.66 , $476.70 , $265.59 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $192.39 , $186.56 , $473.19 , $459.67 , $673.78 , $673.78 , $681.00 , $681.00 , $450.66 , $314.36 , $530.24 , $186.56 , $897.01 , $476.70
78305,5155010052,Hospital Chargemaster,Bone Imaging Multiple Areas,Outpatient,Outpatient Default Percent / Case Rate,341, $652.00 , $358.60 , $537.25 , $450.66 , $456.40 , $254.28 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $444.93 , $431.43 , $473.19 , $459.67 , $652.00 , $652.00 , $652.00 , $652.00 , $450.66 , $314.36 , $530.24 , $254.28 , $897.01 , $456.40
78580,5155010084,Hospital Chargemaster,Lung Perfusion Imaging,Outpatient,Outpatient Default Percent / Case Rate,341, $651.00 , $358.05 , $536.42 , $450.66 , $455.70 , $253.89 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $417.25 , $404.59 , $473.19 , $459.67 , $651.00 , $651.00 , $651.00 , $651.00 , $450.66 , $314.36 , $530.24 , $253.89 , $897.01 , $455.70
78290,5155010048,Hospital Chargemaster,Meckels Divert Exam,Outpatient,Outpatient Default Percent / Case Rate,341, $651.00 , $358.05 , $536.42 , $450.66 , $455.70 , $253.89 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $369.46 , $358.25 , $473.19 , $459.67 , $651.00 , $651.00 , $651.00 , $651.00 , $450.66 , $314.36 , $530.24 , $253.89 , $897.01 , $455.70
78070,5155010008,Hospital Chargemaster,Parathyroid Planar Imaging,Outpatient,Outpatient Default Percent / Case Rate,341, $614.00 , $337.70 , $505.94 , $450.66 , $429.80 , $239.46 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $220.64 , $213.94 , $473.19 , $459.67 , $614.00 , $614.00 , $614.00 , $614.00 , $450.66 , $314.36 , $530.24 , $213.94 , $897.01 , $429.80
78071,5155010009,Hospital Chargemaster,Parathyrd Planar W/Wo Subtrj,Outpatient,Outpatient Default Percent / Case Rate,341, $614.00 , $337.70 , $505.94 , $450.66 , $429.80 , $239.46 , $897.01 , $703.38 , $700.95 , $450.66 , $450.66 , $795.65 , $771.51 , $473.19 , $459.67 , $614.00 , $614.00 , $614.00 , $614.00 , $450.66 , $314.36 , $530.24 , $239.46 , $897.01 , $429.80
78072,5155010010,Hospital Chargemaster,Parathyrd Planar W/Spect&Ct,Outpatient,Outpatient Default Percent / Case Rate,341, $983.00 , $540.65 , $809.99 , $585.03 , $688.10 , $383.37 ," $1,155.90 ", $906.38 , $903.26 , $585.03 , $585.03 , $659.59 , $659.59 , $614.28 , $596.73 , $939.30 , $939.30 , $963.48 , $963.48 , $585.03 , $314.36 , $683.28 , $314.36 ," $1,155.90 ", $688.10
78320,5155010055,Hospital Chargemaster,Bone Imaging (3D),Outpatient,Outpatient Default Percent / Case Rate,341," $1,076.00 ", $591.80 , $886.62 , See APC Packaged Rates , $753.20 , $419.64 ," $1,038.23 "," $1,042.75 ", $554.16 , See APC Packaged Rates , See APC Packaged Rates , $722.00 , $722.00 , See APC Packaged Rates , See APC Packaged Rates ," $1,000.68 "," $1,000.68 "," $1,000.68 "," $1,000.68 ", See APC Packaged Rates , $314.36 , Not Applicable , $314.36 ," $1,042.75 ", $753.20
73723,5170010048,Hospital Chargemaster,MRI joint lwr extr w/o&w/dye,Outpatient,Outpatient Default Percent / Case Rate,350, $418.00 , $229.90 , $344.43 , $440.24 , $292.60 , $163.02 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,422.63 "," $2,349.12 ", $462.26 , $449.05 , $418.00 , $418.00 , $418.00 , $418.00 , $440.24 , $264.00 , $578.82 , $163.02 ," $2,422.63 ", $292.60
73720,5170010045,Hospital Chargemaster,MRI lwr extremity w/o&w/dye,Outpatient,Outpatient Default Percent / Case Rate,350, $418.00 , $229.90 , $344.43 , $440.24 , $292.60 , $163.02 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,361.27 "," $1,319.97 ", $462.26 , $449.05 , $418.00 , $418.00 , $418.00 , $418.00 , $440.24 , $264.00 , $578.82 , $163.02 ," $1,561.69 ", $292.60
73722,5170010047,Hospital Chargemaster,MRI joint of lwr extr w/dye,Outpatient,Outpatient Default Percent / Case Rate,350, $318.00 , $174.90 , $262.03 , $855.31 , $222.60 , $124.02 ," $2,799.56 "," $1,449.22 "," $1,422.33 ", $855.31 , $855.31 ," $1,308.50 "," $1,268.80 ", $898.07 , $872.41 , $318.00 , $318.00 , $318.00 , $318.00 , $855.31 , $264.00 ," $1,037.63 ", $124.02 ," $2,799.56 ", $222.60
73719,5170010044,Hospital Chargemaster,MRI lower extremity w/dye,Outpatient,Outpatient Default Percent / Case Rate,350, $313.00 , $172.15 , $257.91 , $440.24 , $219.10 , $122.07 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,308.50 "," $1,268.80 ", $462.26 , $449.05 , $313.00 , $313.00 , $313.00 , $313.00 , $440.24 , $264.00 , $578.82 , $122.07 ," $1,561.69 ", $219.10
73721,5170010046,Hospital Chargemaster,MRI jnt of lwr extre w/o dye,Outpatient,Outpatient Default Percent / Case Rate,350, $262.00 , $144.10 , $215.89 , $275.09 , $183.40 , $102.18 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $262.00 , $262.00 , $262.00 , $262.00 , $275.09 , $264.00 , $345.84 , $102.18 ," $1,361.27 ", $183.40
76380,5160010054,Hospital Chargemaster,Cat Scan Follow-Up Study,Outpatient,Outpatient Default Percent / Case Rate,350, $585.00 , $321.75 , $482.04 , $96.70 , $409.50 , $228.15 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $425.76 , $412.84 , $101.54 , $98.64 , $141.47 , $141.47 , $145.11 , $145.11 , $96.70 , $264.00 , $93.45 , $93.45 , $482.04 , $409.50
76376,5160010052,Hospital Chargemaster,3D Render W/Intrp Postproces,Outpatient,Outpatient Default Percent / Case Rate,350, $470.00 , $258.50 , $387.28 , See APC Packaged Rates , $329.00 , $183.30 , $52.57 , $41.22 , $41.08 , See APC Packaged Rates , See APC Packaged Rates , $342.13 , $331.75 , See APC Packaged Rates , See APC Packaged Rates , $437.10 , $437.10 , $437.10 , $437.10 , See APC Packaged Rates , $264.00 , $- , $- , $437.10 , $329.00
76377,5160010053,Hospital Chargemaster,3D Render W/Intrp Postproces,Outpatient,Outpatient Default Percent / Case Rate,350, $453.00 , $249.15 , $373.27 , See APC Packaged Rates , $317.10 , $176.67 , $125.22 , $98.19 , $97.85 , See APC Packaged Rates , See APC Packaged Rates , $358.98 , $348.09 , See APC Packaged Rates , See APC Packaged Rates , $421.29 , $421.29 , $421.29 , $421.29 , See APC Packaged Rates , $264.00 , $- , $- , $421.29 , $317.10
77012,5160010056,Hospital Chargemaster,CT Scan For Needle Biopsy,Outpatient,Outpatient Default Percent / Case Rate,350, $926.00 , $509.30 , $763.02 , See APC Packaged Rates , $648.20 , $361.14 , $309.00 , $242.30 , $241.46 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $861.18 , $861.18 , $861.18 , $861.18 , See APC Packaged Rates , $264.00 , $- , $- , $861.18 , $648.20
75571,5161010001,Hospital Chargemaster,CT Heart Calcium Scoring,Outpatient,Outpatient Default Percent / Case Rate,350, $66.00 , $36.30 , $54.38 , $96.70 , $46.20 , $25.74 , $252.12 , $130.51 , $128.09 , $96.70 , $96.70 , $122.27 , $118.56 , $101.54 , $98.64 , $66.00 , $66.00 , $66.00 , $66.00 , $96.70 , $264.00 , $93.45 , $25.74 , $264.00 , $46.20
73725,5170010049,Hospital Chargemaster,MRA ang lwr ext w or w/o dye,Outpatient,Outpatient Default Percent / Case Rate,350," $1,522.00 ", $837.10 ," $1,254.13 ", See APC Packaged Rates ," $1,065.40 ", $593.58 ," $1,942.17 "," $1,005.38 ", $986.72 , See APC Packaged Rates , See APC Packaged Rates ," $1,361.27 "," $1,319.97 ", See APC Packaged Rates , See APC Packaged Rates , $858.82 , $858.82 , $880.93 , $880.93 , See APC Packaged Rates , $264.00 , $462.20 , $264.00 ," $1,942.17 "," $1,065.40 "
70460,5160010002,Hospital Chargemaster,CT Head/Brain W/Dye,Outpatient,Outpatient Default Percent / Case Rate,351," $1,285.00 ", $706.75 ," $1,058.84 ", $213.55 , $899.50 , $501.15 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $688.12 , $667.24 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,058.84 ", $899.50
70470,5160010003,Hospital Chargemaster,CT Head/Brain W/O & W/Dye,Outpatient,Outpatient Default Percent / Case Rate,351," $1,360.00 ", $748.00 ," $1,120.64 ", $213.55 , $952.00 , $530.40 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $859.76 , $833.68 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,120.64 ", $952.00
70491,5160010011,Hospital Chargemaster,CT Soft Tissue Neck W/Dye,Outpatient,Outpatient Default Percent / Case Rate,351," $1,128.00 ", $620.40 , $929.47 , $213.55 , $789.60 , $439.92 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $688.12 , $667.24 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $929.47 , $789.60
70487,5160010008,Hospital Chargemaster,CT Maxillofacial W/Dye,Outpatient,Outpatient Default Percent / Case Rate,351," $1,097.00 ", $603.35 , $903.93 , $213.55 , $767.90 , $427.83 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $688.12 , $667.24 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $903.93 , $767.90
70481,5160010005,Hospital Chargemaster,CT Orbit/Ear/Fossa W/Dye,Outpatient,Outpatient Default Percent / Case Rate,351," $1,097.00 ", $603.35 , $903.93 , $213.55 , $767.90 , $427.83 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $688.12 , $667.24 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $903.93 , $767.90
70492,5160010012,Hospital Chargemaster,CT Sft Tsue Nck W/O & W/Dye,Outpatient,Outpatient Default Percent / Case Rate,351," $1,485.00 ", $816.75 ," $1,223.64 ", $213.55 ," $1,039.50 ", $579.15 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $859.76 , $833.68 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,223.64 "," $1,039.50 "
70488,5160010009,Hospital Chargemaster,CT Maxillofacial W/O & W/Dye,Outpatient,Outpatient Default Percent / Case Rate,351," $1,562.00 ", $859.10 ," $1,287.09 ", $213.55 ," $1,093.40 ", $609.18 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $859.76 , $833.68 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,287.09 "," $1,093.40 "
70482,5160010006,Hospital Chargemaster,CT Orbit/Ear/Fossa W/O&W/Dye,Outpatient,Outpatient Default Percent / Case Rate,351," $1,562.00 ", $859.10 ," $1,287.09 ", $213.55 ," $1,093.40 ", $609.18 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $859.76 , $833.68 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,287.09 "," $1,093.40 "
70496,5160010013,Hospital Chargemaster,CT Angiography Head,Outpatient,Outpatient Default Percent / Case Rate,351," $1,156.00 ", $635.80 , $952.54 , $213.55 , $809.20 , $450.84 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $707.24 , $685.78 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $952.54 , $809.20
70498,5160010014,Hospital Chargemaster,CT Angiography Neck,Outpatient,Outpatient Default Percent / Case Rate,351," $1,074.00 ", $590.70 , $884.98 , $213.55 , $751.80 , $418.86 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $707.24 , $685.78 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $884.98 , $751.80
70450,5160010001,Hospital Chargemaster,CT Head/Brain W/O Dye,Outpatient,Outpatient Default Percent / Case Rate,351," $1,036.00 ", $569.80 , $853.66 , $130.16 , $725.20 , $404.04 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $574.31 , $556.88 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 , $853.66 , $725.20
70490,5160010010,Hospital Chargemaster,CT Soft Tissue Neck W/O Dye,Outpatient,Outpatient Default Percent / Case Rate,351, $784.00 , $431.20 , $646.02 , $130.16 , $548.80 , $305.76 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $574.31 , $556.88 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 , $646.02 , $548.80
70480,5160010004,Hospital Chargemaster,CT Orbit/Ear/Fossa W/O Dye,Outpatient,Outpatient Default Percent / Case Rate,351, $729.00 , $400.95 , $600.70 , $130.16 , $510.30 , $284.31 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $574.31 , $556.88 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 , $600.70 , $510.30
70486,5160010007,Hospital Chargemaster,CT Maxillofacial W/O Dye,Outpatient,Outpatient Default Percent / Case Rate,351, $729.00 , $400.95 , $600.70 , $130.16 , $510.30 , $284.31 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $574.31 , $556.88 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 , $600.70 , $510.30
73201,5160040033,Hospital Chargemaster,CT Upper Extr W/Dye LT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,580.00 ", $869.00 ," $1,301.92 ", $440.24 ," $1,106.00 ", $616.20 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 , $718.24 , $696.45 , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $264.00 , $578.82 , $264.00 ," $1,561.69 "," $1,106.00 "
73201,5160050033,Hospital Chargemaster,CT Upper Extr W/Dye RT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,580.00 ", $869.00 ," $1,301.92 ", $440.24 ," $1,106.00 ", $616.20 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 , $718.24 , $696.45 , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $264.00 , $578.82 , $264.00 ," $1,561.69 "," $1,106.00 "
72132,5160010026,Hospital Chargemaster,CT Lumbar Spine W/Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,640.00 ", $902.00 ," $1,351.36 ", $440.24 ," $1,148.00 ", $639.60 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 , $859.76 , $833.68 , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $264.00 , $578.82 , $264.00 ," $1,561.69 "," $1,148.00 "
72126,5160010020,Hospital Chargemaster,CT Neck Spine W/Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,886.00 "," $1,037.30 "," $1,554.06 ", $440.24 ," $1,320.20 ", $735.54 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 , $859.76 , $833.68 , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $264.00 , $578.82 , $264.00 ," $1,561.69 "," $1,320.20 "
74177,5160010046,Hospital Chargemaster,CT Abd & Pelv W/Contrast,Outpatient,Outpatient Default Percent / Case Rate,352," $2,295.00 "," $1,262.25 "," $1,891.08 ", $440.24 ," $1,606.50 ", $895.05 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 , $679.26 , $658.65 , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $264.00 , $578.82 , $264.00 ," $1,891.08 "," $1,606.50 "
74178,5160010047,Hospital Chargemaster,CT Abd & Pelv 1/> Regns,Outpatient,Outpatient Default Percent / Case Rate,352," $3,413.00 "," $1,877.15 "," $2,812.31 ", $440.24 ," $2,389.10 "," $1,331.07 "," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 , $897.81 , $870.57 , $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $264.00 , $578.82 , $264.00 ," $2,812.31 "," $2,389.10 "
74174,5160010043,Hospital Chargemaster,CT Angio Abd&Pelv W/O&W/Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $2,295.00 "," $1,262.25 "," $1,891.08 ", $440.24 ," $1,606.50 ", $895.05 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,191.67 "," $1,155.51 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $264.00 , $578.82 , $264.00 ," $1,891.08 "," $1,606.50 "
74176,5160010045,Hospital Chargemaster,CT Abd & Pelvis W/O Contrast,Outpatient,Outpatient Default Percent / Case Rate,352," $2,014.00 "," $1,107.70 "," $1,659.54 ", $275.09 ," $1,409.80 ", $785.46 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 , $356.03 , $345.23 , $288.84 , $280.59 , $439.48 , $439.48 , $450.79 , $450.79 , $275.09 , $264.00 , $345.84 , $264.00 ," $1,659.54 "," $1,409.80 "
72129,5160010023,Hospital Chargemaster,CT Chest Spine W/Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,886.00 "," $1,037.30 "," $1,554.06 ", $213.55 ," $1,320.20 ", $735.54 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $859.76 , $833.68 , $224.23 , $217.82 , $389.93 , $389.93 , $399.97 , $399.97 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,554.06 "," $1,320.20 "
75635,5160010051,Hospital Chargemaster,CT Angio Abdominal Arteries,Outpatient,Outpatient Default Percent / Case Rate,352," $1,320.00 ", $726.00 ," $1,087.68 ", $213.55 , $924.00 , $514.80 , $511.92 , $401.42 , $400.03 , $213.55 , $213.55 , $947.79 , $919.04 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,087.68 ", $924.00
72193,5160010030,Hospital Chargemaster,CT Pelvis W/Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,097.00 ", $603.35 , $903.93 , $213.55 , $767.90 , $427.83 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $831.14 , $805.93 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $903.93 , $767.90
73701,5160040037,Hospital Chargemaster,CT Lower Extr W/Dye LT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,580.00 ", $869.00 ," $1,301.92 ", $213.55 ," $1,106.00 ", $616.20 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $718.24 , $696.45 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,301.92 "," $1,106.00 "
73701,5160050037,Hospital Chargemaster,CT Lower Extr W/Dye RT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,580.00 ", $869.00 ," $1,301.92 ", $213.55 ," $1,106.00 ", $616.20 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $718.24 , $696.45 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,301.92 "," $1,106.00 "
71260,5160010016,Hospital Chargemaster,CT Thorax W/Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,528.00 ", $840.40 ," $1,259.07 ", $213.55 ," $1,069.60 ", $595.92 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $859.76 , $833.68 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,259.07 "," $1,069.60 "
74160,5160010041,Hospital Chargemaster,CT Abdomen W/Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,198.00 ", $658.90 , $987.15 , $213.55 , $838.60 , $467.22 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $831.14 , $805.93 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $987.15 , $838.60
72127,5160010021,Hospital Chargemaster,CT Neck Spine W/O & W/Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,886.00 "," $1,037.30 "," $1,554.06 ", $213.55 ," $1,320.20 ", $735.54 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 ," $1,073.64 "," $1,041.06 ", $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,554.06 "," $1,320.20 "
71270,5160010017,Hospital Chargemaster,CT Thorax W/O & W/Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,665.00 ", $915.75 ," $1,371.96 ", $213.55 ," $1,165.50 ", $649.35 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 ," $1,073.64 "," $1,041.06 ", $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,371.96 "," $1,165.50 "
72133,5160010027,Hospital Chargemaster,CT Lumbar Spine W/O & W/Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,886.00 "," $1,037.30 "," $1,554.06 ", $213.55 ," $1,320.20 ", $735.54 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 ," $1,073.64 "," $1,041.06 ", $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,554.06 "," $1,320.20 "
72130,5160010024,Hospital Chargemaster,CT Chest Spine W/O & W/Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,886.00 "," $1,037.30 "," $1,554.06 ", $213.55 ," $1,320.20 ", $735.54 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 ," $1,073.64 "," $1,041.06 ", $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,554.06 "," $1,320.20 "
72194,5160010031,Hospital Chargemaster,CT Pelvis W/O & W/Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,670.00 ", $918.50 ," $1,376.08 ", $213.55 ," $1,169.00 ", $651.30 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 ," $1,030.42 ", $999.15 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,376.08 "," $1,169.00 "
73202,5160040034,Hospital Chargemaster,CT Uppr Extr W/O&W/Dye LT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,173.00 ", $645.15 , $966.55 , $213.55 , $821.10 , $457.47 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $902.96 , $875.56 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $966.55 , $821.10
73702,5160040038,Hospital Chargemaster,CT Lwr Extr W/O&W/Dye LT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,173.00 ", $645.15 , $966.55 , $213.55 , $821.10 , $457.47 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $902.96 , $875.56 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $966.55 , $821.10
73202,5160050034,Hospital Chargemaster,CT Uppr Extr W/O&W/Dye RT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,173.00 ", $645.15 , $966.55 , $213.55 , $821.10 , $457.47 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $902.96 , $875.56 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $966.55 , $821.10
73702,5160050038,Hospital Chargemaster,CT Lwr Extr W/O&W/Dye RT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,173.00 ", $645.15 , $966.55 , $213.55 , $821.10 , $457.47 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $902.96 , $875.56 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $966.55 , $821.10
73206,5160040035,Hospital Chargemaster,CT Angio Upr Extrm WO&WDye LT,Outpatient,Outpatient Default Percent / Case Rate,352, $985.00 , $541.75 , $811.64 , $213.55 , $689.50 , $384.15 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $730.24 , $708.09 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $816.45 , $689.50
73206,5160050035,Hospital Chargemaster,CT Angio Upr Extrm WO&WDye RT,Outpatient,Outpatient Default Percent / Case Rate,352, $985.00 , $541.75 , $811.64 , $213.55 , $689.50 , $384.15 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $730.24 , $708.09 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $816.45 , $689.50
74170,5160010042,Hospital Chargemaster,CT Abdomen W/O & W/Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,743.00 ", $958.65 ," $1,436.23 ", $213.55 ," $1,220.10 ", $679.77 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 ," $1,030.42 ", $999.15 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,436.23 "," $1,220.10 "
71275,5160010018,Hospital Chargemaster,CT Angiography Chest,Outpatient,Outpatient Default Percent / Case Rate,352, $864.00 , $475.20 , $711.94 , $213.55 , $604.80 , $336.96 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $865.80 , $839.53 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $865.80 , $604.80
72191,5160010028,Hospital Chargemaster,CT Angiograph Pelv W/O&W/Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,212.00 ", $666.60 , $998.69 , $213.55 , $848.40 , $472.68 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $831.64 , $806.40 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $998.69 , $848.40
73706,5160040039,Hospital Chargemaster,CT Angio Lwr Extr WO&W/Dye LT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,583.00 ", $870.65 ," $1,304.39 ", $213.55 ," $1,108.10 ", $617.37 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $730.24 , $708.09 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,304.39 "," $1,108.10 "
73706,5160050039,Hospital Chargemaster,CT Angio Lwr Extr WO&W/Dye RT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,583.00 ", $870.65 ," $1,304.39 ", $213.55 ," $1,108.10 ", $617.37 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $730.24 , $708.09 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,304.39 "," $1,108.10 "
73706,5160060039,Hospital Chargemaster,CT Angio Lwr Extr WO&W/Dye Bi,Outpatient,Outpatient Default Percent / Case Rate,352," $1,583.00 ", $870.65 ," $1,304.39 ", $213.55 ," $1,108.10 ", $617.37 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $730.24 , $708.09 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 ," $1,304.39 "," $1,108.10 "
74175,5160010044,Hospital Chargemaster,CT Angio Abdom W/O & W/Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,118.00 ", $614.90 , $921.23 , $213.55 , $782.60 , $436.02 , $816.45 , $422.64 , $414.80 , $213.55 , $213.55 , $831.64 , $806.40 , $224.23 , $217.82 , $366.43 , $366.43 , $375.86 , $375.86 , $213.55 , $264.00 , $302.61 , $213.55 , $921.23 , $782.60
74150,5160010040,Hospital Chargemaster,CT Abdomen W/O Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,001.00 ", $550.55 , $824.82 , $130.16 , $700.70 , $390.39 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $688.12 , $667.24 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 , $824.82 , $700.70
72192,5160010029,Hospital Chargemaster,CT Pelvis W/O Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,013.00 ", $557.15 , $834.71 , $130.16 , $709.10 , $395.07 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $718.24 , $696.45 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 , $834.71 , $709.10
73200,5160040032,Hospital Chargemaster,CT Upper Extr W/O Dye LT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,164.00 ", $640.20 , $959.14 , $130.16 , $814.80 , $453.96 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $603.21 , $584.90 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 , $959.14 , $814.80
73200,5160050032,Hospital Chargemaster,CT Upper Extr W/O Dye RT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,164.00 ", $640.20 , $959.14 , $130.16 , $814.80 , $453.96 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $603.21 , $584.90 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 , $959.14 , $814.80
73700,5160040036,Hospital Chargemaster,CT Lower Extr W/O Dye LT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,164.00 ", $640.20 , $959.14 , $130.16 , $814.80 , $453.96 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $603.21 , $584.90 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 , $959.14 , $814.80
73700,5160050036,Hospital Chargemaster,CT Lower Extr W/O Dye RT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,164.00 ", $640.20 , $959.14 , $130.16 , $814.80 , $453.96 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $603.21 , $584.90 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 , $959.14 , $814.80
71250,5160010015,Hospital Chargemaster,CT Thorax W/O Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,102.00 ", $606.10 , $908.05 , $130.16 , $771.40 , $429.78 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $718.24 , $696.45 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 , $908.05 , $771.40
72131,5160010025,Hospital Chargemaster,CT Lumbar Spine W/O Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,640.00 ", $902.00 ," $1,351.36 ", $130.16 ," $1,148.00 ", $639.60 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $718.24 , $696.45 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 ," $1,351.36 "," $1,148.00 "
72131,5160010060,Hospital Chargemaster,CT Lmbr Spine wo Dye Post Vert,Outpatient,Outpatient Default Percent / Case Rate,352," $1,640.00 ", $902.00 ," $1,351.36 ", $130.16 ," $1,148.00 ", $639.60 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $718.24 , $696.45 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 ," $1,351.36 "," $1,148.00 "
72128,5160010022,Hospital Chargemaster,CT Chest Spine W/O Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,640.00 ", $902.00 ," $1,351.36 ", $130.16 ," $1,148.00 ", $639.60 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $718.24 , $696.45 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 ," $1,351.36 "," $1,148.00 "
72128,5160010059,Hospital Chargemaster,CT Chest Spine W/O Dye Pst Vrt,Outpatient,Outpatient Default Percent / Case Rate,352," $1,640.00 ", $902.00 ," $1,351.36 ", $130.16 ," $1,148.00 ", $639.60 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $718.24 , $696.45 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 ," $1,351.36 "," $1,148.00 "
72125,5160010019,Hospital Chargemaster,CT Neck Spine W/O Dye,Outpatient,Outpatient Default Percent / Case Rate,352," $1,640.00 ", $902.00 ," $1,351.36 ", $130.16 ," $1,148.00 ", $639.60 , $455.33 , $235.71 , $231.33 , $130.16 , $130.16 , $718.24 , $696.45 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $264.00 , $168.77 , $130.16 ," $1,351.36 "," $1,148.00 "
G0297,5160010058,Hospital Chargemaster,LDCT for Lung CA Screen,Outpatient,Outpatient Default Percent / Case Rate,352," $1,102.00 ", $606.10 , $908.05 , See APC Packaged Rates , $771.40 , $429.78 , $252.12 , $130.51 , $128.09 , See APC Packaged Rates , See APC Packaged Rates , $739.44 , $739.44 , See APC Packaged Rates , See APC Packaged Rates , $132.01 , $132.01 , $135.41 , $135.41 , See APC Packaged Rates , $264.00 , Not Applicable , $128.09 , $908.05 , $771.40
71271,5160010061,Hospital Chargemaster,Ct low dose Lung Screening,Outpatient,Outpatient Default Percent / Case Rate,352," $1,102.00 ", $606.10 , $908.05 , $130.16 , $771.40 , $429.78 ," $1,063.32 "," $1,067.95 ", $567.55 , $130.16 , $130.16 , $254.50 , $246.78 , $136.66 , $132.76 ," $1,024.86 "," $1,024.86 "," $1,024.86 "," $1,024.86 ", $130.16 , $264.00 , $121.35 , $121.35 ," $1,067.95 ", $771.40
27096,5160040040,Hospital Chargemaster,Inj for Sacroiliac JT Anest LT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,650.00 ", $907.50 ," $1,236.00 ", See APC Packaged Rates ," $1,155.00 ", $643.50 , $268.32 , $184.16 , $183.18 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates ," $1,534.50 "," $1,534.50 "," $1,534.50 "," $1,534.50 ", See APC Packaged Rates , $264.00 , $- , $- ," $1,534.50 "," $1,155.00 "
27096,5160050040,Hospital Chargemaster,Inj for Sacroiliac JT Anest RT,Outpatient,Outpatient Default Percent / Case Rate,352," $1,650.00 ", $907.50 ," $1,236.00 ", See APC Packaged Rates ," $1,155.00 ", $643.50 , $268.32 , $184.16 , $183.18 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates ," $1,534.50 "," $1,534.50 "," $1,534.50 "," $1,534.50 ", See APC Packaged Rates , $264.00 , $- , $- ," $1,534.50 "," $1,155.00 "
27096,5160060040,Hospital Chargemaster,Inj for Sacroiliac Jt Anest Bi,Outpatient,Outpatient Default Percent / Case Rate,352," $1,650.00 ", $907.50 ," $1,236.00 ", See APC Packaged Rates ," $1,155.00 ", $643.50 , $268.32 , $184.16 , $183.18 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates ," $1,534.50 "," $1,534.50 "," $1,534.50 "," $1,534.50 ", See APC Packaged Rates , $264.00 , $- , $- ," $1,534.50 "," $1,155.00 "
11721,501001065,Hospital Chargemaster,Debride nail 6 or more,Outpatient,Outpatient Default Percent / Case Rate,360, $239.00 , $131.45 ," $1,236.00 ", $66.55 , $167.30 , $93.21 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $185.14 , $185.14 , $185.14 , $185.14 , $66.55 , $83.65 , $- , $- ," $1,236.00 ", $167.30
11720,501001064,Hospital Chargemaster,Debride nail 1-5,Outpatient,Outpatient Default Percent / Case Rate,360, $47.00 , $25.85 ," $1,236.00 ", $66.55 , $32.90 , $18.33 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $47.00 , $47.00 , $47.00 , $47.00 , $66.55 , $16.45 , $- , $- ," $1,236.00 ", $32.90
11719,501001063,Hospital Chargemaster,Trim nail(s) any number,Outpatient,Outpatient Default Percent / Case Rate,360, $35.00 , $19.25 , $28.84 , $66.55 , $24.50 , $13.65 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $35.00 , $35.00 , $35.00 , $35.00 , $66.55 , $12.25 , $- , $- , $122.28 , $24.50
30300,501001172,Hospital Chargemaster,Remove nasal foreign body,Outpatient,Outpatient Default Percent / Case Rate,360, $384.00 , $211.20 , $316.42 , $134.80 , $268.80 , $149.76 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $343.81 , $343.81 , $343.81 , $343.81 , $134.80 , $134.40 , $- , $- , $343.81 , $268.80
11981,501001072,Hospital Chargemaster,Insert drug implant device,Outpatient,Outpatient Default Percent / Case Rate,360, $306.00 , $168.30 ," $1,236.00 ", $134.80 , $214.20 , $119.34 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $306.00 , $306.00 , $306.00 , $306.00 , $134.80 , $107.10 , $- , $- ," $1,236.00 ", $214.20
30901,501001173,Hospital Chargemaster,Control of nosebleed,Outpatient,Outpatient Default Percent / Case Rate,360, $184.00 , $101.20 ," $1,236.00 ", $134.80 , $128.80 , $71.76 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $64.40 , $- , $- ," $1,236.00 ", $128.80
30903,501001174,Hospital Chargemaster,Control of nosebleed,Outpatient,Outpatient Default Percent / Case Rate,360, $242.00 , $133.10 ," $1,236.00 ", $134.80 , $169.40 , $94.38 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $844.48 , $822.61 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $84.70 , $- , $- ," $1,236.00 ", $169.40
29130,501001166,Hospital Chargemaster,Application of finger splint,Outpatient,Outpatient Default Percent / Case Rate,360, $150.00 , $82.50 , $123.60 , $134.80 , $105.00 , $58.50 , $122.28 , $83.93 , $83.48 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $110.05 , $110.05 , $112.89 , $112.89 , $134.80 , $52.50 , $- , $- , $147.89 , $105.00
11740,501001068,Hospital Chargemaster,Drain blood from under nail,Outpatient,Outpatient Default Percent / Case Rate,360, $96.00 , $52.80 ," $1,236.00 ", $134.80 , $67.20 , $37.44 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $96.00 , $96.00 , $96.00 , $96.00 , $134.80 , $33.60 , $- , $- ," $1,236.00 ", $67.20
29581,501001170,Hospital Chargemaster,Apply multlay comprs lwr leg,Outpatient,Outpatient Default Percent / Case Rate,360, $271.00 , $149.05 , $223.30 , $168.90 , $189.70 , $105.69 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $32.27 , $31.29 , $177.35 , $172.28 , $271.00 , $271.00 , $271.00 , $271.00 , $168.90 , $94.85 , $- , $- , $294.51 , $189.70
29580,501001169,Hospital Chargemaster,Application of paste boot,Outpatient,Outpatient Default Percent / Case Rate,360, $244.00 , $134.20 , $201.06 , $168.90 , $170.80 , $95.16 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $85.40 , $- , $- , $294.51 , $170.80
29085,501001165,Hospital Chargemaster,Apply hand/wrist cast,Outpatient,Outpatient Default Percent / Case Rate,360, $197.00 , $108.35 , $162.33 , $168.90 , $137.90 , $76.83 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $266.32 , $258.23 , $177.35 , $172.28 , $197.00 , $197.00 , $197.00 , $197.00 , $168.90 , $68.95 , $- , $- , $294.51 , $137.90
12014,501001078,Hospital Chargemaster,Rpr f/e/e/n/l/m 5.1-7.5 cm,Outpatient,Outpatient Default Percent / Case Rate,360, $431.00 , $237.05 ," $1,236.00 ", $214.68 , $301.70 , $168.09 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $431.00 , $431.00 , $431.00 , $431.00 , $214.68 , $150.85 , $- , $- ," $1,236.00 ", $301.70
12004,501001075,Hospital Chargemaster,Rpr s/n/ax/gen/trk7.6-12.5cm,Outpatient,Outpatient Default Percent / Case Rate,360, $398.00 , $218.90 ," $1,236.00 ", $214.68 , $278.60 , $155.22 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $398.00 , $398.00 , $398.00 , $398.00 , $214.68 , $139.30 , $- , $- ," $1,236.00 ", $278.60
12013,501001077,Hospital Chargemaster,Rpr f/e/e/n/l/m 2.6-5.0 cm,Outpatient,Outpatient Default Percent / Case Rate,360, $362.00 , $199.10 , $298.29 , $214.68 , $253.40 , $141.18 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $362.00 , $362.00 , $362.00 , $362.00 , $214.68 , $126.70 , $- , $- , $844.48 , $253.40
11102,501001031,Hospital Chargemaster,Tangntl bx skin single les,Outpatient,Outpatient Default Percent / Case Rate,360, $353.00 , $194.15 ," $1,236.00 ", $214.68 , $247.10 , $137.67 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $123.55 , $- , $- ," $1,236.00 ", $247.10
12015,501001079,Hospital Chargemaster,Rpr f/e/e/n/l/m 7.6-12.5 cm,Outpatient,Outpatient Default Percent / Case Rate,360, $536.00 , $294.80 ," $1,236.00 ", $214.68 , $375.20 , $209.04 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $187.60 , $- , $- ," $1,236.00 ", $375.20
17270,501001101,Hospital Chargemaster,Destruction of skin lesions,Outpatient,Outpatient Default Percent / Case Rate,360, $446.00 , $245.30 ," $1,236.00 ", $214.68 , $312.20 , $173.94 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $156.10 , $- , $- ," $1,236.00 ", $312.20
17280,501001102,Hospital Chargemaster,Destruction of skin lesions,Outpatient,Outpatient Default Percent / Case Rate,360, $446.00 , $245.30 ," $1,236.00 ", $214.68 , $312.20 , $173.94 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $156.10 , $- , $- ," $1,236.00 ", $312.20
16025,501001094,Hospital Chargemaster,Dress/debrid p-thick burn m,Outpatient,Outpatient Default Percent / Case Rate,360, $344.00 , $189.20 ," $1,442.00 ", $214.68 , $240.80 , $134.16 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $120.40 , $- , $- ," $1,442.00 ", $240.80
12002,501001074,Hospital Chargemaster,Rpr s/n/ax/gen/trnk2.6-7.5cm,Outpatient,Outpatient Default Percent / Case Rate,360, $342.00 , $188.10 , $281.81 , $214.68 , $239.40 , $133.38 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $342.00 , $342.00 , $342.00 , $342.00 , $214.68 , $119.70 , $- , $- , $386.01 , $239.40
12001,501001073,Hospital Chargemaster,Rpr s/n/ax/gen/trnk 2.5cm/<,Outpatient,Outpatient Default Percent / Case Rate,360, $330.00 , $181.50 ," $1,236.00 ", $214.68 , $231.00 , $128.70 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $330.00 , $330.00 , $330.00 , $330.00 , $214.68 , $115.50 , $- , $- ," $1,236.00 ", $231.00
12011,501001076,Hospital Chargemaster,Rpr f/e/e/n/l/m 2.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,360, $317.00 , $174.35 , $261.21 , $214.68 , $221.90 , $123.63 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $317.00 , $317.00 , $317.00 , $317.00 , $214.68 , $110.95 , $- , $- , $844.48 , $221.90
11057,501001030,Hospital Chargemaster,Trim skin lesions over 4,Outpatient,Outpatient Default Percent / Case Rate,360, $271.00 , $149.05 ," $1,236.00 ", $214.68 , $189.70 , $105.69 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $112.55 , $109.14 , $225.42 , $218.98 , $271.00 , $271.00 , $271.00 , $271.00 , $214.68 , $94.85 , $- , $- ," $1,236.00 ", $189.70
11055,501001028,Hospital Chargemaster,Trim skin lesion,Outpatient,Outpatient Default Percent / Case Rate,360, $239.00 , $131.45 ," $1,236.00 ", $214.68 , $167.30 , $93.21 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $61.61 , $59.74 , $225.42 , $218.98 , $239.00 , $239.00 , $239.00 , $239.00 , $214.68 , $83.65 , $- , $- ," $1,236.00 ", $167.30
11200,501001037,Hospital Chargemaster,Removal of skin tags ,Outpatient,Outpatient Default Percent / Case Rate,360, $446.00 , $245.30 ," $1,236.00 ", $312.35 , $312.20 , $173.94 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $89.51 , $86.79 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $156.10 , $- , $- ," $1,236.00 ", $312.20
20600,501001135,Hospital Chargemaster,Drain/inj joint/bursa w/o us,Outpatient,Outpatient Default Percent / Case Rate,360, $446.00 , $245.30 ," $1,236.00 ", $312.35 , $312.20 , $173.94 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $96.34 , $93.41 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $156.10 , $- , $- ," $1,236.00 ", $312.20
20552,501001133,Hospital Chargemaster,Inj trigger point 1/2 muscl,Outpatient,Outpatient Default Percent / Case Rate,360, $446.00 , $245.30 ," $1,236.00 ", $312.35 , $312.20 , $173.94 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $80.71 , $78.26 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $156.10 , $- , $- ," $1,236.00 ", $312.20
36593,501001236,Hospital Chargemaster,Declot vascular device,Outpatient,Outpatient Default Percent / Case Rate,360, $286.00 , $157.30 ," $1,236.00 ", $381.19 , $200.20 , $111.54 , $630.87 , $433.00 , $430.69 , $381.19 , $381.19 , $81.74 , $79.26 , $400.25 , $388.81 , $286.00 , $286.00 , $286.00 , $286.00 , $381.19 , $100.10 , $- , $- ," $1,236.00 ", $200.20
11750,501001069,Hospital Chargemaster,Removal of nail bed,Outpatient,Outpatient Default Percent / Case Rate,360, $526.00 , $289.30 ," $1,236.00 ", $413.21 , $368.20 , $205.14 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $526.00 , $526.00 , $526.00 , $526.00 , $413.21 , $184.10 , $- , $- ," $1,236.00 ", $368.20
11602,501001056,Hospital Chargemaster,Exc tr-ext mal+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,360, $444.00 , $244.20 ," $1,236.00 ", $413.21 , $310.80 , $173.16 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $444.00 , $444.00 , $444.00 , $444.00 , $413.21 , $155.40 , $- , $- ," $1,236.00 ", $310.80
17004,501001098,Hospital Chargemaster,Destroy premal lesions 15/>,Outpatient,Outpatient Default Percent / Case Rate,360, $817.00 , $449.35 ," $1,236.00 ", $413.21 , $571.90 , $318.63 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $285.95 , $- , $- ," $1,236.00 ", $571.90
17106,501001099,Hospital Chargemaster,Destruction of skin lesions,Outpatient,Outpatient Default Percent / Case Rate,360, $975.00 , $536.25 ," $1,236.00 ", $413.21 , $682.50 , $380.25 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $341.25 , $- , $- ," $1,236.00 ", $682.50
16030,501001095,Hospital Chargemaster,Dress/debrid p-thick burn l,Outpatient,Outpatient Default Percent / Case Rate,360, $391.00 , $215.05 ," $1,442.00 ", $413.21 , $273.70 , $152.49 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $136.85 , $- , $- ," $1,442.00 ", $273.70
11104,501001033,Hospital Chargemaster,Punch bx skin single lesion,Outpatient,Outpatient Default Percent / Case Rate,360, $353.00 , $194.15 , $290.87 , $413.21 , $247.10 , $137.67 , $386.01 , $264.94 , $263.52 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $123.55 , $- , $- , $433.88 , $247.10
11401,501001043,Hospital Chargemaster,Exc tr-ext b9+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,360, $341.00 , $187.55 ," $1,236.00 ", $413.21 , $238.70 , $132.99 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $341.00 , $341.00 , $341.00 , $341.00 , $413.21 , $119.35 , $- , $- ," $1,236.00 ", $238.70
10160,501001019,Hospital Chargemaster,Puncture drainage of lesion,Outpatient,Outpatient Default Percent / Case Rate,360, $290.00 , $159.50 ," $1,236.00 ", $413.21 , $203.00 , $113.10 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $269.70 , $269.70 , $269.70 , $269.70 , $413.21 , $101.50 , $- , $- ," $1,236.00 ", $203.00
10120,501001017,Hospital Chargemaster,Remove foreign body,Outpatient,Outpatient Default Percent / Case Rate,360, $278.00 , $152.90 ," $1,236.00 ", $413.21 , $194.60 , $108.42 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $258.54 , $258.54 , $258.54 , $258.54 , $413.21 , $97.30 , $- , $- ," $1,236.00 ", $194.60
12041,501001080,Hospital Chargemaster,Intmd rpr n-hf/genit 2.5cm/<,Outpatient,Outpatient Default Percent / Case Rate,360, $216.00 , $118.80 ," $1,236.00 ", $413.21 , $151.20 , $84.24 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $216.00 , $216.00 , $216.00 , $216.00 , $413.21 , $75.60 , $- , $- ," $1,236.00 ", $151.20
11765,501001070,Hospital Chargemaster,Excision of nail fold toe,Outpatient,Outpatient Default Percent / Case Rate,360, $210.00 , $115.50 ," $1,236.00 ", $413.21 , $147.00 , $81.90 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $210.00 , $210.00 , $210.00 , $210.00 , $413.21 , $73.50 , $- , $- ," $1,236.00 ", $147.00
11300,501001039,Hospital Chargemaster,Shave skin lesion 0.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,360, $186.00 , $102.30 , $153.26 , $413.21 , $130.20 , $72.54 , $386.01 , $264.94 , $263.52 , $413.21 , $413.21 , $66.99 , $64.96 , $433.88 , $421.48 , $185.14 , $185.14 , $185.14 , $185.14 , $413.21 , $65.10 , $- , $- , $433.88 , $130.20
C5271,501001460,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,360, $830.00 , $894.31 ," $1,442.00 ", $626.13 , $581.00 , $323.70 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $556.93 , $556.93 , $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $290.50 , $- , $- ," $1,442.00 ", $581.00
C5275,501001464,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,360, $830.00 , $894.31 ," $1,442.00 ", $626.13 , $581.00 , $323.70 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $556.93 , $556.93 , $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $290.50 , $- , $- ," $1,442.00 ", $581.00
C5277,501001466,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,360, $960.00 , $894.31 ," $1,442.00 ", $626.13 , $672.00 , $374.40 , $926.30 , $930.34 , $837.43 , $626.13 , $626.13 , $644.16 , $644.16 , $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $336.00 , $- , $- ," $1,442.00 ", $672.00
11106,501001035,Hospital Chargemaster,Incal bx skn single les,Outpatient,Outpatient Default Percent / Case Rate,360, $628.00 , $345.40 ," $1,236.00 ", $626.13 , $439.60 , $244.92 , $687.09 , $471.59 , $469.08 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $219.80 , $- , $- ," $1,236.00 ", $439.60
11043,501001023,Hospital Chargemaster,Deb musc/fascia 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,360, $724.00 , $398.20 ," $1,442.00 ", $626.13 , $506.80 , $282.36 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $253.40 , $- , $- ," $1,442.00 ", $506.80
15852,501001091,Hospital Chargemaster,Dressing change not for burn,Outpatient,Outpatient Default Percent / Case Rate,360, $300.00 , $165.00 ," $1,236.00 ", $626.13 , $210.00 , $117.00 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $185.14 , $185.14 , $185.14 , $185.14 , $626.13 , $105.00 , $- , $- ," $1,236.00 ", $210.00
11000,501001020,Hospital Chargemaster,Debride infected skin,Outpatient,Outpatient Default Percent / Case Rate,360, $90.00 , $49.50 ," $1,236.00 ", $626.13 , $63.00 , $35.10 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $83.70 , $83.70 , $83.70 , $83.70 , $626.13 , $31.50 , $- , $- ," $1,236.00 ", $63.00
32555,501001185,Hospital Chargemaster,Aspirate pleura w/ imaging,Outpatient,Outpatient Default Percent / Case Rate,360," $1,142.00 ", $628.10 ," $1,236.00 ", $646.21 , $799.40 , $445.38 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $105.28 , $102.55 , $678.52 , $659.13 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $646.21 , $399.70 , $- , $- ," $1,356.36 ", $799.40
36589,501001234,Hospital Chargemaster,Removal tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 ", $797.50 ," $1,236.00 ", $646.21 ," $1,015.00 ", $565.50 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $844.48 , $822.61 , $678.52 , $659.13 , $740.30 , $740.30 , $740.30 , $740.30 , $646.21 , $507.50 , $- , $- ," $1,356.36 "," $1,015.00 "
36575,501001225,Hospital Chargemaster,Repair tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 ", $797.50 ," $1,442.00 ", $646.21 ," $1,015.00 ", $565.50 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 ," $1,133.44 "," $1,104.09 ", $678.52 , $659.13 , $740.30 , $740.30 , $740.30 , $740.30 , $646.21 , $507.50 , $- , $- ," $1,442.00 "," $1,015.00 "
32552,501001183,Hospital Chargemaster,Remove lung catheter,Outpatient,Outpatient Default Percent / Case Rate,360, $575.00 , $316.25 ," $1,236.00 ", $646.21 , $402.50 , $224.25 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $385.83 , $385.83 , $678.52 , $659.13 , $575.00 , $575.00 , $575.00 , $575.00 , $646.21 , $201.25 , $- , $- ," $1,356.36 ", $402.50
32554,501001184,Hospital Chargemaster,Aspirate pleura w/o imaging,Outpatient,Outpatient Default Percent / Case Rate,360, $110.00 , $60.50 ," $1,236.00 ", $646.21 , $77.00 , $42.90 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $105.28 , $102.55 , $678.52 , $659.13 , $110.00 , $110.00 , $110.00 , $110.00 , $646.21 , $38.50 , $- , $- ," $1,356.36 ", $77.00
33286,501001191,Hospital Chargemaster,Rmvl subq car rhythm mntr,Outpatient,Outpatient Default Percent / Case Rate,360," $1,800.00 ", $990.00 ," $1,236.00 ", $743.95 ," $1,260.00 ", $702.00 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $743.95 , $630.00 , $- , $- ," $1,267.38 "," $1,260.00 "
11600,501001054,Hospital Chargemaster,Exc tr-ext mal+marg 0.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,360," $1,142.00 ", $628.10 ," $1,236.00 ", $743.95 , $799.40 , $445.38 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $743.95 , $399.70 , $- , $- ," $1,267.38 ", $799.40
10005,501001003,Hospital Chargemaster,Fna bx w/us gdn 1st les,Outpatient,Outpatient Default Percent / Case Rate,360, $850.00 , $467.50 ," $1,236.00 ", $743.95 , $595.00 , $331.50 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $790.50 , $790.50 , $790.50 , $790.50 , $743.95 , $297.50 , $- , $- ," $1,267.38 ", $595.00
11621,501001058,Hospital Chargemaster,Exc s/n/h/f/g mal+mrg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,360, $817.00 , $449.35 ," $1,236.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,267.38 ", $571.90
11440,501001051,Hospital Chargemaster,Exc face-mm b9+marg 0.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,360, $817.00 , $449.35 ," $1,442.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,442.00 ", $571.90
11640,501001060,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 0.5cm<,Outpatient,Outpatient Default Percent / Case Rate,360, $817.00 , $449.35 ," $1,442.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,442.00 ", $571.90
11642,501001062,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,360, $817.00 , $449.35 ," $1,442.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,442.00 ", $571.90
11402,501001044,Hospital Chargemaster,Exc tr-ext b9+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,360, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11403,501001045,Hospital Chargemaster,Exc tr-ext b9+marg 2.1-3cm,Outpatient,Outpatient Default Percent / Case Rate,360, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11442,501001053,Hospital Chargemaster,Exc face-mm b9+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,360, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11601,501001055,Hospital Chargemaster,Exc tr-ext mal+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,360, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11622,501001059,Hospital Chargemaster,Exc s/n/h/f/g mal+mrg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,360, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11421,501001048,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,360, $630.00 , $346.50 ," $1,442.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,442.00 ", $441.00
11441,501001052,Hospital Chargemaster,Exc face-mm b9+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,360, $630.00 , $346.50 ," $1,442.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,442.00 ", $441.00
19000,501001103,Hospital Chargemaster,Drainage of breast lesion,Outpatient,Outpatient Default Percent / Case Rate,360, $590.00 , $324.50 ," $1,236.00 ", $743.95 , $413.00 , $230.10 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $590.00 , $590.00 , $590.00 , $590.00 , $743.95 , $206.50 , $- , $- ," $1,267.38 ", $413.00
11641,501001061,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,360, $558.00 , $306.90 ," $1,442.00 ", $743.95 , $390.60 , $217.62 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $558.00 , $558.00 , $558.00 , $558.00 , $743.95 , $195.30 , $- , $- ," $1,442.00 ", $390.60
10030,501001011,Hospital Chargemaster,Guide cathet fluid drainage,Outpatient,Outpatient Default Percent / Case Rate,360, $470.00 , $258.50 ," $1,442.00 ", $743.95 , $329.00 , $183.30 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $437.10 , $437.10 , $437.10 , $437.10 , $743.95 , $164.50 , $- , $- ," $1,442.00 ", $329.00
19281,501001113,Hospital Chargemaster,Perq device breast 1st imag,Outpatient,Outpatient Default Percent / Case Rate,360, $352.00 , $193.60 ," $1,442.00 ", $743.95 , $246.40 , $137.28 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $236.19 , $236.19 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $123.20 , $- , $- ," $1,442.00 ", $246.40
19283,501001115,Hospital Chargemaster,Perq dev breast 1st strtctc,Outpatient,Outpatient Default Percent / Case Rate,360, $352.00 , $193.60 ," $1,442.00 ", $743.95 , $246.40 , $137.28 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $236.19 , $236.19 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $123.20 , $- , $- ," $1,442.00 ", $246.40
19285,501001117,Hospital Chargemaster,Perq dev breast 1st us imag,Outpatient,Outpatient Default Percent / Case Rate,360, $352.00 , $193.60 ," $1,442.00 ", $743.95 , $246.40 , $137.28 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $236.19 , $236.19 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $123.20 , $- , $- ," $1,442.00 ", $246.40
11400,501001042,Hospital Chargemaster,Exc tr-ext b9+marg 0.5 cm<,Outpatient,Outpatient Default Percent / Case Rate,360, $234.00 , $128.70 ," $1,236.00 ", $743.95 , $163.80 , $91.26 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $234.00 , $234.00 , $234.00 , $234.00 , $743.95 , $81.90 , $- , $- ," $1,267.38 ", $163.80
G0260,501001468,Hospital Chargemaster,Inj for sacroiliac jt anesth,Outpatient,Outpatient Default Percent / Case Rate,360," $1,650.00 "," $1,109.00 "," $1,236.00 ", $759.14 ," $1,155.00 ", $643.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 ," $1,107.15 "," $1,107.15 ", $797.10 , $774.33 , $978.40 , $978.40 ," $1,003.60 "," $1,003.60 ", $759.14 , $577.50 , $- , $- ," $1,309.97 "," $1,155.00 "
36580,501001228,Hospital Chargemaster,Replace cvad cath,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 ", $797.50 ," $1,236.00 "," $1,681.14 "," $1,015.00 ", $565.50 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,681.14 ", $507.50 , $- , $- ," $2,392.46 "," $1,015.00 "
36597,501001238,Hospital Chargemaster,Reposition venous catheter,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 ", $797.50 ," $1,236.00 "," $1,681.14 "," $1,015.00 ", $565.50 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $105.28 , $102.55 ," $1,765.20 "," $1,714.76 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,681.14 ", $507.50 , $- , $- ," $2,392.46 "," $1,015.00 "
36584,501001232,Hospital Chargemaster,Compl rplcmt picc rs&i,Outpatient,Outpatient Default Percent / Case Rate,360," $1,400.00 ", $770.00 ," $1,236.00 "," $1,681.14 ", $980.00 , $546.00 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,681.14 ", $490.00 , $- , $- ," $2,392.46 ", $980.00
36576,501001226,Hospital Chargemaster,Repair tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 ", $797.50 ," $1,442.00 "," $1,681.14 "," $1,015.00 ", $565.50 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 "," $1,133.44 "," $1,104.09 "," $1,765.20 "," $1,714.76 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,681.14 ", $507.50 , $- , $- ," $2,392.46 "," $1,015.00 "
36590,501001235,Hospital Chargemaster,Removal tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,360," $1,142.00 ", $628.10 ," $1,236.00 "," $1,681.14 ", $799.40 , $445.38 ," $1,356.36 ", $930.94 , $925.98 ," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,681.14 ", $399.70 , $- , $- ," $1,765.20 ", $799.40
32551,501001182,Hospital Chargemaster,Insertion of chest tube,Outpatient,Outpatient Default Percent / Case Rate,360, $528.00 , $290.40 ," $1,442.00 "," $1,681.14 ", $369.60 , $205.92 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 ", $528.00 , $528.00 , $528.00 , $528.00 ," $1,681.14 ", $184.80 , $- , $- ," $2,392.46 ", $369.60
36569,501001222,Hospital Chargemaster,Insj picc 5 yr+ w/o imaging,Outpatient,Outpatient Default Percent / Case Rate,360," $2,540.00 "," $1,397.00 "," $1,236.00 "," $1,681.14 "," $1,778.00 ", $990.60 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $1,681.14 ", $889.00 , $- , $- ," $2,540.00 "," $1,778.00 "
11423,501001050,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 2.1-3,Outpatient,Outpatient Default Percent / Case Rate,360," $1,483.00 ", $815.65 ," $1,236.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
11406,501001046,Hospital Chargemaster,Exc tr-ext b9+marg >4.0 cm,Outpatient,Outpatient Default Percent / Case Rate,360," $1,483.00 ", $815.65 ," $1,442.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
23065,501001150,Hospital Chargemaster,Biopsy shoulder tissues,Outpatient,Outpatient Default Percent / Case Rate,360," $2,500.00 "," $1,375.00 "," $1,236.00 "," $1,682.11 "," $1,750.00 ", $975.00 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $875.00 , $- , $- ," $3,009.07 "," $1,750.00 "
19081,501001106,Hospital Chargemaster,Bx breast 1st lesion strtctc,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 ", $797.50 ," $1,442.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
11620,501001057,Hospital Chargemaster,Exc h-f-nk-sp mal+marg 0.5/<,Outpatient,Outpatient Default Percent / Case Rate,360," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
20206,501001123,Hospital Chargemaster,Needle biopsy muscle,Outpatient,Outpatient Default Percent / Case Rate,360," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
20220,501001124,Hospital Chargemaster,Bone biopsy trocar/needle,Outpatient,Outpatient Default Percent / Case Rate,360," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
11044,501001024,Hospital Chargemaster,Deb bone 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,360," $1,004.00 ", $552.20 ," $1,442.00 "," $1,682.11 ", $702.80 , $391.56 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,004.00 "," $1,004.00 "," $1,004.00 "," $1,004.00 "," $1,682.11 ", $351.40 , $- , $- ," $3,009.07 ", $702.80
20520,501001127,Hospital Chargemaster,Removal of foreign body,Outpatient,Outpatient Default Percent / Case Rate,360," $1,483.00 ", $815.65 ," $1,442.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $740.30 , $740.30 , $740.30 , $740.30 ," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
23931,501001152,Hospital Chargemaster,Drainage of arm bursa,Outpatient,Outpatient Default Percent / Case Rate,360, $505.00 , $277.75 ," $1,442.00 "," $1,682.11 ", $353.50 , $196.95 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $505.00 , $505.00 , $505.00 , $505.00 ," $1,682.11 ", $176.75 , $- , $- ," $3,009.07 ", $353.50
11422,501001049,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,360, $400.00 , $220.00 ," $1,236.00 "," $1,682.11 ", $280.00 , $156.00 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $400.00 , $400.00 , $400.00 , $400.00 ," $1,682.11 ", $140.00 , $- , $- ," $3,009.07 ", $280.00
10140,501001018,Hospital Chargemaster,Drainage of hematoma/fluid,Outpatient,Outpatient Default Percent / Case Rate,360, $356.00 , $195.80 ," $1,236.00 "," $1,682.11 ", $249.20 , $138.84 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $331.08 , $331.08 , $331.08 , $331.08 ," $1,682.11 ", $124.60 , $- , $- ," $3,009.07 ", $249.20
11420,501001047,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 0.5/<,Outpatient,Outpatient Default Percent / Case Rate,360, $290.00 , $159.50 ," $1,442.00 "," $1,682.11 ", $203.00 , $113.10 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $290.00 , $290.00 , $290.00 , $290.00 ," $1,682.11 ", $101.50 , $- , $- ," $3,009.07 ", $203.00
20225,501001125,Hospital Chargemaster,Bone biopsy trocar/needle,Outpatient,Outpatient Default Percent / Case Rate,360, $260.00 , $143.00 ," $1,442.00 "," $1,682.11 ", $182.00 , $101.40 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $260.00 , $260.00 , $260.00 , $260.00 ," $1,682.11 ", $91.00 , $- , $- ," $3,009.07 ", $182.00
31625,501001177,Hospital Chargemaster,Bronchoscopy w/biopsy(s),Outpatient,Outpatient Default Percent / Case Rate,360," $2,540.00 "," $1,397.00 "," $1,442.00 "," $1,788.65 "," $1,778.00 ", $990.60 ," $2,995.49 "," $2,055.97 "," $2,045.01 "," $1,788.65 "," $1,788.65 ", $844.48 , $822.61 ," $1,878.08 "," $1,824.42 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $1,788.65 ", $889.00 , $- , $- ," $2,995.49 "," $1,778.00 "
31622,501001176,Hospital Chargemaster,Dx bronchoscope/wash,Outpatient,Outpatient Default Percent / Case Rate,360," $2,305.00 "," $1,267.75 "," $1,442.00 "," $1,788.65 "," $1,613.50 ", $898.95 ," $2,995.49 "," $2,055.97 "," $2,045.01 "," $1,788.65 "," $1,788.65 ", $844.48 , $822.61 ," $1,878.08 "," $1,824.42 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,788.65 ", $806.75 , $- , $- ," $2,995.49 "," $1,613.50 "
C5273,501001462,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,360," $3,100.00 "," $2,868.67 "," $1,442.00 "," $2,047.65 "," $2,170.00 "," $1,209.00 "," $2,991.19 "," $3,004.21 "," $2,686.23 "," $2,047.65 "," $2,047.65 "," $2,080.10 "," $2,080.10 "," $2,150.03 "," $2,088.60 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,047.65 "," $1,085.00 ", $- , $- ," $3,004.21 "," $2,170.00 "
15271,501001082,Hospital Chargemaster,Skin sub graft trnk/arm/leg,Outpatient,Outpatient Default Percent / Case Rate,360," $2,265.00 "," $1,245.75 "," $1,442.00 "," $2,047.65 "," $1,585.50 ", $883.35 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $792.75 , $- , $- ," $3,388.54 "," $1,585.50 "
15275,501001086,Hospital Chargemaster,Skin sub graft face/nk/hf/g,Outpatient,Outpatient Default Percent / Case Rate,360," $2,265.00 "," $1,245.75 "," $1,442.00 "," $2,047.65 "," $1,585.50 ", $883.35 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $792.75 , $- , $- ," $3,388.54 "," $1,585.50 "
15277,501001088,Hospital Chargemaster,Skn sub grft f/n/hf/g child,Outpatient,Outpatient Default Percent / Case Rate,360," $2,265.00 "," $1,245.75 "," $1,442.00 "," $2,047.65 "," $1,585.50 ", $883.35 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 ", $740.30 , $740.30 , $740.30 , $740.30 ," $2,047.65 ", $792.75 , $- , $- ," $3,388.54 "," $1,585.50 "
64590,501001431,Hospital Chargemaster,Insrt/redo pn/gastr stimul,Outpatient,Outpatient Default Percent / Case Rate,360," $6,800.00 "," $22,519.67 "," $1,442.00 "," $24,479.81 "," $4,760.00 "," $2,652.00 "," $40,924.25 "," $28,088.63 "," $27,938.88 "," $24,479.81 "," $24,479.81 "," $1,133.44 "," $1,104.09 "," $25,703.80 "," $24,969.41 "," $6,800.00 "," $6,800.00 "," $6,800.00 "," $6,800.00 "," $24,479.81 "," $2,380.00 ", $- , $- ," $40,924.25 "," $4,760.00 "
21554,501001142,Hospital Chargemaster,Exc neck tum deep 5 cm/>,Outpatient,Outpatient Default Percent / Case Rate,360," $3,285.00 "," $1,806.75 "," $2,060.00 "," $2,834.62 "," $2,299.50 "," $1,281.15 "," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,294.72 "," $1,261.20 "," $2,976.35 "," $2,891.31 "," $3,285.00 "," $3,285.00 "," $3,285.00 "," $3,285.00 "," $2,834.62 "," $1,149.75 ", $- , $- ," $5,202.81 "," $2,299.50 "
21556,501001143,Hospital Chargemaster,Exc neck tum deep < 5 cm,Outpatient,Outpatient Default Percent / Case Rate,360," $3,285.00 "," $1,806.75 "," $1,442.00 "," $2,834.62 "," $2,299.50 "," $1,281.15 "," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,133.44 "," $1,104.09 "," $2,976.35 "," $2,891.31 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,834.62 "," $1,149.75 ", $- , $- ," $5,202.81 "," $2,299.50 "
20525,501001128,Hospital Chargemaster,Removal of foreign body,Outpatient,Outpatient Default Percent / Case Rate,360," $1,915.00 "," $1,053.25 "," $2,060.00 "," $2,834.62 "," $1,340.50 ", $746.85 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,294.72 "," $1,261.20 "," $2,976.35 "," $2,891.31 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $2,834.62 ", $670.25 , $- , $- ," $5,202.81 "," $1,340.50 "
36561,501001218,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,360," $3,208.00 "," $1,764.40 "," $2,060.00 "," $3,422.34 "," $2,245.60 "," $1,251.12 "," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $3,422.34 "," $1,122.80 ", $- , $- ," $5,778.66 "," $2,245.60 "
36578,501001227,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,360," $2,629.00 "," $1,445.95 "," $1,442.00 "," $3,422.34 "," $1,840.30 "," $1,025.31 "," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,133.44 "," $1,104.09 "," $3,593.46 "," $3,490.79 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $3,422.34 ", $920.15 , $- , $- ," $5,778.66 "," $1,840.30 "
36565,501001220,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,360," $2,629.00 "," $1,445.95 "," $2,060.00 "," $3,422.34 "," $1,840.30 "," $1,025.31 "," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $3,422.34 ", $920.15 , $- , $- ," $5,778.66 "," $1,840.30 "
36582,501001230,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,360," $2,540.00 "," $1,397.00 "," $2,060.00 "," $3,422.34 "," $1,778.00 ", $990.60 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $3,422.34 ", $889.00 , $- , $- ," $5,778.66 "," $1,778.00 "
36581,501001229,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,360," $1,400.00 ", $770.00 ," $1,442.00 "," $3,422.34 ", $980.00 , $546.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,133.44 "," $1,104.09 "," $3,593.46 "," $3,490.79 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $3,422.34 ", $490.00 , $- , $- ," $5,778.66 ", $980.00
36571,501001223,Hospital Chargemaster,Insert picvad cath,Outpatient,Outpatient Default Percent / Case Rate,360," $1,400.00 ", $770.00 ," $2,060.00 "," $3,422.34 ", $980.00 , $546.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $3,422.34 ", $490.00 , $- , $- ," $5,778.66 ", $980.00
36585,501001233,Hospital Chargemaster,Replace picvad cath,Outpatient,Outpatient Default Percent / Case Rate,360," $1,400.00 ", $770.00 ," $2,060.00 "," $3,422.34 ", $980.00 , $546.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $3,422.34 ", $490.00 , $- , $- ," $5,778.66 ", $980.00
36558,501001217,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,360, $887.00 , $487.85 ," $1,442.00 "," $3,422.34 ", $620.90 , $345.93 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $887.00 , $887.00 , $887.00 , $887.00 ," $3,422.34 ", $310.45 , $- , $- ," $5,778.66 ", $620.90
36555,501001215,Hospital Chargemaster,Insert non-tunnel cv cath,Outpatient,Outpatient Default Percent / Case Rate,360, $378.00 , $207.90 ," $1,236.00 "," $3,422.34 ", $264.60 , $147.42 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $378.00 , $378.00 , $378.00 , $378.00 ," $3,422.34 ", $132.30 , $- , $- ," $3,593.46 ", $264.60
36556,501001216,Hospital Chargemaster,Insert non-tunnel cv cath,Outpatient,Outpatient Default Percent / Case Rate,360, $368.00 , $202.40 ," $1,236.00 "," $3,422.34 ", $257.60 , $143.52 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $368.00 , $368.00 , $368.00 , $368.00 ," $3,422.34 ", $128.80 , $- , $- ," $3,593.46 ", $257.60
31628,501001178,Hospital Chargemaster,Bronchoscopy/lung bx each,Outpatient,Outpatient Default Percent / Case Rate,360, $725.00 , $398.75 ," $1,442.00 "," $3,703.22 ", $507.50 , $282.75 ," $5,995.53 "," $4,115.07 "," $4,093.13 "," $3,703.22 "," $3,703.22 "," $1,133.44 "," $1,104.09 "," $3,888.38 "," $3,777.29 ", $725.00 , $725.00 , $725.00 , $725.00 ," $3,703.22 ", $253.75 , $- , $- ," $5,995.53 ", $507.50
19101,501001112,Hospital Chargemaster,Biopsy of breast open,Outpatient,Outpatient Default Percent / Case Rate,360," $1,162.00 ", $639.10 ," $1,442.00 "," $3,775.12 ", $813.40 , $453.18 ," $6,160.38 "," $4,228.21 "," $4,205.67 "," $3,775.12 "," $3,775.12 "," $1,133.44 "," $1,104.09 "," $3,963.88 "," $3,850.62 "," $1,162.00 "," $1,162.00 "," $1,162.00 "," $1,162.00 "," $3,775.12 ", $406.70 , $- , $- ," $6,160.38 ", $813.40
32550,501001181,Hospital Chargemaster,Insert pleural cath,Outpatient,Outpatient Default Percent / Case Rate,360," $3,500.00 "," $1,925.00 "," $1,442.00 "," $3,803.62 "," $2,450.00 "," $1,365.00 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 "," $2,495.36 "," $2,430.75 "," $3,993.81 "," $3,879.70 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $3,803.62 "," $1,225.00 ", $- , $- ," $6,447.63 "," $2,450.00 "
15273,501001084,Hospital Chargemaster,Skin sub grft t/arm/lg child,Outpatient,Outpatient Default Percent / Case Rate,360," $3,734.00 "," $2,053.70 "," $1,442.00 "," $4,209.66 "," $2,613.80 "," $1,456.26 "," $6,051.26 "," $4,153.32 "," $4,131.18 "," $4,209.66 "," $4,209.66 ", $844.48 , $822.61 ," $4,420.15 "," $4,293.86 ", $740.30 , $740.30 , $740.30 , $740.30 ," $4,209.66 "," $1,306.90 ", $- , $- ," $6,051.26 "," $2,613.80 "
36583,501001231,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,360," $2,540.00 "," $1,397.00 "," $2,060.00 "," $5,701.02 "," $1,778.00 ", $990.60 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 "," $1,294.72 "," $1,261.20 "," $5,986.07 "," $5,815.04 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $5,701.02 ", $889.00 , $- , $- ," $9,574.18 "," $1,778.00 "
36566,501001221,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,360," $1,915.00 "," $1,053.25 "," $2,060.00 "," $5,701.02 "," $1,340.50 ", $746.85 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 "," $1,294.72 "," $1,261.20 "," $5,986.07 "," $5,815.04 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $5,701.02 ", $670.25 , $- , $- ," $9,574.18 "," $1,340.50 "
36563,501001219,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,360," $1,125.00 ", $618.75 ," $2,060.00 "," $5,701.02 ", $787.50 , $438.75 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 "," $1,294.72 "," $1,261.20 "," $5,986.07 "," $5,815.04 "," $1,125.00 "," $1,125.00 "," $1,125.00 "," $1,125.00 "," $5,701.02 ", $393.75 , $- , $- ," $9,574.18 ", $787.50
15830,501001090,Hospital Chargemaster,Exc skin abd,Outpatient,Outpatient Default Percent / Case Rate,360," $1,023.00 ", $562.65 ," $2,060.00 "," $6,616.24 ", $716.10 , $398.97 ," $10,752.63 "," $7,380.14 "," $7,340.79 "," $6,616.24 "," $6,616.24 "," $1,294.72 "," $1,261.20 "," $6,947.05 "," $6,748.56 "," $1,023.00 "," $1,023.00 "," $1,023.00 "," $1,023.00 "," $6,616.24 ", $358.05 , $- , $- ," $10,752.63 ", $716.10
33285,501001190,Hospital Chargemaster,Insj subq car rhythm mntr,Outpatient,Outpatient Default Percent / Case Rate,360," $1,800.00 ", $990.00 ," $1,236.00 "," $9,753.71 "," $1,260.00 ", $702.00 ," $16,197.41 "," $11,117.20 "," $11,057.93 "," $9,753.71 "," $9,753.71 ", $105.28 , $102.55 ," $10,241.39 "," $9,948.78 "," $1,800.00 "," $1,800.00 "," $1,800.00 "," $1,800.00 "," $9,753.71 ", $630.00 , $- , $- ," $16,197.41 "," $1,260.00 "
64402,501001400,Hospital Chargemaster,N block inj facial,Outpatient,Outpatient Default Percent / Case Rate,360, $219.00 , $120.45 ," $2,542.04 ", See APC Packaged Rates , $153.30 , $85.41 , $211.31 , $212.23 , $112.79 , See APC Packaged Rates , See APC Packaged Rates , $146.95 , $146.95 , See APC Packaged Rates , See APC Packaged Rates , $203.67 , $203.67 , $203.67 , $203.67 , See APC Packaged Rates , $76.65 , Not Applicable , $76.65 ," $2,542.04 ", $153.30
64413,501001402,Hospital Chargemaster,N block inj cervical plexus,Outpatient,Outpatient Default Percent / Case Rate,360, $900.00 , $495.00 ," $2,542.04 ", See APC Packaged Rates , $630.00 , $351.00 , $868.41 , $872.19 , $463.52 , See APC Packaged Rates , See APC Packaged Rates , $603.90 , $603.90 , See APC Packaged Rates , See APC Packaged Rates , $837.00 , $837.00 , $837.00 , $837.00 , See APC Packaged Rates , $315.00 , Not Applicable , $315.00 ," $2,542.04 ", $630.00
64517,501001424,Hospital Chargemaster,N block inj hypogas plxs,Outpatient,Outpatient Default Percent / Case Rate,360," $3,000.00 "," $1,416.48 "," $1,442.00 ", $984.14 ," $2,100.00 "," $1,170.00 "," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $290.53 , $281.72 ," $1,033.35 "," $1,003.82 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 ", $984.14 ," $1,050.00 ", $- , $- ," $2,806.32 "," $2,100.00 "
64680,501001449,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,360," $3,000.00 "," $1,416.48 "," $1,442.00 ", $984.14 ," $2,100.00 "," $1,170.00 "," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 ," $1,133.44 "," $1,104.09 "," $1,033.35 "," $1,003.82 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 ", $984.14 ," $1,050.00 ", $- , $- ," $2,806.32 "," $2,100.00 "
49405,501001319,Hospital Chargemaster,Image cath fluid colxn visc,Outpatient,Outpatient Default Percent / Case Rate,360," $3,617.00 "," $1,989.35 "," $1,442.00 "," $1,682.11 "," $2,531.90 "," $1,410.63 "," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,294.72 "," $1,261.20 "," $1,766.22 "," $1,715.75 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $1,682.11 "," $1,265.95 ", $- , $- ," $3,009.07 "," $2,531.90 "
49406,501001320,Hospital Chargemaster,Image cath fluid peri/retro,Outpatient,Outpatient Default Percent / Case Rate,360," $3,617.00 "," $1,989.35 "," $1,442.00 "," $1,682.11 "," $2,531.90 "," $1,410.63 "," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,294.72 "," $1,261.20 "," $1,766.22 "," $1,715.75 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $1,682.11 "," $1,265.95 ", $- , $- ," $3,009.07 "," $2,531.90 "
62320,501001384,Hospital Chargemaster,Njx interlaminar crv/thrc,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 "," $1,109.00 "," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $844.48 , $822.61 , $797.10 , $774.33 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
62322,501001386,Hospital Chargemaster,Njx interlaminar lmbr/sac,Outpatient,Outpatient Default Percent / Case Rate,360," $1,958.00 "," $1,109.00 "," $1,236.00 ", $759.14 ," $1,370.60 ", $763.62 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $844.48 , $822.61 , $797.10 , $774.33 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $759.14 , $685.30 , $- , $- ," $1,370.60 "," $1,370.60 "
64479,501001411,Hospital Chargemaster,Inj foramen epidural c/t,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 "," $1,416.48 "," $1,236.00 ", $984.14 ," $1,015.00 ", $565.50 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $303.73 , $294.52 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $507.50 , $- , $- ," $1,673.19 "," $1,015.00 "
64483,501001413,Hospital Chargemaster,Inj foramen epidural l/s,Outpatient,Outpatient Default Percent / Case Rate,360," $1,200.00 "," $1,416.48 "," $1,236.00 ", $984.14 , $840.00 , $468.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $264.05 , $256.03 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $420.00 , $- , $- ," $1,673.19 ", $840.00
64510,501001423,Hospital Chargemaster,N block stellate ganglion,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 "," $1,416.48 "," $1,236.00 ", $984.14 ," $1,015.00 ", $565.50 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $165.63 , $160.60 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $507.50 , $- , $- ," $1,673.19 "," $1,015.00 "
64600,501001432,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,360," $2,000.00 "," $1,416.48 "," $1,236.00 ", $984.14 ," $1,400.00 ", $780.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $844.48 , $822.61 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $700.00 , $- , $- ," $1,673.19 "," $1,400.00 "
64620,501001437,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,360," $2,000.00 "," $1,416.48 "," $1,236.00 ", $984.14 ," $1,400.00 ", $780.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $844.48 , $822.61 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $700.00 , $- , $- ," $1,673.19 "," $1,400.00 "
40819,501001293,Hospital Chargemaster,Excise lip or cheek fold,Outpatient,Outpatient Default Percent / Case Rate,360," $1,250.00 ", $687.50 ," $1,236.00 "," $1,617.20 ", $875.00 , $487.50 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 ", $844.48 , $822.61 ," $1,698.06 "," $1,649.55 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,617.20 ", $437.50 , $- , $- ," $2,798.18 ", $875.00
38505,501001291,Hospital Chargemaster,Needle biopsy lymph nodes,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 ", $797.50 ," $1,236.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
47000,501001301,Hospital Chargemaster,Needle biopsy of liver,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 ", $797.50 ," $1,236.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
56501,501001359,Hospital Chargemaster,Destroy vulva lesions sim,Outpatient,Outpatient Default Percent / Case Rate,360," $1,725.00 "," $2,868.67 "," $1,236.00 "," $2,047.65 "," $1,207.50 ", $672.75 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $105.28 , $102.55 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $603.75 , $- , $- ," $3,388.54 "," $1,207.50 "
64610,501001433,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,360," $3,000.00 "," $2,719.35 "," $1,236.00 "," $2,099.21 "," $2,100.00 "," $1,170.00 "," $3,569.06 "," $2,449.65 "," $2,436.59 "," $2,099.21 "," $2,099.21 ", $844.48 , $822.61 ," $2,204.17 "," $2,141.20 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,099.21 "," $1,050.00 ", $- , $- ," $3,569.06 "," $2,100.00 "
50434,501001338,Hospital Chargemaster,Convert nephrostomy catheter,Outpatient,Outpatient Default Percent / Case Rate,360," $1,284.00 ", $706.20 ," $1,236.00 "," $2,140.58 ", $898.80 , $500.76 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $105.28 , $102.55 ," $2,247.61 "," $2,183.39 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,140.58 ", $449.40 , $- , $- ," $3,805.91 ", $898.80
49422,501001323,Hospital Chargemaster,Remove tunneled ip cath,Outpatient,Outpatient Default Percent / Case Rate,360," $1,800.00 ", $990.00 ," $1,236.00 "," $3,422.34 "," $1,260.00 ", $702.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,422.34 ", $630.00 , $- , $- ," $5,778.66 "," $1,260.00 "
64585,501001430,Hospital Chargemaster,Revise/remove neuroelectrode,Outpatient,Outpatient Default Percent / Case Rate,360," $3,000.00 "," $5,333.39 "," $1,236.00 "," $3,916.44 "," $2,100.00 "," $1,170.00 "," $6,299.93 "," $4,324.00 "," $4,300.95 "," $3,916.44 "," $3,916.44 ", $844.48 , $822.61 ," $4,112.27 "," $3,994.77 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,916.44 "," $1,050.00 ", $- , $- ," $6,299.93 "," $2,100.00 "
64555,501001427,Hospital Chargemaster,Implant neuroelectrodes,Outpatient,Outpatient Default Percent / Case Rate,360," $6,800.00 "," $9,966.69 "," $1,236.00 "," $7,369.33 "," $4,760.00 "," $2,652.00 "," $13,080.96 "," $8,978.20 "," $8,930.34 "," $7,369.33 "," $7,369.33 "," $4,562.80 "," $4,562.80 "," $7,737.79 "," $7,516.71 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $7,369.33 "," $2,380.00 ", $- , $- ," $13,080.96 "," $4,760.00 "
64575,501001429,Hospital Chargemaster,Implant neuroelectrodes,Outpatient,Outpatient Default Percent / Case Rate,360," $6,800.00 "," $22,519.67 "," $1,236.00 "," $13,442.21 "," $4,760.00 "," $2,652.00 "," $40,924.25 "," $28,088.63 "," $27,938.88 "," $13,442.21 "," $13,442.21 ", $844.48 , $822.61 ," $14,114.33 "," $13,711.06 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $13,442.21 "," $2,380.00 ", $- , $- ," $40,924.25 "," $4,760.00 "
50432,501001336,Hospital Chargemaster,Plmt nephrostomy catheter,Outpatient,Outpatient Default Percent / Case Rate,360," $3,688.00 "," $2,028.40 "," $1,442.00 "," $2,140.58 "," $2,581.60 "," $1,438.32 "," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $105.28 , $102.55 ," $2,247.61 "," $2,183.39 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,140.58 "," $1,290.80 ", $- , $- ," $3,805.91 "," $2,581.60 "
50433,501001337,Hospital Chargemaster,Plmt nephroureteral catheter,Outpatient,Outpatient Default Percent / Case Rate,360," $3,688.00 "," $2,028.40 "," $1,442.00 "," $3,675.67 "," $2,581.60 "," $1,438.32 "," $3,805.91 "," $2,612.21 "," $2,598.29 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,290.80 ", $- , $- ," $3,859.45 "," $2,581.60 "
55700,501001357,Hospital Chargemaster,Biopsy of prostate,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 ", $797.50 ," $1,442.00 "," $2,140.58 "," $1,015.00 ", $565.50 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 "," $1,133.44 "," $1,104.09 "," $2,247.61 "," $2,183.39 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,140.58 ", $507.50 , $- , $- ," $3,805.91 "," $1,015.00 "
47533,501001307,Hospital Chargemaster,Plmt biliary drainage cath,Outpatient,Outpatient Default Percent / Case Rate,360," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $844.48 , $822.61 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
47534,501001308,Hospital Chargemaster,Plmt biliary drainage cath,Outpatient,Outpatient Default Percent / Case Rate,360," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $844.48 , $822.61 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
47535,501001309,Hospital Chargemaster,Conversion ext bil drg cath,Outpatient,Outpatient Default Percent / Case Rate,360," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $844.48 , $822.61 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
47536,501001310,Hospital Chargemaster,Exchange biliary drg cath,Outpatient,Outpatient Default Percent / Case Rate,360," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
49418,501001322,Hospital Chargemaster,Insert tun ip cath perc,Outpatient,Outpatient Default Percent / Case Rate,360," $2,860.00 "," $1,573.00 "," $1,442.00 "," $3,803.62 "," $2,002.00 "," $1,115.40 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,001.00 ", $- , $- ," $6,447.63 "," $2,002.00 "
49407,501001321,Hospital Chargemaster,Image cath fluid trns/vgnl,Outpatient,Outpatient Default Percent / Case Rate,360," $2,240.00 "," $1,232.00 "," $2,060.00 "," $1,682.11 "," $1,568.00 ", $873.60 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,294.72 "," $1,261.20 "," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $784.00 , $- , $- ," $3,009.07 "," $1,568.00 "
50693,501001342,Hospital Chargemaster,Plmt ureteral stent prq,Outpatient,Outpatient Default Percent / Case Rate,360," $5,492.00 "," $3,020.60 "," $2,060.00 "," $3,675.67 "," $3,844.40 "," $2,141.88 "," $3,805.91 "," $2,612.21 "," $2,598.29 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,922.20 ", $- , $- ," $3,859.45 "," $3,844.40 "
50694,501001343,Hospital Chargemaster,Plmt ureteral stent prq,Outpatient,Outpatient Default Percent / Case Rate,360," $5,492.00 "," $3,020.60 "," $2,060.00 "," $3,675.67 "," $3,844.40 "," $2,141.88 "," $6,402.87 "," $4,394.65 "," $4,371.22 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,922.20 ", $- , $- ," $6,402.87 "," $3,844.40 "
50695,501001344,Hospital Chargemaster,Plmt ureteral stent prq,Outpatient,Outpatient Default Percent / Case Rate,360," $5,492.00 "," $3,020.60 "," $2,060.00 "," $3,675.67 "," $3,844.40 "," $2,141.88 "," $6,402.87 "," $4,394.65 "," $4,371.22 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,922.20 ", $- , $- ," $6,402.87 "," $3,844.40 "
46040,501001298,Hospital Chargemaster,Incision of rectal abscess,Outpatient,Outpatient Default Percent / Case Rate,360," $1,185.00 ", $651.75 ," $2,060.00 "," $1,239.71 ", $829.50 , $462.15 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,294.72 "," $1,261.20 "," $1,301.70 "," $1,264.51 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,239.71 ", $414.75 , $- , $- ," $2,143.42 ", $829.50
50389,501001333,Hospital Chargemaster,Remove renal tube w/fluoro,Outpatient,Outpatient Default Percent / Case Rate,360," $1,150.00 ", $632.50 ," $1,236.00 ", $687.79 , $805.00 , $448.50 ," $1,229.98 ", $844.21 , $839.71 , $687.79 , $687.79 , $844.48 , $822.61 , $722.18 , $701.54 ," $1,150.00 "," $1,150.00 "," $1,150.00 "," $1,150.00 ", $687.79 , $402.50 , $- , $- ," $1,236.00 ", $805.00
62281,501001375,Hospital Chargemaster,Treat spinal cord lesion,Outpatient,Outpatient Default Percent / Case Rate,360," $1,142.00 "," $1,416.48 "," $1,236.00 ", $984.14 , $799.40 , $445.38 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $844.48 , $822.61 ," $1,033.35 "," $1,003.82 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $984.14 , $399.70 , $- , $- ," $1,673.19 ", $799.40
41115,501001294,Hospital Chargemaster,Excision of tongue fold,Outpatient,Outpatient Default Percent / Case Rate,360," $1,142.00 ", $628.10 ," $1,236.00 "," $1,617.20 ", $799.40 , $445.38 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 ", $844.48 , $822.61 ," $1,698.06 "," $1,649.55 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,617.20 ", $399.70 , $- , $- ," $2,798.18 ", $799.40
48102,501001313,Hospital Chargemaster,Needle biopsy pancreas,Outpatient,Outpatient Default Percent / Case Rate,360," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
49180,501001317,Hospital Chargemaster,Biopsy abdominal mass,Outpatient,Outpatient Default Percent / Case Rate,360," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
50200,501001331,Hospital Chargemaster,Renal biopsy perq,Outpatient,Outpatient Default Percent / Case Rate,360," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
54150,501001355,Hospital Chargemaster,Circumcision w/regionl block,Outpatient,Outpatient Default Percent / Case Rate,360," $1,142.00 ", $628.10 ," $1,236.00 "," $2,140.58 ", $799.40 , $445.38 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $844.48 , $822.61 ," $2,247.61 "," $2,183.39 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $2,140.58 ", $399.70 , $- , $- ," $3,805.91 ", $799.40
32405,501001180,Hospital Chargemaster,Percut bx lung/mediastinum,Outpatient,Outpatient Default Percent / Case Rate,360," $1,142.00 ", $628.10 ," $2,542.04 ", See APC Packaged Rates , $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 ", See APC Packaged Rates , See APC Packaged Rates , $766.28 , $766.28 , See APC Packaged Rates , See APC Packaged Rates ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", See APC Packaged Rates , $399.70 , Not Applicable , $399.70 ," $3,009.07 ", $799.40
37200,501001255,Hospital Chargemaster,Transcatheter biopsy,Outpatient,Outpatient Default Percent / Case Rate,360," $1,142.00 ", $628.10 ," $2,591.48 "," $5,701.02 ", $799.40 , $445.38 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 ", $844.48 , $822.61 ," $5,986.07 "," $5,815.04 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $5,701.02 ", $399.70 , $- , $- ," $9,574.18 ", $799.40
64445,501001408,Hospital Chargemaster,N block inj sciatic sng,Outpatient,Outpatient Default Percent / Case Rate,360, $900.00 ," $1,109.00 "," $1,236.00 ", $759.14 , $630.00 , $351.00 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $194.20 , $188.30 , $797.10 , $774.33 , $900.00 , $900.00 , $900.00 , $900.00 , $759.14 , $315.00 , $- , $- ," $1,309.97 ", $630.00
64415,501001403,Hospital Chargemaster,N block inj brachial plexus,Outpatient,Outpatient Default Percent / Case Rate,360, $900.00 ," $1,416.48 "," $1,236.00 ", $984.14 , $630.00 , $351.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $174.52 , $169.22 ," $1,033.35 "," $1,003.82 ", $900.00 , $900.00 , $900.00 , $900.00 , $984.14 , $315.00 , $- , $- ," $1,673.19 ", $630.00
64616,501001436,Hospital Chargemaster,Chemodenerv musc neck dyston,Outpatient,Outpatient Default Percent / Case Rate,360, $817.00 , $458.33 ," $1,236.00 ", $312.35 , $571.90 , $318.63 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $740.30 , $740.30 , $740.30 , $740.30 , $312.35 , $285.95 , $- , $- ," $1,236.00 ", $571.90
64418,501001404,Hospital Chargemaster,N block inj suprascapular,Outpatient,Outpatient Default Percent / Case Rate,360," $1,032.00 "," $1,109.00 "," $1,236.00 ", $759.14 , $722.40 , $402.48 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $178.54 , $173.12 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $361.20 , $- , $- ," $1,309.97 ", $722.40
64425,501001407,Hospital Chargemaster,N block inj ilio-ing/hypogi,Outpatient,Outpatient Default Percent / Case Rate,360, $900.00 ," $1,109.00 "," $1,236.00 ", $759.14 , $630.00 , $351.00 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $226.51 , $219.64 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $315.00 , $- , $- ," $1,309.97 ", $630.00
64642,501001443,Hospital Chargemaster,Chemodenerv 1 extremity 1-4,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 "," $1,109.00 "," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
64644,501001445,Hospital Chargemaster,Chemodenerv 1 extrem 5/> mus,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 "," $1,109.00 "," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
64646,501001447,Hospital Chargemaster,Chemodenerv trunk musc 1-5,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 "," $1,109.00 "," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
64647,501001448,Hospital Chargemaster,Chemodenerv trunk musc 6/>,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 "," $1,109.00 "," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
47537,501001311,Hospital Chargemaster,Removal biliary drg cath,Outpatient,Outpatient Default Percent / Case Rate,360," $1,182.00 ", $650.10 ," $1,236.00 ", $967.36 , $827.40 , $460.98 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $105.28 , $102.55 ," $1,015.72 ", $986.70 , $740.30 , $740.30 , $740.30 , $740.30 , $967.36 , $413.70 , $- , $- ," $1,665.99 ", $827.40
49450,501001327,Hospital Chargemaster,Replace g/c tube perc,Outpatient,Outpatient Default Percent / Case Rate,360," $2,102.00 "," $1,156.10 "," $1,236.00 ", $967.36 ," $1,471.40 ", $819.78 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $740.30 , $740.30 , $740.30 , $740.30 , $967.36 , $735.70 , $- , $- ," $1,665.99 "," $1,471.40 "
47532,501001306,Hospital Chargemaster,Injection for cholangiogram,Outpatient,Outpatient Default Percent / Case Rate,360, $709.00 , $389.95 ," $1,442.00 "," $3,803.62 ", $496.30 , $276.51 ," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 ", $709.00 , $709.00 , $709.00 , $709.00 ," $3,803.62 ", $248.15 , $- , $- ," $6,447.63 ", $496.30
56605,501001360,Hospital Chargemaster,Biopsy of vulva/perineum,Outpatient,Outpatient Default Percent / Case Rate,360, $633.00 , $348.15 ," $1,236.00 ", $757.92 , $443.10 , $246.87 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $844.48 , $822.61 , $795.81 , $773.07 , $633.00 , $633.00 , $633.00 , $633.00 , $757.92 , $221.55 , $- , $- ," $1,236.00 ", $443.10
57100,501001361,Hospital Chargemaster,Biopsy of vagina,Outpatient,Outpatient Default Percent / Case Rate,360, $633.00 , $348.15 ," $1,236.00 ", $757.92 , $443.10 , $246.87 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $105.28 , $102.55 , $795.81 , $773.07 , $633.00 , $633.00 , $633.00 , $633.00 , $757.92 , $221.55 , $- , $- ," $1,236.00 ", $443.10
38792,501001292,Hospital Chargemaster,Ra tracer id of sentinl node,Outpatient,Outpatient Default Percent / Case Rate,360, $817.00 , $449.35 ," $1,236.00 ", $450.66 , $571.90 , $318.63 , $773.31 , $530.77 , $527.94 , $450.66 , $450.66 , $105.28 , $102.55 , $473.19 , $459.67 , $581.78 , $581.78 , $596.77 , $596.77 , $450.66 , $285.95 , $- , $- ," $1,236.00 ", $571.90
60100,501001369,Hospital Chargemaster,Biopsy of thyroid,Outpatient,Outpatient Default Percent / Case Rate,360, $590.00 ," $1,072.94 "," $1,236.00 ", $743.95 , $413.00 , $230.10 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $590.00 , $590.00 , $590.00 , $590.00 , $743.95 , $206.50 , $- , $- ," $1,267.38 ", $413.00
38220,501001288,Hospital Chargemaster,Dx bone marrow aspirations,Outpatient,Outpatient Default Percent / Case Rate,360, $590.00 , $324.50 ," $1,236.00 "," $1,682.11 ", $413.00 , $230.10 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $158.51 , $153.70 ," $1,766.22 "," $1,715.75 ", $590.00 , $590.00 , $590.00 , $590.00 ," $1,682.11 ", $206.50 , $- , $- ," $3,009.07 ", $413.00
47531,501001305,Hospital Chargemaster,Injection for cholangiogram,Outpatient,Outpatient Default Percent / Case Rate,360, $563.00 , $309.65 ," $1,236.00 "," $3,803.62 ", $394.10 , $219.57 ," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 ", $563.00 , $563.00 , $563.00 , $563.00 ," $3,803.62 ", $197.05 , $- , $- ," $6,447.63 ", $394.10
60300,501001370,Hospital Chargemaster,Aspir/inj thyroid cyst,Outpatient,Outpatient Default Percent / Case Rate,360, $506.00 ," $1,072.94 "," $1,236.00 ", $743.95 , $354.20 , $197.34 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $506.00 , $506.00 , $506.00 , $506.00 , $743.95 , $177.10 , $- , $- ," $1,267.38 ", $354.20
64612,501001434,Hospital Chargemaster,Destroy nerve face muscle,Outpatient,Outpatient Default Percent / Case Rate,360, $446.00 , $458.33 ," $1,236.00 ", $312.35 , $312.20 , $173.94 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $446.00 , $446.00 , $446.00 , $446.00 , $312.35 , $156.10 , $- , $- ," $1,236.00 ", $312.20
47556,501001312,Hospital Chargemaster,Biliary endoscopy thru skin,Outpatient,Outpatient Default Percent / Case Rate,360, $406.00 , $223.30 ," $2,060.00 "," $6,049.19 ", $284.20 , $158.34 ," $10,054.00 "," $6,900.63 "," $6,863.84 "," $6,049.19 "," $6,049.19 "," $4,032.00 "," $3,927.60 "," $6,351.65 "," $6,170.18 ", $406.00 , $406.00 , $406.00 , $406.00 ," $6,049.19 ", $142.10 , $- , $- ," $10,054.00 ", $284.20
37212,501001257,Hospital Chargemaster,Thrombolytic venous therapy,Outpatient,Outpatient Default Percent / Case Rate,360, $400.00 , $220.00 ," $1,236.00 "," $3,422.34 ", $280.00 , $156.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $400.00 , $400.00 , $400.00 , $400.00 ," $3,422.34 ", $140.00 , $- , $- ," $5,778.66 ", $280.00
54200,501001356,Hospital Chargemaster,Treatment of penis lesion,Outpatient,Outpatient Default Percent / Case Rate,360, $375.00 , $206.25 , $309.00 , $318.13 , $262.50 , $146.25 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $205.12 , $198.90 , $334.03 , $324.49 , $375.00 , $375.00 , $375.00 , $375.00 , $318.13 , $131.25 , $- , $- , $506.26 , $262.50
49465,501001330,Hospital Chargemaster,Fluoro exam of g/colon tube,Outpatient,Outpatient Default Percent / Case Rate,360," $1,300.00 ", $715.00 ," $1,236.00 ", $275.09 , $910.00 , $507.00 , $504.38 , $346.19 , $344.34 , $275.09 , $275.09 , $872.30 , $872.30 , $288.84 , $280.59 , $343.81 , $343.81 , $343.81 , $343.81 , $275.09 , $455.00 , $- , $- ," $1,236.00 ", $910.00
64505,501001422,Hospital Chargemaster,N block spenopalatine gangl,Outpatient,Outpatient Default Percent / Case Rate,360, $645.00 , $458.33 ," $1,236.00 ", $312.35 , $451.50 , $251.55 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $199.70 , $193.64 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $225.75 , $- , $- ," $1,236.00 ", $451.50
67500,501001453,Hospital Chargemaster,Inject/treat eye socket,Outpatient,Outpatient Default Percent / Case Rate,360, $817.00 , $525.08 , $673.21 , $312.73 , $571.90 , $318.63 , $620.23 , $425.70 , $423.43 , $312.73 , $312.73 , $105.28 , $102.55 , $328.37 , $318.99 , $343.81 , $343.81 , $343.81 , $343.81 , $312.73 , $285.95 , $- , $- , $673.21 , $571.90
43752,501001296,Hospital Chargemaster,Nasal/orogastric w/tube plmt,Outpatient,Outpatient Default Percent / Case Rate,360, $334.00 , $183.70 ," $1,442.00 ", $324.46 , $233.80 , $130.26 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $334.00 , $334.00 , $334.00 , $334.00 , $324.46 , $116.90 , $- , $- ," $1,442.00 ", $233.80
56405,501001358,Hospital Chargemaster,I & d of vulva/perineum,Outpatient,Outpatient Default Percent / Case Rate,360, $331.00 , $182.05 ," $1,442.00 ", $337.17 , $231.70 , $129.09 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 ," $1,133.44 "," $1,104.09 ", $354.03 , $343.92 , $331.00 , $331.00 , $331.00 , $331.00 , $337.17 , $115.85 , $- , $- ," $1,442.00 ", $231.70
62273,501001373,Hospital Chargemaster,Inject epidural patch,Outpatient,Outpatient Default Percent / Case Rate,360," $1,142.00 "," $1,109.00 "," $1,236.00 ", $759.14 , $799.40 , $445.38 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $844.48 , $822.61 , $797.10 , $774.33 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $759.14 , $399.70 , $- , $- ," $1,309.97 ", $799.40
46083,501001300,Hospital Chargemaster,Incise external hemorrhoid,Outpatient,Outpatient Default Percent / Case Rate,360, $317.00 , $174.35 ," $1,236.00 ", $318.13 , $221.90 , $123.63 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $317.00 , $317.00 , $317.00 , $317.00 , $318.13 , $110.95 , $- , $- ," $1,236.00 ", $221.90
46050,501001299,Hospital Chargemaster,Incision of anal abscess,Outpatient,Outpatient Default Percent / Case Rate,360, $279.00 , $153.45 ," $1,236.00 ", $948.73 , $195.30 , $108.81 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $844.48 , $822.61 , $996.17 , $967.71 , $279.00 , $279.00 , $279.00 , $279.00 , $948.73 , $97.65 , $- , $- ," $1,629.53 ", $195.30
62270,501001371,Hospital Chargemaster,Spinal fluid tap diagnostic,Outpatient,Outpatient Default Percent / Case Rate,360, $237.00 ," $1,109.00 "," $1,236.00 ", $759.14 , $165.90 , $92.43 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $177.96 , $172.56 , $797.10 , $774.33 , $237.00 , $237.00 , $237.00 , $237.00 , $759.14 , $82.95 , $- , $- ," $1,309.97 ", $165.90
38221,501001289,Hospital Chargemaster,Dx bone marrow biopsies,Outpatient,Outpatient Default Percent / Case Rate,360, $234.00 , $128.70 ," $1,236.00 "," $1,682.11 ", $163.80 , $91.26 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $200.58 , $194.50 ," $1,766.22 "," $1,715.75 ", $234.00 , $234.00 , $234.00 , $234.00 ," $1,682.11 ", $81.90 , $- , $- ," $3,009.07 ", $163.80
58100,501001363,Hospital Chargemaster,Biopsy of uterus lining,Outpatient,Outpatient Default Percent / Case Rate,360, $232.00 , $307.30 ," $1,236.00 ", $203.67 , $162.40 , $90.48 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $105.28 , $102.55 , $213.85 , $207.74 , $232.00 , $232.00 , $232.00 , $232.00 , $203.67 , $81.20 , $- , $- ," $1,236.00 ", $162.40
57500,501001362,Hospital Chargemaster,Biopsy of cervix,Outpatient,Outpatient Default Percent / Case Rate,360, $228.00 ," $1,033.49 "," $1,236.00 ", $757.92 , $159.60 , $88.92 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $105.28 , $102.55 , $795.81 , $773.07 , $228.00 , $228.00 , $228.00 , $228.00 , $757.92 , $79.80 , $- , $- ," $1,236.00 ", $159.60
51703,501001351,Hospital Chargemaster,Insert bladder cath complex,Outpatient,Outpatient Default Percent / Case Rate,360, $265.00 , $145.75 ," $1,236.00 ", $166.91 , $185.50 , $103.35 , $297.41 , $204.13 , $203.04 , $166.91 , $166.91 , $196.14 , $190.19 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $92.75 , $- , $- ," $1,236.00 ", $185.50
51705,501001352,Hospital Chargemaster,Change of bladder tube,Outpatient,Outpatient Default Percent / Case Rate,360, $221.00 , $121.55 ," $1,236.00 ", $318.13 , $154.70 , $86.19 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $221.00 , $221.00 , $221.00 , $221.00 , $318.13 , $77.35 , $- , $- ," $1,236.00 ", $154.70
58300,501001364,Hospital Chargemaster,Insert intrauterine device,Outpatient,Outpatient Default Percent / Case Rate,360, $216.00 , $118.80 ," $1,236.00 ", See APC Packaged Rates , $151.20 , $84.24 , $172.06 , $118.09 , $117.46 , See APC Packaged Rates , See APC Packaged Rates , $131.39 , $127.40 , See APC Packaged Rates , See APC Packaged Rates , $216.00 , $216.00 , $216.00 , $216.00 , See APC Packaged Rates , $75.60 , $- , $- ," $1,236.00 ", $151.20
64450,501001410,Hospital Chargemaster,N block other peripheral,Outpatient,Outpatient Default Percent / Case Rate,360, $208.00 ," $1,109.00 "," $1,236.00 ", $759.14 , $145.60 , $81.12 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $168.83 , $163.71 , $797.10 , $774.33 , $208.00 , $208.00 , $208.00 , $208.00 , $759.14 , $72.80 , $- , $- ," $1,309.97 ", $145.60
58301,501001365,Hospital Chargemaster,Remove intrauterine device,Outpatient,Outpatient Default Percent / Case Rate,360, $203.00 , $307.30 ," $1,236.00 ", $337.17 , $142.10 , $79.17 , $362.99 , $249.14 , $247.81 , $337.17 , $337.17 , $164.50 , $159.51 , $354.03 , $343.92 , $203.00 , $203.00 , $203.00 , $203.00 , $337.17 , $71.05 , $- , $- ," $1,236.00 ", $142.10
64400,501001399,Hospital Chargemaster,N block inj trigeminal,Outpatient,Outpatient Default Percent / Case Rate,360, $194.00 , $458.33 ," $1,236.00 ", $312.35 , $135.80 , $75.66 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $157.25 , $152.48 , $327.96 , $318.59 , $194.00 , $194.00 , $194.00 , $194.00 , $312.35 , $67.90 , $- , $- ," $1,236.00 ", $135.80
37191,501001251,Hospital Chargemaster,Ins endovas vena cava filtr,Outpatient,Outpatient Default Percent / Case Rate,360, $189.00 , $103.95 ," $2,060.00 "," $5,701.02 ", $132.30 , $73.71 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 ", $105.28 , $102.55 ," $5,986.07 "," $5,815.04 ", $189.00 , $189.00 , $189.00 , $189.00 ," $5,701.02 ", $66.15 , $- , $- ," $9,574.18 ", $132.30
54056,501001354,Hospital Chargemaster,Cryosurgery penis lesion(s),Outpatient,Outpatient Default Percent / Case Rate,360, $247.00 , $135.85 , $203.53 , $214.68 , $172.90 , $96.33 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $185.14 , $185.14 , $185.14 , $185.14 , $214.68 , $86.45 , $- , $- , $386.01 , $172.90
43762,501001297,Hospital Chargemaster,Rplc gtube no revj trc,Outpatient,Outpatient Default Percent / Case Rate,360, $174.00 , $95.70 ," $1,236.00 ", $318.13 , $121.80 , $67.86 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 ," $1,133.44 "," $1,104.09 ", $334.03 , $324.49 , $174.00 , $174.00 , $174.00 , $174.00 , $318.13 , $60.90 , $- , $- ," $1,236.00 ", $121.80
95971,501001458,Hospital Chargemaster,Alys smpl sp/pn npgt w/prgrm,Outpatient,Outpatient Default Percent / Case Rate,360, $645.00 , $354.75 , $531.48 , $120.02 , $451.50 , $251.55 , $288.58 , $225.54 , $247.05 , $120.02 , $120.02 , $- , $- , $126.02 , $122.42 , $161.99 , $161.99 , $166.16 , $166.16 , $120.02 , $225.75 , $- , $- , $531.48 , $451.50
38222,501001290,Hospital Chargemaster,Dx bone marrow bx & aspir,Outpatient,Outpatient Default Percent / Case Rate,360, $150.00 , $82.50 ," $1,236.00 "," $2,834.62 ", $105.00 , $58.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $2,834.62 "," $2,834.62 ", $105.28 , $102.55 ," $2,976.35 "," $2,891.31 ", $150.00 , $150.00 , $150.00 , $150.00 ," $2,834.62 ", $52.50 , $- , $- ," $3,009.07 ", $105.00
65205,501001451,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,360, $129.00 , $70.95 , $106.30 , $134.80 , $90.30 , $50.31 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $129.00 , $129.00 , $129.00 , $129.00 , $134.80 , $45.15 , $- , $- , $232.95 , $90.30
65220,501001452,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,360, $124.00 , $68.20 , $102.18 , $324.46 , $86.80 , $48.36 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $124.00 , $124.00 , $124.00 , $124.00 , $324.46 , $43.40 , $- , $- , $761.64 , $86.80
64447,501001409,Hospital Chargemaster,N block inj fem single,Outpatient,Outpatient Default Percent / Case Rate,360, $900.00 ," $1,109.00 ", $741.60 , $759.14 , $630.00 , $351.00 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $164.53 , $159.53 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $315.00 , $- , $- ," $1,309.97 ", $630.00
51702,501001350,Hospital Chargemaster,Insert temp bladder cath,Outpatient,Outpatient Default Percent / Case Rate,360, $98.00 , $53.90 ," $1,236.00 ", $134.80 , $68.60 , $38.22 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $73.01 , $70.79 , $141.54 , $137.50 , $98.00 , $98.00 , $98.00 , $98.00 , $134.80 , $34.30 , $- , $- ," $1,236.00 ", $68.60
69210,501001455,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,360, $97.00 , $53.35 ," $1,236.00 ", $66.55 , $67.90 , $37.83 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $65.09 , $65.09 , $69.87 , $67.88 , $97.00 , $97.00 , $97.00 , $97.00 , $66.55 , $33.95 , $- , $- ," $1,236.00 ", $67.90
49082,501001314,Hospital Chargemaster,Abd paracentesis,Outpatient,Outpatient Default Percent / Case Rate,360, $93.00 , $51.15 ," $1,442.00 ", $967.36 , $65.10 , $36.27 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $93.00 , $93.00 , $93.00 , $93.00 , $967.36 , $32.55 , $- , $- ," $1,665.99 ", $65.10
49083,501001315,Hospital Chargemaster,Abd paracentesis w/imaging,Outpatient,Outpatient Default Percent / Case Rate,360, $93.00 , $51.15 ," $1,442.00 ", $967.36 , $65.10 , $36.27 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $93.00 , $93.00 , $93.00 , $93.00 , $967.36 , $32.55 , $- , $- ," $1,665.99 ", $65.10
51701,501001349,Hospital Chargemaster,Insert bladder catheter,Outpatient,Outpatient Default Percent / Case Rate,360, $88.00 , $48.40 ," $1,236.00 ", $134.80 , $61.60 , $34.32 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $66.83 , $64.80 , $141.54 , $137.50 , $88.00 , $88.00 , $88.00 , $88.00 , $134.80 , $30.80 , $- , $- ," $1,236.00 ", $61.60
97597,501001459,Hospital Chargemaster,Rmvl devital tis 20 cm/<,Outpatient,Outpatient Default Percent / Case Rate,360, $78.00 , $326.79 ," $1,236.00 ", $214.68 , $54.60 , $30.42 , $875.52 , $556.51 , $546.42 , $214.68 , $214.68 , $126.90 , $123.05 , $225.42 , $218.98 , $78.00 , $78.00 , $78.00 , $78.00 , $214.68 , $27.30 , $- , $- ," $1,236.00 ", $54.60
69209,501001454,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,360, $25.00 , $13.75 ," $1,236.00 ", $66.55 , $17.50 , $9.75 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $16.78 , $16.78 , $69.87 , $67.88 , $25.00 , $25.00 , $25.00 , $25.00 , $66.55 , $8.75 , $- , $- ," $1,236.00 ", $17.50
82554,501001457,Hospital Chargemaster,Creatine isoforms,Outpatient,Outpatient Default Percent / Case Rate,360, $817.00 , $24.43 , $673.21 , See APC Packaged Rates , $571.90 , $318.63 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $25.86 , $25.07 , See APC Packaged Rates , See APC Packaged Rates , $20.20 , $20.20 , $20.72 , $20.72 , See APC Packaged Rates , $285.95 , $15.83 , $15.83 , $673.21 , $571.90
10006,501001004,Hospital Chargemaster,Fna bx w/us gdn ea addl,Outpatient,Outpatient Default Percent / Case Rate,360, $260.00 , $143.00 ," $1,236.00 ", See APC Packaged Rates , $182.00 , $101.40 , $159.18 , $109.25 , $108.67 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $241.80 , $241.80 , $241.80 , $241.80 , See APC Packaged Rates , $91.00 , $- , $- ," $1,236.00 ", $182.00
17003,501001097,Hospital Chargemaster,Destruct premalg les 2-14,Outpatient,Outpatient Default Percent / Case Rate,360, $239.00 , $131.45 ," $1,236.00 ", See APC Packaged Rates , $167.30 , $93.21 , $7.86 , $5.40 , $5.37 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $222.27 , $222.27 , $222.27 , $222.27 , See APC Packaged Rates , $83.65 , $- , $- ," $1,236.00 ", $167.30
C5272,501001461,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,360, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $34.41 , $23.62 , $23.49 , See APC Packaged Rates , See APC Packaged Rates , $416.02 , $416.02 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
11001,501001021,Hospital Chargemaster,Debride infected skin add-on,Outpatient,Outpatient Default Percent / Case Rate,360, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $45.41 , $31.17 , $31.00 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
15272,501001083,Hospital Chargemaster,Skin sub graft t/a/l add-on,Outpatient,Outpatient Default Percent / Case Rate,360, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $55.78 , $38.29 , $38.08 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
11732,501001067,Hospital Chargemaster,Remove nail plate add-on,Outpatient,Outpatient Default Percent / Case Rate,360, $150.00 , $82.50 ," $1,236.00 ", See APC Packaged Rates , $105.00 , $58.50 , $56.49 , $38.77 , $38.57 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $139.50 , $139.50 , $139.50 , $139.50 , See APC Packaged Rates , $52.50 , $- , $- ," $1,236.00 ", $105.00
19001,501001104,Hospital Chargemaster,Drain breast lesion add-on,Outpatient,Outpatient Default Percent / Case Rate,360, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $69.14 , $47.45 , $47.20 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
11103,501001032,Hospital Chargemaster,Tangntl bx skin ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,360, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $74.66 , $51.25 , $50.97 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
15276,501001087,Hospital Chargemaster,Skin sub graft f/n/hf/g addl,Outpatient,Outpatient Default Percent / Case Rate,360, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $81.32 , $55.82 , $55.52 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
11105,501001034,Hospital Chargemaster,Punch bx skin ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,360, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $88.21 , $60.54 , $60.22 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
11107,501001036,Hospital Chargemaster,Incal bx skn ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,360, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $105.14 , $72.16 , $71.78 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
20501,501001126,Hospital Chargemaster,Inject sinus tract for x-ray,Outpatient,Outpatient Default Percent / Case Rate,360, $900.00 , $495.00 ," $1,236.00 ", See APC Packaged Rates , $630.00 , $351.00 , $121.46 , $83.36 , $82.92 , See APC Packaged Rates , See APC Packaged Rates , $100.01 , $96.98 , See APC Packaged Rates , See APC Packaged Rates , $837.00 , $837.00 , $837.00 , $837.00 , See APC Packaged Rates , $315.00 , $- , $- ," $1,236.00 ", $630.00
27369,501001160,Hospital Chargemaster,Njx cntrst kne arthg/ct/mri,Outpatient,Outpatient Default Percent / Case Rate,360, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $130.87 , $89.82 , $89.34 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
19286,501001118,Hospital Chargemaster,Perq dev breast add us imag,Outpatient,Outpatient Default Percent / Case Rate,360, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $139.50 , $95.74 , $95.23 , See APC Packaged Rates , See APC Packaged Rates , $236.19 , $236.19 , See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
15274,501001085,Hospital Chargemaster,Skn sub grft t/a/l child add,Outpatient,Outpatient Default Percent / Case Rate,360, $830.00 , $456.50 ," $1,236.00 ", See APC Packaged Rates , $581.00 , $323.70 , $149.08 , $102.32 , $101.78 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $771.90 , $771.90 , $771.90 , $771.90 , See APC Packaged Rates , $290.50 , $- , $- ," $1,236.00 ", $581.00
19282,501001114,Hospital Chargemaster,Perq device breast ea imag,Outpatient,Outpatient Default Percent / Case Rate,360, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $162.99 , $111.87 , $111.27 , See APC Packaged Rates , See APC Packaged Rates , $236.19 , $236.19 , See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
23350,501001151,Hospital Chargemaster,Injection for shoulder x-ray,Outpatient,Outpatient Default Percent / Case Rate,360, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $164.23 , $112.72 , $112.12 , See APC Packaged Rates , See APC Packaged Rates , $119.20 , $115.58 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
11046,501001026,Hospital Chargemaster,Deb musc/fascia add-on,Outpatient,Outpatient Default Percent / Case Rate,360, $286.00 , $157.30 ," $1,236.00 ", See APC Packaged Rates , $200.20 , $111.54 , $179.86 , $123.45 , $122.79 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $265.98 , $265.98 , $265.98 , $265.98 , See APC Packaged Rates , $100.10 , $- , $- ," $1,236.00 ", $200.20
15278,501001089,Hospital Chargemaster,Skn sub grft f/n/hf/g ch add,Outpatient,Outpatient Default Percent / Case Rate,360, $830.00 , $456.50 ," $1,236.00 ", See APC Packaged Rates , $581.00 , $323.70 , $186.21 , $127.81 , $127.13 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $771.90 , $771.90 , $771.90 , $771.90 , See APC Packaged Rates , $290.50 , $- , $- ," $1,236.00 ", $581.00
58340,501001366,Hospital Chargemaster,Catheter for hysterography,Outpatient,Outpatient Default Percent / Case Rate,360, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $186.80 , $128.21 , $127.53 , See APC Packaged Rates , See APC Packaged Rates , $145.67 , $141.25 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
64480,501001412,Hospital Chargemaster,Inj foramen epidural add-on,Outpatient,Outpatient Default Percent / Case Rate,360, $590.00 , $324.50 ," $1,236.00 ", See APC Packaged Rates , $413.00 , $230.10 , $201.34 , $138.19 , $137.46 , See APC Packaged Rates , See APC Packaged Rates , $198.03 , $192.03 , See APC Packaged Rates , See APC Packaged Rates , $548.70 , $548.70 , $548.70 , $548.70 , See APC Packaged Rates , $206.50 , $- , $- ," $1,236.00 ", $413.00
24220,501001153,Hospital Chargemaster,Injection for elbow x-ray,Outpatient,Outpatient Default Percent / Case Rate,360, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $218.10 , $149.70 , $148.90 , See APC Packaged Rates , See APC Packaged Rates , $157.37 , $152.59 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
27093,501001157,Hospital Chargemaster,Injection for hip x-ray,Outpatient,Outpatient Default Percent / Case Rate,360, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $225.37 , $154.68 , $153.86 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
50690,501001341,Hospital Chargemaster,Injection for ureter x-ray,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 ", $797.50 ," $1,236.00 ", See APC Packaged Rates ," $1,015.00 ", $565.50 , $229.10 , $157.24 , $156.41 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,348.50 "," $1,348.50 "," $1,348.50 "," $1,348.50 ", See APC Packaged Rates , $507.50 , $- , $- ," $1,348.50 "," $1,015.00 "
64643,501001444,Hospital Chargemaster,Chemodenerv 1 extrem 1-4 ea,Outpatient,Outpatient Default Percent / Case Rate,360, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $233.96 , $160.58 , $159.72 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
25246,501001155,Hospital Chargemaster,Injection for wrist x-ray,Outpatient,Outpatient Default Percent / Case Rate,360, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $241.52 , $165.77 , $164.88 , See APC Packaged Rates , See APC Packaged Rates , $548.21 , $548.21 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
19084,501001109,Hospital Chargemaster,Bx breast add lesion us imag,Outpatient,Outpatient Default Percent / Case Rate,360, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $254.49 , $174.67 , $173.74 , See APC Packaged Rates , See APC Packaged Rates ," $1,133.44 "," $1,104.09 ", See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
64645,501001446,Hospital Chargemaster,Chemodenerv 1 extrem 5/> ea,Outpatient,Outpatient Default Percent / Case Rate,360, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $269.68 , $185.09 , $184.11 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
27095,501001158,Hospital Chargemaster,Injection for hip x-ray,Outpatient,Outpatient Default Percent / Case Rate,360, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $270.59 , $185.72 , $184.73 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
19082,501001107,Hospital Chargemaster,Bx breast add lesion strtctc,Outpatient,Outpatient Default Percent / Case Rate,360, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $272.37 , $186.94 , $185.95 , See APC Packaged Rates , See APC Packaged Rates ," $1,133.44 "," $1,104.09 ", See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
62284,501001377,Hospital Chargemaster,Injection for myelogram,Outpatient,Outpatient Default Percent / Case Rate,360," $1,500.00 ", $825.00 ," $1,236.00 ", See APC Packaged Rates ," $1,050.00 ", $585.00 , $285.96 , $196.27 , $195.22 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,395.00 "," $1,395.00 "," $1,395.00 "," $1,395.00 ", See APC Packaged Rates , $525.00 , $- , $- ," $1,395.00 "," $1,050.00 "
11047,501001027,Hospital Chargemaster,Deb bone add-on,Outpatient,Outpatient Default Percent / Case Rate,360, $286.00 , $157.30 ," $1,236.00 ", See APC Packaged Rates , $200.20 , $111.54 , $318.48 , $218.59 , $217.42 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $265.98 , $265.98 , $265.98 , $265.98 , See APC Packaged Rates , $100.10 , $- , $- ," $1,236.00 ", $200.20
47001,501001302,Hospital Chargemaster,Needle biopsy liver add-on,Outpatient,Outpatient Default Percent / Case Rate,360, $590.00 , $324.50 ," $1,236.00 ", See APC Packaged Rates , $413.00 , $230.10 , $336.59 , $231.02 , $229.79 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $548.70 , $548.70 , $548.70 , $548.70 , See APC Packaged Rates , $206.50 , $- , $- ," $1,236.00 ", $413.00
36010,501001193,Hospital Chargemaster,Place catheter in vein,Outpatient,Outpatient Default Percent / Case Rate,360, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $354.08 , $243.02 , $241.73 , See APC Packaged Rates , See APC Packaged Rates , $299.66 , $290.57 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
C5274,501001463,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,360, $860.00 , $473.00 ," $1,236.00 ", See APC Packaged Rates , $602.00 , $335.40 , $829.81 , $833.43 , $442.92 , See APC Packaged Rates , See APC Packaged Rates , $577.06 , $577.06 , See APC Packaged Rates , See APC Packaged Rates , $799.80 , $799.80 , $799.80 , $799.80 , See APC Packaged Rates , $301.00 , $- , $- ," $1,236.00 ", $602.00
C5276,501001465,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,360, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $598.24 , $600.84 , $319.31 , See APC Packaged Rates , See APC Packaged Rates , $416.02 , $416.02 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
C5278,501001467,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,360, $830.00 , $456.50 ," $1,236.00 ", See APC Packaged Rates , $581.00 , $323.70 , $800.87 , $804.35 , $427.47 , See APC Packaged Rates , See APC Packaged Rates , $556.93 , $556.93 , See APC Packaged Rates , See APC Packaged Rates , $771.90 , $771.90 , $771.90 , $771.90 , See APC Packaged Rates , $290.50 , $- , $- ," $1,236.00 ", $581.00
36416,501001214,Hospital Chargemaster,Capillary blood draw,Outpatient,Outpatient Default Percent / Case Rate,360, $11.00 , $6.05 , $9.06 , See APC Packaged Rates , $7.70 , $4.29 , $12.68 , $8.51 , $8.15 , See APC Packaged Rates , See APC Packaged Rates , $7.38 , $7.38 , See APC Packaged Rates , See APC Packaged Rates , $10.23 , $10.23 , $10.23 , $10.23 , See APC Packaged Rates , $3.85 , $3.46 , $3.46 , $12.68 , $7.70
36410,501001213,Hospital Chargemaster,Non-routine bl draw 3/> yrs,Outpatient,Outpatient Default Percent / Case Rate,360, $9.65 , $5.31 , $7.95 , See APC Packaged Rates , $6.76 , $3.76 , $30.17 , $20.71 , $20.60 , See APC Packaged Rates , See APC Packaged Rates , $21.29 , $20.65 , See APC Packaged Rates , See APC Packaged Rates , $8.97 , $8.97 , $8.97 , $8.97 , See APC Packaged Rates , $3.38 , $- , $- , $30.17 , $6.76
11201,501001038,Hospital Chargemaster,Remove skin tags add-on,Outpatient,Outpatient Default Percent / Case Rate,360, $271.00 , $149.05 , $223.30 , See APC Packaged Rates , $189.70 , $105.69 , $54.04 , $37.09 , $36.89 , See APC Packaged Rates , See APC Packaged Rates , $38.24 , $37.08 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- , $252.03 , $189.70
51600,501001346,Hospital Chargemaster,Injection for bladder x-ray,Outpatient,Outpatient Default Percent / Case Rate,360," $1,450.00 ", $797.50 ," $1,194.80 ", See APC Packaged Rates ," $1,015.00 ", $565.50 , $143.93 , $98.79 , $98.26 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,348.50 "," $1,348.50 "," $1,348.50 "," $1,348.50 ", See APC Packaged Rates , $507.50 , $- , $- ," $1,348.50 "," $1,015.00 "
77002,501001456,Hospital Chargemaster,Needle localization by xray,Outpatient,Outpatient Default Percent / Case Rate,360, $282.00 , $155.10 , $232.37 , See APC Packaged Rates , $197.40 , $109.98 , $294.75 , $231.12 , $230.33 , See APC Packaged Rates , See APC Packaged Rates , $158.25 , $153.45 , See APC Packaged Rates , See APC Packaged Rates , $262.26 , $262.26 , $262.26 , $262.26 , See APC Packaged Rates , $98.70 , $- , $- , $294.75 , $197.40
,5010010001,Hospital Chargemaster,Surgery - 1st Half Hour,Outpatient,Outpatient Default Percent / Case Rate,360," $1,500.00 ", $825.00 ," $1,200.00 ", See APC Packaged Rates ," $1,050.00 ", $585.00 ," $1,447.35 "," $1,453.65 ", $772.53 , See APC Packaged Rates , See APC Packaged Rates ," $1,006.50 "," $1,006.50 ", See APC Packaged Rates , See APC Packaged Rates ," $1,395.00 "," $1,395.00 "," $1,395.00 "," $1,395.00 ", See APC Packaged Rates , $525.00 , $900.00 , $525.00 ," $1,453.65 "," $1,050.00 "
,5010010002,Hospital Chargemaster,Surgery - EA Addl 1/2 HR,Outpatient,Outpatient Default Percent / Case Rate,360," $1,500.00 ", $825.00 ," $1,200.00 ", See APC Packaged Rates ," $1,050.00 ", $585.00 ," $1,447.35 "," $1,453.65 ", $772.53 , See APC Packaged Rates , See APC Packaged Rates ," $1,006.50 "," $1,006.50 ", See APC Packaged Rates , See APC Packaged Rates ," $1,395.00 "," $1,395.00 "," $1,395.00 "," $1,395.00 ", See APC Packaged Rates , $525.00 , $900.00 , $525.00 ," $1,453.65 "," $1,050.00 "
50430,501001334,Hospital Chargemaster,Njx px nfrosgrm &/urtrgrm,Outpatient,Outpatient Default Percent / Case Rate,360, $984.00 , $541.20 ," $1,236.00 ", $687.79 , $688.80 , $383.76 ," $1,229.98 ", $844.21 , $839.71 , $687.79 , $687.79 , $105.28 , $102.55 , $722.18 , $701.54 , $892.65 , $892.65 , $915.65 , $915.65 , $687.79 , $344.40 , $- , $- ," $1,236.00 ", $688.80
36569,5014016569,Hospital Chargemaster,Insj picc 5 yr+ w/o imaging,Outpatient,Outpatient Default Percent / Case Rate,360," $2,540.00 "," $1,397.00 "," $1,236.00 "," $1,681.14 "," $1,778.00 ", $990.60 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $1,681.14 ", $889.00 , $- , $- ," $2,540.00 "," $1,778.00 "
,61500057,Hospital Chargemaster,Greelight Laser Renal,Outpatient,Outpatient Default Percent / Case Rate,360, $795.00 , $437.25 , $636.00 , See APC Packaged Rates , $556.50 , $310.05 , $767.10 , $770.43 , $409.44 , See APC Packaged Rates , See APC Packaged Rates , $533.45 , $533.45 , See APC Packaged Rates , See APC Packaged Rates , $739.35 , $739.35 , $739.35 , $739.35 , See APC Packaged Rates , $278.25 , $477.00 , $278.25 , $770.43 , $556.50
,61510801,Hospital Chargemaster,Eswl Laser Treatment,Outpatient,Outpatient Default Percent / Case Rate,360," $1,080.00 ", $594.00 , $864.00 , See APC Packaged Rates , $756.00 , $421.20 ," $1,042.09 "," $1,046.63 ", $556.22 , See APC Packaged Rates , See APC Packaged Rates , $724.68 , $724.68 , See APC Packaged Rates , See APC Packaged Rates ," $1,004.40 "," $1,004.40 "," $1,004.40 "," $1,004.40 ", See APC Packaged Rates , $378.00 , $648.00 , $378.00 ," $1,046.63 ", $756.00
,61513160,Hospital Chargemaster,Counterpulsation Laser,Outpatient,Outpatient Default Percent / Case Rate,360, $700.00 , $385.00 , $560.00 , See APC Packaged Rates , $490.00 , $273.00 , $675.43 , $678.37 , $360.51 , See APC Packaged Rates , See APC Packaged Rates , $469.70 , $469.70 , See APC Packaged Rates , See APC Packaged Rates , $651.00 , $651.00 , $651.00 , $651.00 , See APC Packaged Rates , $245.00 , $420.00 , $245.00 , $678.37 , $490.00
11721,501001533,Hospital Chargemaster,Debride nail 6 or more,Outpatient,Outpatient Default Percent / Case Rate,361, $239.00 , $131.45 ," $1,236.00 ", $66.55 , $167.30 , $93.21 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $185.14 , $185.14 , $185.14 , $185.14 , $66.55 , $83.65 , $- , $- ," $1,236.00 ", $167.30
11720,501001532,Hospital Chargemaster,Debride nail 1-5,Outpatient,Outpatient Default Percent / Case Rate,361, $47.00 , $25.85 ," $1,236.00 ", $66.55 , $32.90 , $18.33 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $47.00 , $47.00 , $47.00 , $47.00 , $66.55 , $16.45 , $- , $- ," $1,236.00 ", $32.90
11719,501001531,Hospital Chargemaster,Trim nail(s) any number,Outpatient,Outpatient Default Percent / Case Rate,361, $35.00 , $19.25 , $28.84 , $66.55 , $24.50 , $13.65 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $35.00 , $35.00 , $35.00 , $35.00 , $66.55 , $12.25 , $- , $- , $122.28 , $24.50
30300,501001640,Hospital Chargemaster,Remove nasal foreign body,Outpatient,Outpatient Default Percent / Case Rate,361, $384.00 , $211.20 , $316.42 , $134.80 , $268.80 , $149.76 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $343.81 , $343.81 , $343.81 , $343.81 , $134.80 , $134.40 , $- , $- , $343.81 , $268.80
11981,501001540,Hospital Chargemaster,Insert drug implant device,Outpatient,Outpatient Default Percent / Case Rate,361, $306.00 , $168.30 ," $1,236.00 ", $134.80 , $214.20 , $119.34 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $306.00 , $306.00 , $306.00 , $306.00 , $134.80 , $107.10 , $- , $- ," $1,236.00 ", $214.20
30901,501001641,Hospital Chargemaster,Control of nosebleed,Outpatient,Outpatient Default Percent / Case Rate,361, $184.00 , $101.20 ," $1,236.00 ", $134.80 , $128.80 , $71.76 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $64.40 , $- , $- ," $1,236.00 ", $128.80
30903,501001642,Hospital Chargemaster,Control of nosebleed,Outpatient,Outpatient Default Percent / Case Rate,361, $242.00 , $133.10 ," $1,236.00 ", $134.80 , $169.40 , $94.38 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $844.48 , $822.61 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $84.70 , $- , $- ," $1,236.00 ", $169.40
29130,501001634,Hospital Chargemaster,Application of finger splint,Outpatient,Outpatient Default Percent / Case Rate,361, $150.00 , $82.50 , $123.60 , $134.80 , $105.00 , $58.50 , $122.28 , $83.93 , $83.48 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $110.05 , $110.05 , $112.89 , $112.89 , $134.80 , $52.50 , $- , $- , $147.89 , $105.00
11740,501001536,Hospital Chargemaster,Drain blood from under nail,Outpatient,Outpatient Default Percent / Case Rate,361, $96.00 , $52.80 ," $1,236.00 ", $134.80 , $67.20 , $37.44 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $96.00 , $96.00 , $96.00 , $96.00 , $134.80 , $33.60 , $- , $- ," $1,236.00 ", $67.20
29581,501001638,Hospital Chargemaster,Apply multlay comprs lwr leg,Outpatient,Outpatient Default Percent / Case Rate,361, $271.00 , $149.05 , $223.30 , $168.90 , $189.70 , $105.69 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $32.27 , $31.29 , $177.35 , $172.28 , $271.00 , $271.00 , $271.00 , $271.00 , $168.90 , $94.85 , $- , $- , $294.51 , $189.70
29580,501001637,Hospital Chargemaster,Application of paste boot,Outpatient,Outpatient Default Percent / Case Rate,361, $244.00 , $134.20 , $201.06 , $168.90 , $170.80 , $95.16 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $85.40 , $- , $- , $294.51 , $170.80
29085,501001633,Hospital Chargemaster,Apply hand/wrist cast,Outpatient,Outpatient Default Percent / Case Rate,361, $197.00 , $108.35 , $162.33 , $168.90 , $137.90 , $76.83 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $266.32 , $258.23 , $177.35 , $172.28 , $197.00 , $197.00 , $197.00 , $197.00 , $168.90 , $68.95 , $- , $- , $294.51 , $137.90
12014,501001546,Hospital Chargemaster,Rpr f/e/e/n/l/m 5.1-7.5 cm,Outpatient,Outpatient Default Percent / Case Rate,361, $431.00 , $237.05 ," $1,236.00 ", $214.68 , $301.70 , $168.09 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $431.00 , $431.00 , $431.00 , $431.00 , $214.68 , $150.85 , $- , $- ," $1,236.00 ", $301.70
12004,501001543,Hospital Chargemaster,Rpr s/n/ax/gen/trk7.6-12.5cm,Outpatient,Outpatient Default Percent / Case Rate,361, $398.00 , $218.90 ," $1,236.00 ", $214.68 , $278.60 , $155.22 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $398.00 , $398.00 , $398.00 , $398.00 , $214.68 , $139.30 , $- , $- ," $1,236.00 ", $278.60
12013,501001545,Hospital Chargemaster,Rpr f/e/e/n/l/m 2.6-5.0 cm,Outpatient,Outpatient Default Percent / Case Rate,361, $362.00 , $199.10 , $298.29 , $214.68 , $253.40 , $141.18 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $362.00 , $362.00 , $362.00 , $362.00 , $214.68 , $126.70 , $- , $- , $844.48 , $253.40
11102,501001499,Hospital Chargemaster,Tangntl bx skin single les,Outpatient,Outpatient Default Percent / Case Rate,361, $353.00 , $194.15 ," $1,236.00 ", $214.68 , $247.10 , $137.67 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $123.55 , $- , $- ," $1,236.00 ", $247.10
12015,501001547,Hospital Chargemaster,Rpr f/e/e/n/l/m 7.6-12.5 cm,Outpatient,Outpatient Default Percent / Case Rate,361, $536.00 , $294.80 ," $1,236.00 ", $214.68 , $375.20 , $209.04 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $187.60 , $- , $- ," $1,236.00 ", $375.20
17270,501001569,Hospital Chargemaster,Destruction of skin lesions,Outpatient,Outpatient Default Percent / Case Rate,361, $446.00 , $245.30 ," $1,236.00 ", $214.68 , $312.20 , $173.94 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $156.10 , $- , $- ," $1,236.00 ", $312.20
17280,501001570,Hospital Chargemaster,Destruction of skin lesions,Outpatient,Outpatient Default Percent / Case Rate,361, $446.00 , $245.30 ," $1,236.00 ", $214.68 , $312.20 , $173.94 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $156.10 , $- , $- ," $1,236.00 ", $312.20
16025,501001562,Hospital Chargemaster,Dress/debrid p-thick burn m,Outpatient,Outpatient Default Percent / Case Rate,361, $344.00 , $189.20 ," $1,442.00 ", $214.68 , $240.80 , $134.16 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $120.40 , $- , $- ," $1,442.00 ", $240.80
12002,501001542,Hospital Chargemaster,Rpr s/n/ax/gen/trnk2.6-7.5cm,Outpatient,Outpatient Default Percent / Case Rate,361, $342.00 , $188.10 , $281.81 , $214.68 , $239.40 , $133.38 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $342.00 , $342.00 , $342.00 , $342.00 , $214.68 , $119.70 , $- , $- , $386.01 , $239.40
12001,501001541,Hospital Chargemaster,Rpr s/n/ax/gen/trnk 2.5cm/<,Outpatient,Outpatient Default Percent / Case Rate,361, $330.00 , $181.50 ," $1,236.00 ", $214.68 , $231.00 , $128.70 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $330.00 , $330.00 , $330.00 , $330.00 , $214.68 , $115.50 , $- , $- ," $1,236.00 ", $231.00
12011,501001544,Hospital Chargemaster,Rpr f/e/e/n/l/m 2.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,361, $317.00 , $174.35 , $261.21 , $214.68 , $221.90 , $123.63 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $317.00 , $317.00 , $317.00 , $317.00 , $214.68 , $110.95 , $- , $- , $844.48 , $221.90
11057,501001498,Hospital Chargemaster,Trim skin lesions over 4,Outpatient,Outpatient Default Percent / Case Rate,361, $271.00 , $149.05 ," $1,236.00 ", $214.68 , $189.70 , $105.69 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $112.55 , $109.14 , $225.42 , $218.98 , $271.00 , $271.00 , $271.00 , $271.00 , $214.68 , $94.85 , $- , $- ," $1,236.00 ", $189.70
11055,501001496,Hospital Chargemaster,Trim skin lesion,Outpatient,Outpatient Default Percent / Case Rate,361, $239.00 , $131.45 ," $1,236.00 ", $214.68 , $167.30 , $93.21 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $61.61 , $59.74 , $225.42 , $218.98 , $239.00 , $239.00 , $239.00 , $239.00 , $214.68 , $83.65 , $- , $- ," $1,236.00 ", $167.30
11200,501001505,Hospital Chargemaster,Removal of skin tags ,Outpatient,Outpatient Default Percent / Case Rate,361, $817.00 , $449.35 ," $1,236.00 ", $413.21 , $571.90 , $318.63 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $285.95 , $- , $- ," $1,236.00 ", $571.90
17106,501001567,Hospital Chargemaster,Destruction of skin lesions,Outpatient,Outpatient Default Percent / Case Rate,361, $975.00 , $536.25 ," $1,236.00 ", $413.21 , $682.50 , $380.25 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $341.25 , $- , $- ," $1,236.00 ", $682.50
16030,501001563,Hospital Chargemaster,Dress/debrid p-thick burn l,Outpatient,Outpatient Default Percent / Case Rate,361, $391.00 , $215.05 ," $1,442.00 ", $413.21 , $273.70 , $152.49 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $136.85 , $- , $- ," $1,442.00 ", $273.70
11104,501001501,Hospital Chargemaster,Punch bx skin single lesion,Outpatient,Outpatient Default Percent / Case Rate,361, $353.00 , $194.15 , $290.87 , $413.21 , $247.10 , $137.67 , $386.01 , $264.94 , $263.52 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $123.55 , $- , $- , $433.88 , $247.10
11401,501001511,Hospital Chargemaster,Exc tr-ext b9+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,361, $341.00 , $187.55 ," $1,236.00 ", $413.21 , $238.70 , $132.99 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $341.00 , $341.00 , $341.00 , $341.00 , $413.21 , $119.35 , $- , $- ," $1,236.00 ", $238.70
10160,501001487,Hospital Chargemaster,Puncture drainage of lesion,Outpatient,Outpatient Default Percent / Case Rate,361, $290.00 , $159.50 ," $1,236.00 ", $413.21 , $203.00 , $113.10 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $269.70 , $269.70 , $269.70 , $269.70 , $413.21 , $101.50 , $- , $- ," $1,236.00 ", $203.00
10120,501001485,Hospital Chargemaster,Remove foreign body,Outpatient,Outpatient Default Percent / Case Rate,361, $278.00 , $152.90 ," $1,236.00 ", $413.21 , $194.60 , $108.42 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $258.54 , $258.54 , $258.54 , $258.54 , $413.21 , $97.30 , $- , $- ," $1,236.00 ", $194.60
12041,501001548,Hospital Chargemaster,Intmd rpr n-hf/genit 2.5cm/<,Outpatient,Outpatient Default Percent / Case Rate,361, $216.00 , $118.80 ," $1,236.00 ", $413.21 , $151.20 , $84.24 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $216.00 , $216.00 , $216.00 , $216.00 , $413.21 , $75.60 , $- , $- ," $1,236.00 ", $151.20
11765,501001538,Hospital Chargemaster,Excision of nail fold toe,Outpatient,Outpatient Default Percent / Case Rate,361, $210.00 , $115.50 ," $1,236.00 ", $413.21 , $147.00 , $81.90 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $210.00 , $210.00 , $210.00 , $210.00 , $413.21 , $73.50 , $- , $- ," $1,236.00 ", $147.00
11300,501001507,Hospital Chargemaster,Shave skin lesion 0.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,361, $186.00 , $102.30 , $153.26 , $413.21 , $130.20 , $72.54 , $386.01 , $264.94 , $263.52 , $413.21 , $413.21 , $66.99 , $64.96 , $433.88 , $421.48 , $185.14 , $185.14 , $185.14 , $185.14 , $413.21 , $65.10 , $- , $- , $433.88 , $130.20
C5271,501001928,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,361, $830.00 , $894.31 ," $1,442.00 ", $626.13 , $581.00 , $323.70 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $556.93 , $556.93 , $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $290.50 , $- , $- ," $1,442.00 ", $581.00
C5275,501001932,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,361, $830.00 , $894.31 ," $1,442.00 ", $626.13 , $581.00 , $323.70 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $556.93 , $556.93 , $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $290.50 , $- , $- ," $1,442.00 ", $581.00
C5277,501001934,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,361, $960.00 , $894.31 ," $1,442.00 ", $626.13 , $672.00 , $374.40 , $926.30 , $930.34 , $837.43 , $626.13 , $626.13 , $644.16 , $644.16 , $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $336.00 , $- , $- ," $1,442.00 ", $672.00
11106,501001503,Hospital Chargemaster,Incal bx skn single les,Outpatient,Outpatient Default Percent / Case Rate,361, $628.00 , $345.40 ," $1,236.00 ", $626.13 , $439.60 , $244.92 , $687.09 , $471.59 , $469.08 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $219.80 , $- , $- ," $1,236.00 ", $439.60
11043,501001491,Hospital Chargemaster,Deb musc/fascia 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,361, $724.00 , $398.20 ," $1,442.00 ", $626.13 , $506.80 , $282.36 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $253.40 , $- , $- ," $1,442.00 ", $506.80
15852,501001559,Hospital Chargemaster,Dressing change not for burn,Outpatient,Outpatient Default Percent / Case Rate,361, $300.00 , $165.00 ," $1,236.00 ", $626.13 , $210.00 , $117.00 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $185.14 , $185.14 , $185.14 , $185.14 , $626.13 , $105.00 , $- , $- ," $1,236.00 ", $210.00
11000,501001488,Hospital Chargemaster,Debride infected skin,Outpatient,Outpatient Default Percent / Case Rate,361, $90.00 , $49.50 ," $1,236.00 ", $626.13 , $63.00 , $35.10 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $83.70 , $83.70 , $83.70 , $83.70 , $626.13 , $31.50 , $- , $- ," $1,236.00 ", $63.00
32555,501001653,Hospital Chargemaster,Aspirate pleura w/ imaging,Outpatient,Outpatient Default Percent / Case Rate,361," $1,142.00 ", $628.10 ," $1,236.00 ", $646.21 , $799.40 , $445.38 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $105.28 , $102.55 , $678.52 , $659.13 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $646.21 , $399.70 , $- , $- ," $1,356.36 ", $799.40
36589,501001702,Hospital Chargemaster,Removal tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 ", $797.50 ," $1,236.00 ", $646.21 ," $1,015.00 ", $565.50 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $844.48 , $822.61 , $678.52 , $659.13 , $740.30 , $740.30 , $740.30 , $740.30 , $646.21 , $507.50 , $- , $- ," $1,356.36 "," $1,015.00 "
36575,501001693,Hospital Chargemaster,Repair tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 ", $797.50 ," $1,442.00 ", $646.21 ," $1,015.00 ", $565.50 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 ," $1,133.44 "," $1,104.09 ", $678.52 , $659.13 , $740.30 , $740.30 , $740.30 , $740.30 , $646.21 , $507.50 , $- , $- ," $1,442.00 "," $1,015.00 "
32552,501001651,Hospital Chargemaster,Remove lung catheter,Outpatient,Outpatient Default Percent / Case Rate,361, $575.00 , $316.25 ," $1,236.00 ", $646.21 , $402.50 , $224.25 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $385.83 , $385.83 , $678.52 , $659.13 , $575.00 , $575.00 , $575.00 , $575.00 , $646.21 , $201.25 , $- , $- ," $1,356.36 ", $402.50
32554,501001652,Hospital Chargemaster,Aspirate pleura w/o imaging,Outpatient,Outpatient Default Percent / Case Rate,361, $110.00 , $60.50 ," $1,236.00 ", $646.21 , $77.00 , $42.90 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $105.28 , $102.55 , $678.52 , $659.13 , $110.00 , $110.00 , $110.00 , $110.00 , $646.21 , $38.50 , $- , $- ," $1,356.36 ", $77.00
33286,501001659,Hospital Chargemaster,Rmvl subq car rhythm mntr,Outpatient,Outpatient Default Percent / Case Rate,361," $1,800.00 ", $990.00 ," $1,236.00 ", $743.95 ," $1,260.00 ", $702.00 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $743.95 , $630.00 , $- , $- ," $1,267.38 "," $1,260.00 "
11600,501001522,Hospital Chargemaster,Exc tr-ext mal+marg 0.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,361," $1,142.00 ", $628.10 ," $1,236.00 ", $743.95 , $799.40 , $445.38 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $743.95 , $399.70 , $- , $- ," $1,267.38 ", $799.40
10005,501001471,Hospital Chargemaster,Fna bx w/us gdn 1st les,Outpatient,Outpatient Default Percent / Case Rate,361, $850.00 , $467.50 ," $1,236.00 ", $743.95 , $595.00 , $331.50 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $790.50 , $790.50 , $790.50 , $790.50 , $743.95 , $297.50 , $- , $- ," $1,267.38 ", $595.00
11621,501001526,Hospital Chargemaster,Exc s/n/h/f/g mal+mrg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,361, $817.00 , $449.35 ," $1,236.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,267.38 ", $571.90
11440,501001519,Hospital Chargemaster,Exc face-mm b9+marg 0.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,361, $817.00 , $449.35 ," $1,442.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,442.00 ", $571.90
11640,501001528,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 0.5cm<,Outpatient,Outpatient Default Percent / Case Rate,361, $817.00 , $449.35 ," $1,442.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,442.00 ", $571.90
11642,501001530,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,361, $817.00 , $449.35 ," $1,442.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,442.00 ", $571.90
11402,501001512,Hospital Chargemaster,Exc tr-ext b9+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,361, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11403,501001513,Hospital Chargemaster,Exc tr-ext b9+marg 2.1-3cm,Outpatient,Outpatient Default Percent / Case Rate,361, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11442,501001521,Hospital Chargemaster,Exc face-mm b9+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,361, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11601,501001523,Hospital Chargemaster,Exc tr-ext mal+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,361, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11622,501001527,Hospital Chargemaster,Exc s/n/h/f/g mal+mrg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,361, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11421,501001516,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,361, $630.00 , $346.50 ," $1,442.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,442.00 ", $441.00
11441,501001520,Hospital Chargemaster,Exc face-mm b9+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,361, $630.00 , $346.50 ," $1,442.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,442.00 ", $441.00
19000,501001571,Hospital Chargemaster,Drainage of breast lesion,Outpatient,Outpatient Default Percent / Case Rate,361, $590.00 , $324.50 ," $1,236.00 ", $743.95 , $413.00 , $230.10 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $590.00 , $590.00 , $590.00 , $590.00 , $743.95 , $206.50 , $- , $- ," $1,267.38 ", $413.00
11641,501001529,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,361, $558.00 , $306.90 ," $1,442.00 ", $743.95 , $390.60 , $217.62 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $558.00 , $558.00 , $558.00 , $558.00 , $743.95 , $195.30 , $- , $- ," $1,442.00 ", $390.60
10030,501001479,Hospital Chargemaster,Guide cathet fluid drainage,Outpatient,Outpatient Default Percent / Case Rate,361, $470.00 , $258.50 ," $1,442.00 ", $743.95 , $329.00 , $183.30 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $437.10 , $437.10 , $437.10 , $437.10 , $743.95 , $164.50 , $- , $- ," $1,442.00 ", $329.00
19281,501001581,Hospital Chargemaster,Perq device breast 1st imag,Outpatient,Outpatient Default Percent / Case Rate,361, $352.00 , $193.60 ," $1,442.00 ", $743.95 , $246.40 , $137.28 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $236.19 , $236.19 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $123.20 , $- , $- ," $1,442.00 ", $246.40
19283,501001583,Hospital Chargemaster,Perq dev breast 1st strtctc,Outpatient,Outpatient Default Percent / Case Rate,361, $352.00 , $193.60 ," $1,442.00 ", $743.95 , $246.40 , $137.28 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $236.19 , $236.19 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $123.20 , $- , $- ," $1,442.00 ", $246.40
19285,501001585,Hospital Chargemaster,Perq dev breast 1st us imag,Outpatient,Outpatient Default Percent / Case Rate,361, $352.00 , $193.60 ," $1,442.00 ", $743.95 , $246.40 , $137.28 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $236.19 , $236.19 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $123.20 , $- , $- ," $1,442.00 ", $246.40
11400,501001510,Hospital Chargemaster,Exc tr-ext b9+marg 0.5 cm<,Outpatient,Outpatient Default Percent / Case Rate,361, $234.00 , $128.70 ," $1,236.00 ", $743.95 , $163.80 , $91.26 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $234.00 , $234.00 , $234.00 , $234.00 , $743.95 , $81.90 , $- , $- ," $1,267.38 ", $163.80
G0260,501001936,Hospital Chargemaster,Inj for sacroiliac jt anesth,Outpatient,Outpatient Default Percent / Case Rate,361," $1,650.00 "," $1,109.00 "," $1,236.00 ", $759.14 ," $1,155.00 ", $643.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 ," $1,107.15 "," $1,107.15 ", $797.10 , $774.33 , $978.40 , $978.40 ," $1,003.60 "," $1,003.60 ", $759.14 , $577.50 , $- , $- ," $1,309.97 "," $1,155.00 "
36580,501001696,Hospital Chargemaster,Replace cvad cath,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 ", $797.50 ," $1,236.00 "," $1,681.14 "," $1,015.00 ", $565.50 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,681.14 ", $507.50 , $- , $- ," $2,392.46 "," $1,015.00 "
36597,501001706,Hospital Chargemaster,Reposition venous catheter,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 ", $797.50 ," $1,236.00 "," $1,681.14 "," $1,015.00 ", $565.50 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $105.28 , $102.55 ," $1,765.20 "," $1,714.76 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,681.14 ", $507.50 , $- , $- ," $2,392.46 "," $1,015.00 "
36584,501001700,Hospital Chargemaster,Compl rplcmt picc rs&i,Outpatient,Outpatient Default Percent / Case Rate,361," $1,400.00 ", $770.00 ," $1,236.00 "," $1,681.14 ", $980.00 , $546.00 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,681.14 ", $490.00 , $- , $- ," $2,392.46 ", $980.00
36576,501001694,Hospital Chargemaster,Repair tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 ", $797.50 ," $1,442.00 "," $1,681.14 "," $1,015.00 ", $565.50 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 "," $1,133.44 "," $1,104.09 "," $1,765.20 "," $1,714.76 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,681.14 ", $507.50 , $- , $- ," $2,392.46 "," $1,015.00 "
36590,501001703,Hospital Chargemaster,Removal tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,361," $1,142.00 ", $628.10 ," $1,236.00 "," $1,681.14 ", $799.40 , $445.38 ," $1,356.36 ", $930.94 , $925.98 ," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,681.14 ", $399.70 , $- , $- ," $1,765.20 ", $799.40
32551,501001650,Hospital Chargemaster,Insertion of chest tube,Outpatient,Outpatient Default Percent / Case Rate,361, $528.00 , $290.40 ," $1,442.00 "," $1,681.14 ", $369.60 , $205.92 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 ", $528.00 , $528.00 , $528.00 , $528.00 ," $1,681.14 ", $184.80 , $- , $- ," $2,392.46 ", $369.60
11423,501001518,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 2.1-3,Outpatient,Outpatient Default Percent / Case Rate,361," $1,483.00 ", $815.65 ," $1,236.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
11406,501001514,Hospital Chargemaster,Exc tr-ext b9+marg >4.0 cm,Outpatient,Outpatient Default Percent / Case Rate,361," $1,483.00 ", $815.65 ," $1,442.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
23065,501001618,Hospital Chargemaster,Biopsy shoulder tissues,Outpatient,Outpatient Default Percent / Case Rate,361," $2,500.00 "," $1,375.00 "," $1,236.00 "," $1,682.11 "," $1,750.00 ", $975.00 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $875.00 , $- , $- ," $3,009.07 "," $1,750.00 "
19081,501001574,Hospital Chargemaster,Bx breast 1st lesion strtctc,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 ", $797.50 ," $1,442.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
11620,501001525,Hospital Chargemaster,Exc h-f-nk-sp mal+marg 0.5/<,Outpatient,Outpatient Default Percent / Case Rate,361," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
20206,501001591,Hospital Chargemaster,Needle biopsy muscle,Outpatient,Outpatient Default Percent / Case Rate,361," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
20220,501001592,Hospital Chargemaster,Bone biopsy trocar/needle,Outpatient,Outpatient Default Percent / Case Rate,361," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
11044,501001492,Hospital Chargemaster,Deb bone 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,361," $1,004.00 ", $552.20 ," $1,442.00 "," $1,682.11 ", $702.80 , $391.56 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,004.00 "," $1,004.00 "," $1,004.00 "," $1,004.00 "," $1,682.11 ", $351.40 , $- , $- ," $3,009.07 ", $702.80
20520,501001595,Hospital Chargemaster,Removal of foreign body,Outpatient,Outpatient Default Percent / Case Rate,361," $1,483.00 ", $815.65 ," $1,442.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $740.30 , $740.30 , $740.30 , $740.30 ," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
23931,501001620,Hospital Chargemaster,Drainage of arm bursa,Outpatient,Outpatient Default Percent / Case Rate,361, $505.00 , $277.75 ," $1,442.00 "," $1,682.11 ", $353.50 , $196.95 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $505.00 , $505.00 , $505.00 , $505.00 ," $1,682.11 ", $176.75 , $- , $- ," $3,009.07 ", $353.50
11422,501001517,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,361, $400.00 , $220.00 ," $1,236.00 "," $1,682.11 ", $280.00 , $156.00 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $400.00 , $400.00 , $400.00 , $400.00 ," $1,682.11 ", $140.00 , $- , $- ," $3,009.07 ", $280.00
10140,501001486,Hospital Chargemaster,Drainage of hematoma/fluid,Outpatient,Outpatient Default Percent / Case Rate,361, $356.00 , $195.80 ," $1,236.00 "," $1,682.11 ", $249.20 , $138.84 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $331.08 , $331.08 , $331.08 , $331.08 ," $1,682.11 ", $124.60 , $- , $- ," $3,009.07 ", $249.20
11420,501001515,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 0.5/<,Outpatient,Outpatient Default Percent / Case Rate,361, $290.00 , $159.50 ," $1,442.00 "," $1,682.11 ", $203.00 , $113.10 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $290.00 , $290.00 , $290.00 , $290.00 ," $1,682.11 ", $101.50 , $- , $- ," $3,009.07 ", $203.00
20225,501001593,Hospital Chargemaster,Bone biopsy trocar/needle,Outpatient,Outpatient Default Percent / Case Rate,361, $260.00 , $143.00 ," $1,442.00 "," $1,682.11 ", $182.00 , $101.40 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $260.00 , $260.00 , $260.00 , $260.00 ," $1,682.11 ", $91.00 , $- , $- ," $3,009.07 ", $182.00
31625,501001645,Hospital Chargemaster,Bronchoscopy w/biopsy(s),Outpatient,Outpatient Default Percent / Case Rate,361," $2,540.00 "," $1,397.00 "," $1,442.00 "," $1,788.65 "," $1,778.00 ", $990.60 ," $2,995.49 "," $2,055.97 "," $2,045.01 "," $1,788.65 "," $1,788.65 ", $844.48 , $822.61 ," $1,878.08 "," $1,824.42 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $1,788.65 ", $889.00 , $- , $- ," $2,995.49 "," $1,778.00 "
31622,501001644,Hospital Chargemaster,Dx bronchoscope/wash,Outpatient,Outpatient Default Percent / Case Rate,361," $2,305.00 "," $1,267.75 "," $1,442.00 "," $1,788.65 "," $1,613.50 ", $898.95 ," $2,995.49 "," $2,055.97 "," $2,045.01 "," $1,788.65 "," $1,788.65 ", $844.48 , $822.61 ," $1,878.08 "," $1,824.42 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,788.65 ", $806.75 , $- , $- ," $2,995.49 "," $1,613.50 "
C5273,501001930,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,361," $3,100.00 "," $2,868.67 "," $1,442.00 "," $2,047.65 "," $2,170.00 "," $1,209.00 "," $2,991.19 "," $3,004.21 "," $2,686.23 "," $2,047.65 "," $2,047.65 "," $2,080.10 "," $2,080.10 "," $2,150.03 "," $2,088.60 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,047.65 "," $1,085.00 ", $- , $- ," $3,004.21 "," $2,170.00 "
15271,501001550,Hospital Chargemaster,Skin sub graft trnk/arm/leg,Outpatient,Outpatient Default Percent / Case Rate,361," $2,265.00 "," $1,245.75 "," $1,442.00 "," $2,047.65 "," $1,585.50 ", $883.35 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $792.75 , $- , $- ," $3,388.54 "," $1,585.50 "
15275,501001554,Hospital Chargemaster,Skin sub graft face/nk/hf/g,Outpatient,Outpatient Default Percent / Case Rate,361," $2,265.00 "," $1,245.75 "," $1,442.00 "," $2,047.65 "," $1,585.50 ", $883.35 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $792.75 , $- , $- ," $3,388.54 "," $1,585.50 "
15277,501001556,Hospital Chargemaster,Skn sub grft f/n/hf/g child,Outpatient,Outpatient Default Percent / Case Rate,361," $2,265.00 "," $1,245.75 "," $1,442.00 "," $2,047.65 "," $1,585.50 ", $883.35 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 ", $740.30 , $740.30 , $740.30 , $740.30 ," $2,047.65 ", $792.75 , $- , $- ," $3,388.54 "," $1,585.50 "
64590,501001899,Hospital Chargemaster,Insrt/redo pn/gastr stimul,Outpatient,Outpatient Default Percent / Case Rate,361," $6,800.00 "," $22,519.67 "," $1,442.00 "," $24,479.81 "," $4,760.00 "," $2,652.00 "," $40,924.25 "," $28,088.63 "," $27,938.88 "," $24,479.81 "," $24,479.81 "," $1,133.44 "," $1,104.09 "," $25,703.80 "," $24,969.41 "," $6,800.00 "," $6,800.00 "," $6,800.00 "," $6,800.00 "," $24,479.81 "," $2,380.00 ", $- , $- ," $40,924.25 "," $4,760.00 "
21554,501001610,Hospital Chargemaster,Exc neck tum deep 5 cm/>,Outpatient,Outpatient Default Percent / Case Rate,361," $3,285.00 "," $1,806.75 "," $2,060.00 "," $2,834.62 "," $2,299.50 "," $1,281.15 "," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,294.72 "," $1,261.20 "," $2,976.35 "," $2,891.31 "," $3,285.00 "," $3,285.00 "," $3,285.00 "," $3,285.00 "," $2,834.62 "," $1,149.75 ", $- , $- ," $5,202.81 "," $2,299.50 "
21556,501001611,Hospital Chargemaster,Exc neck tum deep < 5 cm,Outpatient,Outpatient Default Percent / Case Rate,361," $3,285.00 "," $1,806.75 "," $1,442.00 "," $2,834.62 "," $2,299.50 "," $1,281.15 "," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,133.44 "," $1,104.09 "," $2,976.35 "," $2,891.31 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,834.62 "," $1,149.75 ", $- , $- ," $5,202.81 "," $2,299.50 "
20525,501001596,Hospital Chargemaster,Removal of foreign body,Outpatient,Outpatient Default Percent / Case Rate,361," $1,915.00 "," $1,053.25 "," $2,060.00 "," $2,834.62 "," $1,340.50 ", $746.85 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,294.72 "," $1,261.20 "," $2,976.35 "," $2,891.31 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $2,834.62 ", $670.25 , $- , $- ," $5,202.81 "," $1,340.50 "
36561,501001686,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,361," $3,208.00 "," $1,764.40 "," $2,060.00 "," $3,422.34 "," $2,245.60 "," $1,251.12 "," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $3,422.34 "," $1,122.80 ", $- , $- ," $5,778.66 "," $2,245.60 "
36578,501001695,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,361," $2,629.00 "," $1,445.95 "," $1,442.00 "," $3,422.34 "," $1,840.30 "," $1,025.31 "," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,133.44 "," $1,104.09 "," $3,593.46 "," $3,490.79 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $3,422.34 ", $920.15 , $- , $- ," $5,778.66 "," $1,840.30 "
36565,501001688,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,361," $2,629.00 "," $1,445.95 "," $2,060.00 "," $3,422.34 "," $1,840.30 "," $1,025.31 "," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $3,422.34 ", $920.15 , $- , $- ," $5,778.66 "," $1,840.30 "
36582,501001698,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,361," $2,540.00 "," $1,397.00 "," $2,060.00 "," $3,422.34 "," $1,778.00 ", $990.60 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $3,422.34 ", $889.00 , $- , $- ," $5,778.66 "," $1,778.00 "
36581,501001697,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,361," $1,400.00 ", $770.00 ," $1,442.00 "," $3,422.34 ", $980.00 , $546.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,133.44 "," $1,104.09 "," $3,593.46 "," $3,490.79 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $3,422.34 ", $490.00 , $- , $- ," $5,778.66 ", $980.00
36571,501001691,Hospital Chargemaster,Insert picvad cath,Outpatient,Outpatient Default Percent / Case Rate,361," $1,400.00 ", $770.00 ," $2,060.00 "," $3,422.34 ", $980.00 , $546.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $3,422.34 ", $490.00 , $- , $- ," $5,778.66 ", $980.00
36585,501001701,Hospital Chargemaster,Replace picvad cath,Outpatient,Outpatient Default Percent / Case Rate,361," $1,400.00 ", $770.00 ," $2,060.00 "," $3,422.34 ", $980.00 , $546.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $3,422.34 ", $490.00 , $- , $- ," $5,778.66 ", $980.00
36558,501001685,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,361, $887.00 , $487.85 ," $1,442.00 "," $3,422.34 ", $620.90 , $345.93 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $887.00 , $887.00 , $887.00 , $887.00 ," $3,422.34 ", $310.45 , $- , $- ," $5,778.66 ", $620.90
36555,501001683,Hospital Chargemaster,Insert non-tunnel cv cath,Outpatient,Outpatient Default Percent / Case Rate,361, $378.00 , $207.90 ," $1,236.00 "," $3,422.34 ", $264.60 , $147.42 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $378.00 , $378.00 , $378.00 , $378.00 ," $3,422.34 ", $132.30 , $- , $- ," $3,593.46 ", $264.60
36556,501001684,Hospital Chargemaster,Insert non-tunnel cv cath,Outpatient,Outpatient Default Percent / Case Rate,361, $368.00 , $202.40 ," $1,236.00 "," $3,422.34 ", $257.60 , $143.52 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $368.00 , $368.00 , $368.00 , $368.00 ," $3,422.34 ", $128.80 , $- , $- ," $3,593.46 ", $257.60
31628,501001646,Hospital Chargemaster,Bronchoscopy/lung bx each,Outpatient,Outpatient Default Percent / Case Rate,361, $725.00 , $398.75 ," $1,442.00 "," $3,703.22 ", $507.50 , $282.75 ," $5,995.53 "," $4,115.07 "," $4,093.13 "," $3,703.22 "," $3,703.22 "," $1,133.44 "," $1,104.09 "," $3,888.38 "," $3,777.29 ", $725.00 , $725.00 , $725.00 , $725.00 ," $3,703.22 ", $253.75 , $- , $- ," $5,995.53 ", $507.50
19101,501001580,Hospital Chargemaster,Biopsy of breast open,Outpatient,Outpatient Default Percent / Case Rate,361," $1,162.00 ", $639.10 ," $1,442.00 "," $3,775.12 ", $813.40 , $453.18 ," $6,160.38 "," $4,228.21 "," $4,205.67 "," $3,775.12 "," $3,775.12 "," $1,133.44 "," $1,104.09 "," $3,963.88 "," $3,850.62 "," $1,162.00 "," $1,162.00 "," $1,162.00 "," $1,162.00 "," $3,775.12 ", $406.70 , $- , $- ," $6,160.38 ", $813.40
32550,501001649,Hospital Chargemaster,Insert pleural cath,Outpatient,Outpatient Default Percent / Case Rate,361," $3,500.00 "," $1,925.00 "," $1,442.00 "," $3,803.62 "," $2,450.00 "," $1,365.00 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 "," $2,495.36 "," $2,430.75 "," $3,993.81 "," $3,879.70 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $3,803.62 "," $1,225.00 ", $- , $- ," $6,447.63 "," $2,450.00 "
15273,501001552,Hospital Chargemaster,Skin sub grft t/arm/lg child,Outpatient,Outpatient Default Percent / Case Rate,361," $3,734.00 "," $2,053.70 "," $1,442.00 "," $4,209.66 "," $2,613.80 "," $1,456.26 "," $6,051.26 "," $4,153.32 "," $4,131.18 "," $4,209.66 "," $4,209.66 ", $844.48 , $822.61 ," $4,420.15 "," $4,293.86 ", $740.30 , $740.30 , $740.30 , $740.30 ," $4,209.66 "," $1,306.90 ", $- , $- ," $6,051.26 "," $2,613.80 "
36583,501001699,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,361," $2,540.00 "," $1,397.00 "," $2,060.00 "," $5,701.02 "," $1,778.00 ", $990.60 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 "," $1,294.72 "," $1,261.20 "," $5,986.07 "," $5,815.04 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $5,701.02 ", $889.00 , $- , $- ," $9,574.18 "," $1,778.00 "
36566,501001689,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,361," $1,915.00 "," $1,053.25 "," $2,060.00 "," $5,701.02 "," $1,340.50 ", $746.85 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 "," $1,294.72 "," $1,261.20 "," $5,986.07 "," $5,815.04 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $5,701.02 ", $670.25 , $- , $- ," $9,574.18 "," $1,340.50 "
36563,501001687,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,361," $1,125.00 ", $618.75 ," $2,060.00 "," $5,701.02 ", $787.50 , $438.75 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 "," $1,294.72 "," $1,261.20 "," $5,986.07 "," $5,815.04 "," $1,125.00 "," $1,125.00 "," $1,125.00 "," $1,125.00 "," $5,701.02 ", $393.75 , $- , $- ," $9,574.18 ", $787.50
15830,501001558,Hospital Chargemaster,Exc skin abd,Outpatient,Outpatient Default Percent / Case Rate,361," $1,023.00 ", $562.65 ," $2,060.00 "," $6,616.24 ", $716.10 , $398.97 ," $10,752.63 "," $7,380.14 "," $7,340.79 "," $6,616.24 "," $6,616.24 "," $1,294.72 "," $1,261.20 "," $6,947.05 "," $6,748.56 "," $1,023.00 "," $1,023.00 "," $1,023.00 "," $1,023.00 "," $6,616.24 ", $358.05 , $- , $- ," $10,752.63 ", $716.10
33285,501001658,Hospital Chargemaster,Insj subq car rhythm mntr,Outpatient,Outpatient Default Percent / Case Rate,361," $1,800.00 ", $990.00 ," $1,236.00 "," $9,753.71 "," $1,260.00 ", $702.00 ," $16,197.41 "," $11,117.20 "," $11,057.93 "," $9,753.71 "," $9,753.71 ", $105.28 , $102.55 ," $10,241.39 "," $9,948.78 "," $1,800.00 "," $1,800.00 "," $1,800.00 "," $1,800.00 "," $9,753.71 ", $630.00 , $- , $- ," $16,197.41 "," $1,260.00 "
64402,501001868,Hospital Chargemaster,N block inj facial,Outpatient,Outpatient Default Percent / Case Rate,361, $219.00 , $120.45 ," $2,542.04 ", See APC Packaged Rates , $153.30 , $85.41 , $211.31 , $212.23 , $112.79 , See APC Packaged Rates , See APC Packaged Rates , $146.95 , $146.95 , See APC Packaged Rates , See APC Packaged Rates , $203.67 , $203.67 , $203.67 , $203.67 , See APC Packaged Rates , $76.65 , Not Applicable , $76.65 ," $2,542.04 ", $153.30
64413,501001870,Hospital Chargemaster,N block inj cervical plexus,Outpatient,Outpatient Default Percent / Case Rate,361, $900.00 , $495.00 ," $2,542.04 ", See APC Packaged Rates , $630.00 , $351.00 , $868.41 , $872.19 , $463.52 , See APC Packaged Rates , See APC Packaged Rates , $603.90 , $603.90 , See APC Packaged Rates , See APC Packaged Rates , $837.00 , $837.00 , $837.00 , $837.00 , See APC Packaged Rates , $315.00 , Not Applicable , $315.00 ," $2,542.04 ", $630.00
64517,501001892,Hospital Chargemaster,N block inj hypogas plxs,Outpatient,Outpatient Default Percent / Case Rate,361," $3,000.00 "," $1,416.48 "," $1,442.00 ", $984.14 ," $2,100.00 "," $1,170.00 "," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $290.53 , $281.72 ," $1,033.35 "," $1,003.82 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 ", $984.14 ," $1,050.00 ", $- , $- ," $2,806.32 "," $2,100.00 "
64680,501001917,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,361," $3,000.00 "," $1,416.48 "," $1,442.00 ", $984.14 ," $2,100.00 "," $1,170.00 "," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 ," $1,133.44 "," $1,104.09 "," $1,033.35 "," $1,003.82 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 ", $984.14 ," $1,050.00 ", $- , $- ," $2,806.32 "," $2,100.00 "
49405,501001787,Hospital Chargemaster,Image cath fluid colxn visc,Outpatient,Outpatient Default Percent / Case Rate,361," $3,617.00 "," $1,989.35 "," $1,442.00 "," $1,682.11 "," $2,531.90 "," $1,410.63 "," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,294.72 "," $1,261.20 "," $1,766.22 "," $1,715.75 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $1,682.11 "," $1,265.95 ", $- , $- ," $3,009.07 "," $2,531.90 "
49406,501001788,Hospital Chargemaster,Image cath fluid peri/retro,Outpatient,Outpatient Default Percent / Case Rate,361," $3,617.00 "," $1,989.35 "," $1,442.00 "," $1,682.11 "," $2,531.90 "," $1,410.63 "," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,294.72 "," $1,261.20 "," $1,766.22 "," $1,715.75 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $1,682.11 "," $1,265.95 ", $- , $- ," $3,009.07 "," $2,531.90 "
62320,501001852,Hospital Chargemaster,Njx interlaminar crv/thrc,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $844.48 , $822.61 , $797.10 , $774.33 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
62322,501001854,Hospital Chargemaster,Njx interlaminar lmbr/sac,Outpatient,Outpatient Default Percent / Case Rate,361," $1,958.00 "," $1,076.90 "," $1,236.00 ", $759.14 ," $1,370.60 ", $763.62 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $844.48 , $822.61 , $797.10 , $774.33 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $759.14 , $685.30 , $- , $- ," $1,370.60 "," $1,370.60 "
64483,501001881,Hospital Chargemaster,Inj foramen epidural l/s,Outpatient,Outpatient Default Percent / Case Rate,361," $1,200.00 "," $1,416.48 "," $1,236.00 ", $984.14 , $840.00 , $468.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $264.05 , $256.03 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $420.00 , $- , $- ," $1,673.19 ", $840.00
64510,501001891,Hospital Chargemaster,N block stellate ganglion,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 "," $1,416.48 "," $1,236.00 ", $984.14 ," $1,015.00 ", $565.50 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $165.63 , $160.60 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $507.50 , $- , $- ," $1,673.19 "," $1,015.00 "
64600,501001900,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,361," $2,000.00 "," $1,416.48 "," $1,236.00 ", $984.14 ," $1,400.00 ", $780.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $844.48 , $822.61 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $700.00 , $- , $- ," $1,673.19 "," $1,400.00 "
64620,501001905,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,361," $2,000.00 "," $1,416.48 "," $1,236.00 ", $984.14 ," $1,400.00 ", $780.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $844.48 , $822.61 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $700.00 , $- , $- ," $1,673.19 "," $1,400.00 "
40819,501001761,Hospital Chargemaster,Excise lip or cheek fold,Outpatient,Outpatient Default Percent / Case Rate,361," $1,250.00 ", $687.50 ," $1,236.00 "," $1,617.20 ", $875.00 , $487.50 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 ", $844.48 , $822.61 ," $1,698.06 "," $1,649.55 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,617.20 ", $437.50 , $- , $- ," $2,798.18 ", $875.00
38505,501001759,Hospital Chargemaster,Needle biopsy lymph nodes,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 ", $797.50 ," $1,236.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
47000,501001769,Hospital Chargemaster,Needle biopsy of liver,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 ", $797.50 ," $1,236.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
56501,501001827,Hospital Chargemaster,Destroy vulva lesions sim,Outpatient,Outpatient Default Percent / Case Rate,361," $1,725.00 ", $948.75 ," $1,236.00 "," $2,047.65 "," $1,207.50 ", $672.75 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $105.28 , $102.55 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $603.75 , $- , $- ," $3,388.54 "," $1,207.50 "
64610,501001901,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,361," $3,000.00 "," $2,719.35 "," $1,236.00 "," $2,099.21 "," $2,100.00 "," $1,170.00 "," $3,569.06 "," $2,449.65 "," $2,436.59 "," $2,099.21 "," $2,099.21 ", $844.48 , $822.61 ," $2,204.17 "," $2,141.20 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,099.21 "," $1,050.00 ", $- , $- ," $3,569.06 "," $2,100.00 "
50434,501001806,Hospital Chargemaster,Convert nephrostomy catheter,Outpatient,Outpatient Default Percent / Case Rate,361," $1,284.00 ", $706.20 ," $1,236.00 "," $2,140.58 ", $898.80 , $500.76 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $105.28 , $102.55 ," $2,247.61 "," $2,183.39 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,140.58 ", $449.40 , $- , $- ," $3,805.91 ", $898.80
49422,501001791,Hospital Chargemaster,Remove tunneled ip cath,Outpatient,Outpatient Default Percent / Case Rate,361," $1,800.00 ", $990.00 ," $1,236.00 "," $3,422.34 "," $1,260.00 ", $702.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,422.34 ", $630.00 , $- , $- ," $5,778.66 "," $1,260.00 "
64585,501001898,Hospital Chargemaster,Revise/remove neuroelectrode,Outpatient,Outpatient Default Percent / Case Rate,361," $3,000.00 "," $5,333.39 "," $1,236.00 "," $3,916.44 "," $2,100.00 "," $1,170.00 "," $6,299.93 "," $4,324.00 "," $4,300.95 "," $3,916.44 "," $3,916.44 ", $844.48 , $822.61 ," $4,112.27 "," $3,994.77 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,916.44 "," $1,050.00 ", $- , $- ," $6,299.93 "," $2,100.00 "
64555,501001895,Hospital Chargemaster,Implant neuroelectrodes,Outpatient,Outpatient Default Percent / Case Rate,361," $6,800.00 "," $9,966.69 "," $1,236.00 "," $7,369.33 "," $4,760.00 "," $2,652.00 "," $13,080.96 "," $8,978.20 "," $8,930.34 "," $7,369.33 "," $7,369.33 "," $4,562.80 "," $4,562.80 "," $7,737.79 "," $7,516.71 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $7,369.33 "," $2,380.00 ", $- , $- ," $13,080.96 "," $4,760.00 "
64575,501001897,Hospital Chargemaster,Implant neuroelectrodes,Outpatient,Outpatient Default Percent / Case Rate,361," $6,800.00 "," $22,519.67 "," $1,236.00 "," $13,442.21 "," $4,760.00 "," $2,652.00 "," $40,924.25 "," $28,088.63 "," $27,938.88 "," $13,442.21 "," $13,442.21 ", $844.48 , $822.61 ," $14,114.33 "," $13,711.06 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $13,442.21 "," $2,380.00 ", $- , $- ," $40,924.25 "," $4,760.00 "
50432,501001804,Hospital Chargemaster,Plmt nephrostomy catheter,Outpatient,Outpatient Default Percent / Case Rate,361," $3,688.00 "," $2,028.40 "," $1,442.00 "," $2,140.58 "," $2,581.60 "," $1,438.32 "," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $105.28 , $102.55 ," $2,247.61 "," $2,183.39 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,140.58 "," $1,290.80 ", $- , $- ," $3,805.91 "," $2,581.60 "
50433,501001805,Hospital Chargemaster,Plmt nephroureteral catheter,Outpatient,Outpatient Default Percent / Case Rate,361," $3,688.00 "," $2,028.40 "," $1,442.00 "," $3,675.67 "," $2,581.60 "," $1,438.32 "," $3,805.91 "," $2,612.21 "," $2,598.29 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,290.80 ", $- , $- ," $3,859.45 "," $2,581.60 "
55700,501001825,Hospital Chargemaster,Biopsy of prostate,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 ", $797.50 ," $1,442.00 "," $2,140.58 "," $1,015.00 ", $565.50 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 "," $1,133.44 "," $1,104.09 "," $2,247.61 "," $2,183.39 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,140.58 ", $507.50 , $- , $- ," $3,805.91 "," $1,015.00 "
47533,501001775,Hospital Chargemaster,Plmt biliary drainage cath,Outpatient,Outpatient Default Percent / Case Rate,361," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $844.48 , $822.61 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
47534,501001776,Hospital Chargemaster,Plmt biliary drainage cath,Outpatient,Outpatient Default Percent / Case Rate,361," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $844.48 , $822.61 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
47535,501001777,Hospital Chargemaster,Conversion ext bil drg cath,Outpatient,Outpatient Default Percent / Case Rate,361," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $844.48 , $822.61 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
47536,501001778,Hospital Chargemaster,Exchange biliary drg cath,Outpatient,Outpatient Default Percent / Case Rate,361," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
49418,501001790,Hospital Chargemaster,Insert tun ip cath perc,Outpatient,Outpatient Default Percent / Case Rate,361," $2,860.00 "," $1,573.00 "," $1,442.00 "," $3,803.62 "," $2,002.00 "," $1,115.40 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,001.00 ", $- , $- ," $6,447.63 "," $2,002.00 "
49407,501001789,Hospital Chargemaster,Image cath fluid trns/vgnl,Outpatient,Outpatient Default Percent / Case Rate,361," $2,240.00 "," $1,232.00 "," $2,060.00 "," $1,682.11 "," $1,568.00 ", $873.60 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,294.72 "," $1,261.20 "," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $784.00 , $- , $- ," $3,009.07 "," $1,568.00 "
50693,501001810,Hospital Chargemaster,Plmt ureteral stent prq,Outpatient,Outpatient Default Percent / Case Rate,361," $5,492.00 "," $3,020.60 "," $2,060.00 "," $3,675.67 "," $3,844.40 "," $2,141.88 "," $3,805.91 "," $2,612.21 "," $2,598.29 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,922.20 ", $- , $- ," $3,859.45 "," $3,844.40 "
50694,501001811,Hospital Chargemaster,Plmt ureteral stent prq,Outpatient,Outpatient Default Percent / Case Rate,361," $5,492.00 "," $3,020.60 "," $2,060.00 "," $3,675.67 "," $3,844.40 "," $2,141.88 "," $6,402.87 "," $4,394.65 "," $4,371.22 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,922.20 ", $- , $- ," $6,402.87 "," $3,844.40 "
50695,501001812,Hospital Chargemaster,Plmt ureteral stent prq,Outpatient,Outpatient Default Percent / Case Rate,361," $5,492.00 "," $3,020.60 "," $2,060.00 "," $3,675.67 "," $3,844.40 "," $2,141.88 "," $6,402.87 "," $4,394.65 "," $4,371.22 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,922.20 ", $- , $- ," $6,402.87 "," $3,844.40 "
46040,501001766,Hospital Chargemaster,Incision of rectal abscess,Outpatient,Outpatient Default Percent / Case Rate,361," $1,185.00 ", $651.75 ," $2,060.00 "," $1,239.71 ", $829.50 , $462.15 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,294.72 "," $1,261.20 "," $1,301.70 "," $1,264.51 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,239.71 ", $414.75 , $- , $- ," $2,143.42 ", $829.50
50389,501001801,Hospital Chargemaster,Remove renal tube w/fluoro,Outpatient,Outpatient Default Percent / Case Rate,361," $1,150.00 ", $632.50 ," $1,236.00 ", $687.79 , $805.00 , $448.50 ," $1,229.98 ", $844.21 , $839.71 , $687.79 , $687.79 , $844.48 , $822.61 , $722.18 , $701.54 ," $1,150.00 "," $1,150.00 "," $1,150.00 "," $1,150.00 ", $687.79 , $402.50 , $- , $- ," $1,236.00 ", $805.00
62281,501001843,Hospital Chargemaster,Treat spinal cord lesion,Outpatient,Outpatient Default Percent / Case Rate,361," $1,142.00 ", $628.10 ," $1,236.00 ", $984.14 , $799.40 , $445.38 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $844.48 , $822.61 ," $1,033.35 "," $1,003.82 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $984.14 , $399.70 , $- , $- ," $1,673.19 ", $799.40
41115,501001762,Hospital Chargemaster,Excision of tongue fold,Outpatient,Outpatient Default Percent / Case Rate,361," $1,142.00 ", $628.10 ," $1,236.00 "," $1,617.20 ", $799.40 , $445.38 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 ", $844.48 , $822.61 ," $1,698.06 "," $1,649.55 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,617.20 ", $399.70 , $- , $- ," $2,798.18 ", $799.40
48102,501001781,Hospital Chargemaster,Needle biopsy pancreas,Outpatient,Outpatient Default Percent / Case Rate,361," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
49180,501001785,Hospital Chargemaster,Biopsy abdominal mass,Outpatient,Outpatient Default Percent / Case Rate,361," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
50200,501001799,Hospital Chargemaster,Renal biopsy perq,Outpatient,Outpatient Default Percent / Case Rate,361," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
54150,501001823,Hospital Chargemaster,Circumcision w/regionl block,Outpatient,Outpatient Default Percent / Case Rate,361," $1,142.00 ", $628.10 ," $1,236.00 "," $2,140.58 ", $799.40 , $445.38 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $844.48 , $822.61 ," $2,247.61 "," $2,183.39 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $2,140.58 ", $399.70 , $- , $- ," $3,805.91 ", $799.40
32405,501001648,Hospital Chargemaster,Percut bx lung/mediastinum,Outpatient,Outpatient Default Percent / Case Rate,361," $1,142.00 ", $628.10 ," $2,542.04 ", See APC Packaged Rates , $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 ", See APC Packaged Rates , See APC Packaged Rates , $766.28 , $766.28 , See APC Packaged Rates , See APC Packaged Rates ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", See APC Packaged Rates , $399.70 , Not Applicable , $399.70 ," $3,009.07 ", $799.40
37200,501001723,Hospital Chargemaster,Transcatheter biopsy,Outpatient,Outpatient Default Percent / Case Rate,361," $1,142.00 ", $628.10 ," $2,591.48 "," $5,701.02 ", $799.40 , $445.38 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 ", $844.48 , $822.61 ," $5,986.07 "," $5,815.04 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $5,701.02 ", $399.70 , $- , $- ," $9,574.18 ", $799.40
64415,501001871,Hospital Chargemaster,N block inj brachial plexus,Outpatient,Outpatient Default Percent / Case Rate,361, $900.00 ," $1,416.48 "," $1,236.00 ", $984.14 , $630.00 , $351.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $174.52 , $169.22 ," $1,033.35 "," $1,003.82 ", $900.00 , $900.00 , $900.00 , $900.00 , $984.14 , $315.00 , $- , $- ," $1,673.19 ", $630.00
64616,501001904,Hospital Chargemaster,Chemodenerv musc neck dyston,Outpatient,Outpatient Default Percent / Case Rate,361, $817.00 , $458.33 ," $1,236.00 ", $312.35 , $571.90 , $318.63 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $740.30 , $740.30 , $740.30 , $740.30 , $312.35 , $285.95 , $- , $- ," $1,236.00 ", $571.90
64418,501001872,Hospital Chargemaster,N block inj suprascapular,Outpatient,Outpatient Default Percent / Case Rate,361," $1,032.00 "," $1,109.00 "," $1,236.00 ", $759.14 , $722.40 , $402.48 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $178.54 , $173.12 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $361.20 , $- , $- ," $1,309.97 ", $722.40
64425,501001875,Hospital Chargemaster,N block inj ilio-ing/hypogi,Outpatient,Outpatient Default Percent / Case Rate,361, $900.00 ," $1,109.00 "," $1,236.00 ", $759.14 , $630.00 , $351.00 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $226.51 , $219.64 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $315.00 , $- , $- ," $1,309.97 ", $630.00
64642,501001911,Hospital Chargemaster,Chemodenerv 1 extremity 1-4,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 "," $1,109.00 "," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
64644,501001913,Hospital Chargemaster,Chemodenerv 1 extrem 5/> mus,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 "," $1,109.00 "," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
64646,501001915,Hospital Chargemaster,Chemodenerv trunk musc 1-5,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 "," $1,109.00 "," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
64647,501001916,Hospital Chargemaster,Chemodenerv trunk musc 6/>,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 "," $1,109.00 "," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
47537,501001779,Hospital Chargemaster,Removal biliary drg cath,Outpatient,Outpatient Default Percent / Case Rate,361," $1,182.00 ", $650.10 ," $1,236.00 ", $967.36 , $827.40 , $460.98 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $105.28 , $102.55 ," $1,015.72 ", $986.70 , $740.30 , $740.30 , $740.30 , $740.30 , $967.36 , $413.70 , $- , $- ," $1,665.99 ", $827.40
49450,501001795,Hospital Chargemaster,Replace g/c tube perc,Outpatient,Outpatient Default Percent / Case Rate,361," $2,102.00 "," $1,156.10 "," $1,236.00 ", $967.36 ," $1,471.40 ", $819.78 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $740.30 , $740.30 , $740.30 , $740.30 , $967.36 , $735.70 , $- , $- ," $1,665.99 "," $1,471.40 "
47532,501001774,Hospital Chargemaster,Injection for cholangiogram,Outpatient,Outpatient Default Percent / Case Rate,361, $709.00 , $389.95 ," $1,442.00 "," $3,803.62 ", $496.30 , $276.51 ," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 ", $709.00 , $709.00 , $709.00 , $709.00 ," $3,803.62 ", $248.15 , $- , $- ," $6,447.63 ", $496.30
56605,501001828,Hospital Chargemaster,Biopsy of vulva/perineum,Outpatient,Outpatient Default Percent / Case Rate,361, $633.00 , $348.15 ," $1,236.00 ", $757.92 , $443.10 , $246.87 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $844.48 , $822.61 , $795.81 , $773.07 , $633.00 , $633.00 , $633.00 , $633.00 , $757.92 , $221.55 , $- , $- ," $1,236.00 ", $443.10
57100,501001829,Hospital Chargemaster,Biopsy of vagina,Outpatient,Outpatient Default Percent / Case Rate,361, $633.00 , $348.15 ," $1,236.00 ", $757.92 , $443.10 , $246.87 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $105.28 , $102.55 , $795.81 , $773.07 , $633.00 , $633.00 , $633.00 , $633.00 , $757.92 , $221.55 , $- , $- ," $1,236.00 ", $443.10
38792,501001760,Hospital Chargemaster,Ra tracer id of sentinl node,Outpatient,Outpatient Default Percent / Case Rate,361, $817.00 , $449.35 ," $1,236.00 ", $450.66 , $571.90 , $318.63 , $773.31 , $530.77 , $527.94 , $450.66 , $450.66 , $105.28 , $102.55 , $473.19 , $459.67 , $581.78 , $581.78 , $596.77 , $596.77 , $450.66 , $285.95 , $- , $- ," $1,236.00 ", $571.90
60100,501001837,Hospital Chargemaster,Biopsy of thyroid,Outpatient,Outpatient Default Percent / Case Rate,361, $590.00 , $324.50 ," $1,236.00 ", $743.95 , $413.00 , $230.10 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $590.00 , $590.00 , $590.00 , $590.00 , $743.95 , $206.50 , $- , $- ," $1,267.38 ", $413.00
38220,501001756,Hospital Chargemaster,Dx bone marrow aspirations,Outpatient,Outpatient Default Percent / Case Rate,361, $590.00 , $324.50 ," $1,236.00 "," $1,682.11 ", $413.00 , $230.10 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $158.51 , $153.70 ," $1,766.22 "," $1,715.75 ", $590.00 , $590.00 , $590.00 , $590.00 ," $1,682.11 ", $206.50 , $- , $- ," $3,009.07 ", $413.00
47531,501001773,Hospital Chargemaster,Injection for cholangiogram,Outpatient,Outpatient Default Percent / Case Rate,361, $563.00 , $309.65 ," $1,236.00 "," $3,803.62 ", $394.10 , $219.57 ," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 ", $563.00 , $563.00 , $563.00 , $563.00 ," $3,803.62 ", $197.05 , $- , $- ," $6,447.63 ", $394.10
60300,501001838,Hospital Chargemaster,Aspir/inj thyroid cyst,Outpatient,Outpatient Default Percent / Case Rate,361, $506.00 , $278.30 ," $1,236.00 ", $743.95 , $354.20 , $197.34 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $506.00 , $506.00 , $506.00 , $506.00 , $743.95 , $177.10 , $- , $- ," $1,267.38 ", $354.20
64612,501001902,Hospital Chargemaster,Destroy nerve face muscle,Outpatient,Outpatient Default Percent / Case Rate,361, $446.00 , $458.33 ," $1,236.00 ", $312.35 , $312.20 , $173.94 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $446.00 , $446.00 , $446.00 , $446.00 , $312.35 , $156.10 , $- , $- ," $1,236.00 ", $312.20
47556,501001780,Hospital Chargemaster,Biliary endoscopy thru skin,Outpatient,Outpatient Default Percent / Case Rate,361, $406.00 , $223.30 ," $2,060.00 "," $6,049.19 ", $284.20 , $158.34 ," $10,054.00 "," $6,900.63 "," $6,863.84 "," $6,049.19 "," $6,049.19 "," $4,032.00 "," $3,927.60 "," $6,351.65 "," $6,170.18 ", $406.00 , $406.00 , $406.00 , $406.00 ," $6,049.19 ", $142.10 , $- , $- ," $10,054.00 ", $284.20
37212,501001725,Hospital Chargemaster,Thrombolytic venous therapy,Outpatient,Outpatient Default Percent / Case Rate,361, $400.00 , $220.00 ," $1,236.00 "," $3,422.34 ", $280.00 , $156.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $400.00 , $400.00 , $400.00 , $400.00 ," $3,422.34 ", $140.00 , $- , $- ," $5,778.66 ", $280.00
54200,501001824,Hospital Chargemaster,Treatment of penis lesion,Outpatient,Outpatient Default Percent / Case Rate,361, $375.00 , $206.25 , $309.00 , $318.13 , $262.50 , $146.25 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $205.12 , $198.90 , $334.03 , $324.49 , $375.00 , $375.00 , $375.00 , $375.00 , $318.13 , $131.25 , $- , $- , $506.26 , $262.50
49465,501001798,Hospital Chargemaster,Fluoro exam of g/colon tube,Outpatient,Outpatient Default Percent / Case Rate,361," $1,300.00 ", $715.00 ," $1,236.00 ", $275.09 , $910.00 , $507.00 , $504.38 , $346.19 , $344.34 , $275.09 , $275.09 , $872.30 , $872.30 , $288.84 , $280.59 , $343.81 , $343.81 , $343.81 , $343.81 , $275.09 , $455.00 , $- , $- ," $1,236.00 ", $910.00
64505,501001890,Hospital Chargemaster,N block spenopalatine gangl,Outpatient,Outpatient Default Percent / Case Rate,361, $645.00 , $458.33 ," $1,236.00 ", $312.35 , $451.50 , $251.55 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $199.70 , $193.64 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $225.75 , $- , $- ," $1,236.00 ", $451.50
67500,501001921,Hospital Chargemaster,Inject/treat eye socket,Outpatient,Outpatient Default Percent / Case Rate,361, $817.00 , $525.08 , $673.21 , $312.73 , $571.90 , $318.63 , $620.23 , $425.70 , $423.43 , $312.73 , $312.73 , $105.28 , $102.55 , $328.37 , $318.99 , $343.81 , $343.81 , $343.81 , $343.81 , $312.73 , $285.95 , $- , $- , $673.21 , $571.90
43752,501001764,Hospital Chargemaster,Nasal/orogastric w/tube plmt,Outpatient,Outpatient Default Percent / Case Rate,361, $334.00 , $183.70 ," $1,442.00 ", $324.46 , $233.80 , $130.26 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $334.00 , $334.00 , $334.00 , $334.00 , $324.46 , $116.90 , $- , $- ," $1,442.00 ", $233.80
56405,501001826,Hospital Chargemaster,I & d of vulva/perineum,Outpatient,Outpatient Default Percent / Case Rate,361, $331.00 , $182.05 ," $1,442.00 ", $337.17 , $231.70 , $129.09 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 ," $1,133.44 "," $1,104.09 ", $354.03 , $343.92 , $331.00 , $331.00 , $331.00 , $331.00 , $337.17 , $115.85 , $- , $- ," $1,442.00 ", $231.70
46083,501001768,Hospital Chargemaster,Incise external hemorrhoid,Outpatient,Outpatient Default Percent / Case Rate,361, $317.00 , $174.35 ," $1,236.00 ", $318.13 , $221.90 , $123.63 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $317.00 , $317.00 , $317.00 , $317.00 , $318.13 , $110.95 , $- , $- ," $1,236.00 ", $221.90
46050,501001767,Hospital Chargemaster,Incision of anal abscess,Outpatient,Outpatient Default Percent / Case Rate,361, $279.00 , $153.45 ," $1,236.00 ", $948.73 , $195.30 , $108.81 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $844.48 , $822.61 , $996.17 , $967.71 , $279.00 , $279.00 , $279.00 , $279.00 , $948.73 , $97.65 , $- , $- ," $1,629.53 ", $195.30
62270,501001839,Hospital Chargemaster,Spinal fluid tap diagnostic,Outpatient,Outpatient Default Percent / Case Rate,361, $237.00 , $130.35 ," $1,236.00 ", $759.14 , $165.90 , $92.43 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $177.96 , $172.56 , $797.10 , $774.33 , $237.00 , $237.00 , $237.00 , $237.00 , $759.14 , $82.95 , $- , $- ," $1,309.97 ", $165.90
38221,501001757,Hospital Chargemaster,Dx bone marrow biopsies,Outpatient,Outpatient Default Percent / Case Rate,361, $234.00 , $128.70 ," $1,236.00 "," $1,682.11 ", $163.80 , $91.26 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $200.58 , $194.50 ," $1,766.22 "," $1,715.75 ", $234.00 , $234.00 , $234.00 , $234.00 ," $1,682.11 ", $81.90 , $- , $- ," $3,009.07 ", $163.80
58100,501001831,Hospital Chargemaster,Biopsy of uterus lining,Outpatient,Outpatient Default Percent / Case Rate,361, $232.00 , $127.60 ," $1,236.00 ", $203.67 , $162.40 , $90.48 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $105.28 , $102.55 , $213.85 , $207.74 , $232.00 , $232.00 , $232.00 , $232.00 , $203.67 , $81.20 , $- , $- ," $1,236.00 ", $162.40
57500,501001830,Hospital Chargemaster,Biopsy of cervix,Outpatient,Outpatient Default Percent / Case Rate,361, $228.00 , $125.40 ," $1,236.00 ", $757.92 , $159.60 , $88.92 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $105.28 , $102.55 , $795.81 , $773.07 , $228.00 , $228.00 , $228.00 , $228.00 , $757.92 , $79.80 , $- , $- ," $1,236.00 ", $159.60
51703,501001819,Hospital Chargemaster,Insert bladder cath complex,Outpatient,Outpatient Default Percent / Case Rate,361, $265.00 , $145.75 ," $1,236.00 ", $166.91 , $185.50 , $103.35 , $297.41 , $204.13 , $203.04 , $166.91 , $166.91 , $196.14 , $190.19 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $92.75 , $- , $- ," $1,236.00 ", $185.50
51705,501001820,Hospital Chargemaster,Change of bladder tube,Outpatient,Outpatient Default Percent / Case Rate,361, $221.00 , $121.55 ," $1,236.00 ", $318.13 , $154.70 , $86.19 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $221.00 , $221.00 , $221.00 , $221.00 , $318.13 , $77.35 , $- , $- ," $1,236.00 ", $154.70
58300,501001832,Hospital Chargemaster,Insert intrauterine device,Outpatient,Outpatient Default Percent / Case Rate,361, $216.00 , $118.80 ," $1,236.00 ", See APC Packaged Rates , $151.20 , $84.24 , $172.06 , $118.09 , $117.46 , See APC Packaged Rates , See APC Packaged Rates , $131.39 , $127.40 , See APC Packaged Rates , See APC Packaged Rates , $216.00 , $216.00 , $216.00 , $216.00 , See APC Packaged Rates , $75.60 , $- , $- ," $1,236.00 ", $151.20
58301,501001833,Hospital Chargemaster,Remove intrauterine device,Outpatient,Outpatient Default Percent / Case Rate,361, $203.00 , $111.65 ," $1,236.00 ", $337.17 , $142.10 , $79.17 , $362.99 , $249.14 , $247.81 , $337.17 , $337.17 , $164.50 , $159.51 , $354.03 , $343.92 , $203.00 , $203.00 , $203.00 , $203.00 , $337.17 , $71.05 , $- , $- ," $1,236.00 ", $142.10
64400,501001867,Hospital Chargemaster,N block inj trigeminal,Outpatient,Outpatient Default Percent / Case Rate,361, $194.00 , $106.70 ," $1,236.00 ", $312.35 , $135.80 , $75.66 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $157.25 , $152.48 , $327.96 , $318.59 , $194.00 , $194.00 , $194.00 , $194.00 , $312.35 , $67.90 , $- , $- ," $1,236.00 ", $135.80
37191,501001719,Hospital Chargemaster,Ins endovas vena cava filtr,Outpatient,Outpatient Default Percent / Case Rate,361, $189.00 , $103.95 ," $2,060.00 "," $5,701.02 ", $132.30 , $73.71 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 ", $105.28 , $102.55 ," $5,986.07 "," $5,815.04 ", $189.00 , $189.00 , $189.00 , $189.00 ," $5,701.02 ", $66.15 , $- , $- ," $9,574.18 ", $132.30
54056,501001822,Hospital Chargemaster,Cryosurgery penis lesion(s),Outpatient,Outpatient Default Percent / Case Rate,361, $247.00 , $135.85 , $203.53 , $214.68 , $172.90 , $96.33 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $185.14 , $185.14 , $185.14 , $185.14 , $214.68 , $86.45 , $- , $- , $386.01 , $172.90
43762,501001765,Hospital Chargemaster,Rplc gtube no revj trc,Outpatient,Outpatient Default Percent / Case Rate,361, $174.00 , $95.70 ," $1,236.00 ", $318.13 , $121.80 , $67.86 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 ," $1,133.44 "," $1,104.09 ", $334.03 , $324.49 , $174.00 , $174.00 , $174.00 , $174.00 , $318.13 , $60.90 , $- , $- ," $1,236.00 ", $121.80
95971,501001926,Hospital Chargemaster,Alys smpl sp/pn npgt w/prgrm,Outpatient,Outpatient Default Percent / Case Rate,361, $645.00 , $354.75 , $531.48 , $120.02 , $451.50 , $251.55 , $288.58 , $225.54 , $247.05 , $120.02 , $120.02 , $- , $- , $126.02 , $122.42 , $161.99 , $161.99 , $166.16 , $166.16 , $120.02 , $225.75 , $- , $- , $531.48 , $451.50
38222,501001758,Hospital Chargemaster,Dx bone marrow bx & aspir,Outpatient,Outpatient Default Percent / Case Rate,361, $150.00 , $82.50 ," $1,236.00 "," $2,834.62 ", $105.00 , $58.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $2,834.62 "," $2,834.62 ", $105.28 , $102.55 ," $2,976.35 "," $2,891.31 ", $150.00 , $150.00 , $150.00 , $150.00 ," $2,834.62 ", $52.50 , $- , $- ," $3,009.07 ", $105.00
65205,501001919,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,361, $129.00 , $70.95 , $106.30 , $134.80 , $90.30 , $50.31 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $129.00 , $129.00 , $129.00 , $129.00 , $134.80 , $45.15 , $- , $- , $232.95 , $90.30
65220,501001920,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,361, $124.00 , $68.20 , $102.18 , $324.46 , $86.80 , $48.36 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $124.00 , $124.00 , $124.00 , $124.00 , $324.46 , $43.40 , $- , $- , $761.64 , $86.80
51702,501001818,Hospital Chargemaster,Insert temp bladder cath,Outpatient,Outpatient Default Percent / Case Rate,361, $98.00 , $53.90 ," $1,236.00 ", $134.80 , $68.60 , $38.22 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $73.01 , $70.79 , $141.54 , $137.50 , $98.00 , $98.00 , $98.00 , $98.00 , $134.80 , $34.30 , $- , $- ," $1,236.00 ", $68.60
69210,501001923,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,361, $97.00 , $53.35 ," $1,236.00 ", $66.55 , $67.90 , $37.83 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $65.09 , $65.09 , $69.87 , $67.88 , $97.00 , $97.00 , $97.00 , $97.00 , $66.55 , $33.95 , $- , $- ," $1,236.00 ", $67.90
49082,501001782,Hospital Chargemaster,Abd paracentesis,Outpatient,Outpatient Default Percent / Case Rate,361, $93.00 , $51.15 ," $1,442.00 ", $967.36 , $65.10 , $36.27 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $93.00 , $93.00 , $93.00 , $93.00 , $967.36 , $32.55 , $- , $- ," $1,665.99 ", $65.10
49083,501001783,Hospital Chargemaster,Abd paracentesis w/imaging,Outpatient,Outpatient Default Percent / Case Rate,361, $93.00 , $51.15 ," $1,442.00 ", $967.36 , $65.10 , $36.27 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $93.00 , $93.00 , $93.00 , $93.00 , $967.36 , $32.55 , $- , $- ," $1,665.99 ", $65.10
51701,501001817,Hospital Chargemaster,Insert bladder catheter,Outpatient,Outpatient Default Percent / Case Rate,361, $88.00 , $48.40 ," $1,236.00 ", $134.80 , $61.60 , $34.32 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $66.83 , $64.80 , $141.54 , $137.50 , $88.00 , $88.00 , $88.00 , $88.00 , $134.80 , $30.80 , $- , $- ," $1,236.00 ", $61.60
97597,501001927,Hospital Chargemaster,Rmvl devital tis 20 cm/<,Outpatient,Outpatient Default Percent / Case Rate,361, $78.00 , $326.79 ," $1,236.00 ", $214.68 , $54.60 , $30.42 , $875.52 , $556.51 , $546.42 , $214.68 , $214.68 , $126.90 , $123.05 , $225.42 , $218.98 , $78.00 , $78.00 , $78.00 , $78.00 , $214.68 , $27.30 , $- , $- ," $1,236.00 ", $54.60
69209,501001922,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,361, $25.00 , $13.75 ," $1,236.00 ", $66.55 , $17.50 , $9.75 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $16.78 , $16.78 , $69.87 , $67.88 , $25.00 , $25.00 , $25.00 , $25.00 , $66.55 , $8.75 , $- , $- ," $1,236.00 ", $17.50
82554,501001925,Hospital Chargemaster,Creatine isoforms,Outpatient,Outpatient Default Percent / Case Rate,361, $817.00 , $24.43 , $673.21 , See APC Packaged Rates , $571.90 , $318.63 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $25.86 , $25.07 , See APC Packaged Rates , See APC Packaged Rates , $20.20 , $20.20 , $20.72 , $20.72 , See APC Packaged Rates , $285.95 , $15.83 , $15.83 , $673.21 , $571.90
10006,501001472,Hospital Chargemaster,Fna bx w/us gdn ea addl,Outpatient,Outpatient Default Percent / Case Rate,361, $260.00 , $143.00 ," $1,236.00 ", See APC Packaged Rates , $182.00 , $101.40 , $159.18 , $109.25 , $108.67 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $241.80 , $241.80 , $241.80 , $241.80 , See APC Packaged Rates , $91.00 , $- , $- ," $1,236.00 ", $182.00
17003,501001565,Hospital Chargemaster,Destruct premalg les 2-14,Outpatient,Outpatient Default Percent / Case Rate,361, $239.00 , $131.45 ," $1,236.00 ", See APC Packaged Rates , $167.30 , $93.21 , $7.86 , $5.40 , $5.37 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $222.27 , $222.27 , $222.27 , $222.27 , See APC Packaged Rates , $83.65 , $- , $- ," $1,236.00 ", $167.30
C5272,501001929,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,361, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $34.41 , $23.62 , $23.49 , See APC Packaged Rates , See APC Packaged Rates , $416.02 , $416.02 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
11001,501001489,Hospital Chargemaster,Debride infected skin add-on,Outpatient,Outpatient Default Percent / Case Rate,361, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $45.41 , $31.17 , $31.00 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
15272,501001551,Hospital Chargemaster,Skin sub graft t/a/l add-on,Outpatient,Outpatient Default Percent / Case Rate,361, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $55.78 , $38.29 , $38.08 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
11732,501001535,Hospital Chargemaster,Remove nail plate add-on,Outpatient,Outpatient Default Percent / Case Rate,361, $150.00 , $82.50 ," $1,236.00 ", See APC Packaged Rates , $105.00 , $58.50 , $56.49 , $38.77 , $38.57 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $139.50 , $139.50 , $139.50 , $139.50 , See APC Packaged Rates , $52.50 , $- , $- ," $1,236.00 ", $105.00
19001,501001572,Hospital Chargemaster,Drain breast lesion add-on,Outpatient,Outpatient Default Percent / Case Rate,361, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $69.14 , $47.45 , $47.20 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
11103,501001500,Hospital Chargemaster,Tangntl bx skin ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,361, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $74.66 , $51.25 , $50.97 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
15276,501001555,Hospital Chargemaster,Skin sub graft f/n/hf/g addl,Outpatient,Outpatient Default Percent / Case Rate,361, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $81.32 , $55.82 , $55.52 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
11105,501001502,Hospital Chargemaster,Punch bx skin ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,361, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $88.21 , $60.54 , $60.22 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
11107,501001504,Hospital Chargemaster,Incal bx skn ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,361, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $105.14 , $72.16 , $71.78 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
20501,501001594,Hospital Chargemaster,Inject sinus tract for x-ray,Outpatient,Outpatient Default Percent / Case Rate,361, $900.00 , $495.00 ," $1,236.00 ", See APC Packaged Rates , $630.00 , $351.00 , $121.46 , $83.36 , $82.92 , See APC Packaged Rates , See APC Packaged Rates , $100.01 , $96.98 , See APC Packaged Rates , See APC Packaged Rates , $837.00 , $837.00 , $837.00 , $837.00 , See APC Packaged Rates , $315.00 , $- , $- ," $1,236.00 ", $630.00
27369,501001628,Hospital Chargemaster,Njx cntrst kne arthg/ct/mri,Outpatient,Outpatient Default Percent / Case Rate,361, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $130.87 , $89.82 , $89.34 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
19286,501001586,Hospital Chargemaster,Perq dev breast add us imag,Outpatient,Outpatient Default Percent / Case Rate,361, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $139.50 , $95.74 , $95.23 , See APC Packaged Rates , See APC Packaged Rates , $236.19 , $236.19 , See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
15274,501001553,Hospital Chargemaster,Skn sub grft t/a/l child add,Outpatient,Outpatient Default Percent / Case Rate,361, $830.00 , $456.50 ," $1,236.00 ", See APC Packaged Rates , $581.00 , $323.70 , $149.08 , $102.32 , $101.78 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $771.90 , $771.90 , $771.90 , $771.90 , See APC Packaged Rates , $290.50 , $- , $- ," $1,236.00 ", $581.00
19282,501001582,Hospital Chargemaster,Perq device breast ea imag,Outpatient,Outpatient Default Percent / Case Rate,361, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $162.99 , $111.87 , $111.27 , See APC Packaged Rates , See APC Packaged Rates , $236.19 , $236.19 , See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
23350,501001619,Hospital Chargemaster,Injection for shoulder x-ray,Outpatient,Outpatient Default Percent / Case Rate,361, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $164.23 , $112.72 , $112.12 , See APC Packaged Rates , See APC Packaged Rates , $119.20 , $115.58 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
11046,501001494,Hospital Chargemaster,Deb musc/fascia add-on,Outpatient,Outpatient Default Percent / Case Rate,361, $286.00 , $157.30 ," $1,236.00 ", See APC Packaged Rates , $200.20 , $111.54 , $179.86 , $123.45 , $122.79 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $265.98 , $265.98 , $265.98 , $265.98 , See APC Packaged Rates , $100.10 , $- , $- ," $1,236.00 ", $200.20
15278,501001557,Hospital Chargemaster,Skn sub grft f/n/hf/g ch add,Outpatient,Outpatient Default Percent / Case Rate,361, $830.00 , $456.50 ," $1,236.00 ", See APC Packaged Rates , $581.00 , $323.70 , $186.21 , $127.81 , $127.13 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $771.90 , $771.90 , $771.90 , $771.90 , See APC Packaged Rates , $290.50 , $- , $- ," $1,236.00 ", $581.00
58340,501001834,Hospital Chargemaster,Catheter for hysterography,Outpatient,Outpatient Default Percent / Case Rate,361, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $186.80 , $128.21 , $127.53 , See APC Packaged Rates , See APC Packaged Rates , $145.67 , $141.25 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
24220,501001621,Hospital Chargemaster,Injection for elbow x-ray,Outpatient,Outpatient Default Percent / Case Rate,361, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $218.10 , $149.70 , $148.90 , See APC Packaged Rates , See APC Packaged Rates , $157.37 , $152.59 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
27093,501001625,Hospital Chargemaster,Injection for hip x-ray,Outpatient,Outpatient Default Percent / Case Rate,361, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $225.37 , $154.68 , $153.86 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
50690,501001809,Hospital Chargemaster,Injection for ureter x-ray,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 ", $797.50 ," $1,236.00 ", See APC Packaged Rates ," $1,015.00 ", $565.50 , $229.10 , $157.24 , $156.41 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,348.50 "," $1,348.50 "," $1,348.50 "," $1,348.50 ", See APC Packaged Rates , $507.50 , $- , $- ," $1,348.50 "," $1,015.00 "
64643,501001912,Hospital Chargemaster,Chemodenerv 1 extrem 1-4 ea,Outpatient,Outpatient Default Percent / Case Rate,361, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $233.96 , $160.58 , $159.72 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
25246,501001623,Hospital Chargemaster,Injection for wrist x-ray,Outpatient,Outpatient Default Percent / Case Rate,361, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $241.52 , $165.77 , $164.88 , See APC Packaged Rates , See APC Packaged Rates , $548.21 , $548.21 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
19084,501001577,Hospital Chargemaster,Bx breast add lesion us imag,Outpatient,Outpatient Default Percent / Case Rate,361, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $254.49 , $174.67 , $173.74 , See APC Packaged Rates , See APC Packaged Rates ," $1,133.44 "," $1,104.09 ", See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
64645,501001914,Hospital Chargemaster,Chemodenerv 1 extrem 5/> ea,Outpatient,Outpatient Default Percent / Case Rate,361, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $269.68 , $185.09 , $184.11 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
27095,501001626,Hospital Chargemaster,Injection for hip x-ray,Outpatient,Outpatient Default Percent / Case Rate,361, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $270.59 , $185.72 , $184.73 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
19082,501001575,Hospital Chargemaster,Bx breast add lesion strtctc,Outpatient,Outpatient Default Percent / Case Rate,361, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $272.37 , $186.94 , $185.95 , See APC Packaged Rates , See APC Packaged Rates ," $1,133.44 "," $1,104.09 ", See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
62284,501001845,Hospital Chargemaster,Injection for myelogram,Outpatient,Outpatient Default Percent / Case Rate,361," $1,500.00 ", $825.00 ," $1,236.00 ", See APC Packaged Rates ," $1,050.00 ", $585.00 , $285.96 , $196.27 , $195.22 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,395.00 "," $1,395.00 "," $1,395.00 "," $1,395.00 ", See APC Packaged Rates , $525.00 , $- , $- ," $1,395.00 "," $1,050.00 "
11047,501001495,Hospital Chargemaster,Deb bone add-on,Outpatient,Outpatient Default Percent / Case Rate,361, $286.00 , $157.30 ," $1,236.00 ", See APC Packaged Rates , $200.20 , $111.54 , $318.48 , $218.59 , $217.42 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $265.98 , $265.98 , $265.98 , $265.98 , See APC Packaged Rates , $100.10 , $- , $- ," $1,236.00 ", $200.20
47001,501001770,Hospital Chargemaster,Needle biopsy liver add-on,Outpatient,Outpatient Default Percent / Case Rate,361, $590.00 , $324.50 ," $1,236.00 ", See APC Packaged Rates , $413.00 , $230.10 , $336.59 , $231.02 , $229.79 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $548.70 , $548.70 , $548.70 , $548.70 , See APC Packaged Rates , $206.50 , $- , $- ," $1,236.00 ", $413.00
36010,501001661,Hospital Chargemaster,Place catheter in vein,Outpatient,Outpatient Default Percent / Case Rate,361, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $354.08 , $243.02 , $241.73 , See APC Packaged Rates , See APC Packaged Rates , $299.66 , $290.57 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
C5274,501001931,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,361, $860.00 , $473.00 ," $1,236.00 ", See APC Packaged Rates , $602.00 , $335.40 , $829.81 , $833.43 , $442.92 , See APC Packaged Rates , See APC Packaged Rates , $577.06 , $577.06 , See APC Packaged Rates , See APC Packaged Rates , $799.80 , $799.80 , $799.80 , $799.80 , See APC Packaged Rates , $301.00 , $- , $- ," $1,236.00 ", $602.00
C5276,501001933,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,361, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $598.24 , $600.84 , $319.31 , See APC Packaged Rates , See APC Packaged Rates , $416.02 , $416.02 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
C5278,501001935,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,361, $830.00 , $456.50 ," $1,236.00 ", See APC Packaged Rates , $581.00 , $323.70 , $800.87 , $804.35 , $427.47 , See APC Packaged Rates , See APC Packaged Rates , $556.93 , $556.93 , See APC Packaged Rates , See APC Packaged Rates , $771.90 , $771.90 , $771.90 , $771.90 , See APC Packaged Rates , $290.50 , $- , $- ," $1,236.00 ", $581.00
36416,501001682,Hospital Chargemaster,Capillary blood draw,Outpatient,Outpatient Default Percent / Case Rate,361, $11.00 , $6.05 , $9.06 , See APC Packaged Rates , $7.70 , $4.29 , $12.68 , $8.51 , $8.15 , See APC Packaged Rates , See APC Packaged Rates , $7.38 , $7.38 , See APC Packaged Rates , See APC Packaged Rates , $10.23 , $10.23 , $10.23 , $10.23 , See APC Packaged Rates , $3.85 , $3.46 , $3.46 , $12.68 , $7.70
36410,501001681,Hospital Chargemaster,Non-routine bl draw 3/> yrs,Outpatient,Outpatient Default Percent / Case Rate,361, $9.65 , $5.31 , $7.95 , See APC Packaged Rates , $6.76 , $3.76 , $30.17 , $20.71 , $20.60 , See APC Packaged Rates , See APC Packaged Rates , $21.29 , $20.65 , See APC Packaged Rates , See APC Packaged Rates , $8.97 , $8.97 , $8.97 , $8.97 , See APC Packaged Rates , $3.38 , $- , $- , $30.17 , $6.76
11201,501001506,Hospital Chargemaster,Remove skin tags add-on,Outpatient,Outpatient Default Percent / Case Rate,361, $271.00 , $149.05 , $223.30 , See APC Packaged Rates , $189.70 , $105.69 , $54.04 , $37.09 , $36.89 , See APC Packaged Rates , See APC Packaged Rates , $38.24 , $37.08 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- , $252.03 , $189.70
51600,501001814,Hospital Chargemaster,Injection for bladder x-ray,Outpatient,Outpatient Default Percent / Case Rate,361," $1,450.00 ", $797.50 ," $1,194.80 ", See APC Packaged Rates ," $1,015.00 ", $565.50 , $143.93 , $98.79 , $98.26 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,348.50 "," $1,348.50 "," $1,348.50 "," $1,348.50 ", See APC Packaged Rates , $507.50 , $- , $- ," $1,348.50 "," $1,015.00 "
77002,501001924,Hospital Chargemaster,Needle localization by xray,Outpatient,Outpatient Default Percent / Case Rate,361, $282.00 , $155.10 , $232.37 , See APC Packaged Rates , $197.40 , $109.98 , $294.75 , $231.12 , $230.33 , See APC Packaged Rates , See APC Packaged Rates , $158.25 , $153.45 , See APC Packaged Rates , See APC Packaged Rates , $262.26 , $262.26 , $262.26 , $262.26 , See APC Packaged Rates , $98.70 , $- , $- , $294.75 , $197.40
41115,5000010019,Hospital Chargemaster,Frenulectomy,Outpatient,Outpatient Default Percent / Case Rate,361," $1,142.00 ", $628.10 ," $1,236.00 "," $1,617.20 ", $799.40 , $445.38 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 ", $844.48 , $822.61 ," $1,698.06 "," $1,649.55 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,617.20 ", $399.70 , $- , $- ," $2,798.18 ", $799.40
50430,501001802,Hospital Chargemaster,Njx px nfrosgrm &/urtrgrm,Outpatient,Outpatient Default Percent / Case Rate,361, $984.00 , $541.20 ," $1,236.00 ", $687.79 , $688.80 , $383.76 ," $1,229.98 ", $844.21 , $839.71 , $687.79 , $687.79 , $105.28 , $102.55 , $722.18 , $701.54 , $892.65 , $892.65 , $915.65 , $915.65 , $687.79 , $344.40 , $- , $- ," $1,236.00 ", $688.80
11721,501002001,Hospital Chargemaster,Debride nail 6 or more,Outpatient,Outpatient Default Percent / Case Rate,369, $239.00 , $131.45 ," $1,236.00 ", $66.55 , $167.30 , $93.21 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $185.14 , $185.14 , $185.14 , $185.14 , $66.55 , $83.65 , $- , $- ," $1,236.00 ", $167.30
11720,501002000,Hospital Chargemaster,Debride nail 1-5,Outpatient,Outpatient Default Percent / Case Rate,369, $47.00 , $25.85 ," $1,236.00 ", $66.55 , $32.90 , $18.33 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $47.00 , $47.00 , $47.00 , $47.00 , $66.55 , $16.45 , $- , $- ," $1,236.00 ", $32.90
11719,501001999,Hospital Chargemaster,Trim nail(s) any number,Outpatient,Outpatient Default Percent / Case Rate,369, $35.00 , $19.25 , $28.84 , $66.55 , $24.50 , $13.65 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $35.00 , $35.00 , $35.00 , $35.00 , $66.55 , $12.25 , $- , $- , $122.28 , $24.50
30300,501002108,Hospital Chargemaster,Remove nasal foreign body,Outpatient,Outpatient Default Percent / Case Rate,369, $384.00 , $211.20 , $316.42 , $134.80 , $268.80 , $149.76 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $343.81 , $343.81 , $343.81 , $343.81 , $134.80 , $134.40 , $- , $- , $343.81 , $268.80
11981,501002008,Hospital Chargemaster,Insert drug implant device,Outpatient,Outpatient Default Percent / Case Rate,369, $306.00 , $168.30 ," $1,236.00 ", $134.80 , $214.20 , $119.34 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $306.00 , $306.00 , $306.00 , $306.00 , $134.80 , $107.10 , $- , $- ," $1,236.00 ", $214.20
30901,501002109,Hospital Chargemaster,Control of nosebleed,Outpatient,Outpatient Default Percent / Case Rate,369, $184.00 , $101.20 ," $1,236.00 ", $134.80 , $128.80 , $71.76 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $64.40 , $- , $- ," $1,236.00 ", $128.80
30903,501002110,Hospital Chargemaster,Control of nosebleed,Outpatient,Outpatient Default Percent / Case Rate,369, $242.00 , $133.10 ," $1,236.00 ", $134.80 , $169.40 , $94.38 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $844.48 , $822.61 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $84.70 , $- , $- ," $1,236.00 ", $169.40
29130,501002102,Hospital Chargemaster,Application of finger splint,Outpatient,Outpatient Default Percent / Case Rate,369, $150.00 , $82.50 , $123.60 , $134.80 , $105.00 , $58.50 , $122.28 , $83.93 , $83.48 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $110.05 , $110.05 , $112.89 , $112.89 , $134.80 , $52.50 , $- , $- , $147.89 , $105.00
11740,501002004,Hospital Chargemaster,Drain blood from under nail,Outpatient,Outpatient Default Percent / Case Rate,369, $96.00 , $52.80 ," $1,236.00 ", $134.80 , $67.20 , $37.44 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $96.00 , $96.00 , $96.00 , $96.00 , $134.80 , $33.60 , $- , $- ," $1,236.00 ", $67.20
29581,501002106,Hospital Chargemaster,Apply multlay comprs lwr leg,Outpatient,Outpatient Default Percent / Case Rate,369, $271.00 , $149.05 , $223.30 , $168.90 , $189.70 , $105.69 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $32.27 , $31.29 , $177.35 , $172.28 , $271.00 , $271.00 , $271.00 , $271.00 , $168.90 , $94.85 , $- , $- , $294.51 , $189.70
29580,501002105,Hospital Chargemaster,Application of paste boot,Outpatient,Outpatient Default Percent / Case Rate,369, $244.00 , $134.20 , $201.06 , $168.90 , $170.80 , $95.16 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $85.40 , $- , $- , $294.51 , $170.80
29085,501002101,Hospital Chargemaster,Apply hand/wrist cast,Outpatient,Outpatient Default Percent / Case Rate,369, $197.00 , $108.35 , $162.33 , $168.90 , $137.90 , $76.83 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $266.32 , $258.23 , $177.35 , $172.28 , $197.00 , $197.00 , $197.00 , $197.00 , $168.90 , $68.95 , $- , $- , $294.51 , $137.90
12014,501002014,Hospital Chargemaster,Rpr f/e/e/n/l/m 5.1-7.5 cm,Outpatient,Outpatient Default Percent / Case Rate,369, $431.00 , $237.05 ," $1,236.00 ", $214.68 , $301.70 , $168.09 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $431.00 , $431.00 , $431.00 , $431.00 , $214.68 , $150.85 , $- , $- ," $1,236.00 ", $301.70
12004,501002011,Hospital Chargemaster,Rpr s/n/ax/gen/trk7.6-12.5cm,Outpatient,Outpatient Default Percent / Case Rate,369, $398.00 , $218.90 ," $1,236.00 ", $214.68 , $278.60 , $155.22 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $398.00 , $398.00 , $398.00 , $398.00 , $214.68 , $139.30 , $- , $- ," $1,236.00 ", $278.60
12013,501002013,Hospital Chargemaster,Rpr f/e/e/n/l/m 2.6-5.0 cm,Outpatient,Outpatient Default Percent / Case Rate,369, $362.00 , $199.10 , $298.29 , $214.68 , $253.40 , $141.18 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $362.00 , $362.00 , $362.00 , $362.00 , $214.68 , $126.70 , $- , $- , $844.48 , $253.40
11102,501001967,Hospital Chargemaster,Tangntl bx skin single les,Outpatient,Outpatient Default Percent / Case Rate,369, $353.00 , $194.15 ," $1,236.00 ", $214.68 , $247.10 , $137.67 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $123.55 , $- , $- ," $1,236.00 ", $247.10
12015,501002015,Hospital Chargemaster,Rpr f/e/e/n/l/m 7.6-12.5 cm,Outpatient,Outpatient Default Percent / Case Rate,369, $536.00 , $294.80 ," $1,236.00 ", $214.68 , $375.20 , $209.04 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $187.60 , $- , $- ," $1,236.00 ", $375.20
17270,501002037,Hospital Chargemaster,Destruction of skin lesions,Outpatient,Outpatient Default Percent / Case Rate,369, $446.00 , $245.30 ," $1,236.00 ", $214.68 , $312.20 , $173.94 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $156.10 , $- , $- ," $1,236.00 ", $312.20
17280,501002038,Hospital Chargemaster,Destruction of skin lesions,Outpatient,Outpatient Default Percent / Case Rate,369, $446.00 , $245.30 ," $1,236.00 ", $214.68 , $312.20 , $173.94 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $156.10 , $- , $- ," $1,236.00 ", $312.20
16025,501002030,Hospital Chargemaster,Dress/debrid p-thick burn m,Outpatient,Outpatient Default Percent / Case Rate,369, $344.00 , $189.20 ," $1,442.00 ", $214.68 , $240.80 , $134.16 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $120.40 , $- , $- ," $1,442.00 ", $240.80
12002,501002010,Hospital Chargemaster,Rpr s/n/ax/gen/trnk2.6-7.5cm,Outpatient,Outpatient Default Percent / Case Rate,369, $342.00 , $188.10 , $281.81 , $214.68 , $239.40 , $133.38 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $342.00 , $342.00 , $342.00 , $342.00 , $214.68 , $119.70 , $- , $- , $386.01 , $239.40
12001,501002009,Hospital Chargemaster,Rpr s/n/ax/gen/trnk 2.5cm/<,Outpatient,Outpatient Default Percent / Case Rate,369, $330.00 , $181.50 ," $1,236.00 ", $214.68 , $231.00 , $128.70 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $330.00 , $330.00 , $330.00 , $330.00 , $214.68 , $115.50 , $- , $- ," $1,236.00 ", $231.00
12011,501002012,Hospital Chargemaster,Rpr f/e/e/n/l/m 2.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,369, $317.00 , $174.35 , $261.21 , $214.68 , $221.90 , $123.63 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $317.00 , $317.00 , $317.00 , $317.00 , $214.68 , $110.95 , $- , $- , $844.48 , $221.90
11057,501001966,Hospital Chargemaster,Trim skin lesions over 4,Outpatient,Outpatient Default Percent / Case Rate,369, $271.00 , $149.05 ," $1,236.00 ", $214.68 , $189.70 , $105.69 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $112.55 , $109.14 , $225.42 , $218.98 , $271.00 , $271.00 , $271.00 , $271.00 , $214.68 , $94.85 , $- , $- ," $1,236.00 ", $189.70
11055,501001964,Hospital Chargemaster,Trim skin lesion,Outpatient,Outpatient Default Percent / Case Rate,369, $239.00 , $131.45 ," $1,236.00 ", $214.68 , $167.30 , $93.21 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $61.61 , $59.74 , $225.42 , $218.98 , $239.00 , $239.00 , $239.00 , $239.00 , $214.68 , $83.65 , $- , $- ," $1,236.00 ", $167.30
11200,501001973,Hospital Chargemaster,Removal of skin tags ,Outpatient,Outpatient Default Percent / Case Rate,369, $446.00 , $245.30 ," $1,236.00 ", $312.35 , $312.20 , $173.94 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $89.51 , $86.79 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $156.10 , $- , $- ," $1,236.00 ", $312.20
20600,501002071,Hospital Chargemaster,Drain/inj joint/bursa w/o us,Outpatient,Outpatient Default Percent / Case Rate,369, $446.00 , $245.30 ," $1,236.00 ", $312.35 , $312.20 , $173.94 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $96.34 , $93.41 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $156.10 , $- , $- ," $1,236.00 ", $312.20
20552,501002069,Hospital Chargemaster,Inj trigger point 1/2 muscl,Outpatient,Outpatient Default Percent / Case Rate,369, $446.00 , $245.30 ," $1,236.00 ", $312.35 , $312.20 , $173.94 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $80.71 , $78.26 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $156.10 , $- , $- ," $1,236.00 ", $312.20
36593,501002172,Hospital Chargemaster,Declot vascular device,Outpatient,Outpatient Default Percent / Case Rate,369, $286.00 , $157.30 ," $1,236.00 ", $381.19 , $200.20 , $111.54 , $630.87 , $433.00 , $430.69 , $381.19 , $381.19 , $81.74 , $79.26 , $400.25 , $388.81 , $286.00 , $286.00 , $286.00 , $286.00 , $381.19 , $100.10 , $- , $- ," $1,236.00 ", $200.20
11750,501002005,Hospital Chargemaster,Removal of nail bed,Outpatient,Outpatient Default Percent / Case Rate,369, $526.00 , $289.30 ," $1,236.00 ", $413.21 , $368.20 , $205.14 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $526.00 , $526.00 , $526.00 , $526.00 , $413.21 , $184.10 , $- , $- ," $1,236.00 ", $368.20
11602,501001992,Hospital Chargemaster,Exc tr-ext mal+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,369, $444.00 , $244.20 ," $1,236.00 ", $413.21 , $310.80 , $173.16 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $444.00 , $444.00 , $444.00 , $444.00 , $413.21 , $155.40 , $- , $- ," $1,236.00 ", $310.80
17004,501002034,Hospital Chargemaster,Destroy premal lesions 15/>,Outpatient,Outpatient Default Percent / Case Rate,369, $817.00 , $449.35 ," $1,236.00 ", $413.21 , $571.90 , $318.63 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $285.95 , $- , $- ," $1,236.00 ", $571.90
17106,501002035,Hospital Chargemaster,Destruction of skin lesions,Outpatient,Outpatient Default Percent / Case Rate,369, $975.00 , $536.25 ," $1,236.00 ", $413.21 , $682.50 , $380.25 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $341.25 , $- , $- ," $1,236.00 ", $682.50
16030,501002031,Hospital Chargemaster,Dress/debrid p-thick burn l,Outpatient,Outpatient Default Percent / Case Rate,369, $391.00 , $215.05 ," $1,442.00 ", $413.21 , $273.70 , $152.49 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $136.85 , $- , $- ," $1,442.00 ", $273.70
11104,501001969,Hospital Chargemaster,Punch bx skin single lesion,Outpatient,Outpatient Default Percent / Case Rate,369, $353.00 , $194.15 , $290.87 , $413.21 , $247.10 , $137.67 , $386.01 , $264.94 , $263.52 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $123.55 , $- , $- , $433.88 , $247.10
11401,501001979,Hospital Chargemaster,Exc tr-ext b9+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,369, $341.00 , $187.55 ," $1,236.00 ", $413.21 , $238.70 , $132.99 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $341.00 , $341.00 , $341.00 , $341.00 , $413.21 , $119.35 , $- , $- ," $1,236.00 ", $238.70
10160,501001955,Hospital Chargemaster,Puncture drainage of lesion,Outpatient,Outpatient Default Percent / Case Rate,369, $290.00 , $159.50 ," $1,236.00 ", $413.21 , $203.00 , $113.10 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $269.70 , $269.70 , $269.70 , $269.70 , $413.21 , $101.50 , $- , $- ," $1,236.00 ", $203.00
10120,501001953,Hospital Chargemaster,Remove foreign body,Outpatient,Outpatient Default Percent / Case Rate,369, $278.00 , $152.90 ," $1,236.00 ", $413.21 , $194.60 , $108.42 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $258.54 , $258.54 , $258.54 , $258.54 , $413.21 , $97.30 , $- , $- ," $1,236.00 ", $194.60
12041,501002016,Hospital Chargemaster,Intmd rpr n-hf/genit 2.5cm/<,Outpatient,Outpatient Default Percent / Case Rate,369, $216.00 , $118.80 ," $1,236.00 ", $413.21 , $151.20 , $84.24 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $216.00 , $216.00 , $216.00 , $216.00 , $413.21 , $75.60 , $- , $- ," $1,236.00 ", $151.20
11765,501002006,Hospital Chargemaster,Excision of nail fold toe,Outpatient,Outpatient Default Percent / Case Rate,369, $210.00 , $115.50 ," $1,236.00 ", $413.21 , $147.00 , $81.90 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $210.00 , $210.00 , $210.00 , $210.00 , $413.21 , $73.50 , $- , $- ," $1,236.00 ", $147.00
11300,501001975,Hospital Chargemaster,Shave skin lesion 0.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,369, $186.00 , $102.30 , $153.26 , $413.21 , $130.20 , $72.54 , $386.01 , $264.94 , $263.52 , $413.21 , $413.21 , $66.99 , $64.96 , $433.88 , $421.48 , $185.14 , $185.14 , $185.14 , $185.14 , $413.21 , $65.10 , $- , $- , $433.88 , $130.20
C5271,501002396,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,369, $830.00 , $894.31 ," $1,442.00 ", $626.13 , $581.00 , $323.70 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $556.93 , $556.93 , $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $290.50 , $- , $- ," $1,442.00 ", $581.00
C5275,501002400,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,369, $830.00 , $894.31 ," $1,442.00 ", $626.13 , $581.00 , $323.70 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $556.93 , $556.93 , $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $290.50 , $- , $- ," $1,442.00 ", $581.00
C5277,501002402,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,369, $960.00 , $894.31 ," $1,442.00 ", $626.13 , $672.00 , $374.40 , $926.30 , $930.34 , $837.43 , $626.13 , $626.13 , $644.16 , $644.16 , $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $336.00 , $- , $- ," $1,442.00 ", $672.00
11106,501001971,Hospital Chargemaster,Incal bx skn single les,Outpatient,Outpatient Default Percent / Case Rate,369, $628.00 , $345.40 ," $1,236.00 ", $626.13 , $439.60 , $244.92 , $687.09 , $471.59 , $469.08 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $219.80 , $- , $- ," $1,236.00 ", $439.60
11043,501001959,Hospital Chargemaster,Deb musc/fascia 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,369, $724.00 , $398.20 ," $1,442.00 ", $626.13 , $506.80 , $282.36 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $253.40 , $- , $- ," $1,442.00 ", $506.80
15852,501002027,Hospital Chargemaster,Dressing change not for burn,Outpatient,Outpatient Default Percent / Case Rate,369, $300.00 , $165.00 ," $1,236.00 ", $626.13 , $210.00 , $117.00 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $185.14 , $185.14 , $185.14 , $185.14 , $626.13 , $105.00 , $- , $- ," $1,236.00 ", $210.00
11000,501001956,Hospital Chargemaster,Debride infected skin,Outpatient,Outpatient Default Percent / Case Rate,369, $90.00 , $49.50 ," $1,236.00 ", $626.13 , $63.00 , $35.10 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $83.70 , $83.70 , $83.70 , $83.70 , $626.13 , $31.50 , $- , $- ," $1,236.00 ", $63.00
32555,501002121,Hospital Chargemaster,Aspirate pleura w/ imaging,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $1,236.00 ", $646.21 , $799.40 , $445.38 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $105.28 , $102.55 , $678.52 , $659.13 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $646.21 , $399.70 , $- , $- ," $1,356.36 ", $799.40
36589,501002170,Hospital Chargemaster,Removal tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $646.21 ," $1,015.00 ", $565.50 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $844.48 , $822.61 , $678.52 , $659.13 , $740.30 , $740.30 , $740.30 , $740.30 , $646.21 , $507.50 , $- , $- ," $1,356.36 "," $1,015.00 "
36575,501002161,Hospital Chargemaster,Repair tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,442.00 ", $646.21 ," $1,015.00 ", $565.50 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 ," $1,133.44 "," $1,104.09 ", $678.52 , $659.13 , $740.30 , $740.30 , $740.30 , $740.30 , $646.21 , $507.50 , $- , $- ," $1,442.00 "," $1,015.00 "
32552,501002119,Hospital Chargemaster,Remove lung catheter,Outpatient,Outpatient Default Percent / Case Rate,369, $575.00 , $316.25 ," $1,236.00 ", $646.21 , $402.50 , $224.25 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $385.83 , $385.83 , $678.52 , $659.13 , $575.00 , $575.00 , $575.00 , $575.00 , $646.21 , $201.25 , $- , $- ," $1,356.36 ", $402.50
32554,501002120,Hospital Chargemaster,Aspirate pleura w/o imaging,Outpatient,Outpatient Default Percent / Case Rate,369, $110.00 , $60.50 ," $1,236.00 ", $646.21 , $77.00 , $42.90 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $105.28 , $102.55 , $678.52 , $659.13 , $110.00 , $110.00 , $110.00 , $110.00 , $646.21 , $38.50 , $- , $- ," $1,356.36 ", $77.00
33286,501002127,Hospital Chargemaster,Rmvl subq car rhythm mntr,Outpatient,Outpatient Default Percent / Case Rate,369," $1,800.00 ", $990.00 ," $1,236.00 ", $743.95 ," $1,260.00 ", $702.00 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $743.95 , $630.00 , $- , $- ," $1,267.38 "," $1,260.00 "
11600,501001990,Hospital Chargemaster,Exc tr-ext mal+marg 0.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $1,236.00 ", $743.95 , $799.40 , $445.38 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $743.95 , $399.70 , $- , $- ," $1,267.38 ", $799.40
10005,501001939,Hospital Chargemaster,Fna bx w/us gdn 1st les,Outpatient,Outpatient Default Percent / Case Rate,369, $850.00 , $467.50 ," $1,236.00 ", $743.95 , $595.00 , $331.50 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $790.50 , $790.50 , $790.50 , $790.50 , $743.95 , $297.50 , $- , $- ," $1,267.38 ", $595.00
11621,501001994,Hospital Chargemaster,Exc s/n/h/f/g mal+mrg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,369, $817.00 , $449.35 ," $1,236.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,267.38 ", $571.90
11440,501001987,Hospital Chargemaster,Exc face-mm b9+marg 0.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,369, $817.00 , $449.35 ," $1,442.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,442.00 ", $571.90
11640,501001996,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 0.5cm<,Outpatient,Outpatient Default Percent / Case Rate,369, $817.00 , $449.35 ," $1,442.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,442.00 ", $571.90
11642,501001998,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,369, $817.00 , $449.35 ," $1,442.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,442.00 ", $571.90
11402,501001980,Hospital Chargemaster,Exc tr-ext b9+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,369, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11403,501001981,Hospital Chargemaster,Exc tr-ext b9+marg 2.1-3cm,Outpatient,Outpatient Default Percent / Case Rate,369, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11442,501001989,Hospital Chargemaster,Exc face-mm b9+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,369, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11601,501001991,Hospital Chargemaster,Exc tr-ext mal+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,369, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11622,501001995,Hospital Chargemaster,Exc s/n/h/f/g mal+mrg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,369, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11421,501001984,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,369, $630.00 , $346.50 ," $1,442.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,442.00 ", $441.00
11441,501001988,Hospital Chargemaster,Exc face-mm b9+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,369, $630.00 , $346.50 ," $1,442.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,442.00 ", $441.00
19000,501002039,Hospital Chargemaster,Drainage of breast lesion,Outpatient,Outpatient Default Percent / Case Rate,369, $590.00 , $324.50 ," $1,236.00 ", $743.95 , $413.00 , $230.10 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $590.00 , $590.00 , $590.00 , $590.00 , $743.95 , $206.50 , $- , $- ," $1,267.38 ", $413.00
11641,501001997,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,369, $558.00 , $306.90 ," $1,442.00 ", $743.95 , $390.60 , $217.62 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $558.00 , $558.00 , $558.00 , $558.00 , $743.95 , $195.30 , $- , $- ," $1,442.00 ", $390.60
10030,501001947,Hospital Chargemaster,Guide cathet fluid drainage,Outpatient,Outpatient Default Percent / Case Rate,369, $470.00 , $258.50 ," $1,442.00 ", $743.95 , $329.00 , $183.30 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $437.10 , $437.10 , $437.10 , $437.10 , $743.95 , $164.50 , $- , $- ," $1,442.00 ", $329.00
19281,501002049,Hospital Chargemaster,Perq device breast 1st imag,Outpatient,Outpatient Default Percent / Case Rate,369, $352.00 , $193.60 ," $1,442.00 ", $743.95 , $246.40 , $137.28 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $236.19 , $236.19 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $123.20 , $- , $- ," $1,442.00 ", $246.40
19283,501002051,Hospital Chargemaster,Perq dev breast 1st strtctc,Outpatient,Outpatient Default Percent / Case Rate,369, $352.00 , $193.60 ," $1,442.00 ", $743.95 , $246.40 , $137.28 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $236.19 , $236.19 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $123.20 , $- , $- ," $1,442.00 ", $246.40
19285,501002053,Hospital Chargemaster,Perq dev breast 1st us imag,Outpatient,Outpatient Default Percent / Case Rate,369, $352.00 , $193.60 ," $1,442.00 ", $743.95 , $246.40 , $137.28 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $236.19 , $236.19 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $123.20 , $- , $- ," $1,442.00 ", $246.40
11400,501001978,Hospital Chargemaster,Exc tr-ext b9+marg 0.5 cm<,Outpatient,Outpatient Default Percent / Case Rate,369, $234.00 , $128.70 ," $1,236.00 ", $743.95 , $163.80 , $91.26 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $234.00 , $234.00 , $234.00 , $234.00 , $743.95 , $81.90 , $- , $- ," $1,267.38 ", $163.80
G0260,501002404,Hospital Chargemaster,Inj for sacroiliac jt anesth,Outpatient,Outpatient Default Percent / Case Rate,369," $1,650.00 "," $1,109.00 "," $1,236.00 ", $759.14 ," $1,155.00 ", $643.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 ," $1,107.15 "," $1,107.15 ", $797.10 , $774.33 , $978.40 , $978.40 ," $1,003.60 "," $1,003.60 ", $759.14 , $577.50 , $- , $- ," $1,309.97 "," $1,155.00 "
36580,501002164,Hospital Chargemaster,Replace cvad cath,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 "," $1,681.14 "," $1,015.00 ", $565.50 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,681.14 ", $507.50 , $- , $- ," $2,392.46 "," $1,015.00 "
36597,501002174,Hospital Chargemaster,Reposition venous catheter,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 "," $1,681.14 "," $1,015.00 ", $565.50 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $105.28 , $102.55 ," $1,765.20 "," $1,714.76 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,681.14 ", $507.50 , $- , $- ," $2,392.46 "," $1,015.00 "
36584,501002168,Hospital Chargemaster,Compl rplcmt picc rs&i,Outpatient,Outpatient Default Percent / Case Rate,369," $1,400.00 ", $770.00 ," $1,236.00 "," $1,681.14 ", $980.00 , $546.00 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,681.14 ", $490.00 , $- , $- ," $2,392.46 ", $980.00
36576,501002162,Hospital Chargemaster,Repair tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,442.00 "," $1,681.14 "," $1,015.00 ", $565.50 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 "," $1,133.44 "," $1,104.09 "," $1,765.20 "," $1,714.76 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,681.14 ", $507.50 , $- , $- ," $2,392.46 "," $1,015.00 "
36590,501002171,Hospital Chargemaster,Removal tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $1,236.00 "," $1,681.14 ", $799.40 , $445.38 ," $1,356.36 ", $930.94 , $925.98 ," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,681.14 ", $399.70 , $- , $- ," $1,765.20 ", $799.40
32551,501002118,Hospital Chargemaster,Insertion of chest tube,Outpatient,Outpatient Default Percent / Case Rate,369, $528.00 , $290.40 ," $1,442.00 "," $1,681.14 ", $369.60 , $205.92 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 ", $528.00 , $528.00 , $528.00 , $528.00 ," $1,681.14 ", $184.80 , $- , $- ," $2,392.46 ", $369.60
11423,501001986,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 2.1-3,Outpatient,Outpatient Default Percent / Case Rate,369," $1,483.00 ", $815.65 ," $1,236.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
11406,501001982,Hospital Chargemaster,Exc tr-ext b9+marg >4.0 cm,Outpatient,Outpatient Default Percent / Case Rate,369," $1,483.00 ", $815.65 ," $1,442.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
23065,501002086,Hospital Chargemaster,Biopsy shoulder tissues,Outpatient,Outpatient Default Percent / Case Rate,369," $2,500.00 "," $1,375.00 "," $1,236.00 "," $1,682.11 "," $1,750.00 ", $975.00 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $875.00 , $- , $- ," $3,009.07 "," $1,750.00 "
19081,501002042,Hospital Chargemaster,Bx breast 1st lesion strtctc,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,442.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
19083,501002044,Hospital Chargemaster,Bx breast 1st lesion us imag,Outpatient,Outpatient Default Percent / Case Rate,369," $2,267.00 "," $1,246.85 "," $1,442.00 "," $1,682.11 "," $1,586.90 ", $884.13 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $793.45 , $- , $- ," $3,009.07 "," $1,586.90 "
11620,501001993,Hospital Chargemaster,Exc h-f-nk-sp mal+marg 0.5/<,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
20206,501002059,Hospital Chargemaster,Needle biopsy muscle,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
20220,501002060,Hospital Chargemaster,Bone biopsy trocar/needle,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
11044,501001960,Hospital Chargemaster,Deb bone 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,369," $1,004.00 ", $552.20 ," $1,442.00 "," $1,682.11 ", $702.80 , $391.56 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,004.00 "," $1,004.00 "," $1,004.00 "," $1,004.00 "," $1,682.11 ", $351.40 , $- , $- ," $3,009.07 ", $702.80
20520,501002063,Hospital Chargemaster,Removal of foreign body,Outpatient,Outpatient Default Percent / Case Rate,369," $1,483.00 ", $815.65 ," $1,442.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $740.30 , $740.30 , $740.30 , $740.30 ," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
23931,501002088,Hospital Chargemaster,Drainage of arm bursa,Outpatient,Outpatient Default Percent / Case Rate,369, $505.00 , $277.75 ," $1,442.00 "," $1,682.11 ", $353.50 , $196.95 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $505.00 , $505.00 , $505.00 , $505.00 ," $1,682.11 ", $176.75 , $- , $- ," $3,009.07 ", $353.50
11422,501001985,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,369, $400.00 , $220.00 ," $1,236.00 "," $1,682.11 ", $280.00 , $156.00 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $400.00 , $400.00 , $400.00 , $400.00 ," $1,682.11 ", $140.00 , $- , $- ," $3,009.07 ", $280.00
10140,501001954,Hospital Chargemaster,Drainage of hematoma/fluid,Outpatient,Outpatient Default Percent / Case Rate,369, $356.00 , $195.80 ," $1,236.00 "," $1,682.11 ", $249.20 , $138.84 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $331.08 , $331.08 , $331.08 , $331.08 ," $1,682.11 ", $124.60 , $- , $- ," $3,009.07 ", $249.20
11420,501001983,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 0.5/<,Outpatient,Outpatient Default Percent / Case Rate,369, $290.00 , $159.50 ," $1,442.00 "," $1,682.11 ", $203.00 , $113.10 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $290.00 , $290.00 , $290.00 , $290.00 ," $1,682.11 ", $101.50 , $- , $- ," $3,009.07 ", $203.00
20225,501002061,Hospital Chargemaster,Bone biopsy trocar/needle,Outpatient,Outpatient Default Percent / Case Rate,369, $260.00 , $143.00 ," $1,442.00 "," $1,682.11 ", $182.00 , $101.40 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $260.00 , $260.00 , $260.00 , $260.00 ," $1,682.11 ", $91.00 , $- , $- ," $3,009.07 ", $182.00
63685,501002334,Hospital Chargemaster,Insrt/redo spine n generator,Outpatient,Outpatient Default Percent / Case Rate,369," $4,800.00 "," $2,640.00 "," $1,442.00 "," $35,191.71 "," $3,360.00 "," $1,872.00 "," $60,592.50 "," $41,588.05 "," $41,366.34 "," $35,191.71 "," $35,191.71 "," $1,133.44 "," $1,104.09 "," $36,951.29 "," $35,895.54 "," $4,800.00 "," $4,800.00 "," $4,800.00 "," $4,800.00 "," $35,191.71 "," $1,680.00 ", $- , $- ," $60,592.50 "," $3,360.00 "
31625,501002113,Hospital Chargemaster,Bronchoscopy w/biopsy(s),Outpatient,Outpatient Default Percent / Case Rate,369," $2,540.00 "," $1,397.00 "," $1,442.00 "," $1,788.65 "," $1,778.00 ", $990.60 ," $2,995.49 "," $2,055.97 "," $2,045.01 "," $1,788.65 "," $1,788.65 ", $844.48 , $822.61 ," $1,878.08 "," $1,824.42 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $1,788.65 ", $889.00 , $- , $- ," $2,995.49 "," $1,778.00 "
31622,501002112,Hospital Chargemaster,Dx bronchoscope/wash,Outpatient,Outpatient Default Percent / Case Rate,369," $2,305.00 "," $1,267.75 "," $1,442.00 "," $1,788.65 "," $1,613.50 ", $898.95 ," $2,995.49 "," $2,055.97 "," $2,045.01 "," $1,788.65 "," $1,788.65 ", $844.48 , $822.61 ," $1,878.08 "," $1,824.42 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,788.65 ", $806.75 , $- , $- ," $2,995.49 "," $1,613.50 "
C5273,501002398,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,369," $3,100.00 "," $2,868.67 "," $1,442.00 "," $2,047.65 "," $2,170.00 "," $1,209.00 "," $2,991.19 "," $3,004.21 "," $2,686.23 "," $2,047.65 "," $2,047.65 "," $2,080.10 "," $2,080.10 "," $2,150.03 "," $2,088.60 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,047.65 "," $1,085.00 ", $- , $- ," $3,004.21 "," $2,170.00 "
15271,501002018,Hospital Chargemaster,Skin sub graft trnk/arm/leg,Outpatient,Outpatient Default Percent / Case Rate,369," $2,265.00 "," $1,245.75 "," $1,442.00 "," $2,047.65 "," $1,585.50 ", $883.35 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $792.75 , $- , $- ," $3,388.54 "," $1,585.50 "
15275,501002022,Hospital Chargemaster,Skin sub graft face/nk/hf/g,Outpatient,Outpatient Default Percent / Case Rate,369," $2,265.00 "," $1,245.75 "," $1,442.00 "," $2,047.65 "," $1,585.50 ", $883.35 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $792.75 , $- , $- ," $3,388.54 "," $1,585.50 "
15277,501002024,Hospital Chargemaster,Skn sub grft f/n/hf/g child,Outpatient,Outpatient Default Percent / Case Rate,369," $2,265.00 "," $1,245.75 "," $1,442.00 "," $2,047.65 "," $1,585.50 ", $883.35 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 ", $740.30 , $740.30 , $740.30 , $740.30 ," $2,047.65 ", $792.75 , $- , $- ," $3,388.54 "," $1,585.50 "
64590,501002367,Hospital Chargemaster,Insrt/redo pn/gastr stimul,Outpatient,Outpatient Default Percent / Case Rate,369," $6,800.00 "," $3,740.00 "," $1,442.00 "," $24,479.81 "," $4,760.00 "," $2,652.00 "," $40,924.25 "," $28,088.63 "," $27,938.88 "," $24,479.81 "," $24,479.81 "," $1,133.44 "," $1,104.09 "," $25,703.80 "," $24,969.41 "," $6,800.00 "," $6,800.00 "," $6,800.00 "," $6,800.00 "," $24,479.81 "," $2,380.00 ", $- , $- ," $40,924.25 "," $4,760.00 "
21554,501002078,Hospital Chargemaster,Exc neck tum deep 5 cm/>,Outpatient,Outpatient Default Percent / Case Rate,369," $3,285.00 "," $1,806.75 "," $2,060.00 "," $2,834.62 "," $2,299.50 "," $1,281.15 "," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,294.72 "," $1,261.20 "," $2,976.35 "," $2,891.31 "," $3,285.00 "," $3,285.00 "," $3,285.00 "," $3,285.00 "," $2,834.62 "," $1,149.75 ", $- , $- ," $5,202.81 "," $2,299.50 "
21556,501002079,Hospital Chargemaster,Exc neck tum deep < 5 cm,Outpatient,Outpatient Default Percent / Case Rate,369," $3,285.00 "," $1,806.75 "," $1,442.00 "," $2,834.62 "," $2,299.50 "," $1,281.15 "," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,133.44 "," $1,104.09 "," $2,976.35 "," $2,891.31 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,834.62 "," $1,149.75 ", $- , $- ," $5,202.81 "," $2,299.50 "
20525,501002064,Hospital Chargemaster,Removal of foreign body,Outpatient,Outpatient Default Percent / Case Rate,369," $1,915.00 "," $1,053.25 "," $2,060.00 "," $2,834.62 "," $1,340.50 ", $746.85 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,294.72 "," $1,261.20 "," $2,976.35 "," $2,891.31 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $2,834.62 ", $670.25 , $- , $- ," $5,202.81 "," $1,340.50 "
36561,501002154,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,369," $3,208.00 "," $1,764.40 "," $2,060.00 "," $3,422.34 "," $2,245.60 "," $1,251.12 "," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $3,422.34 "," $1,122.80 ", $- , $- ," $5,778.66 "," $2,245.60 "
36578,501002163,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,369," $2,629.00 "," $1,445.95 "," $1,442.00 "," $3,422.34 "," $1,840.30 "," $1,025.31 "," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,133.44 "," $1,104.09 "," $3,593.46 "," $3,490.79 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $3,422.34 ", $920.15 , $- , $- ," $5,778.66 "," $1,840.30 "
36565,501002156,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,369," $2,629.00 "," $1,445.95 "," $2,060.00 "," $3,422.34 "," $1,840.30 "," $1,025.31 "," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $3,422.34 ", $920.15 , $- , $- ," $5,778.66 "," $1,840.30 "
36582,501002166,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,369," $2,540.00 "," $1,397.00 "," $2,060.00 "," $3,422.34 "," $1,778.00 ", $990.60 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $3,422.34 ", $889.00 , $- , $- ," $5,778.66 "," $1,778.00 "
36581,501002165,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,369," $1,400.00 ", $770.00 ," $1,442.00 "," $3,422.34 ", $980.00 , $546.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,133.44 "," $1,104.09 "," $3,593.46 "," $3,490.79 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $3,422.34 ", $490.00 , $- , $- ," $5,778.66 ", $980.00
36571,501002159,Hospital Chargemaster,Insert picvad cath,Outpatient,Outpatient Default Percent / Case Rate,369," $1,400.00 ", $770.00 ," $2,060.00 "," $3,422.34 ", $980.00 , $546.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $3,422.34 ", $490.00 , $- , $- ," $5,778.66 ", $980.00
36585,501002169,Hospital Chargemaster,Replace picvad cath,Outpatient,Outpatient Default Percent / Case Rate,369," $1,400.00 ", $770.00 ," $2,060.00 "," $3,422.34 ", $980.00 , $546.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $3,422.34 ", $490.00 , $- , $- ," $5,778.66 ", $980.00
36558,501002153,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,369, $887.00 , $487.85 ," $1,442.00 "," $3,422.34 ", $620.90 , $345.93 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $887.00 , $887.00 , $887.00 , $887.00 ," $3,422.34 ", $310.45 , $- , $- ," $5,778.66 ", $620.90
36555,501002151,Hospital Chargemaster,Insert non-tunnel cv cath,Outpatient,Outpatient Default Percent / Case Rate,369, $378.00 , $207.90 ," $1,236.00 "," $3,422.34 ", $264.60 , $147.42 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $378.00 , $378.00 , $378.00 , $378.00 ," $3,422.34 ", $132.30 , $- , $- ," $3,593.46 ", $264.60
36556,501002152,Hospital Chargemaster,Insert non-tunnel cv cath,Outpatient,Outpatient Default Percent / Case Rate,369, $368.00 , $202.40 ," $1,236.00 "," $3,422.34 ", $257.60 , $143.52 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $368.00 , $368.00 , $368.00 , $368.00 ," $3,422.34 ", $128.80 , $- , $- ," $3,593.46 ", $257.60
31628,501002114,Hospital Chargemaster,Bronchoscopy/lung bx each,Outpatient,Outpatient Default Percent / Case Rate,369, $725.00 , $398.75 ," $1,442.00 "," $3,703.22 ", $507.50 , $282.75 ," $5,995.53 "," $4,115.07 "," $4,093.13 "," $3,703.22 "," $3,703.22 "," $1,133.44 "," $1,104.09 "," $3,888.38 "," $3,777.29 ", $725.00 , $725.00 , $725.00 , $725.00 ," $3,703.22 ", $253.75 , $- , $- ," $5,995.53 ", $507.50
19101,501002048,Hospital Chargemaster,Biopsy of breast open,Outpatient,Outpatient Default Percent / Case Rate,369," $1,162.00 ", $639.10 ," $1,442.00 "," $3,775.12 ", $813.40 , $453.18 ," $6,160.38 "," $4,228.21 "," $4,205.67 "," $3,775.12 "," $3,775.12 "," $1,133.44 "," $1,104.09 "," $3,963.88 "," $3,850.62 "," $1,162.00 "," $1,162.00 "," $1,162.00 "," $1,162.00 "," $3,775.12 ", $406.70 , $- , $- ," $6,160.38 ", $813.40
32550,501002117,Hospital Chargemaster,Insert pleural cath,Outpatient,Outpatient Default Percent / Case Rate,369," $3,500.00 "," $1,925.00 "," $1,442.00 "," $3,803.62 "," $2,450.00 "," $1,365.00 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 "," $2,495.36 "," $2,430.75 "," $3,993.81 "," $3,879.70 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $3,803.62 "," $1,225.00 ", $- , $- ," $6,447.63 "," $2,450.00 "
15273,501002020,Hospital Chargemaster,Skin sub grft t/arm/lg child,Outpatient,Outpatient Default Percent / Case Rate,369," $3,734.00 "," $2,053.70 "," $1,442.00 "," $4,209.66 "," $2,613.80 "," $1,456.26 "," $6,051.26 "," $4,153.32 "," $4,131.18 "," $4,209.66 "," $4,209.66 ", $844.48 , $822.61 ," $4,420.15 "," $4,293.86 ", $740.30 , $740.30 , $740.30 , $740.30 ," $4,209.66 "," $1,306.90 ", $- , $- ," $6,051.26 "," $2,613.80 "
36583,501002167,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,369," $2,540.00 "," $1,397.00 "," $2,060.00 "," $5,701.02 "," $1,778.00 ", $990.60 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 "," $1,294.72 "," $1,261.20 "," $5,986.07 "," $5,815.04 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $5,701.02 ", $889.00 , $- , $- ," $9,574.18 "," $1,778.00 "
36566,501002157,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,369," $1,915.00 "," $1,053.25 "," $2,060.00 "," $5,701.02 "," $1,340.50 ", $746.85 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 "," $1,294.72 "," $1,261.20 "," $5,986.07 "," $5,815.04 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $5,701.02 ", $670.25 , $- , $- ," $9,574.18 "," $1,340.50 "
36563,501002155,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,369," $1,125.00 ", $618.75 ," $2,060.00 "," $5,701.02 ", $787.50 , $438.75 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 "," $1,294.72 "," $1,261.20 "," $5,986.07 "," $5,815.04 "," $1,125.00 "," $1,125.00 "," $1,125.00 "," $1,125.00 "," $5,701.02 ", $393.75 , $- , $- ," $9,574.18 ", $787.50
15830,501002026,Hospital Chargemaster,Exc skin abd,Outpatient,Outpatient Default Percent / Case Rate,369," $1,023.00 ", $562.65 ," $2,060.00 "," $6,616.24 ", $716.10 , $398.97 ," $10,752.63 "," $7,380.14 "," $7,340.79 "," $6,616.24 "," $6,616.24 "," $1,294.72 "," $1,261.20 "," $6,947.05 "," $6,748.56 "," $1,023.00 "," $1,023.00 "," $1,023.00 "," $1,023.00 "," $6,616.24 ", $358.05 , $- , $- ," $10,752.63 ", $716.10
33285,501002126,Hospital Chargemaster,Insj subq car rhythm mntr,Outpatient,Outpatient Default Percent / Case Rate,369," $1,800.00 ", $990.00 ," $1,236.00 "," $9,753.71 "," $1,260.00 ", $702.00 ," $16,197.41 "," $11,117.20 "," $11,057.93 "," $9,753.71 "," $9,753.71 ", $105.28 , $102.55 ," $10,241.39 "," $9,948.78 "," $1,800.00 "," $1,800.00 "," $1,800.00 "," $1,800.00 "," $9,753.71 ", $630.00 , $- , $- ," $16,197.41 "," $1,260.00 "
64402,501002336,Hospital Chargemaster,N block inj facial,Outpatient,Outpatient Default Percent / Case Rate,369, $219.00 , $120.45 ," $2,542.04 ", See APC Packaged Rates , $153.30 , $85.41 , $211.31 , $212.23 , $112.79 , See APC Packaged Rates , See APC Packaged Rates , $146.95 , $146.95 , See APC Packaged Rates , See APC Packaged Rates , $203.67 , $203.67 , $203.67 , $203.67 , See APC Packaged Rates , $76.65 , Not Applicable , $76.65 ," $2,542.04 ", $153.30
64413,501002338,Hospital Chargemaster,N block inj cervical plexus,Outpatient,Outpatient Default Percent / Case Rate,369, $900.00 , $495.00 ," $2,542.04 ", See APC Packaged Rates , $630.00 , $351.00 , $868.41 , $872.19 , $463.52 , See APC Packaged Rates , See APC Packaged Rates , $603.90 , $603.90 , See APC Packaged Rates , See APC Packaged Rates , $837.00 , $837.00 , $837.00 , $837.00 , See APC Packaged Rates , $315.00 , Not Applicable , $315.00 ," $2,542.04 ", $630.00
64517,501002360,Hospital Chargemaster,N block inj hypogas plxs,Outpatient,Outpatient Default Percent / Case Rate,369," $3,000.00 "," $1,650.00 "," $1,442.00 ", $984.14 ," $2,100.00 "," $1,170.00 "," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $290.53 , $281.72 ," $1,033.35 "," $1,003.82 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 ", $984.14 ," $1,050.00 ", $- , $- ," $2,806.32 "," $2,100.00 "
64680,501002385,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,369," $3,000.00 "," $1,650.00 "," $1,442.00 ", $984.14 ," $2,100.00 "," $1,170.00 "," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 ," $1,133.44 "," $1,104.09 "," $1,033.35 "," $1,003.82 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 ", $984.14 ," $1,050.00 ", $- , $- ," $2,806.32 "," $2,100.00 "
49405,501002255,Hospital Chargemaster,Image cath fluid colxn visc,Outpatient,Outpatient Default Percent / Case Rate,369," $3,617.00 "," $1,989.35 "," $1,442.00 "," $1,682.11 "," $2,531.90 "," $1,410.63 "," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,294.72 "," $1,261.20 "," $1,766.22 "," $1,715.75 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $1,682.11 "," $1,265.95 ", $- , $- ," $3,009.07 "," $2,531.90 "
49406,501002256,Hospital Chargemaster,Image cath fluid peri/retro,Outpatient,Outpatient Default Percent / Case Rate,369," $3,617.00 "," $1,989.35 "," $1,442.00 "," $1,682.11 "," $2,531.90 "," $1,410.63 "," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,294.72 "," $1,261.20 "," $1,766.22 "," $1,715.75 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $1,682.11 "," $1,265.95 ", $- , $- ," $3,009.07 "," $2,531.90 "
63650,501002333,Hospital Chargemaster,Implant neuroelectrodes,Outpatient,Outpatient Default Percent / Case Rate,369," $3,000.00 "," $1,650.00 "," $1,442.00 "," $7,369.33 "," $2,100.00 "," $1,170.00 "," $13,080.96 "," $8,978.20 "," $8,930.34 "," $7,369.33 "," $7,369.33 "," $1,133.44 "," $1,104.09 "," $7,737.79 "," $7,516.71 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $7,369.33 "," $1,050.00 ", $- , $- ," $13,080.96 "," $2,100.00 "
64490,501002352,Hospital Chargemaster,Inj paravert f jnt c/t 1 lev,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $984.14 ," $1,015.00 ", $565.50 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $272.00 , $263.75 ," $1,033.35 "," $1,003.82 "," $1,241.64 "," $1,241.64 "," $1,273.63 "," $1,273.63 ", $984.14 , $507.50 , $- , $- ," $1,673.19 "," $1,015.00 "
64493,501002355,Hospital Chargemaster,Inj paravert f jnt l/s 1 lev,Outpatient,Outpatient Default Percent / Case Rate,369," $1,433.00 ", $788.15 ," $1,236.00 ", $984.14 ," $1,003.10 ", $558.87 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $231.40 , $224.38 ," $1,033.35 "," $1,003.82 "," $1,241.64 "," $1,241.64 "," $1,273.63 "," $1,273.63 ", $984.14 , $501.55 , $- , $- ," $1,673.19 "," $1,003.10 "
62320,501002320,Hospital Chargemaster,Njx interlaminar crv/thrc,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $844.48 , $822.61 , $797.10 , $774.33 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
62321,501002321,Hospital Chargemaster,Njx interlaminar crv/thrc,Outpatient,Outpatient Default Percent / Case Rate,369," $1,958.00 "," $1,076.90 "," $1,236.00 ", $759.14 ," $1,370.60 ", $763.62 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $844.48 , $822.61 , $797.10 , $774.33 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $759.14 , $685.30 , $- , $- ," $1,370.60 "," $1,370.60 "
62322,501002322,Hospital Chargemaster,Njx interlaminar lmbr/sac,Outpatient,Outpatient Default Percent / Case Rate,369," $1,958.00 "," $1,076.90 "," $1,236.00 ", $759.14 ," $1,370.60 ", $763.62 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $844.48 , $822.61 , $797.10 , $774.33 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $759.14 , $685.30 , $- , $- ," $1,370.60 "," $1,370.60 "
62323,501002323,Hospital Chargemaster,Njx interlaminar lmbr/sac,Outpatient,Outpatient Default Percent / Case Rate,369," $1,958.00 "," $1,076.90 "," $1,236.00 ", $759.14 ," $1,370.60 ", $763.62 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $844.48 , $822.61 , $797.10 , $774.33 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $759.14 , $685.30 , $- , $- ," $1,370.60 "," $1,370.60 "
64421,501002342,Hospital Chargemaster,N block inj intercost mlt,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $984.14 ," $1,015.00 ", $565.50 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $220.26 , $213.58 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $507.50 , $- , $- ," $1,673.19 "," $1,015.00 "
64479,501002347,Hospital Chargemaster,Inj foramen epidural c/t,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $984.14 ," $1,015.00 ", $565.50 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $303.73 , $294.52 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $507.50 , $- , $- ," $1,673.19 "," $1,015.00 "
64483,501002349,Hospital Chargemaster,Inj foramen epidural l/s,Outpatient,Outpatient Default Percent / Case Rate,369," $1,200.00 ", $660.00 ," $1,236.00 ", $984.14 , $840.00 , $468.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $264.05 , $256.03 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $420.00 , $- , $- ," $1,673.19 ", $840.00
64510,501002359,Hospital Chargemaster,N block stellate ganglion,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $984.14 ," $1,015.00 ", $565.50 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $165.63 , $160.60 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $507.50 , $- , $- ," $1,673.19 "," $1,015.00 "
64530,501002362,Hospital Chargemaster,N block inj celiac pelus,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $984.14 ," $1,015.00 ", $565.50 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $220.10 , $213.42 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $507.50 , $- , $- ," $1,673.19 "," $1,015.00 "
64600,501002368,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,369," $2,000.00 "," $1,100.00 "," $1,236.00 ", $984.14 ," $1,400.00 ", $780.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $844.48 , $822.61 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $700.00 , $- , $- ," $1,673.19 "," $1,400.00 "
64620,501002373,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,369," $2,000.00 "," $1,100.00 "," $1,236.00 ", $984.14 ," $1,400.00 ", $780.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $844.48 , $822.61 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $700.00 , $- , $- ," $1,673.19 "," $1,400.00 "
64640,501002378,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $984.14 ," $1,015.00 ", $565.50 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $105.28 , $102.55 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $507.50 , $- , $- ," $1,673.19 "," $1,015.00 "
40819,501002229,Hospital Chargemaster,Excise lip or cheek fold,Outpatient,Outpatient Default Percent / Case Rate,369," $1,250.00 ", $687.50 ," $1,236.00 "," $1,617.20 ", $875.00 , $487.50 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 ", $844.48 , $822.61 ," $1,698.06 "," $1,649.55 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,617.20 ", $437.50 , $- , $- ," $2,798.18 ", $875.00
38505,501002227,Hospital Chargemaster,Needle biopsy lymph nodes,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
47000,501002237,Hospital Chargemaster,Needle biopsy of liver,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
56501,501002295,Hospital Chargemaster,Destroy vulva lesions sim,Outpatient,Outpatient Default Percent / Case Rate,369," $1,725.00 ", $948.75 ," $1,236.00 "," $2,047.65 "," $1,207.50 ", $672.75 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $105.28 , $102.55 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $603.75 , $- , $- ," $3,388.54 "," $1,207.50 "
64610,501002369,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,369," $3,000.00 "," $1,650.00 "," $1,236.00 "," $2,099.21 "," $2,100.00 "," $1,170.00 "," $3,569.06 "," $2,449.65 "," $2,436.59 "," $2,099.21 "," $2,099.21 ", $844.48 , $822.61 ," $2,204.17 "," $2,141.20 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,099.21 "," $1,050.00 ", $- , $- ," $3,569.06 "," $2,100.00 "
64633,501002374,Hospital Chargemaster,Destroy cerv/thor facet jnt,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 "," $2,099.21 "," $1,015.00 ", $565.50 ," $3,569.06 "," $2,449.65 "," $2,436.59 "," $2,099.21 "," $2,099.21 ", $844.48 , $822.61 ," $2,204.17 "," $2,141.20 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,099.21 ", $507.50 , $- , $- ," $3,569.06 "," $1,015.00 "
64635,501002376,Hospital Chargemaster,Destroy lumb/sac facet jnt,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 "," $2,099.21 "," $1,015.00 ", $565.50 ," $3,569.06 "," $2,449.65 "," $2,436.59 "," $2,099.21 "," $2,099.21 ", $105.28 , $102.55 ," $2,204.17 "," $2,141.20 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,099.21 ", $507.50 , $- , $- ," $3,569.06 "," $1,015.00 "
50434,501002274,Hospital Chargemaster,Convert nephrostomy catheter,Outpatient,Outpatient Default Percent / Case Rate,369," $1,284.00 ", $706.20 ," $1,236.00 "," $2,140.58 ", $898.80 , $500.76 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $105.28 , $102.55 ," $2,247.61 "," $2,183.39 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,140.58 ", $449.40 , $- , $- ," $3,805.91 ", $898.80
49422,501002259,Hospital Chargemaster,Remove tunneled ip cath,Outpatient,Outpatient Default Percent / Case Rate,369," $1,800.00 ", $990.00 ," $1,236.00 "," $3,422.34 "," $1,260.00 ", $702.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,422.34 ", $630.00 , $- , $- ," $5,778.66 "," $1,260.00 "
64585,501002366,Hospital Chargemaster,Revise/remove neuroelectrode,Outpatient,Outpatient Default Percent / Case Rate,369," $3,000.00 "," $1,650.00 "," $1,236.00 "," $3,916.44 "," $2,100.00 "," $1,170.00 "," $6,299.93 "," $4,324.00 "," $4,300.95 "," $3,916.44 "," $3,916.44 ", $844.48 , $822.61 ," $4,112.27 "," $3,994.77 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,916.44 "," $1,050.00 ", $- , $- ," $6,299.93 "," $2,100.00 "
64555,501002363,Hospital Chargemaster,Implant neuroelectrodes,Outpatient,Outpatient Default Percent / Case Rate,369," $6,800.00 "," $3,740.00 "," $1,236.00 "," $7,369.33 "," $4,760.00 "," $2,652.00 "," $13,080.96 "," $8,978.20 "," $8,930.34 "," $7,369.33 "," $7,369.33 "," $4,562.80 "," $4,562.80 "," $7,737.79 "," $7,516.71 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $7,369.33 "," $2,380.00 ", $- , $- ," $13,080.96 "," $4,760.00 "
64575,501002365,Hospital Chargemaster,Implant neuroelectrodes,Outpatient,Outpatient Default Percent / Case Rate,369," $6,800.00 "," $3,740.00 "," $1,236.00 "," $13,442.21 "," $4,760.00 "," $2,652.00 "," $40,924.25 "," $28,088.63 "," $27,938.88 "," $13,442.21 "," $13,442.21 ", $844.48 , $822.61 ," $14,114.33 "," $13,711.06 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $13,442.21 "," $2,380.00 ", $- , $- ," $40,924.25 "," $4,760.00 "
50432,501002272,Hospital Chargemaster,Plmt nephrostomy catheter,Outpatient,Outpatient Default Percent / Case Rate,369," $3,688.00 "," $2,028.40 "," $1,442.00 "," $2,140.58 "," $2,581.60 "," $1,438.32 "," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $105.28 , $102.55 ," $2,247.61 "," $2,183.39 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,140.58 "," $1,290.80 ", $- , $- ," $3,805.91 "," $2,581.60 "
50433,501002273,Hospital Chargemaster,Plmt nephroureteral catheter,Outpatient,Outpatient Default Percent / Case Rate,369," $3,688.00 "," $2,028.40 "," $1,442.00 "," $3,675.67 "," $2,581.60 "," $1,438.32 "," $3,805.91 "," $2,612.21 "," $2,598.29 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,290.80 ", $- , $- ," $3,859.45 "," $2,581.60 "
55700,501002293,Hospital Chargemaster,Biopsy of prostate,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,442.00 "," $2,140.58 "," $1,015.00 ", $565.50 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 "," $1,133.44 "," $1,104.09 "," $2,247.61 "," $2,183.39 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,140.58 ", $507.50 , $- , $- ," $3,805.91 "," $1,015.00 "
47533,501002243,Hospital Chargemaster,Plmt biliary drainage cath,Outpatient,Outpatient Default Percent / Case Rate,369," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $844.48 , $822.61 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
47534,501002244,Hospital Chargemaster,Plmt biliary drainage cath,Outpatient,Outpatient Default Percent / Case Rate,369," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $844.48 , $822.61 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
47535,501002245,Hospital Chargemaster,Conversion ext bil drg cath,Outpatient,Outpatient Default Percent / Case Rate,369," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $844.48 , $822.61 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
47536,501002246,Hospital Chargemaster,Exchange biliary drg cath,Outpatient,Outpatient Default Percent / Case Rate,369," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
49418,501002258,Hospital Chargemaster,Insert tun ip cath perc,Outpatient,Outpatient Default Percent / Case Rate,369," $2,860.00 "," $1,573.00 "," $1,442.00 "," $3,803.62 "," $2,002.00 "," $1,115.40 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,001.00 ", $- , $- ," $6,447.63 "," $2,002.00 "
49407,501002257,Hospital Chargemaster,Image cath fluid trns/vgnl,Outpatient,Outpatient Default Percent / Case Rate,369," $2,240.00 "," $1,232.00 "," $2,060.00 "," $1,682.11 "," $1,568.00 ", $873.60 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,294.72 "," $1,261.20 "," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $784.00 , $- , $- ," $3,009.07 "," $1,568.00 "
50693,501002278,Hospital Chargemaster,Plmt ureteral stent prq,Outpatient,Outpatient Default Percent / Case Rate,369," $5,492.00 "," $3,020.60 "," $2,060.00 "," $3,675.67 "," $3,844.40 "," $2,141.88 "," $3,805.91 "," $2,612.21 "," $2,598.29 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,922.20 ", $- , $- ," $3,859.45 "," $3,844.40 "
50694,501002279,Hospital Chargemaster,Plmt ureteral stent prq,Outpatient,Outpatient Default Percent / Case Rate,369," $5,492.00 "," $3,020.60 "," $2,060.00 "," $3,675.67 "," $3,844.40 "," $2,141.88 "," $6,402.87 "," $4,394.65 "," $4,371.22 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,922.20 ", $- , $- ," $6,402.87 "," $3,844.40 "
50695,501002280,Hospital Chargemaster,Plmt ureteral stent prq,Outpatient,Outpatient Default Percent / Case Rate,369," $5,492.00 "," $3,020.60 "," $2,060.00 "," $3,675.67 "," $3,844.40 "," $2,141.88 "," $6,402.87 "," $4,394.65 "," $4,371.22 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,922.20 ", $- , $- ," $6,402.87 "," $3,844.40 "
46040,501002234,Hospital Chargemaster,Incision of rectal abscess,Outpatient,Outpatient Default Percent / Case Rate,369," $1,185.00 ", $651.75 ," $2,060.00 "," $1,239.71 ", $829.50 , $462.15 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,294.72 "," $1,261.20 "," $1,301.70 "," $1,264.51 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,239.71 ", $414.75 , $- , $- ," $2,143.42 ", $829.50
50389,501002269,Hospital Chargemaster,Remove renal tube w/fluoro,Outpatient,Outpatient Default Percent / Case Rate,369," $1,150.00 ", $632.50 ," $1,236.00 ", $687.79 , $805.00 , $448.50 ," $1,229.98 ", $844.21 , $839.71 , $687.79 , $687.79 , $844.48 , $822.61 , $722.18 , $701.54 ," $1,150.00 "," $1,150.00 "," $1,150.00 "," $1,150.00 ", $687.79 , $402.50 , $- , $- ," $1,236.00 ", $805.00
62281,501002311,Hospital Chargemaster,Treat spinal cord lesion,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $1,236.00 ", $984.14 , $799.40 , $445.38 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $844.48 , $822.61 ," $1,033.35 "," $1,003.82 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $984.14 , $399.70 , $- , $- ," $1,673.19 ", $799.40
41115,501002230,Hospital Chargemaster,Excision of tongue fold,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $1,236.00 "," $1,617.20 ", $799.40 , $445.38 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 ", $844.48 , $822.61 ," $1,698.06 "," $1,649.55 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,617.20 ", $399.70 , $- , $- ," $2,798.18 ", $799.40
48102,501002249,Hospital Chargemaster,Needle biopsy pancreas,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
49180,501002253,Hospital Chargemaster,Biopsy abdominal mass,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
50200,501002267,Hospital Chargemaster,Renal biopsy perq,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
54150,501002291,Hospital Chargemaster,Circumcision w/regionl block,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $1,236.00 "," $2,140.58 ", $799.40 , $445.38 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $844.48 , $822.61 ," $2,247.61 "," $2,183.39 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $2,140.58 ", $399.70 , $- , $- ," $3,805.91 ", $799.40
32405,501002116,Hospital Chargemaster,Percut bx lung/mediastinum,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $2,542.04 ", See APC Packaged Rates , $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 ", See APC Packaged Rates , See APC Packaged Rates , $766.28 , $766.28 , See APC Packaged Rates , See APC Packaged Rates ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", See APC Packaged Rates , $399.70 , Not Applicable , $399.70 ," $3,009.07 ", $799.40
37200,501002191,Hospital Chargemaster,Transcatheter biopsy,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $2,591.48 "," $5,701.02 ", $799.40 , $445.38 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 ", $844.48 , $822.61 ," $5,986.07 "," $5,815.04 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $5,701.02 ", $399.70 , $- , $- ," $9,574.18 ", $799.40
64445,501002344,Hospital Chargemaster,N block inj sciatic sng,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $194.20 , $188.30 , $797.10 , $774.33 , $900.00 , $900.00 , $900.00 , $900.00 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
64415,501002339,Hospital Chargemaster,N block inj brachial plexus,Outpatient,Outpatient Default Percent / Case Rate,369, $900.00 , $495.00 ," $1,236.00 ", $984.14 , $630.00 , $351.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $174.52 , $169.22 ," $1,033.35 "," $1,003.82 ", $900.00 , $900.00 , $900.00 , $900.00 , $984.14 , $315.00 , $- , $- ," $1,673.19 ", $630.00
64616,501002372,Hospital Chargemaster,Chemodenerv musc neck dyston,Outpatient,Outpatient Default Percent / Case Rate,369, $817.00 , $449.35 ," $1,236.00 ", $312.35 , $571.90 , $318.63 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $740.30 , $740.30 , $740.30 , $740.30 , $312.35 , $285.95 , $- , $- ," $1,236.00 ", $571.90
64418,501002340,Hospital Chargemaster,N block inj suprascapular,Outpatient,Outpatient Default Percent / Case Rate,369," $1,032.00 ", $567.60 ," $1,236.00 ", $759.14 , $722.40 , $402.48 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $178.54 , $173.12 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $361.20 , $- , $- ," $1,309.97 ", $722.40
64420,501002341,Hospital Chargemaster,N block inj intercost sng,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $160.48 , $155.61 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
64425,501002343,Hospital Chargemaster,N block inj ilio-ing/hypogi,Outpatient,Outpatient Default Percent / Case Rate,369, $900.00 , $495.00 ," $1,236.00 ", $759.14 , $630.00 , $351.00 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $226.51 , $219.64 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $315.00 , $- , $- ," $1,309.97 ", $630.00
64642,501002379,Hospital Chargemaster,Chemodenerv 1 extremity 1-4,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
64644,501002381,Hospital Chargemaster,Chemodenerv 1 extrem 5/> mus,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
64646,501002383,Hospital Chargemaster,Chemodenerv trunk musc 1-5,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
64647,501002384,Hospital Chargemaster,Chemodenerv trunk musc 6/>,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
47537,501002247,Hospital Chargemaster,Removal biliary drg cath,Outpatient,Outpatient Default Percent / Case Rate,369," $1,182.00 ", $650.10 ," $1,236.00 ", $967.36 , $827.40 , $460.98 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $105.28 , $102.55 ," $1,015.72 ", $986.70 , $740.30 , $740.30 , $740.30 , $740.30 , $967.36 , $413.70 , $- , $- ," $1,665.99 ", $827.40
49450,501002263,Hospital Chargemaster,Replace g/c tube perc,Outpatient,Outpatient Default Percent / Case Rate,369," $2,102.00 "," $1,156.10 "," $1,236.00 ", $967.36 ," $1,471.40 ", $819.78 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $740.30 , $740.30 , $740.30 , $740.30 , $967.36 , $735.70 , $- , $- ," $1,665.99 "," $1,471.40 "
47532,501002242,Hospital Chargemaster,Injection for cholangiogram,Outpatient,Outpatient Default Percent / Case Rate,369, $709.00 , $389.95 ," $1,442.00 "," $3,803.62 ", $496.30 , $276.51 ," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 ", $709.00 , $709.00 , $709.00 , $709.00 ," $3,803.62 ", $248.15 , $- , $- ," $6,447.63 ", $496.30
56605,501002296,Hospital Chargemaster,Biopsy of vulva/perineum,Outpatient,Outpatient Default Percent / Case Rate,369, $633.00 , $348.15 ," $1,236.00 ", $757.92 , $443.10 , $246.87 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $844.48 , $822.61 , $795.81 , $773.07 , $633.00 , $633.00 , $633.00 , $633.00 , $757.92 , $221.55 , $- , $- ," $1,236.00 ", $443.10
57100,501002297,Hospital Chargemaster,Biopsy of vagina,Outpatient,Outpatient Default Percent / Case Rate,369, $633.00 , $348.15 ," $1,236.00 ", $757.92 , $443.10 , $246.87 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $105.28 , $102.55 , $795.81 , $773.07 , $633.00 , $633.00 , $633.00 , $633.00 , $757.92 , $221.55 , $- , $- ," $1,236.00 ", $443.10
38792,501002228,Hospital Chargemaster,Ra tracer id of sentinl node,Outpatient,Outpatient Default Percent / Case Rate,369, $817.00 , $449.35 ," $1,236.00 ", $450.66 , $571.90 , $318.63 , $773.31 , $530.77 , $527.94 , $450.66 , $450.66 , $105.28 , $102.55 , $473.19 , $459.67 , $581.78 , $581.78 , $596.77 , $596.77 , $450.66 , $285.95 , $- , $- ," $1,236.00 ", $571.90
60100,501002305,Hospital Chargemaster,Biopsy of thyroid,Outpatient,Outpatient Default Percent / Case Rate,369, $590.00 , $324.50 ," $1,236.00 ", $743.95 , $413.00 , $230.10 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $590.00 , $590.00 , $590.00 , $590.00 , $743.95 , $206.50 , $- , $- ," $1,267.38 ", $413.00
38220,501002224,Hospital Chargemaster,Dx bone marrow aspirations,Outpatient,Outpatient Default Percent / Case Rate,369, $590.00 , $324.50 ," $1,236.00 "," $1,682.11 ", $413.00 , $230.10 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $158.51 , $153.70 ," $1,766.22 "," $1,715.75 ", $590.00 , $590.00 , $590.00 , $590.00 ," $1,682.11 ", $206.50 , $- , $- ," $3,009.07 ", $413.00
47531,501002241,Hospital Chargemaster,Injection for cholangiogram,Outpatient,Outpatient Default Percent / Case Rate,369, $563.00 , $309.65 ," $1,236.00 "," $3,803.62 ", $394.10 , $219.57 ," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 ", $563.00 , $563.00 , $563.00 , $563.00 ," $3,803.62 ", $197.05 , $- , $- ," $6,447.63 ", $394.10
60300,501002306,Hospital Chargemaster,Aspir/inj thyroid cyst,Outpatient,Outpatient Default Percent / Case Rate,369, $506.00 , $278.30 ," $1,236.00 ", $743.95 , $354.20 , $197.34 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $506.00 , $506.00 , $506.00 , $506.00 , $743.95 , $177.10 , $- , $- ," $1,267.38 ", $354.20
64612,501002370,Hospital Chargemaster,Destroy nerve face muscle,Outpatient,Outpatient Default Percent / Case Rate,369, $446.00 , $245.30 ," $1,236.00 ", $312.35 , $312.20 , $173.94 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $446.00 , $446.00 , $446.00 , $446.00 , $312.35 , $156.10 , $- , $- ," $1,236.00 ", $312.20
47556,501002248,Hospital Chargemaster,Biliary endoscopy thru skin,Outpatient,Outpatient Default Percent / Case Rate,369, $406.00 , $223.30 ," $2,060.00 "," $6,049.19 ", $284.20 , $158.34 ," $10,054.00 "," $6,900.63 "," $6,863.84 "," $6,049.19 "," $6,049.19 "," $4,032.00 "," $3,927.60 "," $6,351.65 "," $6,170.18 ", $406.00 , $406.00 , $406.00 , $406.00 ," $6,049.19 ", $142.10 , $- , $- ," $10,054.00 ", $284.20
37212,501002193,Hospital Chargemaster,Thrombolytic venous therapy,Outpatient,Outpatient Default Percent / Case Rate,369, $400.00 , $220.00 ," $1,236.00 "," $3,422.34 ", $280.00 , $156.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $400.00 , $400.00 , $400.00 , $400.00 ," $3,422.34 ", $140.00 , $- , $- ," $5,778.66 ", $280.00
54200,501002292,Hospital Chargemaster,Treatment of penis lesion,Outpatient,Outpatient Default Percent / Case Rate,369, $375.00 , $206.25 , $309.00 , $318.13 , $262.50 , $146.25 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $205.12 , $198.90 , $334.03 , $324.49 , $375.00 , $375.00 , $375.00 , $375.00 , $318.13 , $131.25 , $- , $- , $506.26 , $262.50
49465,501002266,Hospital Chargemaster,Fluoro exam of g/colon tube,Outpatient,Outpatient Default Percent / Case Rate,369," $1,300.00 ", $715.00 ," $1,236.00 ", $275.09 , $910.00 , $507.00 , $504.38 , $346.19 , $344.34 , $275.09 , $275.09 , $872.30 , $872.30 , $288.84 , $280.59 , $343.81 , $343.81 , $343.81 , $343.81 , $275.09 , $455.00 , $- , $- ," $1,236.00 ", $910.00
64505,501002358,Hospital Chargemaster,N block spenopalatine gangl,Outpatient,Outpatient Default Percent / Case Rate,369, $645.00 , $354.75 ," $1,236.00 ", $312.35 , $451.50 , $251.55 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $199.70 , $193.64 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $225.75 , $- , $- ," $1,236.00 ", $451.50
67500,501002389,Hospital Chargemaster,Inject/treat eye socket,Outpatient,Outpatient Default Percent / Case Rate,369, $817.00 , $449.35 , $673.21 , $312.73 , $571.90 , $318.63 , $620.23 , $425.70 , $423.43 , $312.73 , $312.73 , $105.28 , $102.55 , $328.37 , $318.99 , $343.81 , $343.81 , $343.81 , $343.81 , $312.73 , $285.95 , $- , $- , $673.21 , $571.90
43752,501002232,Hospital Chargemaster,Nasal/orogastric w/tube plmt,Outpatient,Outpatient Default Percent / Case Rate,369, $334.00 , $183.70 ," $1,442.00 ", $324.46 , $233.80 , $130.26 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $334.00 , $334.00 , $334.00 , $334.00 , $324.46 , $116.90 , $- , $- ," $1,442.00 ", $233.80
56405,501002294,Hospital Chargemaster,I & d of vulva/perineum,Outpatient,Outpatient Default Percent / Case Rate,369, $331.00 , $182.05 ," $1,442.00 ", $337.17 , $231.70 , $129.09 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 ," $1,133.44 "," $1,104.09 ", $354.03 , $343.92 , $331.00 , $331.00 , $331.00 , $331.00 , $337.17 , $115.85 , $- , $- ," $1,442.00 ", $231.70
46083,501002236,Hospital Chargemaster,Incise external hemorrhoid,Outpatient,Outpatient Default Percent / Case Rate,369, $317.00 , $174.35 ," $1,236.00 ", $318.13 , $221.90 , $123.63 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $317.00 , $317.00 , $317.00 , $317.00 , $318.13 , $110.95 , $- , $- ," $1,236.00 ", $221.90
46050,501002235,Hospital Chargemaster,Incision of anal abscess,Outpatient,Outpatient Default Percent / Case Rate,369, $279.00 , $153.45 ," $1,236.00 ", $948.73 , $195.30 , $108.81 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $844.48 , $822.61 , $996.17 , $967.71 , $279.00 , $279.00 , $279.00 , $279.00 , $948.73 , $97.65 , $- , $- ," $1,629.53 ", $195.30
62270,501002307,Hospital Chargemaster,Spinal fluid tap diagnostic,Outpatient,Outpatient Default Percent / Case Rate,369, $237.00 , $130.35 ," $1,236.00 ", $759.14 , $165.90 , $92.43 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $177.96 , $172.56 , $797.10 , $774.33 , $237.00 , $237.00 , $237.00 , $237.00 , $759.14 , $82.95 , $- , $- ," $1,309.97 ", $165.90
38221,501002225,Hospital Chargemaster,Dx bone marrow biopsies,Outpatient,Outpatient Default Percent / Case Rate,369, $234.00 , $128.70 ," $1,236.00 "," $1,682.11 ", $163.80 , $91.26 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $200.58 , $194.50 ," $1,766.22 "," $1,715.75 ", $234.00 , $234.00 , $234.00 , $234.00 ," $1,682.11 ", $81.90 , $- , $- ," $3,009.07 ", $163.80
58100,501002299,Hospital Chargemaster,Biopsy of uterus lining,Outpatient,Outpatient Default Percent / Case Rate,369, $232.00 , $127.60 ," $1,236.00 ", $203.67 , $162.40 , $90.48 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $105.28 , $102.55 , $213.85 , $207.74 , $232.00 , $232.00 , $232.00 , $232.00 , $203.67 , $81.20 , $- , $- ," $1,236.00 ", $162.40
64405,501002337,Hospital Chargemaster,N block inj occipital,Outpatient,Outpatient Default Percent / Case Rate,369," $1,032.00 ", $567.60 ," $1,236.00 ", $312.35 , $722.40 , $402.48 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $185.94 , $180.29 , $327.96 , $318.59 , $740.30 , $740.30 , $740.30 , $740.30 , $312.35 , $361.20 , $- , $- ," $1,236.00 ", $722.40
57500,501002298,Hospital Chargemaster,Biopsy of cervix,Outpatient,Outpatient Default Percent / Case Rate,369, $228.00 , $125.40 ," $1,236.00 ", $757.92 , $159.60 , $88.92 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $105.28 , $102.55 , $795.81 , $773.07 , $228.00 , $228.00 , $228.00 , $228.00 , $757.92 , $79.80 , $- , $- ," $1,236.00 ", $159.60
51703,501002287,Hospital Chargemaster,Insert bladder cath complex,Outpatient,Outpatient Default Percent / Case Rate,369, $265.00 , $145.75 ," $1,236.00 ", $166.91 , $185.50 , $103.35 , $297.41 , $204.13 , $203.04 , $166.91 , $166.91 , $196.14 , $190.19 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $92.75 , $- , $- ," $1,236.00 ", $185.50
51705,501002288,Hospital Chargemaster,Change of bladder tube,Outpatient,Outpatient Default Percent / Case Rate,369, $221.00 , $121.55 ," $1,236.00 ", $318.13 , $154.70 , $86.19 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $221.00 , $221.00 , $221.00 , $221.00 , $318.13 , $77.35 , $- , $- ," $1,236.00 ", $154.70
58300,501002300,Hospital Chargemaster,Insert intrauterine device,Outpatient,Outpatient Default Percent / Case Rate,369, $216.00 , $118.80 ," $1,236.00 ", See APC Packaged Rates , $151.20 , $84.24 , $172.06 , $118.09 , $117.46 , See APC Packaged Rates , See APC Packaged Rates , $131.39 , $127.40 , See APC Packaged Rates , See APC Packaged Rates , $216.00 , $216.00 , $216.00 , $216.00 , See APC Packaged Rates , $75.60 , $- , $- ," $1,236.00 ", $151.20
64450,501002346,Hospital Chargemaster,N block other peripheral,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $168.83 , $163.71 , $797.10 , $774.33 , $208.00 , $208.00 , $208.00 , $208.00 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
58301,501002301,Hospital Chargemaster,Remove intrauterine device,Outpatient,Outpatient Default Percent / Case Rate,369, $203.00 , $111.65 ," $1,236.00 ", $337.17 , $142.10 , $79.17 , $362.99 , $249.14 , $247.81 , $337.17 , $337.17 , $164.50 , $159.51 , $354.03 , $343.92 , $203.00 , $203.00 , $203.00 , $203.00 , $337.17 , $71.05 , $- , $- ," $1,236.00 ", $142.10
64400,501002335,Hospital Chargemaster,N block inj trigeminal,Outpatient,Outpatient Default Percent / Case Rate,369, $194.00 , $106.70 ," $1,236.00 ", $312.35 , $135.80 , $75.66 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $157.25 , $152.48 , $327.96 , $318.59 , $194.00 , $194.00 , $194.00 , $194.00 , $312.35 , $67.90 , $- , $- ," $1,236.00 ", $135.80
37191,501002187,Hospital Chargemaster,Ins endovas vena cava filtr,Outpatient,Outpatient Default Percent / Case Rate,369, $189.00 , $103.95 ," $2,060.00 "," $5,701.02 ", $132.30 , $73.71 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 ", $105.28 , $102.55 ," $5,986.07 "," $5,815.04 ", $189.00 , $189.00 , $189.00 , $189.00 ," $5,701.02 ", $66.15 , $- , $- ," $9,574.18 ", $132.30
54056,501002290,Hospital Chargemaster,Cryosurgery penis lesion(s),Outpatient,Outpatient Default Percent / Case Rate,369, $247.00 , $135.85 , $203.53 , $214.68 , $172.90 , $96.33 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $185.14 , $185.14 , $185.14 , $185.14 , $214.68 , $86.45 , $- , $- , $386.01 , $172.90
43762,501002233,Hospital Chargemaster,Rplc gtube no revj trc,Outpatient,Outpatient Default Percent / Case Rate,369, $174.00 , $95.70 ," $1,236.00 ", $318.13 , $121.80 , $67.86 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 ," $1,133.44 "," $1,104.09 ", $334.03 , $324.49 , $174.00 , $174.00 , $174.00 , $174.00 , $318.13 , $60.90 , $- , $- ," $1,236.00 ", $121.80
95971,501002394,Hospital Chargemaster,Alys smpl sp/pn npgt w/prgrm,Outpatient,Outpatient Default Percent / Case Rate,369, $645.00 , $354.75 , $531.48 , $120.02 , $451.50 , $251.55 , $288.58 , $225.54 , $247.05 , $120.02 , $120.02 , $- , $- , $126.02 , $122.42 , $161.99 , $161.99 , $166.16 , $166.16 , $120.02 , $225.75 , $- , $- , $531.48 , $451.50
38222,501002226,Hospital Chargemaster,Dx bone marrow bx & aspir,Outpatient,Outpatient Default Percent / Case Rate,369, $150.00 , $82.50 ," $1,236.00 "," $2,834.62 ", $105.00 , $58.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $2,834.62 "," $2,834.62 ", $105.28 , $102.55 ," $2,976.35 "," $2,891.31 ", $150.00 , $150.00 , $150.00 , $150.00 ," $2,834.62 ", $52.50 , $- , $- ," $3,009.07 ", $105.00
65205,501002387,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,369, $129.00 , $70.95 , $106.30 , $134.80 , $90.30 , $50.31 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $129.00 , $129.00 , $129.00 , $129.00 , $134.80 , $45.15 , $- , $- , $232.95 , $90.30
65220,501002388,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,369, $124.00 , $68.20 , $102.18 , $324.46 , $86.80 , $48.36 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $124.00 , $124.00 , $124.00 , $124.00 , $324.46 , $43.40 , $- , $- , $761.64 , $86.80
64447,501002345,Hospital Chargemaster,N block inj fem single,Outpatient,Outpatient Default Percent / Case Rate,369," $1,032.00 ", $567.60 , $850.37 , $759.14 , $722.40 , $402.48 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $164.53 , $159.53 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $361.20 , $- , $- ," $1,309.97 ", $722.40
51702,501002286,Hospital Chargemaster,Insert temp bladder cath,Outpatient,Outpatient Default Percent / Case Rate,369, $98.00 , $53.90 ," $1,236.00 ", $134.80 , $68.60 , $38.22 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $73.01 , $70.79 , $141.54 , $137.50 , $98.00 , $98.00 , $98.00 , $98.00 , $134.80 , $34.30 , $- , $- ," $1,236.00 ", $68.60
69210,501002391,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,369, $97.00 , $53.35 ," $1,236.00 ", $66.55 , $67.90 , $37.83 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $65.09 , $65.09 , $69.87 , $67.88 , $97.00 , $97.00 , $97.00 , $97.00 , $66.55 , $33.95 , $- , $- ," $1,236.00 ", $67.90
49082,501002250,Hospital Chargemaster,Abd paracentesis,Outpatient,Outpatient Default Percent / Case Rate,369, $93.00 , $51.15 ," $1,442.00 ", $967.36 , $65.10 , $36.27 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $93.00 , $93.00 , $93.00 , $93.00 , $967.36 , $32.55 , $- , $- ," $1,665.99 ", $65.10
49083,501002251,Hospital Chargemaster,Abd paracentesis w/imaging,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $1,442.00 ", $967.36 , $799.40 , $445.38 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $93.00 , $93.00 , $93.00 , $93.00 , $967.36 , $399.70 , $- , $- ," $1,665.99 ", $799.40
51701,501002285,Hospital Chargemaster,Insert bladder catheter,Outpatient,Outpatient Default Percent / Case Rate,369, $88.00 , $48.40 ," $1,236.00 ", $134.80 , $61.60 , $34.32 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $66.83 , $64.80 , $141.54 , $137.50 , $88.00 , $88.00 , $88.00 , $88.00 , $134.80 , $30.80 , $- , $- ," $1,236.00 ", $61.60
97597,501002395,Hospital Chargemaster,Rmvl devital tis 20 cm/<,Outpatient,Outpatient Default Percent / Case Rate,369, $78.00 , $326.79 ," $1,236.00 ", $214.68 , $54.60 , $30.42 , $875.52 , $556.51 , $546.42 , $214.68 , $214.68 , $126.90 , $123.05 , $225.42 , $218.98 , $78.00 , $78.00 , $78.00 , $78.00 , $214.68 , $27.30 , $- , $- ," $1,236.00 ", $54.60
69209,501002390,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,369, $25.00 , $13.75 ," $1,236.00 ", $66.55 , $17.50 , $9.75 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $16.78 , $16.78 , $69.87 , $67.88 , $25.00 , $25.00 , $25.00 , $25.00 , $66.55 , $8.75 , $- , $- ," $1,236.00 ", $17.50
82554,501002393,Hospital Chargemaster,Creatine isoforms,Outpatient,Outpatient Default Percent / Case Rate,369, $817.00 , $24.43 , $673.21 , See APC Packaged Rates , $571.90 , $318.63 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $25.86 , $25.07 , See APC Packaged Rates , See APC Packaged Rates , $20.20 , $20.20 , $20.72 , $20.72 , See APC Packaged Rates , $285.95 , $15.83 , $15.83 , $673.21 , $571.90
10006,501001940,Hospital Chargemaster,Fna bx w/us gdn ea addl,Outpatient,Outpatient Default Percent / Case Rate,369, $260.00 , $143.00 ," $1,236.00 ", See APC Packaged Rates , $182.00 , $101.40 , $159.18 , $109.25 , $108.67 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $241.80 , $241.80 , $241.80 , $241.80 , See APC Packaged Rates , $91.00 , $- , $- ," $1,236.00 ", $182.00
17003,501002033,Hospital Chargemaster,Destruct premalg les 2-14,Outpatient,Outpatient Default Percent / Case Rate,369, $239.00 , $131.45 ," $1,236.00 ", See APC Packaged Rates , $167.30 , $93.21 , $7.86 , $5.40 , $5.37 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $222.27 , $222.27 , $222.27 , $222.27 , See APC Packaged Rates , $83.65 , $- , $- ," $1,236.00 ", $167.30
C5272,501002397,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,369, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $34.41 , $23.62 , $23.49 , See APC Packaged Rates , See APC Packaged Rates , $416.02 , $416.02 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
11001,501001957,Hospital Chargemaster,Debride infected skin add-on,Outpatient,Outpatient Default Percent / Case Rate,369, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $45.41 , $31.17 , $31.00 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
15272,501002019,Hospital Chargemaster,Skin sub graft t/a/l add-on,Outpatient,Outpatient Default Percent / Case Rate,369, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $55.78 , $38.29 , $38.08 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
11732,501002003,Hospital Chargemaster,Remove nail plate add-on,Outpatient,Outpatient Default Percent / Case Rate,369, $150.00 , $82.50 ," $1,236.00 ", See APC Packaged Rates , $105.00 , $58.50 , $56.49 , $38.77 , $38.57 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $139.50 , $139.50 , $139.50 , $139.50 , See APC Packaged Rates , $52.50 , $- , $- ," $1,236.00 ", $105.00
19001,501002040,Hospital Chargemaster,Drain breast lesion add-on,Outpatient,Outpatient Default Percent / Case Rate,369, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $69.14 , $47.45 , $47.20 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
11103,501001968,Hospital Chargemaster,Tangntl bx skin ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,369, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $74.66 , $51.25 , $50.97 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
15276,501002023,Hospital Chargemaster,Skin sub graft f/n/hf/g addl,Outpatient,Outpatient Default Percent / Case Rate,369, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $81.32 , $55.82 , $55.52 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
11105,501001970,Hospital Chargemaster,Punch bx skin ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,369, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $88.21 , $60.54 , $60.22 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
11107,501001972,Hospital Chargemaster,Incal bx skn ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,369, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $105.14 , $72.16 , $71.78 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
20501,501002062,Hospital Chargemaster,Inject sinus tract for x-ray,Outpatient,Outpatient Default Percent / Case Rate,369, $900.00 , $495.00 ," $1,236.00 ", See APC Packaged Rates , $630.00 , $351.00 , $121.46 , $83.36 , $82.92 , See APC Packaged Rates , See APC Packaged Rates , $100.01 , $96.98 , See APC Packaged Rates , See APC Packaged Rates , $837.00 , $837.00 , $837.00 , $837.00 , See APC Packaged Rates , $315.00 , $- , $- ," $1,236.00 ", $630.00
27369,501002096,Hospital Chargemaster,Njx cntrst kne arthg/ct/mri,Outpatient,Outpatient Default Percent / Case Rate,369, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $130.87 , $89.82 , $89.34 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
19286,501002054,Hospital Chargemaster,Perq dev breast add us imag,Outpatient,Outpatient Default Percent / Case Rate,369, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $139.50 , $95.74 , $95.23 , See APC Packaged Rates , See APC Packaged Rates , $236.19 , $236.19 , See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
15274,501002021,Hospital Chargemaster,Skn sub grft t/a/l child add,Outpatient,Outpatient Default Percent / Case Rate,369, $830.00 , $456.50 ," $1,236.00 ", See APC Packaged Rates , $581.00 , $323.70 , $149.08 , $102.32 , $101.78 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $771.90 , $771.90 , $771.90 , $771.90 , See APC Packaged Rates , $290.50 , $- , $- ," $1,236.00 ", $581.00
19282,501002050,Hospital Chargemaster,Perq device breast ea imag,Outpatient,Outpatient Default Percent / Case Rate,369, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $162.99 , $111.87 , $111.27 , See APC Packaged Rates , See APC Packaged Rates , $236.19 , $236.19 , See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
23350,501002087,Hospital Chargemaster,Injection for shoulder x-ray,Outpatient,Outpatient Default Percent / Case Rate,369, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $164.23 , $112.72 , $112.12 , See APC Packaged Rates , See APC Packaged Rates , $119.20 , $115.58 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
64494,501002356,Hospital Chargemaster,Inj paravert f jnt l/s 2 lev,Outpatient,Outpatient Default Percent / Case Rate,369, $440.00 , $242.00 ," $1,236.00 ", See APC Packaged Rates , $308.00 , $171.60 , $166.68 , $114.40 , $113.79 , See APC Packaged Rates , See APC Packaged Rates , $14.32 , $13.89 , See APC Packaged Rates , See APC Packaged Rates , $409.20 , $409.20 , $409.20 , $409.20 , See APC Packaged Rates , $154.00 , $- , $- ," $1,236.00 ", $308.00
64484,501002350,Hospital Chargemaster,Inj foramen epidural add-on,Outpatient,Outpatient Default Percent / Case Rate,369, $658.00 , $361.90 ," $1,236.00 ", See APC Packaged Rates , $460.60 , $256.62 , $166.79 , $114.48 , $113.87 , See APC Packaged Rates , See APC Packaged Rates , $165.37 , $160.35 , See APC Packaged Rates , See APC Packaged Rates , $611.94 , $611.94 , $611.94 , $611.94 , See APC Packaged Rates , $230.30 , $- , $- ," $1,236.00 ", $460.60
64495,501002357,Hospital Chargemaster,Inj paravert f jnt l/s 3 lev,Outpatient,Outpatient Default Percent / Case Rate,369, $440.00 , $242.00 ," $1,236.00 ", See APC Packaged Rates , $308.00 , $171.60 , $169.13 , $116.08 , $115.46 , See APC Packaged Rates , See APC Packaged Rates , $135.21 , $131.10 , See APC Packaged Rates , See APC Packaged Rates , $409.20 , $409.20 , $409.20 , $409.20 , See APC Packaged Rates , $154.00 , $- , $- ," $1,236.00 ", $308.00
11046,501001962,Hospital Chargemaster,Deb musc/fascia add-on,Outpatient,Outpatient Default Percent / Case Rate,369, $286.00 , $157.30 ," $1,236.00 ", See APC Packaged Rates , $200.20 , $111.54 , $179.86 , $123.45 , $122.79 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $265.98 , $265.98 , $265.98 , $265.98 , See APC Packaged Rates , $100.10 , $- , $- ," $1,236.00 ", $200.20
15278,501002025,Hospital Chargemaster,Skn sub grft f/n/hf/g ch add,Outpatient,Outpatient Default Percent / Case Rate,369, $830.00 , $456.50 ," $1,236.00 ", See APC Packaged Rates , $581.00 , $323.70 , $186.21 , $127.81 , $127.13 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $771.90 , $771.90 , $771.90 , $771.90 , See APC Packaged Rates , $290.50 , $- , $- ," $1,236.00 ", $581.00
58340,501002302,Hospital Chargemaster,Catheter for hysterography,Outpatient,Outpatient Default Percent / Case Rate,369, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $186.80 , $128.21 , $127.53 , See APC Packaged Rates , See APC Packaged Rates , $145.67 , $141.25 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
64636,501002377,Hospital Chargemaster,Destroy l/s facet jnt addl,Outpatient,Outpatient Default Percent / Case Rate,369," $1,142.00 ", $628.10 ," $1,236.00 ", See APC Packaged Rates , $799.40 , $445.38 , $191.26 , $131.27 , $130.57 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates ," $1,062.06 "," $1,062.06 "," $1,062.06 "," $1,062.06 ", See APC Packaged Rates , $399.70 , $- , $- ," $1,236.00 ", $799.40
64491,501002353,Hospital Chargemaster,Inj paravert f jnt c/t 2 lev,Outpatient,Outpatient Default Percent / Case Rate,369, $645.00 , $354.75 ," $1,236.00 ", See APC Packaged Rates , $451.50 , $251.55 , $192.37 , $132.04 , $131.33 , See APC Packaged Rates , See APC Packaged Rates , $154.77 , $150.07 , See APC Packaged Rates , See APC Packaged Rates , $599.85 , $599.85 , $599.85 , $599.85 , See APC Packaged Rates , $225.75 , $- , $- ," $1,236.00 ", $451.50
64492,501002354,Hospital Chargemaster,Inj paravert f jnt c/t 3 lev,Outpatient,Outpatient Default Percent / Case Rate,369, $645.00 , $354.75 ," $1,236.00 ", See APC Packaged Rates , $451.50 , $251.55 , $194.82 , $133.72 , $133.00 , See APC Packaged Rates , See APC Packaged Rates , $157.72 , $152.93 , See APC Packaged Rates , See APC Packaged Rates , $599.85 , $599.85 , $599.85 , $599.85 , See APC Packaged Rates , $225.75 , $- , $- ," $1,236.00 ", $451.50
64480,501002348,Hospital Chargemaster,Inj foramen epidural add-on,Outpatient,Outpatient Default Percent / Case Rate,369," $1,032.00 ", $567.60 ," $1,236.00 ", See APC Packaged Rates , $722.40 , $402.48 , $201.34 , $138.19 , $137.46 , See APC Packaged Rates , See APC Packaged Rates , $198.03 , $192.03 , See APC Packaged Rates , See APC Packaged Rates , $959.76 , $959.76 , $959.76 , $959.76 , See APC Packaged Rates , $361.20 , $- , $- ," $1,236.00 ", $722.40
64634,501002375,Hospital Chargemaster,Destroy c/th facet jnt addl,Outpatient,Outpatient Default Percent / Case Rate,369, $645.00 , $354.75 ," $1,236.00 ", See APC Packaged Rates , $451.50 , $251.55 , $218.06 , $149.67 , $148.87 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $599.85 , $599.85 , $599.85 , $599.85 , See APC Packaged Rates , $225.75 , $- , $- ," $1,236.00 ", $451.50
24220,501002089,Hospital Chargemaster,Injection for elbow x-ray,Outpatient,Outpatient Default Percent / Case Rate,369, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $218.10 , $149.70 , $148.90 , See APC Packaged Rates , See APC Packaged Rates , $157.37 , $152.59 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
27093,501002093,Hospital Chargemaster,Injection for hip x-ray,Outpatient,Outpatient Default Percent / Case Rate,369, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $225.37 , $154.68 , $153.86 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
50690,501002277,Hospital Chargemaster,Injection for ureter x-ray,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", See APC Packaged Rates ," $1,015.00 ", $565.50 , $229.10 , $157.24 , $156.41 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,348.50 "," $1,348.50 "," $1,348.50 "," $1,348.50 ", See APC Packaged Rates , $507.50 , $- , $- ," $1,348.50 "," $1,015.00 "
64643,501002380,Hospital Chargemaster,Chemodenerv 1 extrem 1-4 ea,Outpatient,Outpatient Default Percent / Case Rate,369, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $233.96 , $160.58 , $159.72 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
25246,501002091,Hospital Chargemaster,Injection for wrist x-ray,Outpatient,Outpatient Default Percent / Case Rate,369, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $241.52 , $165.77 , $164.88 , See APC Packaged Rates , See APC Packaged Rates , $548.21 , $548.21 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
19084,501002045,Hospital Chargemaster,Bx breast add lesion us imag,Outpatient,Outpatient Default Percent / Case Rate,369, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $254.49 , $174.67 , $173.74 , See APC Packaged Rates , See APC Packaged Rates ," $1,133.44 "," $1,104.09 ", See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
64645,501002382,Hospital Chargemaster,Chemodenerv 1 extrem 5/> ea,Outpatient,Outpatient Default Percent / Case Rate,369, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $269.68 , $185.09 , $184.11 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
27095,501002094,Hospital Chargemaster,Injection for hip x-ray,Outpatient,Outpatient Default Percent / Case Rate,369, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $270.59 , $185.72 , $184.73 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
19082,501002043,Hospital Chargemaster,Bx breast add lesion strtctc,Outpatient,Outpatient Default Percent / Case Rate,369, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $272.37 , $186.94 , $185.95 , See APC Packaged Rates , See APC Packaged Rates ," $1,133.44 "," $1,104.09 ", See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
62284,501002313,Hospital Chargemaster,Injection for myelogram,Outpatient,Outpatient Default Percent / Case Rate,369," $1,500.00 ", $825.00 ," $1,236.00 ", See APC Packaged Rates ," $1,050.00 ", $585.00 , $285.96 , $196.27 , $195.22 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,395.00 "," $1,395.00 "," $1,395.00 "," $1,395.00 ", See APC Packaged Rates , $525.00 , $- , $- ," $1,395.00 "," $1,050.00 "
11047,501001963,Hospital Chargemaster,Deb bone add-on,Outpatient,Outpatient Default Percent / Case Rate,369, $286.00 , $157.30 ," $1,236.00 ", See APC Packaged Rates , $200.20 , $111.54 , $318.48 , $218.59 , $217.42 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $265.98 , $265.98 , $265.98 , $265.98 , See APC Packaged Rates , $100.10 , $- , $- ," $1,236.00 ", $200.20
47001,501002238,Hospital Chargemaster,Needle biopsy liver add-on,Outpatient,Outpatient Default Percent / Case Rate,369, $590.00 , $324.50 ," $1,236.00 ", See APC Packaged Rates , $413.00 , $230.10 , $336.59 , $231.02 , $229.79 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $548.70 , $548.70 , $548.70 , $548.70 , See APC Packaged Rates , $206.50 , $- , $- ," $1,236.00 ", $413.00
36010,501002129,Hospital Chargemaster,Place catheter in vein,Outpatient,Outpatient Default Percent / Case Rate,369, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $354.08 , $243.02 , $241.73 , See APC Packaged Rates , See APC Packaged Rates , $299.66 , $290.57 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
C5274,501002399,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,369, $860.00 , $473.00 ," $1,236.00 ", See APC Packaged Rates , $602.00 , $335.40 , $829.81 , $833.43 , $442.92 , See APC Packaged Rates , See APC Packaged Rates , $577.06 , $577.06 , See APC Packaged Rates , See APC Packaged Rates , $799.80 , $799.80 , $799.80 , $799.80 , See APC Packaged Rates , $301.00 , $- , $- ," $1,236.00 ", $602.00
C5276,501002401,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,369, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $598.24 , $600.84 , $319.31 , See APC Packaged Rates , See APC Packaged Rates , $416.02 , $416.02 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
C5278,501002403,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,369, $830.00 , $456.50 ," $1,236.00 ", See APC Packaged Rates , $581.00 , $323.70 , $800.87 , $804.35 , $427.47 , See APC Packaged Rates , See APC Packaged Rates , $556.93 , $556.93 , See APC Packaged Rates , See APC Packaged Rates , $771.90 , $771.90 , $771.90 , $771.90 , See APC Packaged Rates , $290.50 , $- , $- ," $1,236.00 ", $581.00
36416,501002150,Hospital Chargemaster,Capillary blood draw,Outpatient,Outpatient Default Percent / Case Rate,369, $11.00 , $6.05 , $9.06 , See APC Packaged Rates , $7.70 , $4.29 , $12.68 , $8.51 , $8.15 , See APC Packaged Rates , See APC Packaged Rates , $7.38 , $7.38 , See APC Packaged Rates , See APC Packaged Rates , $10.23 , $10.23 , $10.23 , $10.23 , See APC Packaged Rates , $3.85 , $3.46 , $3.46 , $12.68 , $7.70
36410,501002149,Hospital Chargemaster,Non-routine bl draw 3/> yrs,Outpatient,Outpatient Default Percent / Case Rate,369, $9.65 , $5.31 , $7.95 , See APC Packaged Rates , $6.76 , $3.76 , $30.17 , $20.71 , $20.60 , See APC Packaged Rates , See APC Packaged Rates , $21.29 , $20.65 , See APC Packaged Rates , See APC Packaged Rates , $8.97 , $8.97 , $8.97 , $8.97 , See APC Packaged Rates , $3.38 , $- , $- , $30.17 , $6.76
11201,501001974,Hospital Chargemaster,Remove skin tags add-on,Outpatient,Outpatient Default Percent / Case Rate,369, $271.00 , $149.05 , $223.30 , See APC Packaged Rates , $189.70 , $105.69 , $54.04 , $37.09 , $36.89 , See APC Packaged Rates , See APC Packaged Rates , $38.24 , $37.08 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- , $252.03 , $189.70
51600,501002282,Hospital Chargemaster,Injection for bladder x-ray,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,194.80 ", See APC Packaged Rates ," $1,015.00 ", $565.50 , $143.93 , $98.79 , $98.26 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,348.50 "," $1,348.50 "," $1,348.50 "," $1,348.50 ", See APC Packaged Rates , $507.50 , $- , $- ," $1,348.50 "," $1,015.00 "
77002,501002392,Hospital Chargemaster,Needle localization by xray,Outpatient,Outpatient Default Percent / Case Rate,369, $282.00 , $155.10 , $232.37 , See APC Packaged Rates , $197.40 , $109.98 , $294.75 , $231.12 , $230.33 , See APC Packaged Rates , See APC Packaged Rates , $158.25 , $153.45 , See APC Packaged Rates , See APC Packaged Rates , $262.26 , $262.26 , $262.26 , $262.26 , See APC Packaged Rates , $98.70 , $- , $- , $294.75 , $197.40
27096,501002095,Hospital Chargemaster,Inject sacroiliac joint,Outpatient,Outpatient Default Percent / Case Rate,369," $1,650.00 ", $907.50 ," $1,236.00 ", See APC Packaged Rates ," $1,155.00 ", $643.50 , $268.32 , $184.16 , $183.18 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates ," $1,534.50 "," $1,534.50 "," $1,534.50 "," $1,534.50 ", See APC Packaged Rates , $577.50 , $- , $- ," $1,534.50 "," $1,155.00 "
50430,501002270,Hospital Chargemaster,Njx px nfrosgrm &/urtrgrm,Outpatient,Outpatient Default Percent / Case Rate,369, $984.00 , $541.20 ," $1,236.00 ", $687.79 , $688.80 , $383.76 ," $1,229.98 ", $844.21 , $839.71 , $687.79 , $687.79 , $105.28 , $102.55 , $722.18 , $701.54 , $892.65 , $892.65 , $915.65 , $915.65 , $687.79 , $344.40 , $- , $- ," $1,236.00 ", $688.80
51610,501002284,Hospital Chargemaster,Injection for bladder x-ray,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,194.80 ", See APC Packaged Rates ," $1,015.00 ", $565.50 , $210.01 , $144.14 , $143.37 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,348.50 "," $1,348.50 "," $1,348.50 "," $1,348.50 ", See APC Packaged Rates , $507.50 , $- , $- ," $1,348.50 "," $1,015.00 "
64454,501002873,Hospital Chargemaster,Njx AA & Strd Gnclr Nrv Brnch,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,310.44 ", $899.43 , $894.64 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $978.40 , $978.40 ," $1,003.60 "," $1,003.60 ", $759.14 , $507.50 , $- , $- ," $1,310.44 "," $1,015.00 "
19081,501004042,Hospital Chargemaster,Bx breast 1st lesion strtct LT,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,442.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
19081,501005042,Hospital Chargemaster,Bx breast 1st lesion strtct RT,Outpatient,Outpatient Default Percent / Case Rate,369," $1,450.00 ", $797.50 ," $1,442.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
99153,5012110004,Hospital Chargemaster,Mod sed same phys/qhp ea,Outpatient,Outpatient Default Percent / Case Rate,370, $45.00 , $24.75 , $37.08 , See APC Packaged Rates , $31.50 , $17.55 , $41.22 , $32.22 , $35.29 , See APC Packaged Rates , See APC Packaged Rates , $30.20 , $30.20 , See APC Packaged Rates , See APC Packaged Rates , $41.85 , $41.85 , $41.85 , $41.85 , See APC Packaged Rates , $15.75 , $- , $- , $41.85 , $31.50
99152,5012110003,Hospital Chargemaster,Mod sed same phys/qhp 5/>yrs,Outpatient,Outpatient Default Percent / Case Rate,370, $45.00 , $24.75 , $37.08 , See APC Packaged Rates , $31.50 , $17.55 , $43.69 , $34.15 , $37.40 , See APC Packaged Rates , See APC Packaged Rates , $30.20 , $30.20 , See APC Packaged Rates , See APC Packaged Rates , $41.85 , $41.85 , $41.85 , $41.85 , See APC Packaged Rates , $15.75 , $- , $- , $43.69 , $31.50
99151,5012110002,Hospital Chargemaster,Mod sed same phys/qhp <5 yrs,Outpatient,Outpatient Default Percent / Case Rate,370, $45.00 , $24.75 , $37.08 , See APC Packaged Rates , $31.50 , $17.55 , $90.02 , $70.36 , $77.07 , See APC Packaged Rates , See APC Packaged Rates , $30.20 , $30.20 , See APC Packaged Rates , See APC Packaged Rates , $41.85 , $41.85 , $41.85 , $41.85 , See APC Packaged Rates , $15.75 , $- , $- , $90.02 , $31.50
99156,5012110005,Hospital Chargemaster,Mod sed oth phys/qhp 5/>yrs,Outpatient,Outpatient Default Percent / Case Rate,370, $152.00 , $83.60 , $125.25 , See APC Packaged Rates , $106.40 , $59.28 , $278.53 , $217.69 , $238.44 , See APC Packaged Rates , See APC Packaged Rates , $101.99 , $101.99 , See APC Packaged Rates , See APC Packaged Rates , $141.36 , $141.36 , $141.36 , $141.36 , See APC Packaged Rates , $53.20 , $- , $- , $278.53 , $106.40
,5010010007,Hospital Chargemaster,Anesthesia - 1st Half Hour,Outpatient,Outpatient Default Percent / Case Rate,370, $55.00 , $30.25 , $44.00 , See APC Packaged Rates , $38.50 , $21.45 , $53.07 , $53.30 , $28.33 , See APC Packaged Rates , See APC Packaged Rates , $36.91 , $36.91 , See APC Packaged Rates , See APC Packaged Rates , $51.15 , $51.15 , $51.15 , $51.15 , See APC Packaged Rates , $19.25 , $33.00 , $19.25 , $53.30 , $38.50
,5010010008,Hospital Chargemaster,Anesthesia - EA Addl 1/2 Hour,Outpatient,Outpatient Default Percent / Case Rate,370, $55.00 , $30.25 , $44.00 , See APC Packaged Rates , $38.50 , $21.45 , $53.07 , $53.30 , $28.33 , See APC Packaged Rates , See APC Packaged Rates , $36.91 , $36.91 , See APC Packaged Rates , See APC Packaged Rates , $51.15 , $51.15 , $51.15 , $51.15 , See APC Packaged Rates , $19.25 , $33.00 , $19.25 , $53.30 , $38.50
,5012110001,Hospital Chargemaster,General Anesthesia,Outpatient,Outpatient Default Percent / Case Rate,370, $98.00 , $53.90 , $78.40 , See APC Packaged Rates , $68.60 , $38.22 , $94.56 , $94.97 , $50.47 , See APC Packaged Rates , See APC Packaged Rates , $65.76 , $65.76 , See APC Packaged Rates , See APC Packaged Rates , $91.14 , $91.14 , $91.14 , $91.14 , See APC Packaged Rates , $34.30 , $58.80 , $34.30 , $94.97 , $68.60
P9059,5210010095,Hospital Chargemaster,"Plasma, frz between 8-24hour",Outpatient,Outpatient Default Percent / Case Rate,390, $182.00 , $100.10 , $149.97 , $85.03 , $127.40 , $70.98 , $242.76 , $162.89 , $155.96 , $85.03 , $85.03 , $122.12 , $122.12 , $89.28 , $86.73 , $73.35 , $73.35 , $75.24 , $75.24 , $85.03 , $63.70 , $- , $- , $242.76 , $127.40
P9019,5210010086,Hospital Chargemaster,"Platelets, each unit",Outpatient,Outpatient Default Percent / Case Rate,390, $232.00 , $127.60 , $191.17 , $85.21 , $162.40 , $90.48 , $223.86 , $224.83 , $119.48 , $85.21 , $85.21 , $155.67 , $155.67 , $89.47 , $86.91 , $71.83 , $71.83 , $73.68 , $73.68 , $85.21 , $81.20 , $- , $- , $224.83 , $162.40
P9019,5210010119,Hospital Chargemaster,"Platelets, each unit",Outpatient,Outpatient Default Percent / Case Rate,390, $232.00 , $127.60 , $191.17 , $85.21 , $162.40 , $90.48 , $223.86 , $224.83 , $119.48 , $85.21 , $85.21 , $155.67 , $155.67 , $89.47 , $86.91 , $71.83 , $71.83 , $73.68 , $73.68 , $85.21 , $81.20 , $- , $- , $224.83 , $162.40
P9019,5210010129,Hospital Chargemaster,"Platelets, each unit",Outpatient,Outpatient Default Percent / Case Rate,390, $232.00 , $127.60 , $191.17 , $85.21 , $162.40 , $90.48 , $223.86 , $224.83 , $119.48 , $85.21 , $85.21 , $155.67 , $155.67 , $89.47 , $86.91 , $71.83 , $71.83 , $73.68 , $73.68 , $85.21 , $81.20 , $- , $- , $224.83 , $162.40
P9012,5210010084,Hospital Chargemaster,Cryoprecipitate each unit,Outpatient,Outpatient Default Percent / Case Rate,390, $199.00 , $109.45 , $163.98 , $95.44 , $139.30 , $77.61 , $156.42 , $104.96 , $100.50 , $95.44 , $95.44 , $133.53 , $133.53 , $100.21 , $97.35 , $79.64 , $79.64 , $81.69 , $81.69 , $95.44 , $69.65 , $- , $- , $163.98 , $139.30
P9012,5210010099,Hospital Chargemaster,Cryoprecipitate each unit,Outpatient,Outpatient Default Percent / Case Rate,390, $199.00 , $109.45 , $163.98 , $95.44 , $139.30 , $77.61 , $156.42 , $104.96 , $100.50 , $95.44 , $95.44 , $133.53 , $133.53 , $100.21 , $97.35 , $79.64 , $79.64 , $81.69 , $81.69 , $95.44 , $69.65 , $- , $- , $163.98 , $139.30
P9012,5210010113,Hospital Chargemaster,Cryoprecipitate each unit,Outpatient,Outpatient Default Percent / Case Rate,390, $199.00 , $109.45 , $163.98 , $95.44 , $139.30 , $77.61 , $156.42 , $104.96 , $100.50 , $95.44 , $95.44 , $133.53 , $133.53 , $100.21 , $97.35 , $79.64 , $79.64 , $81.69 , $81.69 , $95.44 , $69.65 , $- , $- , $163.98 , $139.30
P9012,5210010115,Hospital Chargemaster,Cryoprecipitate each unit,Outpatient,Outpatient Default Percent / Case Rate,390, $199.00 , $109.45 , $163.98 , $95.44 , $139.30 , $77.61 , $156.42 , $104.96 , $100.50 , $95.44 , $95.44 , $133.53 , $133.53 , $100.21 , $97.35 , $79.64 , $79.64 , $81.69 , $81.69 , $95.44 , $69.65 , $- , $- , $163.98 , $139.30
P9012,5210010122,Hospital Chargemaster,Cryoprecipitate each unit,Outpatient,Outpatient Default Percent / Case Rate,390, $199.00 , $109.45 , $163.98 , $95.44 , $139.30 , $77.61 , $156.42 , $104.96 , $100.50 , $95.44 , $95.44 , $133.53 , $133.53 , $100.21 , $97.35 , $79.64 , $79.64 , $81.69 , $81.69 , $95.44 , $69.65 , $- , $- , $163.98 , $139.30
P9012,5210010131,Hospital Chargemaster,Cryoprecipitate each unit,Outpatient,Outpatient Default Percent / Case Rate,390, $199.00 , $109.45 , $163.98 , $95.44 , $139.30 , $77.61 , $156.42 , $104.96 , $100.50 , $95.44 , $95.44 , $133.53 , $133.53 , $100.21 , $97.35 , $79.64 , $79.64 , $81.69 , $81.69 , $95.44 , $69.65 , $- , $- , $163.98 , $139.30
P9017,5210010082,Hospital Chargemaster,Plasma 1 donor frz w/in 8 hr,Outpatient,Outpatient Default Percent / Case Rate,390, $198.00 , $108.90 , $163.15 , $98.80 , $138.60 , $77.22 , $226.50 , $151.98 , $145.52 , $98.80 , $98.80 , $132.86 , $132.86 , $103.74 , $100.77 , $83.78 , $83.78 , $85.94 , $85.94 , $98.80 , $69.30 , $- , $- , $226.50 , $138.60
P9017,5210010103,Hospital Chargemaster,Plasma 1 donor frz w/in 8 hr,Outpatient,Outpatient Default Percent / Case Rate,390, $198.00 , $108.90 , $163.15 , $98.80 , $138.60 , $77.22 , $226.50 , $151.98 , $145.52 , $98.80 , $98.80 , $132.86 , $132.86 , $103.74 , $100.77 , $83.78 , $83.78 , $85.94 , $85.94 , $98.80 , $69.30 , $- , $- , $226.50 , $138.60
P9017,5210010114,Hospital Chargemaster,Plasma 1 donor frz w/in 8 hr,Outpatient,Outpatient Default Percent / Case Rate,390, $198.00 , $108.90 , $163.15 , $98.80 , $138.60 , $77.22 , $226.50 , $151.98 , $145.52 , $98.80 , $98.80 , $132.86 , $132.86 , $103.74 , $100.77 , $83.78 , $83.78 , $85.94 , $85.94 , $98.80 , $69.30 , $- , $- , $226.50 , $138.60
P9017,5210010128,Hospital Chargemaster,Plasma 1 donor frz w/in 8 hr,Outpatient,Outpatient Default Percent / Case Rate,390, $198.00 , $108.90 , $163.15 , $98.80 , $138.60 , $77.22 , $226.50 , $151.98 , $145.52 , $98.80 , $98.80 , $132.86 , $132.86 , $103.74 , $100.77 , $83.78 , $83.78 , $85.94 , $85.94 , $98.80 , $69.30 , $- , $- , $226.50 , $138.60
P9023,5210010083,Hospital Chargemaster,"Frozen plasma, pooled, sd",Outpatient,Outpatient Default Percent / Case Rate,390, $181.00 , $99.55 , $149.14 , $106.53 , $126.70 , $70.59 , $174.65 , $175.41 , $93.22 , $106.53 , $106.53 , $121.45 , $121.45 , $111.86 , $108.67 , $82.46 , $82.46 , $84.59 , $84.59 , $106.53 , $63.35 , $- , $- , $175.41 , $126.70
P9021,5210010074,Hospital Chargemaster,Red blood cells unit,Outpatient,Outpatient Default Percent / Case Rate,390, $385.00 , $211.75 , $317.24 , $164.50 , $269.50 , $150.15 , $443.70 , $297.73 , $285.07 , $164.50 , $164.50 , $258.34 , $258.34 , $172.73 , $167.79 , $139.79 , $139.79 , $143.40 , $143.40 , $164.50 , $134.75 , $- , $- , $443.70 , $269.50
P9021,5210010117,Hospital Chargemaster,Red blood cells unit,Outpatient,Outpatient Default Percent / Case Rate,390, $385.00 , $211.75 , $317.24 , $164.50 , $269.50 , $150.15 , $443.70 , $297.73 , $285.07 , $164.50 , $164.50 , $258.34 , $258.34 , $172.73 , $167.79 , $139.79 , $139.79 , $143.40 , $143.40 , $164.50 , $134.75 , $- , $- , $443.70 , $269.50
P9021,5210010132,Hospital Chargemaster,Red blood cells unit,Outpatient,Outpatient Default Percent / Case Rate,390, $385.00 , $211.75 , $317.24 , $164.50 , $269.50 , $150.15 , $443.70 , $297.73 , $285.07 , $164.50 , $164.50 , $258.34 , $258.34 , $172.73 , $167.79 , $139.79 , $139.79 , $143.40 , $143.40 , $164.50 , $134.75 , $- , $- , $443.70 , $269.50
P9010,5210010078,Hospital Chargemaster,Whole blood for transfusion,Outpatient,Outpatient Default Percent / Case Rate,390, $507.00 , $278.85 , $417.77 , $179.30 , $354.90 , $197.73 , $489.20 , $491.33 , $261.12 , $179.30 , $179.30 , $340.20 , $340.20 , $188.26 , $182.88 , $149.81 , $149.81 , $153.68 , $153.68 , $179.30 , $177.45 , $- , $- , $491.33 , $354.90
P9010,5210010096,Hospital Chargemaster,Whole blood for transfusion,Outpatient,Outpatient Default Percent / Case Rate,390, $507.00 , $278.85 , $417.77 , $179.30 , $354.90 , $197.73 , $489.20 , $491.33 , $261.12 , $179.30 , $179.30 , $340.20 , $340.20 , $188.26 , $182.88 , $149.81 , $149.81 , $153.68 , $153.68 , $179.30 , $177.45 , $- , $- , $491.33 , $354.90
P9038,5210010076,Hospital Chargemaster,Rbc irradiated,Outpatient,Outpatient Default Percent / Case Rate,390, $550.00 , $302.50 , $453.20 , $202.36 , $385.00 , $214.50 , $530.70 , $533.01 , $283.26 , $202.36 , $202.36 , $369.05 , $369.05 , $212.48 , $206.41 , $169.29 , $169.29 , $173.66 , $173.66 , $202.36 , $192.50 , $- , $- , $533.01 , $385.00
P9016,5210010081,Hospital Chargemaster,Rbc leukocytes reduced,Outpatient,Outpatient Default Percent / Case Rate,390, $490.00 , $269.50 , $403.76 , $225.21 , $343.00 , $191.10 , $585.12 , $392.61 , $375.92 , $225.21 , $225.21 , $328.79 , $328.79 , $236.47 , $229.71 , $191.98 , $191.98 , $196.93 , $196.93 , $225.21 , $171.50 , $- , $- , $585.12 , $343.00
P9016,5210010094,Hospital Chargemaster,Rbc leukocytes reduced,Outpatient,Outpatient Default Percent / Case Rate,390, $490.00 , $269.50 , $403.76 , $225.21 , $343.00 , $191.10 , $585.12 , $392.61 , $375.92 , $225.21 , $225.21 , $328.79 , $328.79 , $236.47 , $229.71 , $191.98 , $191.98 , $196.93 , $196.93 , $225.21 , $171.50 , $- , $- , $585.12 , $343.00
P9016,5210010100,Hospital Chargemaster,Rbc leukocytes reduced,Outpatient,Outpatient Default Percent / Case Rate,390, $490.00 , $269.50 , $403.76 , $225.21 , $343.00 , $191.10 , $585.12 , $392.61 , $375.92 , $225.21 , $225.21 , $328.79 , $328.79 , $236.47 , $229.71 , $191.98 , $191.98 , $196.93 , $196.93 , $225.21 , $171.50 , $- , $- , $585.12 , $343.00
P9016,5210010118,Hospital Chargemaster,Rbc leukocytes reduced,Outpatient,Outpatient Default Percent / Case Rate,390, $490.00 , $269.50 , $403.76 , $225.21 , $343.00 , $191.10 , $585.12 , $392.61 , $375.92 , $225.21 , $225.21 , $328.79 , $328.79 , $236.47 , $229.71 , $191.98 , $191.98 , $196.93 , $196.93 , $225.21 , $171.50 , $- , $- , $585.12 , $343.00
P9016,5210010123,Hospital Chargemaster,Rbc leukocytes reduced,Outpatient,Outpatient Default Percent / Case Rate,390, $490.00 , $269.50 , $403.76 , $225.21 , $343.00 , $191.10 , $585.12 , $392.61 , $375.92 , $225.21 , $225.21 , $328.79 , $328.79 , $236.47 , $229.71 , $191.98 , $191.98 , $196.93 , $196.93 , $225.21 , $171.50 , $- , $- , $585.12 , $343.00
P9051,5210010089,Hospital Chargemaster,"Blood, l/r, cmv-neg",Outpatient,Outpatient Default Percent / Case Rate,390, $450.00 , $247.50 , $370.80 , $253.64 , $315.00 , $175.50 , $434.21 , $436.10 , $231.76 , $253.64 , $253.64 , $301.95 , $301.95 , $266.32 , $258.71 , $223.15 , $223.15 , $228.91 , $228.91 , $253.64 , $157.50 , $- , $- , $436.10 , $315.00
P9058,5210010075,Hospital Chargemaster,"Rbc, l/r, cmv-neg, irrad",Outpatient,Outpatient Default Percent / Case Rate,390, $714.00 , $392.70 , $588.34 , $291.46 , $499.80 , $278.46 , $688.94 , $691.94 , $367.72 , $291.46 , $291.46 , $479.09 , $479.09 , $306.04 , $297.29 , $244.78 , $244.78 , $251.10 , $251.10 , $291.46 , $249.90 , $- , $- , $691.94 , $499.80
P9058,5210010102,Hospital Chargemaster,"Rbc, l/r, cmv-neg, irrad",Outpatient,Outpatient Default Percent / Case Rate,390, $714.00 , $392.70 , $588.34 , $291.46 , $499.80 , $278.46 , $688.94 , $691.94 , $367.72 , $291.46 , $291.46 , $479.09 , $479.09 , $306.04 , $297.29 , $244.78 , $244.78 , $251.10 , $251.10 , $291.46 , $249.90 , $- , $- , $691.94 , $499.80
P9022,5210010077,Hospital Chargemaster,Washed red blood cells unit,Outpatient,Outpatient Default Percent / Case Rate,390, $714.00 , $392.70 , $588.34 , $454.01 , $499.80 , $278.46 , $688.94 , $691.94 , $367.72 , $454.01 , $454.01 , $479.09 , $479.09 , $476.71 , $463.09 , $365.72 , $365.72 , $375.16 , $375.16 , $454.01 , $249.90 , $- , $- , $691.94 , $499.80
P9022,5210010108,Hospital Chargemaster,Washed red blood cells unit,Outpatient,Outpatient Default Percent / Case Rate,390, $714.00 , $392.70 , $588.34 , $454.01 , $499.80 , $278.46 , $688.94 , $691.94 , $367.72 , $454.01 , $454.01 , $479.09 , $479.09 , $476.71 , $463.09 , $365.72 , $365.72 , $375.16 , $375.16 , $454.01 , $249.90 , $- , $- , $691.94 , $499.80
P9022,5210010133,Hospital Chargemaster,Washed red blood cells unit,Outpatient,Outpatient Default Percent / Case Rate,390, $714.00 , $392.70 , $588.34 , $454.01 , $499.80 , $278.46 , $688.94 , $691.94 , $367.72 , $454.01 , $454.01 , $479.09 , $479.09 , $476.71 , $463.09 , $365.72 , $365.72 , $375.16 , $375.16 , $454.01 , $249.90 , $- , $- , $691.94 , $499.80
P9039,5210010080,Hospital Chargemaster,Rbc deglycerolized,Outpatient,Outpatient Default Percent / Case Rate,390," $1,215.00 ", $668.25 ," $1,001.16 ", $521.88 , $850.50 , $473.85 ," $1,172.35 "," $1,177.46 ", $625.75 , $521.88 , $521.88 , $815.27 , $815.27 , $547.97 , $532.32 , $446.88 , $446.88 , $458.41 , $458.41 , $521.88 , $425.25 , $- , $- ," $1,177.46 ", $850.50
P9039,5210010104,Hospital Chargemaster,Rbc deglycerolized,Outpatient,Outpatient Default Percent / Case Rate,390," $1,215.00 ", $668.25 ," $1,001.16 ", $521.88 , $850.50 , $473.85 ," $1,172.35 "," $1,177.46 ", $625.75 , $521.88 , $521.88 , $815.27 , $815.27 , $547.97 , $532.32 , $446.88 , $446.88 , $458.41 , $458.41 , $521.88 , $425.25 , $- , $- ," $1,177.46 ", $850.50
P9039,5210010116,Hospital Chargemaster,Rbc deglycerolized,Outpatient,Outpatient Default Percent / Case Rate,390," $1,215.00 ", $668.25 ," $1,001.16 ", $521.88 , $850.50 , $473.85 ," $1,172.35 "," $1,177.46 ", $625.75 , $521.88 , $521.88 , $815.27 , $815.27 , $547.97 , $532.32 , $446.88 , $446.88 , $458.41 , $458.41 , $521.88 , $425.25 , $- , $- ," $1,177.46 ", $850.50
P9039,5210010130,Hospital Chargemaster,Rbc deglycerolized,Outpatient,Outpatient Default Percent / Case Rate,390," $1,215.00 ", $668.25 ," $1,001.16 ", $521.88 , $850.50 , $473.85 ," $1,172.35 "," $1,177.46 ", $625.75 , $521.88 , $521.88 , $815.27 , $815.27 , $547.97 , $532.32 , $446.88 , $446.88 , $458.41 , $458.41 , $521.88 , $425.25 , $- , $- ," $1,177.46 ", $850.50
P9053,5210010079,Hospital Chargemaster,"Plt, pher, l/r cmv-neg, irr",Outpatient,Outpatient Default Percent / Case Rate,390," $1,673.00 ", $920.15 ," $1,378.55 ", $534.62 ," $1,171.10 ", $652.47 ," $1,614.28 "," $1,621.30 ", $861.63 , $534.62 , $534.62 ," $1,122.58 "," $1,122.58 ", $561.35 , $545.31 , $437.12 , $437.12 , $448.40 , $448.40 , $534.62 , $585.55 , $- , $- ," $1,621.30 "," $1,171.10 "
P9053,5210010088,Hospital Chargemaster,"Plt, pher, l/r cmv-neg, irr",Outpatient,Outpatient Default Percent / Case Rate,390," $1,570.00 ", $863.50 ," $1,293.68 ", $534.62 ," $1,099.00 ", $612.30 ," $1,514.89 "," $1,521.49 ", $808.58 , $534.62 , $534.62 ," $1,053.47 "," $1,053.47 ", $561.35 , $545.31 , $437.12 , $437.12 , $448.40 , $448.40 , $534.62 , $549.50 , $- , $- ," $1,521.49 "," $1,099.00 "
P9053,5210010093,Hospital Chargemaster,"Plt, pher, l/r cmv-neg, irr",Outpatient,Outpatient Default Percent / Case Rate,390," $1,570.00 ", $863.50 ," $1,293.68 ", $534.62 ," $1,099.00 ", $612.30 ," $1,514.89 "," $1,521.49 ", $808.58 , $534.62 , $534.62 ," $1,053.47 "," $1,053.47 ", $561.35 , $545.31 , $437.12 , $437.12 , $448.40 , $448.40 , $534.62 , $549.50 , $- , $- ," $1,521.49 "," $1,099.00 "
P9053,5210010097,Hospital Chargemaster,"Plt, pher, l/r cmv-neg, irr",Outpatient,Outpatient Default Percent / Case Rate,390," $1,570.00 ", $863.50 ," $1,293.68 ", $534.62 ," $1,099.00 ", $612.30 ," $1,514.89 "," $1,521.49 ", $808.58 , $534.62 , $534.62 ," $1,053.47 "," $1,053.47 ", $561.35 , $545.31 , $437.12 , $437.12 , $448.40 , $448.40 , $534.62 , $549.50 , $- , $- ," $1,521.49 "," $1,099.00 "
P9053,5210010098,Hospital Chargemaster,"Plt, pher, l/r cmv-neg, irr",Outpatient,Outpatient Default Percent / Case Rate,390," $1,570.00 ", $863.50 ," $1,293.68 ", $534.62 ," $1,099.00 ", $612.30 ," $1,514.89 "," $1,521.49 ", $808.58 , $534.62 , $534.62 ," $1,053.47 "," $1,053.47 ", $561.35 , $545.31 , $437.12 , $437.12 , $448.40 , $448.40 , $534.62 , $549.50 , $- , $- ," $1,521.49 "," $1,099.00 "
P9055,5210010085,Hospital Chargemaster,"Plt, aph/pher, l/r, cmv-neg",Outpatient,Outpatient Default Percent / Case Rate,390," $1,110.00 ", $610.50 , $914.64 , $573.74 , $777.00 , $432.90 ," $1,071.04 "," $1,075.70 ", $571.67 , $573.74 , $573.74 , $744.81 , $744.81 , $602.42 , $585.21 , $482.26 , $482.26 , $494.70 , $494.70 , $573.74 , $388.50 , $- , $- ," $1,075.70 ", $777.00
P9055,5210010090,Hospital Chargemaster,"Plt, aph/pher, l/r, cmv-neg",Outpatient,Outpatient Default Percent / Case Rate,390," $1,110.00 ", $610.50 , $914.64 , $573.74 , $777.00 , $432.90 ," $1,071.04 "," $1,075.70 ", $571.67 , $573.74 , $573.74 , $744.81 , $744.81 , $602.42 , $585.21 , $482.26 , $482.26 , $494.70 , $494.70 , $573.74 , $388.50 , $- , $- ," $1,075.70 ", $777.00
P9055,5210010101,Hospital Chargemaster,"Plt, aph/pher, l/r, cmv-neg",Outpatient,Outpatient Default Percent / Case Rate,390," $1,110.00 ", $610.50 , $914.64 , $573.74 , $777.00 , $432.90 ," $1,071.04 "," $1,075.70 ", $571.67 , $573.74 , $573.74 , $744.81 , $744.81 , $602.42 , $585.21 , $482.26 , $482.26 , $494.70 , $494.70 , $573.74 , $388.50 , $- , $- ," $1,075.70 ", $777.00
P9037,5210010087,Hospital Chargemaster,Plate pheres leukoredu irrad,Outpatient,Outpatient Default Percent / Case Rate,390," $1,638.00 ", $900.90 ," $1,349.71 ", $737.84 ," $1,146.60 ", $638.82 ," $1,978.84 "," $1,327.80 "," $1,271.34 ", $737.84 , $737.84 ," $1,099.10 "," $1,099.10 ", $774.73 , $752.60 , $625.64 , $625.64 , $641.78 , $641.78 , $737.84 , $573.30 , $- , $- ," $1,978.84 "," $1,146.60 "
P9037,5210010092,Hospital Chargemaster,Plate pheres leukoredu irrad,Outpatient,Outpatient Default Percent / Case Rate,390," $1,648.00 ", $906.40 ," $1,357.95 ", $737.84 ," $1,153.60 ", $642.72 ," $1,978.84 "," $1,327.80 "," $1,271.34 ", $737.84 , $737.84 ," $1,105.81 "," $1,105.81 ", $774.73 , $752.60 , $625.64 , $625.64 , $641.78 , $641.78 , $737.84 , $576.80 , $- , $- ," $1,978.84 "," $1,153.60 "
P9037,5210010106,Hospital Chargemaster,Plate pheres leukoredu irrad,Outpatient,Outpatient Default Percent / Case Rate,390," $1,648.00 ", $906.40 ," $1,357.95 ", $737.84 ," $1,153.60 ", $642.72 ," $1,978.84 "," $1,327.80 "," $1,271.34 ", $737.84 , $737.84 ," $1,105.81 "," $1,105.81 ", $774.73 , $752.60 , $625.64 , $625.64 , $641.78 , $641.78 , $737.84 , $576.80 , $- , $- ," $1,978.84 "," $1,153.60 "
P9037,5210010110,Hospital Chargemaster,Plate pheres leukoredu irrad,Outpatient,Outpatient Default Percent / Case Rate,390," $1,648.00 ", $906.40 ," $1,357.95 ", $737.84 ," $1,153.60 ", $642.72 ," $1,978.84 "," $1,327.80 "," $1,271.34 ", $737.84 , $737.84 ," $1,105.81 "," $1,105.81 ", $774.73 , $752.60 , $625.64 , $625.64 , $641.78 , $641.78 , $737.84 , $576.80 , $- , $- ," $1,978.84 "," $1,153.60 "
P9037,5210010125,Hospital Chargemaster,Plate pheres leukoredu irrad,Outpatient,Outpatient Default Percent / Case Rate,390," $1,648.00 ", $906.40 ," $1,357.95 ", $737.84 ," $1,153.60 ", $642.72 ," $1,978.84 "," $1,327.80 "," $1,271.34 ", $737.84 , $737.84 ," $1,105.81 "," $1,105.81 ", $774.73 , $752.60 , $625.64 , $625.64 , $641.78 , $641.78 , $737.84 , $576.80 , $- , $- ," $1,978.84 "," $1,153.60 "
P9052,5210010091,Hospital Chargemaster,"Platelets, hla-m, l/r, unit",Outpatient,Outpatient Default Percent / Case Rate,390," $1,965.00 "," $1,080.75 "," $1,619.16 ", $962.35 ," $1,375.50 ", $766.35 ," $1,896.03 "," $1,904.28 "," $1,012.01 ", $962.35 , $962.35 ," $1,318.52 "," $1,318.52 "," $1,010.46 ", $981.59 , $818.20 , $818.20 , $839.31 , $839.31 , $962.35 , $687.75 , $- , $- ," $1,904.28 "," $1,375.50 "
P9035,5210010105,Hospital Chargemaster,Platelet pheres leukoreduced,Outpatient,Outpatient Default Percent / Case Rate,390," $1,050.00 ", $577.50 , $865.20 , $581.67 , $735.00 , $409.50 ," $1,539.87 "," $1,033.25 ", $989.32 , $581.67 , $581.67 , $704.55 , $704.55 , $610.76 , $593.31 , $496.75 , $496.75 , $509.57 , $509.57 , $581.67 , $367.50 , $- , $- ," $1,539.87 ", $735.00
P9035,5210010112,Hospital Chargemaster,Platelet pheres leukoreduced,Outpatient,Outpatient Default Percent / Case Rate,390," $1,050.00 ", $577.50 , $865.20 , $581.67 , $735.00 , $409.50 ," $1,539.87 "," $1,033.25 ", $989.32 , $581.67 , $581.67 , $704.55 , $704.55 , $610.76 , $593.31 , $496.75 , $496.75 , $509.57 , $509.57 , $581.67 , $367.50 , $- , $- ," $1,539.87 ", $735.00
P9035,5210010127,Hospital Chargemaster,Platelet pheres leukoreduced,Outpatient,Outpatient Default Percent / Case Rate,390," $1,050.00 ", $577.50 , $865.20 , $581.67 , $735.00 , $409.50 ," $1,539.87 "," $1,033.25 ", $989.32 , $581.67 , $581.67 , $704.55 , $704.55 , $610.76 , $593.31 , $496.75 , $496.75 , $509.57 , $509.57 , $581.67 , $367.50 , $- , $- ," $1,539.87 ", $735.00
86921,5210010135,Hospital Chargemaster,Compatability Test Incubate,Outpatient,Outpatient Default Percent / Case Rate,390, $40.00 , $268.04 , $32.96 , $178.30 , $28.00 , $15.60 , $458.30 , $307.52 , $294.44 , $178.30 , $178.30 , $26.84 , $26.84 , $187.22 , $181.87 , $40.00 , $40.00 , $40.00 , $40.00 , $178.30 , $14.00 , $173.68 , $14.00 , $458.30 , $28.00
P9073,5210010136,Hospital Chargemaster,Platelets pheresis path redu,Outpatient,Outpatient Default Percent / Case Rate,390," $1,648.00 ", $906.40 ," $1,357.95 ", $697.82 ," $1,153.60 ", $642.72 ," $1,978.84 "," $1,327.80 "," $1,271.34 ", $697.82 , $697.82 ," $1,105.81 "," $1,105.81 ", $732.71 , $711.77 , $591.25 , $591.25 , $606.50 , $606.50 , $697.82 , $576.80 , $- , $- ," $1,978.84 "," $1,153.60 "
36430,5210010134,Hospital Chargemaster,Blood transfusion service,Outpatient,Outpatient Default Percent / Case Rate,391," $1,450.00 ", $797.50 ," $1,236.00 ", $474.52 ," $1,015.00 ", $565.50 , $837.65 , $574.92 , $571.86 , $474.52 , $474.52 , $504.15 , $488.86 , $498.24 , $484.01 , $611.48 , $611.48 , $627.23 , $627.23 , $474.52 , $507.50 , $- , $- ," $1,236.00 "," $1,015.00 "
77066,5150010006,Hospital Chargemaster,DX Mammo Incl CAD BI,Outpatient,Outpatient Default Percent / Case Rate,401, $570.00 , $313.50 , $469.68 , See APC Packaged Rates , $399.00 , $222.30 , $475.69 , $373.00 , $371.72 , See APC Packaged Rates , See APC Packaged Rates , $318.75 , $309.08 , See APC Packaged Rates , See APC Packaged Rates , $244.97 , $244.97 , $251.29 , $251.29 , See APC Packaged Rates , $199.50 , $180.56 , $180.56 , $475.69 , $399.00
77065,5150040004,Hospital Chargemaster,DX Mammo Incl CAD UNI LT,Outpatient,Outpatient Default Percent / Case Rate,401, $532.00 , $292.60 , $438.37 , See APC Packaged Rates , $372.40 , $207.48 , $371.68 , $291.45 , $290.45 , See APC Packaged Rates , See APC Packaged Rates , $249.14 , $241.58 , See APC Packaged Rates , See APC Packaged Rates , $192.12 , $192.12 , $197.08 , $197.08 , See APC Packaged Rates , $186.20 , $141.09 , $141.09 , $438.37 , $372.40
77065,5150050005,Hospital Chargemaster,DX Mammo Incl CAD UNI RT,Outpatient,Outpatient Default Percent / Case Rate,401, $532.00 , $292.60 , $438.37 , See APC Packaged Rates , $372.40 , $207.48 , $371.68 , $291.45 , $290.45 , See APC Packaged Rates , See APC Packaged Rates , $249.14 , $241.58 , See APC Packaged Rates , See APC Packaged Rates , $192.12 , $192.12 , $197.08 , $197.08 , See APC Packaged Rates , $186.20 , $141.09 , $141.09 , $438.37 , $372.40
77061,5150010001,Hospital Chargemaster,Breast Tomosynthesis UNI,Outpatient,Outpatient Default Percent / Case Rate,401, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $465.70 , $365.17 , $363.91 , See APC Packaged Rates , See APC Packaged Rates , $43.62 , $43.62 , See APC Packaged Rates , See APC Packaged Rates , $65.00 , $65.00 , $65.00 , $65.00 , See APC Packaged Rates , $22.75 , $141.09 , $22.75 , $465.70 , $45.50
77062,5150010002,Hospital Chargemaster,Breast Tomosynthesis BI Diag,Outpatient,Outpatient Default Percent / Case Rate,401, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $589.70 , $462.41 , $460.81 , See APC Packaged Rates , See APC Packaged Rates , $43.62 , $43.62 , See APC Packaged Rates , See APC Packaged Rates , $65.00 , $65.00 , $65.00 , $65.00 , See APC Packaged Rates , $22.75 , $180.56 , $22.75 , $589.70 , $45.50
76831,5145010040,Hospital Chargemaster,Echo exam uterUS,Outpatient,Outpatient Default Percent / Case Rate,402, $414.00 , $227.70 , $341.14 , $275.09 , $289.80 , $161.46 , $585.06 , $458.77 , $457.19 , $275.09 , $275.09 , $185.66 , $180.02 , $288.84 , $280.59 , $414.00 , $414.00 , $414.00 , $414.00 , $275.09 , $144.90 , $345.84 , $144.90 , $585.06 , $289.80
76700,5145010013,Hospital Chargemaster,US exam abdom complete,Outpatient,Outpatient Default Percent / Case Rate,402, $704.00 , $387.20 , $580.10 , $130.16 , $492.80 , $274.56 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $239.83 , $232.55 , $136.66 , $132.76 , $229.16 , $229.16 , $235.06 , $235.06 , $130.16 , $246.40 , $168.77 , $130.16 , $580.10 , $492.80
76805,5145010022,Hospital Chargemaster,OB US >/= 14 wks sngl fetUS,Outpatient,Outpatient Default Percent / Case Rate,402, $674.00 , $370.70 , $555.38 , $130.16 , $471.80 , $262.86 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $255.34 , $247.59 , $136.66 , $132.76 , $210.52 , $210.52 , $215.94 , $215.94 , $130.16 , $235.90 , $168.77 , $130.16 , $555.38 , $471.80
76819,5145010032,Hospital Chargemaster,Fetal biophys profil w/o nst,Outpatient,Outpatient Default Percent / Case Rate,402, $332.00 , $182.60 , $273.57 , $130.16 , $232.40 , $129.48 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $159.21 , $154.38 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $116.20 , $168.77 , $116.20 , $285.50 , $232.40
76815,5145010028,Hospital Chargemaster,OB US limited fetUS(s),Outpatient,Outpatient Default Percent / Case Rate,402, $506.00 , $278.30 , $416.94 , $130.16 , $354.20 , $197.34 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $172.58 , $167.34 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $177.10 , $168.77 , $130.16 , $416.94 , $354.20
76604,5145010010,Hospital Chargemaster,US exam chest,Outpatient,Outpatient Default Percent / Case Rate,402, $290.00 , $159.50 , $238.96 , $130.16 , $203.00 , $113.10 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $158.25 , $153.45 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $101.50 , $168.77 , $101.50 , $285.50 , $203.00
76817,5145010030,Hospital Chargemaster,Transvaginal US OBstetric,Outpatient,Outpatient Default Percent / Case Rate,402, $285.00 , $156.75 , $234.84 , $130.16 , $199.50 , $111.15 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $150.11 , $145.56 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $99.75 , $168.77 , $99.75 , $285.50 , $199.50
76706,5145010015,Hospital Chargemaster,US abdl aorta screen aaa,Outpatient,Outpatient Default Percent / Case Rate,402, $674.00 , $370.70 , $555.38 , $130.16 , $471.80 , $262.86 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $175.76 , $170.42 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $235.90 , $168.77 , $130.16 , $555.38 , $471.80
76818,5145010031,Hospital Chargemaster,Fetal biophys profile w/nst,Outpatient,Outpatient Default Percent / Case Rate,402, $354.00 , $194.70 , $291.70 , $130.16 , $247.80 , $138.06 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $196.61 , $190.64 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $123.90 , $168.77 , $123.90 , $291.70 , $247.80
76705,5145010014,Hospital Chargemaster,Echo exam of abdomen,Outpatient,Outpatient Default Percent / Case Rate,402, $867.00 , $476.85 , $714.41 , $130.16 , $606.90 , $338.13 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $172.58 , $167.34 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $303.45 , $168.77 , $130.16 , $714.41 , $606.90
76801,5145010020,Hospital Chargemaster,OB US < 14 wks single fetUS,Outpatient,Outpatient Default Percent / Case Rate,402, $295.00 , $162.25 , $243.08 , $130.16 , $206.50 , $115.05 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $107.83 , $104.56 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $103.25 , $168.77 , $103.25 , $285.50 , $206.50
76775,5145010017,Hospital Chargemaster,US exam abdo back wall lim,Outpatient,Outpatient Default Percent / Case Rate,402, $368.00 , $202.40 , $303.23 , $130.16 , $257.60 , $143.52 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $172.58 , $167.34 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $128.80 , $168.77 , $128.80 , $303.23 , $257.60
76856,5145010041,Hospital Chargemaster,US exam pelvic complete,Outpatient,Outpatient Default Percent / Case Rate,402, $380.00 , $209.00 , $313.12 , $130.16 , $266.00 , $148.20 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $185.66 , $180.02 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $133.00 , $168.77 , $130.16 , $313.12 , $266.00
76830,5145010039,Hospital Chargemaster,Transvaginal US non-OB,Outpatient,Outpatient Default Percent / Case Rate,402, $429.00 , $235.95 , $353.50 , $130.16 , $300.30 , $167.31 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $185.66 , $180.02 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $150.15 , $168.77 , $130.16 , $353.50 , $300.30
76506,5145010000,Hospital Chargemaster,Echo exam of head,Outpatient,Outpatient Default Percent / Case Rate,402," $1,245.00 ", $684.75 ," $1,025.88 ", $130.16 , $871.50 , $485.55 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $172.58 , $167.34 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $435.75 , $168.77 , $130.16 ," $1,025.88 ", $871.50
76870,5145010043,Hospital Chargemaster,US exam scrotum,Outpatient,Outpatient Default Percent / Case Rate,402, $674.00 , $370.70 , $555.38 , $130.16 , $471.80 , $262.86 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $185.66 , $180.02 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $235.90 , $168.77 , $130.16 , $555.38 , $471.80
76536,5145010009,Hospital Chargemaster,US exam of head and neck,Outpatient,Outpatient Default Percent / Case Rate,402, $500.00 , $275.00 , $412.00 , $130.16 , $350.00 , $195.00 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $172.58 , $167.34 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $175.00 , $168.77 , $130.16 , $412.00 , $350.00
76770,5145010016,Hospital Chargemaster,US exam abdo back wall comp,Outpatient,Outpatient Default Percent / Case Rate,402, $674.00 , $370.70 , $555.38 , $130.16 , $471.80 , $262.86 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $239.83 , $232.55 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $235.90 , $168.77 , $130.16 , $555.38 , $471.80
76872,5145010044,Hospital Chargemaster,US transrectal,Outpatient,Outpatient Default Percent / Case Rate,402, $386.00 , $212.30 , $318.06 , $130.16 , $270.20 , $150.54 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $185.66 , $180.02 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $135.10 , $168.77 , $130.16 , $318.06 , $270.20
76881,5145010046,Hospital Chargemaster,US compl joint r-t w/img,Outpatient,Outpatient Default Percent / Case Rate,402, $315.00 , $173.25 , $259.56 , $130.16 , $220.50 , $122.85 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $232.97 , $225.90 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $110.25 , $168.77 , $110.25 , $285.50 , $220.50
76800,5145010019,Hospital Chargemaster,US exam spinal canal,Outpatient,Outpatient Default Percent / Case Rate,402, $315.00 , $173.25 , $259.56 , $130.16 , $220.50 , $122.85 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $172.58 , $167.34 , $136.66 , $132.76 , $207.52 , $207.52 , $212.86 , $212.86 , $130.16 , $110.25 , $168.77 , $110.25 , $285.50 , $220.50
76882,5145010047,Hospital Chargemaster,US lmtd jt/nonvasc xtr strux,Outpatient,Outpatient Default Percent / Case Rate,402, $224.00 , $123.20 , $184.58 , $130.16 , $156.80 , $87.36 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $27.28 , $26.46 , $136.66 , $132.76 , $203.81 , $203.81 , $209.06 , $209.06 , $130.16 , $78.40 , $168.77 , $26.46 , $285.50 , $156.80
76820,5145010033,Hospital Chargemaster,Umbilical artery echo,Outpatient,Outpatient Default Percent / Case Rate,402, $342.00 , $188.10 , $281.81 , $130.16 , $239.40 , $133.38 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $176.51 , $171.15 , $136.66 , $132.76 , $203.81 , $203.81 , $209.06 , $209.06 , $130.16 , $119.70 , $168.77 , $119.70 , $285.50 , $239.40
76857,5145010042,Hospital Chargemaster,US exam pelvic limited,Outpatient,Outpatient Default Percent / Case Rate,402, $336.00 , $184.80 , $276.86 , $130.16 , $235.20 , $131.04 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $128.16 , $124.27 , $136.66 , $132.76 , $203.81 , $203.81 , $209.06 , $209.06 , $130.16 , $117.60 , $168.77 , $117.60 , $285.50 , $235.20
76641,5145010011,Hospital Chargemaster,Ultrasound breast complete,Outpatient,Outpatient Default Percent / Case Rate,402, $674.00 , $370.70 , $555.38 , $130.16 , $471.80 , $262.86 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $187.83 , $182.13 , $136.66 , $132.76 , $203.81 , $203.81 , $209.06 , $209.06 , $130.16 , $235.90 , $168.77 , $130.16 , $555.38 , $471.80
76641,5145040081,Hospital Chargemaster,Ultrasound Breast Complete LT,Outpatient,Outpatient Default Percent / Case Rate,402, $674.00 , $370.70 , $555.38 , $130.16 , $471.80 , $262.86 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $187.83 , $182.13 , $136.66 , $132.76 , $203.81 , $203.81 , $209.06 , $209.06 , $130.16 , $235.90 , $168.77 , $130.16 , $555.38 , $471.80
76641,5145050081,Hospital Chargemaster,Ultrasound Breast Complete RT,Outpatient,Outpatient Default Percent / Case Rate,402, $674.00 , $370.70 , $555.38 , $130.16 , $471.80 , $262.86 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $187.83 , $182.13 , $136.66 , $132.76 , $203.81 , $203.81 , $209.06 , $209.06 , $130.16 , $235.90 , $168.77 , $130.16 , $555.38 , $471.80
76816,5145010029,Hospital Chargemaster,OB US follow-up per fetUS,Outpatient,Outpatient Default Percent / Case Rate,402, $194.00 , $106.70 , $159.86 , $130.16 , $135.80 , $75.66 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $135.44 , $131.33 , $136.66 , $132.76 , $194.00 , $194.00 , $194.00 , $194.00 , $130.16 , $67.90 , $168.77 , $67.90 , $285.50 , $135.80
76970,5145010061,Hospital Chargemaster,Ultrasound exam follow-up,Outpatient,Outpatient Default Percent / Case Rate,402, $194.00 , $106.70 , $159.86 , See APC Packaged Rates , $135.80 , $75.66 , $285.50 , $223.87 , $223.10 , See APC Packaged Rates , See APC Packaged Rates , $130.17 , $130.17 , See APC Packaged Rates , See APC Packaged Rates , $194.00 , $194.00 , $194.00 , $194.00 , See APC Packaged Rates , $67.90 , Not Applicable , $67.90 , $285.50 , $135.80
76642,5145010012,Hospital Chargemaster,Ultrasound breast limited,Outpatient,Outpatient Default Percent / Case Rate,402, $674.00 , $370.70 , $555.38 , $96.70 , $471.80 , $262.86 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $143.82 , $139.45 , $101.54 , $98.64 , $153.88 , $153.88 , $157.84 , $157.84 , $96.70 , $235.90 , $93.45 , $93.45 , $555.38 , $471.80
76642,5145040012,Hospital Chargemaster,Ultrasound Breast Limited LT,Outpatient,Outpatient Default Percent / Case Rate,402, $674.00 , $370.70 , $555.38 , $96.70 , $471.80 , $262.86 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $143.82 , $139.45 , $101.54 , $98.64 , $153.88 , $153.88 , $157.84 , $157.84 , $96.70 , $235.90 , $93.45 , $93.45 , $555.38 , $471.80
76642,5145050012,Hospital Chargemaster,Ultrasound Breast Limited RT,Outpatient,Outpatient Default Percent / Case Rate,402, $674.00 , $370.70 , $555.38 , $96.70 , $471.80 , $262.86 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $143.82 , $139.45 , $101.54 , $98.64 , $153.88 , $153.88 , $157.84 , $157.84 , $96.70 , $235.90 , $93.45 , $93.45 , $555.38 , $471.80
76885,5145010048,Hospital Chargemaster,US exam infant hips dynamic,Outpatient,Outpatient Default Percent / Case Rate,402, $251.00 , $138.05 , $206.82 , $96.70 , $175.70 , $97.89 , $158.08 , $123.96 , $123.53 , $96.70 , $96.70 , $185.66 , $180.02 , $101.54 , $98.64 , $144.44 , $144.44 , $148.16 , $148.16 , $96.70 , $87.85 , $93.45 , $87.85 , $206.82 , $175.70
76946,5145010058,Hospital Chargemaster,Echo guide for amniocentesis,Outpatient,Outpatient Default Percent / Case Rate,402, $278.00 , $152.90 , $229.07 , See APC Packaged Rates , $194.60 , $108.42 , $52.57 , $41.22 , $41.08 , See APC Packaged Rates , See APC Packaged Rates , $185.66 , $180.02 , See APC Packaged Rates , See APC Packaged Rates , $258.54 , $258.54 , $258.54 , $258.54 , See APC Packaged Rates , $97.30 , $- , $- , $258.54 , $194.60
76937,5145010053,Hospital Chargemaster,US guide vascular access,Outpatient,Outpatient Default Percent / Case Rate,402, $322.00 , $177.10 , $265.33 , See APC Packaged Rates , $225.40 , $125.58 , $78.35 , $61.44 , $61.23 , See APC Packaged Rates , See APC Packaged Rates ," $4,972.50 "," $4,821.63 ", See APC Packaged Rates , See APC Packaged Rates , $299.46 , $299.46 , $299.46 , $299.46 , See APC Packaged Rates , $112.70 , $- , $- ," $4,972.50 ", $225.40
76802,5145010021,Hospital Chargemaster,OB US < 14 wks addl fetUS,Outpatient,Outpatient Default Percent / Case Rate,402, $145.00 , $79.75 , $119.48 , See APC Packaged Rates , $101.50 , $56.55 , $86.90 , $68.14 , $67.90 , See APC Packaged Rates , See APC Packaged Rates , $107.83 , $104.56 , See APC Packaged Rates , See APC Packaged Rates , $134.85 , $134.85 , $134.85 , $134.85 , See APC Packaged Rates , $50.75 , $- , $- , $134.85 , $101.50
76942,5145010056,Hospital Chargemaster,Echo guide for biopsy,Outpatient,Outpatient Default Percent / Case Rate,402, $260.00 , $143.00 , $214.24 , See APC Packaged Rates , $182.00 , $101.40 , $99.59 , $78.09 , $77.82 , See APC Packaged Rates , See APC Packaged Rates , $185.66 , $180.02 , See APC Packaged Rates , See APC Packaged Rates , $241.80 , $241.80 , $241.80 , $241.80 , See APC Packaged Rates , $91.00 , $- , $- , $241.80 , $182.00
76810,5145010023,Hospital Chargemaster,OB US >/= 14 wks addl fetUS,Outpatient,Outpatient Default Percent / Case Rate,402, $700.00 , $385.00 , $576.80 , See APC Packaged Rates , $490.00 , $273.00 , $170.95 , $134.05 , $133.59 , See APC Packaged Rates , See APC Packaged Rates , $509.75 , $494.28 , See APC Packaged Rates , See APC Packaged Rates , $651.00 , $651.00 , $651.00 , $651.00 , See APC Packaged Rates , $245.00 , $- , $- , $651.00 , $490.00
76819,5145010084,Hospital Chargemaster,Fetal Biophys Profil W/o Nst59,Outpatient,Outpatient Default Percent / Case Rate,402, $332.00 , $182.60 , $273.57 , $130.16 , $232.40 , $129.48 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $159.21 , $154.38 , $136.66 , $132.76 , $208.66 , $208.66 , $214.03 , $214.03 , $130.16 , $116.20 , $168.77 , $116.20 , $285.50 , $232.40
76816,5145010085,Hospital Chargemaster,OB Us Follow-Up Per Fetus 59,Outpatient,Outpatient Default Percent / Case Rate,402, $194.00 , $106.70 , $159.86 , $130.16 , $135.80 , $75.66 , $285.50 , $223.87 , $223.10 , $130.16 , $130.16 , $135.44 , $131.33 , $136.66 , $132.76 , $194.00 , $194.00 , $194.00 , $194.00 , $130.16 , $67.90 , $168.77 , $67.90 , $285.50 , $135.80
77067,5150010007,Hospital Chargemaster,SCR Mammo BI Incl CAD,Outpatient,Outpatient Default Percent / Case Rate,403, $480.00 , $264.00 , $395.52 , See APC Packaged Rates , $336.00 , $187.20 , $393.05 , $308.21 , $307.14 , See APC Packaged Rates , See APC Packaged Rates , $263.32 , $255.33 , See APC Packaged Rates , See APC Packaged Rates , $203.14 , $203.14 , $208.38 , $208.38 , See APC Packaged Rates , $168.00 , $149.21 , $149.21 , $395.52 , $336.00
77067,5150010008,Hospital Chargemaster,SCR Mammo UNI Incl CAD,Outpatient,Outpatient Default Percent / Case Rate,403, $480.00 , $264.00 , $395.52 , See APC Packaged Rates , $336.00 , $187.20 , $393.05 , $308.21 , $307.14 , See APC Packaged Rates , See APC Packaged Rates , $263.32 , $255.33 , See APC Packaged Rates , See APC Packaged Rates , $203.14 , $203.14 , $208.38 , $208.38 , See APC Packaged Rates , $168.00 , $149.21 , $149.21 , $395.52 , $336.00
77063,5150010003,Hospital Chargemaster,Breast Tomosynthesis BI Screen,Outpatient,Outpatient Default Percent / Case Rate,403, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $99.72 , $78.20 , $77.93 , See APC Packaged Rates , See APC Packaged Rates , $43.62 , $43.62 , See APC Packaged Rates , See APC Packaged Rates , $51.37 , $51.37 , $52.70 , $52.70 , See APC Packaged Rates , $22.75 , $37.85 , $22.75 , $99.72 , $45.50
77063,5150010004,Hospital Chargemaster,Breast Tomosynthesis Scr 52RS,Outpatient,Outpatient Default Percent / Case Rate,403, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $99.72 , $78.20 , $77.93 , See APC Packaged Rates , See APC Packaged Rates , $43.62 , $43.62 , See APC Packaged Rates , See APC Packaged Rates , $51.37 , $51.37 , $52.70 , $52.70 , See APC Packaged Rates , $22.75 , $37.85 , $22.75 , $99.72 , $45.50
77063,5155010161,Hospital Chargemaster,Breast Tomosynthesis Scr 52RS,Outpatient,Outpatient Default Percent / Case Rate,403, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $99.72 , $78.20 , $77.93 , See APC Packaged Rates , See APC Packaged Rates , $43.62 , $43.62 , See APC Packaged Rates , See APC Packaged Rates , $51.37 , $51.37 , $52.70 , $52.70 , See APC Packaged Rates , $22.75 , $37.85 , $22.75 , $99.72 , $45.50
77063,5155010162,Hospital Chargemaster,Breast Tomosynthesis BI Screen,Outpatient,Outpatient Default Percent / Case Rate,403, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $99.72 , $78.20 , $77.93 , See APC Packaged Rates , See APC Packaged Rates , $43.62 , $43.62 , See APC Packaged Rates , See APC Packaged Rates , $51.37 , $51.37 , $52.70 , $52.70 , See APC Packaged Rates , $22.75 , $37.85 , $22.75 , $99.72 , $45.50
94002,5310010001,Hospital Chargemaster,Vent Mgmt Inpat Init Day,Outpatient,Outpatient Default Percent / Case Rate,410," $1,046.00 ", $575.30 , $861.90 , $582.41 , $732.20 , $407.94 ," $1,252.09 ", $978.58 ," $1,071.88 ", $582.41 , $582.41 , $701.87 , $701.87 , $611.53 , $594.06 , $753.91 , $753.91 , $773.34 , $773.34 , $582.41 , $366.10 , $- , $- ," $1,252.09 ", $732.20
94003,5310010002,Hospital Chargemaster,Vent Mgmt Inpat Subq Day,Outpatient,Outpatient Default Percent / Case Rate,410," $1,046.00 ", $575.30 , $861.90 , $582.41 , $732.20 , $407.94 ," $1,252.09 ", $978.58 ," $1,071.88 ", $582.41 , $582.41 , $701.87 , $701.87 , $611.53 , $594.06 , $753.91 , $753.91 , $773.34 , $773.34 , $582.41 , $366.10 , $- , $- ," $1,252.09 ", $732.20
94660,5310010028,Hospital Chargemaster,Pos Airway Pressure Cpap,Outpatient,Outpatient Default Percent / Case Rate,410, $285.00 , $156.75 , $234.84 , $224.72 , $199.50 , $111.15 , $470.43 , $367.67 , $402.72 , $224.72 , $224.72 , $170.35 , $165.18 , $235.95 , $229.21 , $285.00 , $285.00 , $285.00 , $285.00 , $224.72 , $99.75 , $- , $- , $470.43 , $199.50
94664,5310010030,Hospital Chargemaster,Evaluate Pt Use Of Inhaler,Outpatient,Outpatient Default Percent / Case Rate,410, $181.00 , $99.55 , $149.14 , $224.72 , $126.70 , $70.59 , $470.43 , $367.67 , $402.72 , $224.72 , $224.72 , $66.92 , $64.89 , $235.95 , $229.21 , $181.00 , $181.00 , $181.00 , $181.00 , $224.72 , $63.35 , $- , $- , $470.43 , $126.70
94667,5310010031,Hospital Chargemaster,Chest Wall Manipulation,Outpatient,Outpatient Default Percent / Case Rate,410, $181.00 , $99.55 , $149.14 , $134.80 , $126.70 , $70.59 , $261.44 , $204.33 , $223.81 , $134.80 , $134.80 , $73.01 , $70.79 , $141.54 , $137.50 , $163.67 , $163.67 , $167.89 , $167.89 , $134.80 , $63.35 , $- , $- , $261.44 , $126.70
94668,5310010032,Hospital Chargemaster,Chest Wall Manipulation,Outpatient,Outpatient Default Percent / Case Rate,410, $89.00 , $48.95 , $73.34 , $134.80 , $62.30 , $34.71 , $261.44 , $204.33 , $223.81 , $134.80 , $134.80 , $45.63 , $44.25 , $141.54 , $137.50 , $89.00 , $89.00 , $89.00 , $89.00 , $134.80 , $31.15 , $- , $- , $261.44 , $62.30
94640,5310010024,Hospital Chargemaster,Airway Inhalation Treatment,Outpatient,Outpatient Default Percent / Case Rate,410, $181.00 , $99.55 , $149.14 , $224.72 , $126.70 , $70.59 , $470.43 , $367.67 , $402.72 , $224.72 , $224.72 , $51.71 , $50.14 , $235.95 , $229.21 , $181.00 , $181.00 , $181.00 , $181.00 , $224.72 , $63.35 , $- , $- , $470.43 , $126.70
36600,5310010047,Hospital Chargemaster,Withdrawal Of Arterial Blood,Outpatient,Outpatient Default Percent / Case Rate,410, $239.00 , $131.45 ," $2,542.04 ", $134.80 , $167.30 , $93.21 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $38.14 , $36.98 , $141.54 , $137.50 , $157.34 , $157.34 , $161.39 , $161.39 , $134.80 , $83.65 , $- , $- ," $2,542.04 ", $167.30
94640,66904003,Hospital Chargemaster,Airway Inhalation Treatment,Outpatient,Outpatient Default Percent / Case Rate,410, $89.00 , $48.95 , $73.34 , $224.72 , $62.30 , $34.71 , $470.43 , $367.67 , $402.72 , $224.72 , $224.72 , $51.71 , $50.14 , $235.95 , $229.21 , $181.00 , $181.00 , $181.00 , $181.00 , $224.72 , $31.15 , $- , $- , $470.43 , $62.30
99183,6500011874,Hospital Chargemaster,Hyperbaric Oxygen Therapy,Outpatient,Outpatient Default Percent / Case Rate,413, $500.00 , $275.00 , $412.00 , See APC Packaged Rates , $350.00 , $195.00 , $390.60 , $305.28 , $334.39 , See APC Packaged Rates , See APC Packaged Rates , $288.78 , $280.02 , See APC Packaged Rates , See APC Packaged Rates , $188.07 , $188.07 , $192.92 , $192.92 , See APC Packaged Rates , $175.00 , $- , $- , $412.00 , $350.00
29131,5410010064,Hospital Chargemaster,Applic finger splint Dynamic,Outpatient,Outpatient Default Percent / Case Rate,420, $116.00 , $63.80 , $95.58 , $66.55 , $81.20 , $45.24 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $85.99 , $85.99 , $88.21 , $88.21 , $66.55 , $179.29 , $- , $- , $179.29 , $81.20
29550,5410010071,Hospital Chargemaster,Strapping of toes,Outpatient,Outpatient Default Percent / Case Rate,420, $116.00 , $63.80 , $95.58 , $66.55 , $81.20 , $45.24 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $85.99 , $85.99 , $88.21 , $88.21 , $66.55 , $179.29 , $- , $- , $179.29 , $81.20
29260,5410010067,Hospital Chargemaster,Strapping of elbow or wrist,Outpatient,Outpatient Default Percent / Case Rate,420, $116.00 , $63.80 , $95.58 , $66.55 , $81.20 , $45.24 , $70.26 , $48.23 , $47.97 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $62.64 , $62.64 , $64.26 , $64.26 , $66.55 , $179.29 , $- , $- , $179.29 , $81.20
29280,5410010068,Hospital Chargemaster,Strapping of hand or finger,Outpatient,Outpatient Default Percent / Case Rate,420, $116.00 , $63.80 , $95.58 , $66.55 , $81.20 , $45.24 , $70.26 , $48.23 , $47.97 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $62.64 , $62.64 , $64.26 , $64.26 , $66.55 , $179.29 , $- , $- , $179.29 , $81.20
29240,5410010066,Hospital Chargemaster,Strapping of shoulder,Outpatient,Outpatient Default Percent / Case Rate,420, $125.00 , $68.75 , $103.00 , $134.80 , $87.50 , $48.75 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $125.00 , $125.00 , $125.00 , $125.00 , $134.80 , $179.29 , $- , $- , $232.95 , $87.50
29530,5410010070,Hospital Chargemaster,Strapping of knee,Outpatient,Outpatient Default Percent / Case Rate,420, $125.00 , $68.75 , $103.00 , $134.80 , $87.50 , $48.75 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $125.00 , $125.00 , $125.00 , $125.00 , $134.80 , $179.29 , $- , $- , $232.95 , $87.50
29125,5410010061,Hospital Chargemaster,Apply forearm splint Static,Outpatient,Outpatient Default Percent / Case Rate,420, $116.00 , $63.80 , $95.58 , $134.80 , $81.20 , $45.24 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $116.00 , $116.00 , $116.00 , $116.00 , $134.80 , $179.29 , $- , $- , $232.95 , $81.20
29126,5410010062,Hospital Chargemaster,Apply forearm splint Dynamic,Outpatient,Outpatient Default Percent / Case Rate,420, $116.00 , $63.80 , $95.58 , $134.80 , $81.20 , $45.24 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $116.00 , $116.00 , $116.00 , $116.00 , $134.80 , $179.29 , $- , $- , $232.95 , $81.20
29130,5410010063,Hospital Chargemaster,Applic finger splint Static,Outpatient,Outpatient Default Percent / Case Rate,420, $150.00 , $82.50 , $123.60 , $134.80 , $105.00 , $58.50 , $122.28 , $83.93 , $83.48 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $110.05 , $110.05 , $112.89 , $112.89 , $134.80 , $179.29 , $- , $- , $179.29 , $105.00
29580,5410010072,Hospital Chargemaster,Strapping Uba boot,Outpatient,Outpatient Default Percent / Case Rate,420, $488.00 , $268.40 , $402.11 , $168.90 , $341.60 , $190.32 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $179.29 , $- , $- , $402.11 , $341.60
29799,5410010073,Hospital Chargemaster,Unlist Casting strapping proc,Outpatient,Outpatient Default Percent / Case Rate,420, $240.00 , $132.00 , $197.76 , $168.90 , $168.00 , $93.60 , $231.58 , $232.58 , $123.60 , $168.90 , $168.90 , $161.04 , $161.04 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $179.29 , $- , $- , $232.58 , $168.00
29105,5410010060,Hospital Chargemaster,Apply long arm splint,Outpatient,Outpatient Default Percent / Case Rate,420, $116.00 , $63.80 , $95.58 , $168.90 , $81.20 , $45.24 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $116.00 , $116.00 , $116.00 , $116.00 , $168.90 , $179.29 , $- , $- , $294.51 , $81.20
29200,5410010065,Hospital Chargemaster,Strapping of chest,Outpatient,Outpatient Default Percent / Case Rate,420, $116.00 , $63.80 , $95.58 , $168.90 , $81.20 , $45.24 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $89.39 , $86.68 , $177.35 , $172.28 , $116.00 , $116.00 , $116.00 , $116.00 , $168.90 , $179.29 , $- , $- , $294.51 , $81.20
97602,5410010043,Hospital Chargemaster,Wound(s) care non-selective,Outpatient,Outpatient Default Percent / Case Rate,420, $80.00 , $326.79 , $65.92 , $214.68 , $56.00 , $31.20 , $875.52 , $556.51 , $546.42 , $214.68 , $214.68 , $53.68 , $53.68 , $225.42 , $218.98 , $80.00 , $80.00 , $80.00 , $80.00 , $214.68 , $179.29 , $- , $- , $875.52 , $56.00
97597,5410010041,Hospital Chargemaster,Rmvl devital tis 20 cm or less,Outpatient,Outpatient Default Percent / Case Rate,420, $275.00 , $151.25 ," $1,236.00 ", $214.68 , $192.50 , $107.25 , $875.52 , $556.51 , $546.42 , $214.68 , $214.68 , $126.90 , $123.05 , $225.42 , $218.98 , $78.00 , $78.00 , $78.00 , $78.00 , $214.68 , $179.29 , $- , $- ," $1,236.00 ", $192.50
97537,5410010037,Hospital Chargemaster,Community work reinteg 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $75.00 , $41.25 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $241.94 , $153.79 , $151.00 , See APC Packaged Rates , See APC Packaged Rates , $61.21 , $59.36 , See APC Packaged Rates , See APC Packaged Rates , $63.52 , $63.52 , $65.15 , $65.15 , See APC Packaged Rates , $179.29 , $- , $- , $241.94 , $52.50
97535,5410010036,Hospital Chargemaster,Self care mgmt train EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $254.14 , $161.54 , $158.61 , See APC Packaged Rates , See APC Packaged Rates , $76.92 , $74.58 , See APC Packaged Rates , See APC Packaged Rates , $65.00 , $65.00 , $65.00 , $65.00 , See APC Packaged Rates , $179.29 , $- , $- , $254.14 , $45.50
97750,5410010049,Hospital Chargemaster,Physical perf test wRPT 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $259.69 , $165.07 , $162.07 , See APC Packaged Rates , See APC Packaged Rates , $43.62 , $43.62 , See APC Packaged Rates , See APC Packaged Rates , $65.00 , $65.00 , $65.00 , $65.00 , See APC Packaged Rates , $179.29 , $- , $- , $259.69 , $45.50
97598,5410010042,Hospital Chargemaster,Rmvl devital tis addl 20cm,Outpatient,Outpatient Default Percent / Case Rate,420, $350.00 , $192.50 ," $1,236.00 ", See APC Packaged Rates , $245.00 , $136.50 , $35.52 , $24.38 , $24.25 , See APC Packaged Rates , See APC Packaged Rates , $161.09 , $156.20 , See APC Packaged Rates , See APC Packaged Rates , $325.50 , $325.50 , $325.50 , $325.50 , See APC Packaged Rates , $179.29 , $- , $- ," $1,236.00 ", $245.00
97012,5410010006,Hospital Chargemaster,Mechanical traction therapy,Outpatient,Outpatient Default Percent / Case Rate,420, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $108.08 , $68.70 , $67.46 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $29.10 , $29.10 , $29.85 , $29.85 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $45.50
97014,5410010007,Hospital Chargemaster,Electric stim therapy Unatt,Outpatient,Outpatient Default Percent / Case Rate,420, $50.00 , $27.50 , $41.20 , See APC Packaged Rates , $35.00 , $19.50 , $110.51 , $70.25 , $68.97 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $46.50 , $46.50 , $46.50 , $46.50 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $35.00
97016,5410010008,Hospital Chargemaster,Vasopneumatic device therapy,Outpatient,Outpatient Default Percent / Case Rate,420, $75.00 , $41.25 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $93.81 , $59.63 , $58.55 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $26.01 , $26.01 , $26.68 , $26.68 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $52.50
97018,5410010009,Hospital Chargemaster,Paraffin bath therapy,Outpatient,Outpatient Default Percent / Case Rate,420, $75.00 , $41.25 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $53.37 , $33.92 , $33.31 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $14.30 , $14.30 , $14.67 , $14.67 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $52.50
97022,5410010010,Hospital Chargemaster,Whirlpool therapy,Outpatient,Outpatient Default Percent / Case Rate,420, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $135.94 , $86.41 , $84.84 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $35.71 , $35.71 , $36.64 , $36.64 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $45.50
97024,5410010011,Hospital Chargemaster,Diathermy eg microwave,Outpatient,Outpatient Default Percent / Case Rate,420, $75.00 , $41.25 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $53.37 , $33.92 , $33.31 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $13.98 , $13.98 , $14.34 , $14.34 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $52.50
97026,5410010012,Hospital Chargemaster,Infrared therapy,Outpatient,Outpatient Default Percent / Case Rate,420, $75.00 , $41.25 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $47.77 , $30.37 , $29.82 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $12.51 , $12.51 , $12.83 , $12.83 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $52.50
97028,5410010013,Hospital Chargemaster,Ultraviolet therapy,Outpatient,Outpatient Default Percent / Case Rate,420, $75.00 , $41.25 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $61.05 , $38.81 , $38.10 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $15.99 , $15.99 , $16.40 , $16.40 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $52.50
97032,5410010014,Hospital Chargemaster,Electrical stim EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $108.08 , $68.70 , $67.46 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $28.37 , $28.37 , $29.10 , $29.10 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $45.50
97033,5410010015,Hospital Chargemaster,Electric cur therapy EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $88.00 , $48.40 , $72.51 , See APC Packaged Rates , $61.60 , $34.32 , $155.12 , $98.60 , $96.81 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $40.76 , $40.76 , $41.81 , $41.81 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $61.60
97034,5410010016,Hospital Chargemaster,Contr bath therapy EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $39.00 , $21.45 , $32.14 , See APC Packaged Rates , $27.30 , $15.21 , $112.25 , $71.35 , $70.06 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $29.48 , $29.48 , $30.24 , $30.24 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $27.30
97035,5410010017,Hospital Chargemaster,Ultrasound therapy EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $101.10 , $64.26 , $63.10 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $27.74 , $27.74 , $28.45 , $28.45 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $45.50
97036,5410010018,Hospital Chargemaster,Hydrotherapy EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $75.00 , $41.25 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $265.85 , $168.98 , $165.92 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $70.65 , $70.65 , $72.47 , $72.47 , See APC Packaged Rates , $179.29 , $- , $- , $265.85 , $52.50
97110,5410010020,Hospital Chargemaster,Therapeutic exer EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $226.28 , $143.83 , $141.22 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $59.40 , $59.40 , $60.93 , $60.93 , See APC Packaged Rates , $179.29 , $- , $- , $226.28 , $45.50
97112,5410010021,Hospital Chargemaster,Neuromuscular reeduc EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $130.00 , $71.50 , $107.12 , See APC Packaged Rates , $91.00 , $50.70 , $258.00 , $163.99 , $161.02 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $68.48 , $68.48 , $70.24 , $70.24 , See APC Packaged Rates , $179.29 , $- , $- , $258.00 , $91.00
97113,5410010022,Hospital Chargemaster,Aquatic therapy exer EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $75.00 , $41.25 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $289.32 , $183.90 , $180.57 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $75.00 , $75.00 , $75.00 , $75.00 , See APC Packaged Rates , $179.29 , $- , $- , $289.32 , $52.50
97116,5410010023,Hospital Chargemaster,Gait training ther EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $58.00 , $31.90 , $47.79 , See APC Packaged Rates , $40.60 , $22.62 , $223.50 , $142.06 , $139.49 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $58.00 , $58.00 , $58.00 , $58.00 , See APC Packaged Rates , $179.29 , $- , $- , $223.50 , $40.60
97124,5410010024,Hospital Chargemaster,Massage therapy EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $36.00 , $19.80 , $29.66 , See APC Packaged Rates , $25.20 , $14.04 , $213.31 , $135.58 , $133.13 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $36.00 , $36.00 , $36.00 , $36.00 , See APC Packaged Rates , $179.29 , $- , $- , $213.31 , $25.20
97129,5410010025,Hospital Chargemaster,Cognitive skill deve EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $72.00 , $39.60 , $59.33 , See APC Packaged Rates , $50.40 , $28.08 , $169.96 , $108.03 , $106.07 , See APC Packaged Rates , See APC Packaged Rates , $61.19 , $59.33 , See APC Packaged Rates , See APC Packaged Rates , $41.25 , $41.25 , $42.32 , $42.32 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $50.40
97139,5410010026,Hospital Chargemaster,Unlisted therapeutic,Outpatient,Outpatient Default Percent / Case Rate,420, $50.00 , $27.50 , $41.20 , See APC Packaged Rates , $35.00 , $19.50 , $48.25 , $48.46 , $25.75 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $45.00 , $45.00 , $46.16 , $46.16 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $35.00
97140,5410010027,Hospital Chargemaster,Manual therapy tech EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $80.00 , $44.00 , $65.92 , See APC Packaged Rates , $56.00 , $31.20 , $204.97 , $130.29 , $127.93 , See APC Packaged Rates , See APC Packaged Rates , $63.11 , $61.19 , See APC Packaged Rates , See APC Packaged Rates , $54.44 , $54.44 , $55.85 , $55.85 , See APC Packaged Rates , $179.29 , $- , $- , $204.97 , $56.00
97150,5410010028,Hospital Chargemaster,Group therapeutic proc 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $35.00 , $19.25 , $28.84 , See APC Packaged Rates , $24.50 , $13.65 , $134.55 , $85.53 , $83.98 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $35.00 , $35.00 , $35.00 , $35.00 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $24.50
97150,5410010029,Hospital Chargemaster,Group therapeutic proc 30 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $50.00 , $27.50 , $41.20 , See APC Packaged Rates , $35.00 , $19.50 , $134.55 , $85.53 , $83.98 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $35.00 , $35.00 , $35.00 , $35.00 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $35.00
97150,5410010030,Hospital Chargemaster,Group therapeutic proc 45 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $71.00 , $39.05 , $58.50 , See APC Packaged Rates , $49.70 , $27.69 , $134.55 , $85.53 , $83.98 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $35.00 , $35.00 , $35.00 , $35.00 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $49.70
97150,5410010031,Hospital Chargemaster,Group therapeutic proc 60 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $183.00 , $100.65 , $150.79 , See APC Packaged Rates , $128.10 , $71.37 , $134.55 , $85.53 , $83.98 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $35.00 , $35.00 , $35.00 , $35.00 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $128.10
97150,5410010032,Hospital Chargemaster,Group therapeutic proc 90 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $221.00 , $121.55 , $182.10 , See APC Packaged Rates , $154.70 , $86.19 , $134.55 , $85.53 , $83.98 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $35.00 , $35.00 , $35.00 , $35.00 , See APC Packaged Rates , $179.29 , $- , $- , $182.10 , $154.70
97150,5410010033,Hospital Chargemaster,Group therapeutic proc 120 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $259.00 , $142.45 , $213.42 , See APC Packaged Rates , $181.30 , $101.01 , $134.55 , $85.53 , $83.98 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $35.00 , $35.00 , $35.00 , $35.00 , See APC Packaged Rates , $179.29 , $- , $- , $213.42 , $181.30
97530,5410010034,Hospital Chargemaster,Therapeutic active EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $72.00 , $39.60 , $59.33 , See APC Packaged Rates , $50.40 , $28.08 , $299.04 , $190.08 , $186.64 , See APC Packaged Rates , See APC Packaged Rates , $86.11 , $83.50 , See APC Packaged Rates , See APC Packaged Rates , $72.00 , $72.00 , $72.00 , $72.00 , See APC Packaged Rates , $179.29 , $- , $- , $299.04 , $50.40
97533,5410010035,Hospital Chargemaster,Sensory integration EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $75.00 , $41.25 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $319.96 , $203.37 , $199.69 , See APC Packaged Rates , See APC Packaged Rates , $61.31 , $59.45 , See APC Packaged Rates , See APC Packaged Rates , $75.00 , $75.00 , $75.00 , $75.00 , See APC Packaged Rates , $179.29 , $- , $- , $319.96 , $52.50
97542,5410010038,Hospital Chargemaster,Wheelchair mgmt train 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $43.00 , $23.65 , $35.43 , See APC Packaged Rates , $30.10 , $16.77 , $244.72 , $155.55 , $152.73 , See APC Packaged Rates , See APC Packaged Rates , $63.23 , $61.31 , See APC Packaged Rates , See APC Packaged Rates , $43.00 , $43.00 , $43.00 , $43.00 , See APC Packaged Rates , $179.29 , $- , $- , $244.72 , $30.10
97545,5410010039,Hospital Chargemaster,Work hardening Init 2 Hrs,Outpatient,Outpatient Default Percent / Case Rate,420, $536.00 , $294.80 , $441.66 , See APC Packaged Rates , $375.20 , $209.04 ," $1,051.04 ", $668.07 , $655.96 , See APC Packaged Rates , See APC Packaged Rates , $136.89 , $132.74 , See APC Packaged Rates , See APC Packaged Rates , $498.48 , $498.48 , $498.48 , $498.48 , See APC Packaged Rates , $179.29 , $- , $- ," $1,051.04 ", $375.20
97546,5410010040,Hospital Chargemaster,Work hardening add-on 1 HR,Outpatient,Outpatient Default Percent / Case Rate,420, $270.00 , $148.50 , $222.48 , See APC Packaged Rates , $189.00 , $105.30 , $260.52 , $261.66 , $139.06 , See APC Packaged Rates , See APC Packaged Rates , $60.84 , $58.99 , See APC Packaged Rates , See APC Packaged Rates , $251.10 , $251.10 , $251.10 , $251.10 , See APC Packaged Rates , $179.29 , $- , $- , $261.66 , $189.00
97760,5410010051,Hospital Chargemaster,Orthotic mgmt&trainj EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $358.27 , $227.73 , $223.60 , See APC Packaged Rates , See APC Packaged Rates , $123.44 , $119.69 , See APC Packaged Rates , See APC Packaged Rates , $65.00 , $65.00 , $65.00 , $65.00 , See APC Packaged Rates , $179.29 , $- , $- , $358.27 , $45.50
97761,5410010052,Hospital Chargemaster,Prosthetic trainj EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,420, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $305.34 , $194.08 , $190.56 , See APC Packaged Rates , See APC Packaged Rates , $43.62 , $43.62 , See APC Packaged Rates , See APC Packaged Rates , $65.00 , $65.00 , $65.00 , $65.00 , See APC Packaged Rates , $179.29 , $- , $- , $305.34 , $45.50
97763,5410010053,Hospital Chargemaster,Orthc/prostc mgmt sbsq enc,Outpatient,Outpatient Default Percent / Case Rate,420, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $381.22 , $242.32 , $237.92 , See APC Packaged Rates , See APC Packaged Rates , $127.30 , $123.43 , See APC Packaged Rates , See APC Packaged Rates , $65.00 , $65.00 , $65.00 , $65.00 , See APC Packaged Rates , $179.29 , $- , $- , $381.22 , $45.50
95831,5410010054,Hospital Chargemaster,Limb muscle testing manual,Outpatient,Outpatient Default Percent / Case Rate,420, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $62.72 , $62.99 , $33.48 , See APC Packaged Rates , See APC Packaged Rates , $43.62 , $43.62 , See APC Packaged Rates , See APC Packaged Rates , $60.45 , $60.45 , $60.45 , $60.45 , See APC Packaged Rates , $179.29 , Not Applicable , $25.35 , $179.29 , $45.50
95832,5410010055,Hospital Chargemaster,Hand muscle testing manual,Outpatient,Outpatient Default Percent / Case Rate,420, $72.00 , $39.60 , $59.33 , See APC Packaged Rates , $50.40 , $28.08 , $69.47 , $69.78 , $37.08 , See APC Packaged Rates , See APC Packaged Rates , $48.31 , $48.31 , See APC Packaged Rates , See APC Packaged Rates , $66.96 , $66.96 , $66.96 , $66.96 , See APC Packaged Rates , $179.29 , Not Applicable , $28.08 , $179.29 , $50.40
95851,5410010058,Hospital Chargemaster,ROM Measurement w rpt,Outpatient,Outpatient Default Percent / Case Rate,420, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $27.46 , $21.46 , $23.51 , See APC Packaged Rates , See APC Packaged Rates , $48.67 , $47.20 , See APC Packaged Rates , See APC Packaged Rates , $11.45 , $11.45 , $11.74 , $11.74 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $45.50
95852,5410010059,Hospital Chargemaster,ROM Measurement Hand,Outpatient,Outpatient Default Percent / Case Rate,420, $72.00 , $39.60 , $59.33 , See APC Packaged Rates , $50.40 , $28.08 , $21.43 , $16.75 , $18.34 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $8.52 , $8.52 , $8.74 , $8.74 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $50.40
29520,5410010069,Hospital Chargemaster,Strapping of hip,Outpatient,Outpatient Default Percent / Case Rate,420, $116.00 , $63.80 , $95.58 , $134.80 , $81.20 , $45.24 , $122.28 , $83.93 , $83.48 , $134.80 , $134.80 , $90.32 , $87.58 , $141.54 , $137.50 , $110.05 , $110.05 , $112.89 , $112.89 , $134.80 , $179.29 , $- , $- , $179.29 , $81.20
97161,5410010001,Hospital Chargemaster,PT Eval Low Complex 30 min,Outpatient,Outpatient Default Percent / Case Rate,424, $250.00 , $137.50 , $206.00 , See APC Packaged Rates , $175.00 , $97.50 , $625.77 , $397.76 , $390.55 , See APC Packaged Rates , See APC Packaged Rates , $209.31 , $202.96 , See APC Packaged Rates , See APC Packaged Rates , $125.46 , $125.46 , $128.70 , $128.70 , See APC Packaged Rates , $179.29 , $- , $- , $625.77 , $175.00
97162,5410010002,Hospital Chargemaster,PT Eval Mod Complex 45 min,Outpatient,Outpatient Default Percent / Case Rate,424, $250.00 , $137.50 , $206.00 , See APC Packaged Rates , $175.00 , $97.50 , $625.77 , $397.76 , $390.55 , See APC Packaged Rates , See APC Packaged Rates , $209.31 , $202.96 , See APC Packaged Rates , See APC Packaged Rates , $125.46 , $125.46 , $128.70 , $128.70 , See APC Packaged Rates , $179.29 , $- , $- , $625.77 , $175.00
97163,5410010003,Hospital Chargemaster,PT Eval High Complex 60 min,Outpatient,Outpatient Default Percent / Case Rate,424, $250.00 , $137.50 , $206.00 , See APC Packaged Rates , $175.00 , $97.50 , $625.77 , $397.76 , $390.55 , See APC Packaged Rates , See APC Packaged Rates , $209.31 , $202.96 , See APC Packaged Rates , See APC Packaged Rates , $125.46 , $125.46 , $128.70 , $128.70 , See APC Packaged Rates , $179.29 , $- , $- , $625.77 , $175.00
97164,5410010004,Hospital Chargemaster,PT Re-eval est plan care,Outpatient,Outpatient Default Percent / Case Rate,424, $132.00 , $72.60 , $108.77 , See APC Packaged Rates , $92.40 , $51.48 , $427.35 , $271.64 , $266.71 , See APC Packaged Rates , See APC Packaged Rates , $141.24 , $136.96 , See APC Packaged Rates , See APC Packaged Rates , $115.19 , $115.19 , $118.16 , $118.16 , See APC Packaged Rates , $179.29 , $- , $- , $427.35 , $92.40
29131,5450010064,Hospital Chargemaster,Applica finger splint Dynamic,Outpatient,Outpatient Default Percent / Case Rate,430, $127.00 , $69.85 , $104.65 , $66.55 , $88.90 , $49.53 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $85.99 , $85.99 , $88.21 , $88.21 , $66.55 , $179.29 , $- , $- , $179.29 , $88.90
29550,5450010071,Hospital Chargemaster,Strapping of toes,Outpatient,Outpatient Default Percent / Case Rate,430, $116.00 , $63.80 , $95.58 , $66.55 , $81.20 , $45.24 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $85.99 , $85.99 , $88.21 , $88.21 , $66.55 , $179.29 , $- , $- , $179.29 , $81.20
29260,5450010067,Hospital Chargemaster,Strapping of elbow or wrist,Outpatient,Outpatient Default Percent / Case Rate,430, $140.00 , $77.00 , $115.36 , $66.55 , $98.00 , $54.60 , $70.26 , $48.23 , $47.97 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $62.64 , $62.64 , $64.26 , $64.26 , $66.55 , $179.29 , $- , $- , $179.29 , $98.00
29280,5450010068,Hospital Chargemaster,Strapping of hand or finger,Outpatient,Outpatient Default Percent / Case Rate,430, $140.00 , $77.00 , $115.36 , $66.55 , $98.00 , $54.60 , $70.26 , $48.23 , $47.97 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $62.64 , $62.64 , $64.26 , $64.26 , $66.55 , $179.29 , $- , $- , $179.29 , $98.00
29240,5450010066,Hospital Chargemaster,Strapping of shoulder,Outpatient,Outpatient Default Percent / Case Rate,430, $140.00 , $77.00 , $115.36 , $134.80 , $98.00 , $54.60 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $125.00 , $125.00 , $125.00 , $125.00 , $134.80 , $179.29 , $- , $- , $232.95 , $98.00
29530,5450010070,Hospital Chargemaster,Strapping of knee,Outpatient,Outpatient Default Percent / Case Rate,430, $140.00 , $77.00 , $115.36 , $134.80 , $98.00 , $54.60 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $125.00 , $125.00 , $125.00 , $125.00 , $134.80 , $179.29 , $- , $- , $232.95 , $98.00
29125,5450010061,Hospital Chargemaster,Apply forearm splint Static,Outpatient,Outpatient Default Percent / Case Rate,430, $150.00 , $82.50 , $123.60 , $134.80 , $105.00 , $58.50 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $116.00 , $116.00 , $116.00 , $116.00 , $134.80 , $179.29 , $- , $- , $232.95 , $105.00
29126,5450010062,Hospital Chargemaster,Apply forearm splint Dynamic,Outpatient,Outpatient Default Percent / Case Rate,430, $113.00 , $62.15 , $93.11 , $134.80 , $79.10 , $44.07 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $116.00 , $116.00 , $116.00 , $116.00 , $134.80 , $179.29 , $- , $- , $232.95 , $79.10
29130,5450010063,Hospital Chargemaster,Applica finger splint Static,Outpatient,Outpatient Default Percent / Case Rate,430, $150.00 , $82.50 , $123.60 , $134.80 , $105.00 , $58.50 , $122.28 , $83.93 , $83.48 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $110.05 , $110.05 , $112.89 , $112.89 , $134.80 , $179.29 , $- , $- , $179.29 , $105.00
29580,5450010072,Hospital Chargemaster,Strapping Uba boot,Outpatient,Outpatient Default Percent / Case Rate,430, $488.00 , $268.40 , $402.11 , $168.90 , $341.60 , $190.32 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $179.29 , $- , $- , $402.11 , $341.60
29799,5450010073,Hospital Chargemaster,Unlist Casting strapping proc,Outpatient,Outpatient Default Percent / Case Rate,430, $221.00 , $121.55 , $182.10 , $168.90 , $154.70 , $86.19 , $213.24 , $214.17 , $113.82 , $168.90 , $168.90 , $148.29 , $148.29 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $179.29 , $- , $- , $220.97 , $154.70
29105,5450010060,Hospital Chargemaster,Apply long arm splint,Outpatient,Outpatient Default Percent / Case Rate,430, $127.00 , $69.85 , $104.65 , $168.90 , $88.90 , $49.53 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $116.00 , $116.00 , $116.00 , $116.00 , $168.90 , $179.29 , $- , $- , $294.51 , $88.90
29200,5450010065,Hospital Chargemaster,Strapping of chest,Outpatient,Outpatient Default Percent / Case Rate,430, $140.00 , $77.00 , $115.36 , $168.90 , $98.00 , $54.60 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $89.39 , $86.68 , $177.35 , $172.28 , $116.00 , $116.00 , $116.00 , $116.00 , $168.90 , $179.29 , $- , $- , $294.51 , $98.00
97602,5450010043,Hospital Chargemaster,Wound(s) care non-selective,Outpatient,Outpatient Default Percent / Case Rate,430, $91.00 , $50.05 , $74.98 , $214.68 , $63.70 , $35.49 , $875.52 , $556.51 , $546.42 , $214.68 , $214.68 , $61.06 , $61.06 , $225.42 , $218.98 , $80.00 , $80.00 , $80.00 , $80.00 , $214.68 , $179.29 , $- , $- , $875.52 , $63.70
97597,5450010041,Hospital Chargemaster,Rmvl devital tis 20 cm or less,Outpatient,Outpatient Default Percent / Case Rate,430, $275.00 , $151.25 ," $1,236.00 ", $214.68 , $192.50 , $107.25 , $875.52 , $556.51 , $546.42 , $214.68 , $214.68 , $126.90 , $123.05 , $225.42 , $218.98 , $78.00 , $78.00 , $78.00 , $78.00 , $214.68 , $179.29 , $- , $- ," $1,236.00 ", $192.50
97537,5450010037,Hospital Chargemaster,Comm work reintegration 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $83.00 , $45.65 , $68.39 , See APC Packaged Rates , $58.10 , $32.37 , $241.94 , $153.79 , $151.00 , See APC Packaged Rates , See APC Packaged Rates , $61.21 , $59.36 , See APC Packaged Rates , See APC Packaged Rates , $63.52 , $63.52 , $65.15 , $65.15 , See APC Packaged Rates , $179.29 , $- , $- , $241.94 , $58.10
97535,5450010036,Hospital Chargemaster,Self care mgmt train EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $71.00 , $39.05 , $58.50 , See APC Packaged Rates , $49.70 , $27.69 , $254.14 , $161.54 , $158.61 , See APC Packaged Rates , See APC Packaged Rates , $76.92 , $74.58 , See APC Packaged Rates , See APC Packaged Rates , $65.00 , $65.00 , $65.00 , $65.00 , See APC Packaged Rates , $179.29 , $- , $- , $254.14 , $49.70
97750,5450010049,Hospital Chargemaster,Physical perf test wRPT 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $259.69 , $165.07 , $162.07 , See APC Packaged Rates , See APC Packaged Rates , $43.62 , $43.62 , See APC Packaged Rates , See APC Packaged Rates , $65.00 , $65.00 , $65.00 , $65.00 , See APC Packaged Rates , $179.29 , $- , $- , $259.69 , $45.50
97598,5450010042,Hospital Chargemaster,Rmvl devital tis addl 20cm,Outpatient,Outpatient Default Percent / Case Rate,430, $350.00 , $192.50 ," $1,236.00 ", See APC Packaged Rates , $245.00 , $136.50 , $35.52 , $24.38 , $24.25 , See APC Packaged Rates , See APC Packaged Rates , $161.09 , $156.20 , See APC Packaged Rates , See APC Packaged Rates , $325.50 , $325.50 , $325.50 , $325.50 , See APC Packaged Rates , $179.29 , $- , $- ," $1,236.00 ", $245.00
97014,5450010007,Hospital Chargemaster,Electric stim therapy Unatt,Outpatient,Outpatient Default Percent / Case Rate,430, $50.00 , $27.50 , $41.20 , See APC Packaged Rates , $35.00 , $19.50 , $110.51 , $70.25 , $68.97 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $46.50 , $46.50 , $46.50 , $46.50 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $35.00
97016,5450010008,Hospital Chargemaster,Vasopneumatic device therapy,Outpatient,Outpatient Default Percent / Case Rate,430, $75.00 , $41.25 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $93.81 , $59.63 , $58.55 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $26.01 , $26.01 , $26.68 , $26.68 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $52.50
97018,5450010009,Hospital Chargemaster,Paraffin bath therapy,Outpatient,Outpatient Default Percent / Case Rate,430, $83.00 , $45.65 , $68.39 , See APC Packaged Rates , $58.10 , $32.37 , $53.37 , $33.92 , $33.31 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $14.30 , $14.30 , $14.67 , $14.67 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $58.10
97022,5450010010,Hospital Chargemaster,Whirlpool therapy,Outpatient,Outpatient Default Percent / Case Rate,430, $72.00 , $39.60 , $59.33 , See APC Packaged Rates , $50.40 , $28.08 , $135.94 , $86.41 , $84.84 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $35.71 , $35.71 , $36.64 , $36.64 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $50.40
97032,5450010014,Hospital Chargemaster,Electrical stim EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $145.00 , $79.75 , $119.48 , See APC Packaged Rates , $101.50 , $56.55 , $108.08 , $68.70 , $67.46 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $28.37 , $28.37 , $29.10 , $29.10 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $101.50
97033,5450010015,Hospital Chargemaster,Electric cur therapy EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $97.00 , $53.35 , $79.93 , See APC Packaged Rates , $67.90 , $37.83 , $155.12 , $98.60 , $96.81 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $40.76 , $40.76 , $41.81 , $41.81 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $67.90
97034,5450010016,Hospital Chargemaster,Contr bath therapy EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $83.00 , $45.65 , $68.39 , See APC Packaged Rates , $58.10 , $32.37 , $112.25 , $71.35 , $70.06 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $29.48 , $29.48 , $30.24 , $30.24 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $58.10
97035,5450010017,Hospital Chargemaster,Ultrasound therapy EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $69.00 , $37.95 , $56.86 , See APC Packaged Rates , $48.30 , $26.91 , $101.10 , $64.26 , $63.10 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $27.74 , $27.74 , $28.45 , $28.45 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $48.30
97110,5450010020,Hospital Chargemaster,Therapeutic exerc EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $75.00 , $41.25 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $226.28 , $143.83 , $141.22 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $59.40 , $59.40 , $60.93 , $60.93 , See APC Packaged Rates , $179.29 , $- , $- , $226.28 , $52.50
97112,5450010021,Hospital Chargemaster,Neuromuscular reeduc EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $79.00 , $43.45 , $65.10 , See APC Packaged Rates , $55.30 , $30.81 , $258.00 , $163.99 , $161.02 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $68.48 , $68.48 , $70.24 , $70.24 , See APC Packaged Rates , $179.29 , $- , $- , $258.00 , $55.30
97116,5450010023,Hospital Chargemaster,Gait train therapy EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $58.00 , $31.90 , $47.79 , See APC Packaged Rates , $40.60 , $22.62 , $223.50 , $142.06 , $139.49 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $58.00 , $58.00 , $58.00 , $58.00 , See APC Packaged Rates , $179.29 , $- , $- , $223.50 , $40.60
97124,5450010024,Hospital Chargemaster,Massage therapy EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $72.00 , $39.60 , $59.33 , See APC Packaged Rates , $50.40 , $28.08 , $213.31 , $135.58 , $133.13 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $36.00 , $36.00 , $36.00 , $36.00 , See APC Packaged Rates , $179.29 , $- , $- , $213.31 , $50.40
97129,5450010025,Hospital Chargemaster,Cognitive skill deve EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $72.00 , $39.60 , $59.33 , See APC Packaged Rates , $50.40 , $28.08 , $169.96 , $108.03 , $106.07 , See APC Packaged Rates , See APC Packaged Rates , $61.19 , $59.33 , See APC Packaged Rates , See APC Packaged Rates , $41.25 , $41.25 , $42.32 , $42.32 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $50.40
97140,5450010027,Hospital Chargemaster,Manual therapy tech EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $69.00 , $37.95 , $56.86 , See APC Packaged Rates , $48.30 , $26.91 , $204.97 , $130.29 , $127.93 , See APC Packaged Rates , See APC Packaged Rates , $63.11 , $61.19 , See APC Packaged Rates , See APC Packaged Rates , $54.44 , $54.44 , $55.85 , $55.85 , See APC Packaged Rates , $179.29 , $- , $- , $204.97 , $48.30
97150,5450010028,Hospital Chargemaster,Group therapeutic proc 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $30.00 , $16.50 , $24.72 , See APC Packaged Rates , $21.00 , $11.70 , $134.55 , $85.53 , $83.98 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $35.00 , $35.00 , $35.00 , $35.00 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $21.00
97150,5450010029,Hospital Chargemaster,Group therapeutic proc 30 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $97.00 , $53.35 , $79.93 , See APC Packaged Rates , $67.90 , $37.83 , $134.55 , $85.53 , $83.98 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $35.00 , $35.00 , $35.00 , $35.00 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $67.90
97150,5450010030,Hospital Chargemaster,Group therapeutic proc 45 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $134.00 , $73.70 , $110.42 , See APC Packaged Rates , $93.80 , $52.26 , $134.55 , $85.53 , $83.98 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $35.00 , $35.00 , $35.00 , $35.00 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $93.80
97150,5450010031,Hospital Chargemaster,Group therapeutic proc 60 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $174.00 , $95.70 , $143.38 , See APC Packaged Rates , $121.80 , $67.86 , $134.55 , $85.53 , $83.98 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $35.00 , $35.00 , $35.00 , $35.00 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $121.80
97150,5450010032,Hospital Chargemaster,Group therapeutic proc 90 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $242.00 , $133.10 , $199.41 , See APC Packaged Rates , $169.40 , $94.38 , $134.55 , $85.53 , $83.98 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $35.00 , $35.00 , $35.00 , $35.00 , See APC Packaged Rates , $179.29 , $- , $- , $199.41 , $169.40
97150,5450010033,Hospital Chargemaster,Group therapeutic proc 120 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $283.00 , $155.65 , $233.19 , See APC Packaged Rates , $198.10 , $110.37 , $134.55 , $85.53 , $83.98 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $35.00 , $35.00 , $35.00 , $35.00 , See APC Packaged Rates , $179.29 , $- , $- , $233.19 , $198.10
97530,5450010034,Hospital Chargemaster,Therap activities EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $72.00 , $39.60 , $59.33 , See APC Packaged Rates , $50.40 , $28.08 , $299.04 , $190.08 , $186.64 , See APC Packaged Rates , See APC Packaged Rates , $86.11 , $83.50 , See APC Packaged Rates , See APC Packaged Rates , $72.00 , $72.00 , $72.00 , $72.00 , See APC Packaged Rates , $179.29 , $- , $- , $299.04 , $50.40
97533,5450010035,Hospital Chargemaster,Sensory integration EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $83.00 , $45.65 , $68.39 , See APC Packaged Rates , $58.10 , $32.37 , $319.96 , $203.37 , $199.69 , See APC Packaged Rates , See APC Packaged Rates , $61.31 , $59.45 , See APC Packaged Rates , See APC Packaged Rates , $75.00 , $75.00 , $75.00 , $75.00 , See APC Packaged Rates , $179.29 , $- , $- , $319.96 , $58.10
97542,5450010038,Hospital Chargemaster,Wheelchair mgmt train 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $43.00 , $23.65 , $35.43 , See APC Packaged Rates , $30.10 , $16.77 , $244.72 , $155.55 , $152.73 , See APC Packaged Rates , See APC Packaged Rates , $63.23 , $61.31 , See APC Packaged Rates , See APC Packaged Rates , $43.00 , $43.00 , $43.00 , $43.00 , See APC Packaged Rates , $179.29 , $- , $- , $244.72 , $30.10
97545,5450010039,Hospital Chargemaster,Work hardening Init 2 Hrs,Outpatient,Outpatient Default Percent / Case Rate,430, $536.00 , $294.80 , $441.66 , See APC Packaged Rates , $375.20 , $209.04 ," $1,051.04 ", $668.07 , $655.96 , See APC Packaged Rates , See APC Packaged Rates , $136.89 , $132.74 , See APC Packaged Rates , See APC Packaged Rates , $498.48 , $498.48 , $498.48 , $498.48 , See APC Packaged Rates , $179.29 , $- , $- ," $1,051.04 ", $375.20
97546,5450010040,Hospital Chargemaster,Work hardening add-on 1 HR,Outpatient,Outpatient Default Percent / Case Rate,430, $270.00 , $148.50 , $222.48 , See APC Packaged Rates , $189.00 , $105.30 , $260.52 , $261.66 , $139.06 , See APC Packaged Rates , See APC Packaged Rates , $60.84 , $58.99 , See APC Packaged Rates , See APC Packaged Rates , $251.10 , $251.10 , $251.10 , $251.10 , See APC Packaged Rates , $179.29 , $- , $- , $261.66 , $189.00
97760,5450010051,Hospital Chargemaster,Orthotic mgmt&trainj EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $358.27 , $227.73 , $223.60 , See APC Packaged Rates , See APC Packaged Rates , $123.44 , $119.69 , See APC Packaged Rates , See APC Packaged Rates , $65.00 , $65.00 , $65.00 , $65.00 , See APC Packaged Rates , $179.29 , $- , $- , $358.27 , $45.50
97761,5450010052,Hospital Chargemaster,Prosthetic trainj EA 15 Min,Outpatient,Outpatient Default Percent / Case Rate,430, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $305.34 , $194.08 , $190.56 , See APC Packaged Rates , See APC Packaged Rates , $43.62 , $43.62 , See APC Packaged Rates , See APC Packaged Rates , $65.00 , $65.00 , $65.00 , $65.00 , See APC Packaged Rates , $179.29 , $- , $- , $305.34 , $45.50
97763,5450010053,Hospital Chargemaster,Orthc/prostc mgmt sbsq enc,Outpatient,Outpatient Default Percent / Case Rate,430, $65.00 , $35.75 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $381.22 , $242.32 , $237.92 , See APC Packaged Rates , See APC Packaged Rates , $127.30 , $123.43 , See APC Packaged Rates , See APC Packaged Rates , $65.00 , $65.00 , $65.00 , $65.00 , See APC Packaged Rates , $179.29 , $- , $- , $381.22 , $45.50
95831,5450010054,Hospital Chargemaster,Limb muscle testing manual,Outpatient,Outpatient Default Percent / Case Rate,430, $72.00 , $39.60 , $59.33 , See APC Packaged Rates , $50.40 , $28.08 , $69.47 , $69.78 , $37.08 , See APC Packaged Rates , See APC Packaged Rates , $48.31 , $48.31 , See APC Packaged Rates , See APC Packaged Rates , $66.96 , $66.96 , $66.96 , $66.96 , See APC Packaged Rates , $179.29 , Not Applicable , $28.08 , $179.29 , $50.40
95851,5450010058,Hospital Chargemaster,ROM Measurement w rpt,Outpatient,Outpatient Default Percent / Case Rate,430, $72.00 , $39.60 , $59.33 , See APC Packaged Rates , $50.40 , $28.08 , $27.46 , $21.46 , $23.51 , See APC Packaged Rates , See APC Packaged Rates , $48.67 , $47.20 , See APC Packaged Rates , See APC Packaged Rates , $11.45 , $11.45 , $11.74 , $11.74 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $50.40
95852,5450010059,Hospital Chargemaster,ROM Measurement Hand,Outpatient,Outpatient Default Percent / Case Rate,430, $72.00 , $39.60 , $59.33 , See APC Packaged Rates , $50.40 , $28.08 , $21.43 , $16.75 , $18.34 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $8.52 , $8.52 , $8.74 , $8.74 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $50.40
29520,5450010069,Hospital Chargemaster,Strapping of hip,Outpatient,Outpatient Default Percent / Case Rate,430, $140.00 , $77.00 , $115.36 , $134.80 , $98.00 , $54.60 , $122.28 , $83.93 , $83.48 , $134.80 , $134.80 , $90.32 , $87.58 , $141.54 , $137.50 , $110.05 , $110.05 , $112.89 , $112.89 , $134.80 , $179.29 , $- , $- , $179.29 , $98.00
90901,5450010082,Hospital Chargemaster,Biofeedback train any meth,Outpatient,Outpatient Default Percent / Case Rate,431, $144.00 , $79.20 , $118.66 , See APC Packaged Rates , $100.80 , $56.16 , $138.95 , $139.55 , $74.16 , See APC Packaged Rates , See APC Packaged Rates , $96.62 , $96.62 , See APC Packaged Rates , See APC Packaged Rates , $74.16 , $74.16 , $76.07 , $76.07 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $100.80
97165,5450010001,Hospital Chargemaster,OT Eval Low Complex 30 min,Outpatient,Outpatient Default Percent / Case Rate,434, $215.00 , $118.25 , $177.16 , See APC Packaged Rates , $150.50 , $83.85 , $675.93 , $429.64 , $421.85 , See APC Packaged Rates , See APC Packaged Rates , $239.41 , $232.14 , See APC Packaged Rates , See APC Packaged Rates , $133.75 , $133.75 , $137.20 , $137.20 , See APC Packaged Rates , $179.29 , $- , $- , $675.93 , $150.50
97166,5450010002,Hospital Chargemaster,OT Eval Mod Complex 45 min,Outpatient,Outpatient Default Percent / Case Rate,434, $215.00 , $118.25 , $177.16 , See APC Packaged Rates , $150.50 , $83.85 , $675.93 , $429.64 , $421.85 , See APC Packaged Rates , See APC Packaged Rates , $239.41 , $232.14 , See APC Packaged Rates , See APC Packaged Rates , $133.20 , $133.20 , $136.63 , $136.63 , See APC Packaged Rates , $179.29 , $- , $- , $675.93 , $150.50
97167,5450010003,Hospital Chargemaster,OT Eval High Complex 60 min,Outpatient,Outpatient Default Percent / Case Rate,434, $215.00 , $118.25 , $177.16 , See APC Packaged Rates , $150.50 , $83.85 , $675.93 , $429.64 , $421.85 , See APC Packaged Rates , See APC Packaged Rates , $239.41 , $232.14 , See APC Packaged Rates , See APC Packaged Rates , $133.20 , $133.20 , $136.63 , $136.63 , See APC Packaged Rates , $179.29 , $- , $- , $675.93 , $150.50
97168,5450010004,Hospital Chargemaster,OT Re-eval est plan care,Outpatient,Outpatient Default Percent / Case Rate,434, $125.00 , $68.75 , $103.00 , See APC Packaged Rates , $87.50 , $48.75 , $466.36 , $296.43 , $291.06 , See APC Packaged Rates , See APC Packaged Rates , $159.35 , $154.52 , See APC Packaged Rates , See APC Packaged Rates , $123.27 , $123.27 , $125.00 , $125.00 , See APC Packaged Rates , $179.29 , $- , $- , $466.36 , $87.50
92507,5420010001,Hospital Chargemaster,Speech/Hearing Therapy Indiv,Outpatient,Outpatient Default Percent / Case Rate,441, $250.00 , $137.50 , $206.00 , See APC Packaged Rates , $175.00 , $97.50 , $574.96 , $365.46 , $358.84 , See APC Packaged Rates , See APC Packaged Rates , $152.10 , $147.49 , See APC Packaged Rates , See APC Packaged Rates , $114.82 , $114.82 , $117.77 , $117.77 , See APC Packaged Rates , $179.29 , $- , $- , $574.96 , $175.00
92526,5420010008,Hospital Chargemaster,Oral Function Therapy,Outpatient,Outpatient Default Percent / Case Rate,441, $160.00 , $88.00 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 , $312.77 , $244.45 , $267.76 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $156.47 , $156.47 , $160.00 , $160.00 , See APC Packaged Rates , $179.29 , $- , $- , $312.77 , $112.00
92607,5420010009,Hospital Chargemaster,Ex For Speech Device Rx 1Hr,Outpatient,Outpatient Default Percent / Case Rate,441, $434.00 , $238.70 , $357.62 , See APC Packaged Rates , $303.80 , $169.26 , $962.13 , $611.56 , $600.47 , See APC Packaged Rates , See APC Packaged Rates , $287.45 , $278.72 , See APC Packaged Rates , See APC Packaged Rates , $143.41 , $143.41 , $147.11 , $147.11 , See APC Packaged Rates , $179.29 , $- , $- , $962.13 , $303.80
92609,5420010011,Hospital Chargemaster,Use Of Speech Device Service,Outpatient,Outpatient Default Percent / Case Rate,441, $325.00 , $178.75 , $267.80 , See APC Packaged Rates , $227.50 , $126.75 , $804.84 , $511.58 , $502.31 , See APC Packaged Rates , See APC Packaged Rates , $155.56 , $150.84 , See APC Packaged Rates , See APC Packaged Rates , $120.59 , $120.59 , $123.70 , $123.70 , See APC Packaged Rates , $179.29 , $- , $- , $804.84 , $227.50
92507,5420010014,Hospital Chargemaster,Tele Speech/Hearing Therapy In,Outpatient,Outpatient Default Percent / Case Rate,441, $250.00 , $137.50 , $206.00 , See APC Packaged Rates , $175.00 , $97.50 , $574.96 , $365.46 , $358.84 , See APC Packaged Rates , See APC Packaged Rates , $152.10 , $147.49 , See APC Packaged Rates , See APC Packaged Rates , $114.82 , $114.82 , $117.77 , $117.77 , See APC Packaged Rates , $179.29 , $- , $- , $574.96 , $175.00
96125,5420010015,Hospital Chargemaster,Cognitive Test By Hc Pro,Outpatient,Outpatient Default Percent / Case Rate,441, $550.00 , $302.50 , $453.20 , See APC Packaged Rates , $385.00 , $214.50 , $808.53 , $513.93 , $504.61 , See APC Packaged Rates , See APC Packaged Rates , $191.44 , $185.63 , See APC Packaged Rates , See APC Packaged Rates , $511.50 , $511.50 , $511.50 , $511.50 , See APC Packaged Rates , $179.29 , $- , $- , $808.53 , $385.00
92526,67000020,Hospital Chargemaster,Treat Swallowing Dysfuction,Outpatient,Outpatient Default Percent / Case Rate,441, $180.00 , $99.00 , $148.32 , See APC Packaged Rates , $126.00 , $70.20 , $312.77 , $244.45 , $267.76 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $156.47 , $156.47 , $160.00 , $160.00 , See APC Packaged Rates , $179.29 , $- , $- , $312.77 , $126.00
92526,67000022,Hospital Chargemaster,Treat Swallowing Dysfunction,Outpatient,Outpatient Default Percent / Case Rate,441, $220.00 , $121.00 , $181.28 , See APC Packaged Rates , $154.00 , $85.80 , $312.77 , $244.45 , $267.76 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $156.47 , $156.47 , $160.00 , $160.00 , See APC Packaged Rates , $179.29 , $- , $- , $312.77 , $154.00
92508,5420010002,Hospital Chargemaster,Speech/Hearing Therapy Group,Outpatient,Outpatient Default Percent / Case Rate,443, $75.00 , $41.25 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $174.99 , $111.23 , $109.21 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $35.20 , $35.20 , $36.10 , $36.10 , See APC Packaged Rates , $179.29 , $- , $- , $179.29 , $52.50
92523,5420010006,Hospital Chargemaster,Speech Sound Lang Comprehen,Outpatient,Outpatient Default Percent / Case Rate,444, $550.00 , $302.50 , $453.20 , See APC Packaged Rates , $385.00 , $214.50 ," $1,436.73 ", $913.23 , $896.67 , See APC Packaged Rates , See APC Packaged Rates , $510.89 , $495.39 , See APC Packaged Rates , See APC Packaged Rates , $321.36 , $321.36 , $329.64 , $329.64 , See APC Packaged Rates , $179.29 , $- , $- ," $1,436.73 ", $385.00
92521,5420010004,Hospital Chargemaster,Evaluation Of Speech Fluency,Outpatient,Outpatient Default Percent / Case Rate,444, $550.00 , $302.50 , $453.20 , See APC Packaged Rates , $385.00 , $214.50 , $832.18 , $528.96 , $519.37 , See APC Packaged Rates , See APC Packaged Rates , $295.96 , $286.98 , See APC Packaged Rates , See APC Packaged Rates , $190.82 , $190.82 , $195.74 , $195.74 , See APC Packaged Rates , $179.29 , $- , $- , $832.18 , $385.00
92524,5420010007,Hospital Chargemaster,Behavral Qualit Analys Voice,Outpatient,Outpatient Default Percent / Case Rate,444, $550.00 , $302.50 , $453.20 , See APC Packaged Rates , $385.00 , $214.50 , $645.51 , $410.31 , $402.87 , See APC Packaged Rates , See APC Packaged Rates , $230.86 , $223.86 , See APC Packaged Rates , See APC Packaged Rates , $160.20 , $160.20 , $164.33 , $164.33 , See APC Packaged Rates , $179.29 , $- , $- , $645.51 , $385.00
92522,5420010005,Hospital Chargemaster,Evaluate Speech Production,Outpatient,Outpatient Default Percent / Case Rate,444, $550.00 , $302.50 , $453.20 , See APC Packaged Rates , $385.00 , $214.50 , $670.29 , $426.06 , $418.33 , See APC Packaged Rates , See APC Packaged Rates , $239.36 , $232.10 , See APC Packaged Rates , See APC Packaged Rates , $154.38 , $154.38 , $158.35 , $158.35 , See APC Packaged Rates , $179.29 , $- , $- , $670.29 , $385.00
92610,5420010012,Hospital Chargemaster,Evaluate Swallowing Function,Outpatient,Outpatient Default Percent / Case Rate,444, $235.00 , $129.25 , $193.64 , See APC Packaged Rates , $164.50 , $91.65 , $260.92 , $203.93 , $223.37 , See APC Packaged Rates , See APC Packaged Rates , $109.68 , $106.35 , See APC Packaged Rates , See APC Packaged Rates , $235.00 , $235.00 , $235.00 , $235.00 , See APC Packaged Rates , $179.29 , $- , $- , $260.92 , $164.50
29131,6010010270,Hospital Chargemaster,Application of finger splint,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $66.55 , $167.30 , $93.21 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $85.99 , $85.99 , $88.21 , $88.21 , $66.55 , $83.65 , $- , $- , $336.00 , $167.30
29550,6010010284,Hospital Chargemaster,Strapping of toes,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $66.55 , $167.30 , $93.21 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $85.99 , $85.99 , $88.21 , $88.21 , $66.55 , $83.65 , $- , $- , $336.00 , $167.30
29260,6010010273,Hospital Chargemaster,Strapping of elbow or wrist,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $66.55 , $167.30 , $93.21 , $70.26 , $48.23 , $47.97 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $62.64 , $62.64 , $64.26 , $64.26 , $66.55 , $83.65 , $- , $- , $336.00 , $167.30
29280,6010010274,Hospital Chargemaster,Strapping of hand or finger,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $66.55 , $167.30 , $93.21 , $70.26 , $48.23 , $47.97 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $62.64 , $62.64 , $64.26 , $64.26 , $66.55 , $83.65 , $- , $- , $336.00 , $167.30
11720,6010010036,Hospital Chargemaster,Debride nail 1-5,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 ," $1,236.00 ", $66.55 , $167.30 , $93.21 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $47.00 , $47.00 , $47.00 , $47.00 , $66.55 , $83.65 , $- , $- ," $1,236.00 ", $167.30
11719,6010010035,Hospital Chargemaster,Trim nail(s) any number,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $66.55 , $167.30 , $93.21 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $35.00 , $35.00 , $35.00 , $35.00 , $66.55 , $83.65 , $- , $- , $336.00 , $167.30
30905,6010010296,Hospital Chargemaster,Control of nosebleed,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $134.80 , $799.40 , $445.38 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $844.48 , $822.61 , $141.54 , $137.50 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $134.80 , $399.70 , $- , $- ," $1,236.00 ", $799.40
30300,6010010292,Hospital Chargemaster,Remove nasal foreign body,Outpatient,Outpatient Default Percent / Case Rate,450, $271.00 , $336.00 , $223.30 , $134.80 , $189.70 , $105.69 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $343.81 , $343.81 , $343.81 , $343.81 , $134.80 , $94.85 , $- , $- , $343.81 , $189.70
30901,6010010294,Hospital Chargemaster,Control of nosebleed,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", $134.80 , $312.20 , $173.94 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $156.10 , $- , $- ," $1,236.00 ", $312.20
30903,6010010295,Hospital Chargemaster,Control of nosebleed,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,236.00 ", $134.80 , $571.90 , $318.63 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $844.48 , $822.61 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $285.95 , $- , $- ," $1,236.00 ", $571.90
36600,6010010334,Hospital Chargemaster,Withdrawal of arterial blood,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 ," $2,542.04 ", $134.80 , $167.30 , $93.21 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $38.14 , $36.98 , $141.54 , $137.50 , $157.34 , $157.34 , $161.39 , $161.39 , $134.80 , $83.65 , $- , $- ," $2,542.04 ", $167.30
29240,6010010272,Hospital Chargemaster,Strapping of shoulder,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $134.80 , $167.30 , $93.21 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $125.00 , $125.00 , $125.00 , $125.00 , $134.80 , $83.65 , $- , $- , $336.00 , $167.30
29530,6010010282,Hospital Chargemaster,Strapping of knee,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $134.80 , $167.30 , $93.21 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $125.00 , $125.00 , $125.00 , $125.00 , $134.80 , $83.65 , $- , $- , $336.00 , $167.30
36591,6010010332,Hospital Chargemaster,Draw blood off venous device,Outpatient,Outpatient Default Percent / Case Rate,450, $124.00 , $336.00 , $102.18 , $134.80 , $86.80 , $48.36 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $83.20 , $83.20 , $141.54 , $137.50 , $124.00 , $124.00 , $124.00 , $124.00 , $134.80 , $43.40 , $- , $- , $336.00 , $86.80
29125,6010010268,Hospital Chargemaster,Apply forearm splint,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $134.80 , $167.30 , $93.21 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $116.00 , $116.00 , $116.00 , $116.00 , $134.80 , $83.65 , $- , $- , $336.00 , $167.30
36420,6010010324,Hospital Chargemaster,Vein access cutdown < 1 yr,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", $134.80 , $312.20 , $173.94 , $122.28 , $83.93 , $83.48 , $134.80 , $134.80 , $38.52 , $37.35 , $141.54 , $137.50 , $110.05 , $110.05 , $112.89 , $112.89 , $134.80 , $156.10 , $- , $- ," $1,236.00 ", $312.20
29130,6010010269,Hospital Chargemaster,Application of finger splint,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $134.80 , $167.30 , $93.21 , $122.28 , $83.93 , $83.48 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $110.05 , $110.05 , $112.89 , $112.89 , $134.80 , $83.65 , $- , $- , $336.00 , $167.30
11740,6010010039,Hospital Chargemaster,Drain blood from under nail,Outpatient,Outpatient Default Percent / Case Rate,450, $271.00 , $336.00 ," $1,236.00 ", $134.80 , $189.70 , $105.69 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $96.00 , $96.00 , $96.00 , $96.00 , $134.80 , $94.85 , $- , $- ," $1,236.00 ", $189.70
29505,6010010280,Hospital Chargemaster,Application long leg splint,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $168.90 , $167.30 , $93.21 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $83.65 , $- , $- , $336.00 , $167.30
29515,6010010281,Hospital Chargemaster,Application lower leg splint,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $168.90 , $167.30 , $93.21 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $83.65 , $- , $- , $336.00 , $167.30
29580,6010010285,Hospital Chargemaster,Application of paste boot,Outpatient,Outpatient Default Percent / Case Rate,450, $488.00 , $336.00 , $402.11 , $168.90 , $341.60 , $190.32 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $170.80 , $- , $- , $402.11 , $341.60
29730,6010010288,Hospital Chargemaster,Windowing of cast,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $168.90 , $167.30 , $93.21 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $90.32 , $87.58 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $83.65 , $- , $- , $336.00 , $167.30
29799,6010010289,Hospital Chargemaster,Casting/strapping procedure,Outpatient,Outpatient Default Percent / Case Rate,450, $221.00 , $336.00 , $182.10 , $168.90 , $154.70 , $86.19 , $213.24 , $214.17 , $314.63 , $168.90 , $168.90 , $148.29 , $148.29 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $77.35 , $- , $- , $336.00 , $154.70
29540,6010010283,Hospital Chargemaster,Strapping of ankle and/or ft,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $168.90 , $167.30 , $93.21 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $210.35 , $210.35 , $215.76 , $215.76 , $168.90 , $83.65 , $- , $- , $336.00 , $167.30
29085,6010010266,Hospital Chargemaster,Apply hand/wrist cast,Outpatient,Outpatient Default Percent / Case Rate,450, $366.00 , $336.00 , $301.58 , $168.90 , $256.20 , $142.74 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $266.32 , $258.23 , $177.35 , $172.28 , $197.00 , $197.00 , $197.00 , $197.00 , $168.90 , $128.10 , $- , $- , $336.00 , $256.20
29105,6010010267,Hospital Chargemaster,Apply long arm splint,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $168.90 , $167.30 , $93.21 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $116.00 , $116.00 , $116.00 , $116.00 , $168.90 , $83.65 , $- , $- , $336.00 , $167.30
29200,6010010271,Hospital Chargemaster,Strapping of chest,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $168.90 , $167.30 , $93.21 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $89.39 , $86.68 , $177.35 , $172.28 , $116.00 , $116.00 , $116.00 , $116.00 , $168.90 , $83.65 , $- , $- , $336.00 , $167.30
31575,6010010305,Hospital Chargemaster,Diagnostic laryngoscopy,Outpatient,Outpatient Default Percent / Case Rate,450, $271.00 , $336.00 ," $1,442.00 ", $196.80 , $189.70 , $105.69 , $358.71 , $246.20 , $244.89 , $196.80 , $196.80 , $105.28 , $102.55 , $206.64 , $200.73 , $271.00 , $271.00 , $271.00 , $271.00 , $196.80 , $94.85 , $- , $- ," $1,442.00 ", $189.70
12007,6010010051,Hospital Chargemaster,Rpr s/n/ax/gen/trnk >30.0 cm,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,442.00 ", $214.68 , $571.90 , $318.63 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 ," $1,133.44 "," $1,104.09 ", $225.42 , $218.98 , $817.00 , $817.00 , $817.00 , $817.00 , $214.68 , $285.95 , $- , $- ," $1,442.00 ", $571.90
12018,6010010058,Hospital Chargemaster,Rpr f/e/e/n/l/m >30.0 cm,Outpatient,Outpatient Default Percent / Case Rate,450, $640.00 , $336.00 ," $1,442.00 ", $214.68 , $448.00 , $249.60 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 ," $1,133.44 "," $1,104.09 ", $225.42 , $218.98 , $640.00 , $640.00 , $640.00 , $640.00 , $214.68 , $224.00 , $- , $- ," $1,442.00 ", $448.00
12014,6010010054,Hospital Chargemaster,Rpr f/e/e/n/l/m 5.1-7.5 cm,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $214.68 , $799.40 , $445.38 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $431.00 , $431.00 , $431.00 , $431.00 , $214.68 , $399.70 , $- , $- ," $1,236.00 ", $799.40
12004,6010010048,Hospital Chargemaster,Rpr s/n/ax/gen/trk7.6-12.5cm,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $214.68 , $799.40 , $445.38 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $398.00 , $398.00 , $398.00 , $398.00 , $214.68 , $399.70 , $- , $- ," $1,236.00 ", $799.40
12013,6010010053,Hospital Chargemaster,Rpr f/e/e/n/l/m 2.6-5.0 cm,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 , $941.01 , $214.68 , $799.40 , $445.38 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $362.00 , $362.00 , $362.00 , $362.00 , $214.68 , $399.70 , $- , $- , $941.01 , $799.40
12015,6010010055,Hospital Chargemaster,Rpr f/e/e/n/l/m 7.6-12.5 cm,Outpatient,Outpatient Default Percent / Case Rate,450, $500.00 , $336.00 ," $1,236.00 ", $214.68 , $350.00 , $195.00 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $175.00 , $- , $- ," $1,236.00 ", $350.00
16025,6010010096,Hospital Chargemaster,Dress/debrid p-thick burn m,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,442.00 ", $214.68 , $312.20 , $173.94 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $156.10 , $- , $- ," $1,442.00 ", $312.20
26010,6010010181,Hospital Chargemaster,Drainage of finger abscess,Outpatient,Outpatient Default Percent / Case Rate,450, $800.00 , $336.00 , $659.20 , $214.68 , $560.00 , $312.00 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $280.00 , $- , $- , $659.20 , $560.00
12002,6010010047,Hospital Chargemaster,Rpr s/n/ax/gen/trnk2.6-7.5cm,Outpatient,Outpatient Default Percent / Case Rate,450, $470.00 , $336.00 , $387.28 , $214.68 , $329.00 , $183.30 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $342.00 , $342.00 , $342.00 , $342.00 , $214.68 , $164.50 , $- , $- , $387.28 , $329.00
12001,6010010046,Hospital Chargemaster,Rpr s/n/ax/gen/trnk 2.5cm/<,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", $214.68 , $312.20 , $173.94 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $330.00 , $330.00 , $330.00 , $330.00 , $214.68 , $156.10 , $- , $- ," $1,236.00 ", $312.20
12011,6010010052,Hospital Chargemaster,Rpr f/e/e/n/l/m 2.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 , $941.01 , $214.68 , $799.40 , $445.38 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $317.00 , $317.00 , $317.00 , $317.00 , $214.68 , $399.70 , $- , $- , $941.01 , $799.40
10060,6010010010,Hospital Chargemaster,Drainage of skin abscess,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", $214.68 , $312.20 , $173.94 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $414.78 , $414.78 , $414.78 , $414.78 , $214.68 , $156.10 , $- , $- ," $1,236.00 ", $312.20
11055,6010010028,Hospital Chargemaster,Trim skin lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 ," $1,236.00 ", $214.68 , $167.30 , $93.21 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $61.61 , $59.74 , $225.42 , $218.98 , $239.00 , $239.00 , $239.00 , $239.00 , $214.68 , $83.65 , $- , $- ," $1,236.00 ", $167.30
11200,6010010029,Hospital Chargemaster,Removal of skin tags ,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", $312.35 , $312.20 , $173.94 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $89.51 , $86.79 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $156.10 , $- , $- ," $1,236.00 ", $312.20
20600,6010010111,Hospital Chargemaster,Drain/inj joint/bursa w/o us,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", $312.35 , $312.20 , $173.94 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $96.34 , $93.41 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $156.10 , $- , $- ," $1,236.00 ", $312.20
20552,6010010109,Hospital Chargemaster,Inj trigger point 1/2 muscl,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", $312.35 , $312.20 , $173.94 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $80.71 , $78.26 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $156.10 , $- , $- ," $1,236.00 ", $312.20
20611,6010010115,Hospital Chargemaster,Drain/inj joint/bursa w/us,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $312.35 , $- , $- , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $- , $- , $- , $- , $312.35 , $- , $- , $- ," $1,236.00 ", $-
11982,6010010045,Hospital Chargemaster,Remove drug implant device,Outpatient,Outpatient Default Percent / Case Rate,450, $346.00 , $336.00 ," $1,236.00 ", $324.46 , $242.20 , $134.94 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $343.81 , $343.81 , $343.81 , $343.81 , $324.46 , $121.10 , $- , $- ," $1,236.00 ", $242.20
36680,6010010336,Hospital Chargemaster,Insert needle bone cavity,Outpatient,Outpatient Default Percent / Case Rate,450, $334.00 , $336.00 ," $1,236.00 ", $324.46 , $233.80 , $130.26 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $334.00 , $334.00 , $334.00 , $334.00 , $324.46 , $116.90 , $- , $- ," $1,236.00 ", $233.80
36425,6010010325,Hospital Chargemaster,Vein access cutdown > 1 yr,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 ," $1,236.00 ", $324.46 , $167.30 , $93.21 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $38.52 , $37.35 , $340.68 , $330.95 , $239.00 , $239.00 , $239.00 , $239.00 , $324.46 , $83.65 , $- , $- ," $1,236.00 ", $167.30
36593,6010010333,Hospital Chargemaster,Declot vascular device,Outpatient,Outpatient Default Percent / Case Rate,450, $286.00 , $336.00 ," $1,236.00 ", $381.19 , $200.20 , $111.54 , $630.87 , $433.00 , $430.69 , $381.19 , $381.19 , $81.74 , $79.26 , $400.25 , $388.81 , $286.00 , $286.00 , $286.00 , $286.00 , $381.19 , $100.10 , $- , $- ," $1,236.00 ", $200.20
12005,6010010049,Hospital Chargemaster,Rpr s/n/a/gen/trk12.6-20.0cm,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,442.00 ", $413.21 , $799.40 , $445.38 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $413.21 , $399.70 , $- , $- ," $1,442.00 ", $799.40
12042,6010010068,Hospital Chargemaster,Intmd rpr n-hf/genit2.6-7.5,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,236.00 ", $413.21 , $571.90 , $318.63 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $740.30 , $740.30 , $740.30 , $740.30 , $413.21 , $285.95 , $- , $- ," $1,236.00 ", $571.90
12052,6010010074,Hospital Chargemaster,Intmd rpr face/mm 2.6-5.0 cm,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,236.00 ", $413.21 , $571.90 , $318.63 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $740.30 , $740.30 , $740.30 , $740.30 , $413.21 , $285.95 , $- , $- ," $1,236.00 ", $571.90
12053,6010010075,Hospital Chargemaster,Intmd rpr face/mm 5.1-7.5 cm,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,236.00 ", $413.21 , $571.90 , $318.63 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $740.30 , $740.30 , $740.30 , $740.30 , $413.21 , $285.95 , $- , $- ," $1,236.00 ", $571.90
12034,6010010063,Hospital Chargemaster,Intmd rpr s/tr/ext 7.6-12.5,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,442.00 ", $413.21 , $571.90 , $318.63 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $740.30 , $740.30 , $740.30 , $740.30 , $413.21 , $285.95 , $- , $- ," $1,442.00 ", $571.90
12035,6010010064,Hospital Chargemaster,Intmd rpr s/a/t/ext 12.6-20,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,442.00 ", $413.21 , $571.90 , $318.63 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $740.30 , $740.30 , $740.30 , $740.30 , $413.21 , $285.95 , $- , $- ," $1,442.00 ", $571.90
12055,6010010077,Hospital Chargemaster,Intmd rpr face/mm 12.6-20 cm,Outpatient,Outpatient Default Percent / Case Rate,450," $1,400.00 ", $336.00 ," $1,442.00 ", $413.21 , $980.00 , $546.00 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $740.30 , $740.30 , $740.30 , $740.30 , $413.21 , $490.00 , $- , $- ," $1,442.00 ", $980.00
13131,6010010084,Hospital Chargemaster,Cmplx rpr f/c/c/m/n/ax/g/h/f,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,442.00 ", $413.21 , $571.90 , $318.63 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $740.30 , $740.30 , $740.30 , $740.30 , $413.21 , $285.95 , $- , $- ," $1,442.00 ", $571.90
12006,6010010050,Hospital Chargemaster,Rpr s/n/a/gen/trk20.1-30.0cm,Outpatient,Outpatient Default Percent / Case Rate,450, $600.00 , $336.00 ," $1,442.00 ", $413.21 , $420.00 , $234.00 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $600.00 , $600.00 , $600.00 , $600.00 , $413.21 , $210.00 , $- , $- ," $1,442.00 ", $420.00
12017,6010010057,Hospital Chargemaster,Rpr fe/e/en/l/m 20.1-30.0 cm,Outpatient,Outpatient Default Percent / Case Rate,450, $600.00 , $336.00 ," $1,442.00 ", $413.21 , $420.00 , $234.00 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $600.00 , $600.00 , $600.00 , $600.00 , $413.21 , $210.00 , $- , $- ," $1,442.00 ", $420.00
12031,6010010061,Hospital Chargemaster,Intmd rpr s/a/t/ext 2.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,450, $590.00 , $336.00 ," $1,236.00 ", $413.21 , $413.00 , $230.10 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $590.00 , $590.00 , $590.00 , $590.00 , $413.21 , $206.50 , $- , $- ," $1,236.00 ", $413.00
12032,6010010062,Hospital Chargemaster,Intmd rpr s/a/t/ext 2.6-7.5,Outpatient,Outpatient Default Percent / Case Rate,450, $590.00 , $336.00 ," $1,236.00 ", $413.21 , $413.00 , $230.10 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $590.00 , $590.00 , $590.00 , $590.00 , $413.21 , $206.50 , $- , $- ," $1,236.00 ", $413.00
12051,6010010073,Hospital Chargemaster,Intmd rpr face/mm 2.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,450, $590.00 , $336.00 ," $1,236.00 ", $413.21 , $413.00 , $230.10 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $590.00 , $590.00 , $590.00 , $590.00 , $413.21 , $206.50 , $- , $- ," $1,236.00 ", $413.00
12016,6010010056,Hospital Chargemaster,Rpr fe/e/en/l/m 12.6-20.0 cm,Outpatient,Outpatient Default Percent / Case Rate,450, $530.00 , $336.00 ," $1,442.00 ", $413.21 , $371.00 , $206.70 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $530.00 , $530.00 , $530.00 , $530.00 , $413.21 , $185.50 , $- , $- ," $1,442.00 ", $371.00
11750,6010010040,Hospital Chargemaster,Removal of nail bed,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,236.00 ", $413.21 , $571.90 , $318.63 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $526.00 , $526.00 , $526.00 , $526.00 , $413.21 , $285.95 , $- , $- ," $1,236.00 ", $571.90
10021,6010010008,Hospital Chargemaster,Fna bx w/o img gdn 1st les,Outpatient,Outpatient Default Percent / Case Rate,450, $500.00 , $336.00 ," $1,236.00 ", $413.21 , $350.00 , $195.00 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $465.00 , $465.00 , $465.00 , $465.00 , $413.21 , $175.00 , $- , $- ," $1,236.00 ", $350.00
10061,6010010011,Hospital Chargemaster,Drainage of skin abscess,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", $413.21 , $312.20 , $173.94 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $414.78 , $414.78 , $414.78 , $414.78 , $413.21 , $156.10 , $- , $- ," $1,236.00 ", $312.20
16030,6010010097,Hospital Chargemaster,Dress/debrid p-thick burn l,Outpatient,Outpatient Default Percent / Case Rate,450, $271.00 , $336.00 ," $1,442.00 ", $413.21 , $189.70 , $105.69 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $94.85 , $- , $- ," $1,442.00 ", $189.70
10160,6010010017,Hospital Chargemaster,Puncture drainage of lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", $413.21 , $312.20 , $173.94 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $414.78 , $414.78 , $414.78 , $414.78 , $413.21 , $156.10 , $- , $- ," $1,236.00 ", $312.20
10120,6010010014,Hospital Chargemaster,Remove foreign body,Outpatient,Outpatient Default Percent / Case Rate,450, $515.00 , $336.00 ," $1,236.00 ", $413.21 , $360.50 , $200.85 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $478.95 , $478.95 , $478.95 , $478.95 , $413.21 , $180.25 , $- , $- ," $1,236.00 ", $360.50
12054,6010010076,Hospital Chargemaster,Intmd rpr face/mm 7.6-12.5cm,Outpatient,Outpatient Default Percent / Case Rate,450, $271.00 , $336.00 ," $1,442.00 ", $413.21 , $189.70 , $105.69 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $271.00 , $271.00 , $271.00 , $271.00 , $413.21 , $94.85 , $- , $- ," $1,442.00 ", $189.70
12041,6010010067,Hospital Chargemaster,Intmd rpr n-hf/genit 2.5cm/<,Outpatient,Outpatient Default Percent / Case Rate,450," $1,012.00 ", $336.00 ," $1,236.00 ", $413.21 , $708.40 , $394.68 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $216.00 , $216.00 , $216.00 , $216.00 , $413.21 , $354.20 , $- , $- ," $1,236.00 ", $708.40
11765,6010010043,Hospital Chargemaster,Excision of nail fold toe,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", $413.21 , $312.20 , $173.94 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $210.00 , $210.00 , $210.00 , $210.00 , $413.21 , $156.10 , $- , $- ," $1,236.00 ", $312.20
11042,6010010022,Hospital Chargemaster,Deb subq tissue 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,442.00 ", $413.21 ," $1,015.00 ", $565.50 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $507.50 , $- , $- ," $1,442.00 "," $1,015.00 "
36430,6010010326,Hospital Chargemaster,Blood transfusion service,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,236.00 ", $474.52 ," $1,015.00 ", $565.50 , $837.65 , $574.92 , $571.86 , $474.52 , $474.52 , $504.15 , $488.86 , $498.24 , $484.01 , $611.48 , $611.48 , $627.23 , $627.23 , $474.52 , $507.50 , $- , $- ," $1,236.00 "," $1,015.00 "
20100,6010010103,Hospital Chargemaster,Explore wound neck,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 , $941.01 , $540.69 , $799.40 , $445.38 ," $1,065.66 ", $731.42 , $727.52 , $540.69 , $540.69 , $105.28 , $102.55 , $567.73 , $551.50 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $540.69 , $399.70 , $- , $- ," $1,142.00 ", $799.40
30020,6010010291,Hospital Chargemaster,Drainage of nose lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $928.00 , $336.00 ," $1,236.00 ", $540.69 , $649.60 , $361.92 ," $1,065.66 ", $731.42 , $727.52 , $540.69 , $540.69 , $105.28 , $102.55 , $567.73 , $551.50 , $740.30 , $740.30 , $740.30 , $740.30 , $540.69 , $324.80 , $- , $- ," $1,236.00 ", $649.60
12020,6010010059,Hospital Chargemaster,Closure of split wound,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,236.00 ", $626.13 , $571.90 , $318.63 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $844.48 , $822.61 , $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $285.95 , $- , $- ," $1,236.00 ", $571.90
12036,6010010065,Hospital Chargemaster,Intmd rpr s/a/t/ext 20.1-30,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,442.00 ", $626.13 , $571.90 , $318.63 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $285.95 , $- , $- ," $1,442.00 ", $571.90
12044,6010010069,Hospital Chargemaster,Intmd rpr n-hf/genit7.6-12.5,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,442.00 ", $626.13 , $571.90 , $318.63 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $285.95 , $- , $- ," $1,442.00 ", $571.90
13120,6010010081,Hospital Chargemaster,Cmplx rpr s/a/l 1.1-2.5 cm,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,442.00 ", $626.13 , $571.90 , $318.63 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $285.95 , $- , $- ," $1,442.00 ", $571.90
13132,6010010085,Hospital Chargemaster,Cmplx rpr f/c/c/m/n/ax/g/h/f,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $2,060.00 ", $626.13 ," $1,015.00 ", $565.50 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,294.72 "," $1,261.20 ", $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $507.50 , $- , $- ," $2,060.00 "," $1,015.00 "
13152,6010010088,Hospital Chargemaster,Cmplx rpr e/n/e/l 2.6-7.5 cm,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $2,060.00 ", $626.13 ," $1,015.00 ", $565.50 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,294.72 "," $1,261.20 ", $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $507.50 , $- , $- ," $2,060.00 "," $1,015.00 "
12046,6010010071,Hospital Chargemaster,Intmd rpr n-hf/genit20.1-30,Outpatient,Outpatient Default Percent / Case Rate,450, $590.00 , $336.00 ," $1,442.00 ", $626.13 , $413.00 , $230.10 , $687.09 , $471.59 , $469.08 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $590.00 , $590.00 , $590.00 , $590.00 , $626.13 , $206.50 , $- , $- ," $1,442.00 ", $413.00
12045,6010010070,Hospital Chargemaster,Intmd rpr n-hf/genit12.6-20,Outpatient,Outpatient Default Percent / Case Rate,450, $590.00 , $336.00 ," $1,442.00 ", $626.13 , $413.00 , $230.10 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $590.00 , $590.00 , $590.00 , $590.00 , $626.13 , $206.50 , $- , $- ," $1,442.00 ", $413.00
13100,6010010078,Hospital Chargemaster,Cmplx rpr trunk 1.1-2.5 cm,Outpatient,Outpatient Default Percent / Case Rate,450, $590.00 , $336.00 ," $1,442.00 ", $626.13 , $413.00 , $230.10 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $590.00 , $590.00 , $590.00 , $590.00 , $626.13 , $206.50 , $- , $- ," $1,442.00 ", $413.00
13101,6010010079,Hospital Chargemaster,Cmplx rpr trunk 2.6-7.5 cm,Outpatient,Outpatient Default Percent / Case Rate,450, $590.00 , $336.00 ," $2,060.00 ", $626.13 , $413.00 , $230.10 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,294.72 "," $1,261.20 ", $657.44 , $638.65 , $590.00 , $590.00 , $590.00 , $590.00 , $626.13 , $206.50 , $- , $- ," $2,060.00 ", $413.00
13121,6010010082,Hospital Chargemaster,Cmplx rpr s/a/l 2.6-7.5 cm,Outpatient,Outpatient Default Percent / Case Rate,450, $590.00 , $336.00 ," $2,060.00 ", $626.13 , $413.00 , $230.10 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,294.72 "," $1,261.20 ", $657.44 , $638.65 , $590.00 , $590.00 , $590.00 , $590.00 , $626.13 , $206.50 , $- , $- ," $2,060.00 ", $413.00
13151,6010010087,Hospital Chargemaster,Cmplx rpr e/n/e/l 1.1-2.5 cm,Outpatient,Outpatient Default Percent / Case Rate,450, $590.00 , $336.00 ," $2,060.00 ", $626.13 , $413.00 , $230.10 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,294.72 "," $1,261.20 ", $657.44 , $638.65 , $590.00 , $590.00 , $590.00 , $590.00 , $626.13 , $206.50 , $- , $- ," $2,060.00 ", $413.00
11760,6010010041,Hospital Chargemaster,Repair of nail bed,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", $626.13 , $312.20 , $173.94 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $156.10 , $- , $- ," $1,236.00 ", $312.20
11043,6010010023,Hospital Chargemaster,Deb musc/fascia 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,442.00 ", $626.13 ," $1,015.00 ", $565.50 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $507.50 , $- , $- ," $1,442.00 "," $1,015.00 "
11000,6010010019,Hospital Chargemaster,Debride infected skin,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,236.00 ", $626.13 , $571.90 , $318.63 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $759.81 , $759.81 , $759.81 , $759.81 , $626.13 , $285.95 , $- , $- ," $1,236.00 ", $571.90
32554,6010010310,Hospital Chargemaster,Aspirate pleura w/o imaging,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,236.00 ", $646.21 , $571.90 , $318.63 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $105.28 , $102.55 , $678.52 , $659.13 , $110.00 , $110.00 , $110.00 , $110.00 , $646.21 , $285.95 , $- , $- ," $1,356.36 ", $571.90
10081,6010010013,Hospital Chargemaster,Drainage of pilonidal cyst,Outpatient,Outpatient Default Percent / Case Rate,450," $1,600.00 ", $336.00 ," $1,236.00 ", $743.95 ," $1,120.00 ", $624.00 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 ," $1,488.00 "," $1,488.00 "," $1,488.00 "," $1,488.00 ", $743.95 , $560.00 , $- , $- ," $1,488.00 "," $1,120.00 "
20103,6010010105,Hospital Chargemaster,Explore wound extremity,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $743.95 , $799.40 , $445.38 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $844.48 , $822.61 , $781.15 , $758.83 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $743.95 , $399.70 , $- , $- ," $1,267.38 ", $799.40
28190,6010010245,Hospital Chargemaster,Removal of foot foreign body,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,442.00 ", $743.95 , $799.40 , $445.38 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $743.95 , $399.70 , $- , $- ," $1,442.00 ", $799.40
11010,6010010020,Hospital Chargemaster,Debride skin at fx site,Outpatient,Outpatient Default Percent / Case Rate,450," $1,515.00 ", $336.00 ," $1,442.00 ", $743.95 ," $1,060.50 ", $590.85 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $530.25 , $- , $- ," $1,442.00 "," $1,060.50 "
11402,6010010031,Hospital Chargemaster,Exc tr-ext b9+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,450, $630.00 , $336.00 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
10080,6010010012,Hospital Chargemaster,Drainage of pilonidal cyst,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $743.95 , $799.40 , $445.38 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 ," $1,062.06 "," $1,062.06 "," $1,062.06 "," $1,062.06 ", $743.95 , $399.70 , $- , $- ," $1,267.38 ", $799.40
11400,6010010030,Hospital Chargemaster,Exc tr-ext b9+marg 0.5 cm<,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,236.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $234.00 , $234.00 , $234.00 , $234.00 , $743.95 , $285.95 , $- , $- ," $1,267.38 ", $571.90
20606,6010010113,Hospital Chargemaster,Drain/inj joint/bursa w/us,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $759.14 , $- , $- ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $- , $- , $- , $- , $759.14 , $- , $- , $- ," $1,309.97 ", $-
54420,6010010409,Hospital Chargemaster,Revision of penis,Outpatient,Outpatient Default Percent / Case Rate,450," $4,432.00 ", $336.00 ," $2,591.48 "," $3,675.67 "," $3,102.40 "," $1,728.48 "," $3,805.91 "," $2,612.21 "," $2,598.29 "," $3,675.67 "," $3,675.67 "," $1,599.36 "," $1,557.95 "," $3,859.45 "," $3,749.18 "," $4,315.01 "," $4,315.01 "," $4,315.01 "," $4,315.01 "," $3,675.67 "," $1,551.20 ", $- , $- ," $4,315.01 "," $3,102.40 "
21315,6010010120,Hospital Chargemaster,Closed tx nose fx w/o stablj,Outpatient,Outpatient Default Percent / Case Rate,450," $2,280.00 ", $336.00 ," $1,442.00 "," $1,617.20 "," $1,596.00 ", $889.20 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 "," $1,133.44 "," $1,104.09 "," $1,698.06 "," $1,649.55 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,617.20 ", $798.00 , $- , $- ," $2,798.18 "," $1,596.00 "
31603,6010010306,Hospital Chargemaster,Incision of windpipe,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 "," $1,617.20 ", $799.40 , $445.38 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 ", $844.48 , $822.61 ," $1,698.06 "," $1,649.55 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,617.20 ", $399.70 , $- , $- ," $2,798.18 ", $799.40
30320,6010010293,Hospital Chargemaster,Remove nasal foreign body,Outpatient,Outpatient Default Percent / Case Rate,450, $593.00 , $336.00 ," $1,442.00 "," $1,617.20 ", $415.10 , $231.27 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 "," $1,133.44 "," $1,104.09 "," $1,698.06 "," $1,649.55 ", $593.00 , $593.00 , $593.00 , $593.00 ," $1,617.20 ", $207.55 , $- , $- ," $2,798.18 ", $415.10
23665,6010010139,Hospital Chargemaster,Treat dislocation/fracture,Outpatient,Outpatient Default Percent / Case Rate,450," $4,156.00 ", $336.00 ," $1,442.00 "," $1,665.16 "," $2,909.20 "," $1,620.84 "," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $1,665.16 "," $1,454.60 ", $- , $- ," $2,909.20 "," $2,909.20 "
27502,6010010218,Hospital Chargemaster,Treatment of thigh fracture,Outpatient,Outpatient Default Percent / Case Rate,450," $3,050.00 ", $336.00 ," $1,442.00 "," $1,665.16 "," $2,135.00 "," $1,189.50 "," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $1,665.16 "," $1,067.50 ", $- , $- ," $2,873.10 "," $2,135.00 "
23605,6010010135,Hospital Chargemaster,Treat humerus fracture,Outpatient,Outpatient Default Percent / Case Rate,450," $2,704.00 ", $336.00 ," $1,442.00 "," $1,665.16 "," $1,892.80 "," $1,054.56 "," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 "," $2,704.00 "," $2,704.00 "," $2,704.00 "," $2,704.00 "," $1,665.16 ", $946.40 , $- , $- ," $2,873.10 "," $1,892.80 "
26410,6010010186,Hospital Chargemaster,Repair hand tendon,Outpatient,Outpatient Default Percent / Case Rate,450," $1,915.00 ", $336.00 ," $2,060.00 "," $1,665.16 "," $1,340.50 ", $746.85 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,294.72 "," $1,261.20 "," $1,748.42 "," $1,698.46 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,665.16 ", $670.25 , $- , $- ," $2,873.10 "," $1,340.50 "
26418,6010010187,Hospital Chargemaster,Repair finger tendon,Outpatient,Outpatient Default Percent / Case Rate,450," $1,915.00 ", $336.00 ," $2,591.48 "," $1,665.16 "," $1,340.50 ", $746.85 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,599.36 "," $1,557.95 "," $1,748.42 "," $1,698.46 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,665.16 ", $670.25 , $- , $- ," $2,873.10 "," $1,340.50 "
23675,6010010140,Hospital Chargemaster,Treat dislocation/fracture,Outpatient,Outpatient Default Percent / Case Rate,450," $1,870.00 ", $336.00 ," $1,442.00 "," $1,665.16 "," $1,309.00 ", $729.30 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 "," $1,870.00 "," $1,870.00 "," $1,870.00 "," $1,870.00 "," $1,665.16 ", $654.50 , $- , $- ," $2,873.10 "," $1,309.00 "
27257,6010010210,Hospital Chargemaster,Treat hip dislocation,Outpatient,Outpatient Default Percent / Case Rate,450," $1,870.00 ", $336.00 ," $2,060.00 "," $1,665.16 "," $1,309.00 ", $729.30 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 "," $1,870.00 "," $1,870.00 "," $1,870.00 "," $1,870.00 "," $1,665.16 ", $654.50 , $- , $- ," $2,873.10 "," $1,309.00 "
23505,6010010127,Hospital Chargemaster,Treat clavicle fracture,Outpatient,Outpatient Default Percent / Case Rate,450," $1,620.00 ", $336.00 ," $1,236.00 "," $1,665.16 "," $1,134.00 ", $631.80 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $567.00 , $- , $- ," $2,873.10 "," $1,134.00 "
23655,6010010138,Hospital Chargemaster,Treat shoulder dislocation,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,236.00 "," $1,665.16 "," $1,015.00 ", $565.50 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $507.50 , $- , $- ," $2,873.10 "," $1,015.00 "
24505,6010010146,Hospital Chargemaster,Treat humerus fracture,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,236.00 "," $1,665.16 "," $1,015.00 ", $565.50 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $507.50 , $- , $- ," $2,873.10 "," $1,015.00 "
27752,6010010228,Hospital Chargemaster,Treatment of tibia fracture,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,236.00 "," $1,665.16 "," $1,015.00 ", $565.50 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $507.50 , $- , $- ," $2,873.10 "," $1,015.00 "
27781,6010010233,Hospital Chargemaster,Treatment of fibula fracture,Outpatient,Outpatient Default Percent / Case Rate,450," $1,484.00 ", $336.00 ," $1,236.00 "," $1,665.16 "," $1,038.80 ", $578.76 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $519.40 , $- , $- ," $2,873.10 "," $1,038.80 "
27266,6010010212,Hospital Chargemaster,Treat hip dislocation,Outpatient,Outpatient Default Percent / Case Rate,450," $1,471.20 ", $336.00 ," $1,442.00 "," $1,665.16 "," $1,029.84 ", $573.77 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $514.92 , $- , $- ," $2,873.10 "," $1,029.84 "
25605,6010010171,Hospital Chargemaster,Treat fracture radius/ulna,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $2,060.00 "," $1,665.16 "," $1,015.00 ", $565.50 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,294.72 "," $1,261.20 "," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $507.50 , $- , $- ," $2,873.10 "," $1,015.00 "
23575,6010010133,Hospital Chargemaster,Treat shoulder blade fx,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 "," $1,665.16 ", $799.40 , $445.38 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $399.70 , $- , $- ," $2,873.10 ", $799.40
24675,6010010160,Hospital Chargemaster,Treat ulnar fracture,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 "," $1,665.16 ", $799.40 , $445.38 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $399.70 , $- , $- ," $2,873.10 ", $799.40
25505,6010010165,Hospital Chargemaster,Treat fracture of radius,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 "," $1,665.16 ", $799.40 , $445.38 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $399.70 , $- , $- ," $2,873.10 ", $799.40
26645,6010010192,Hospital Chargemaster,Treat thumb fracture,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 "," $1,665.16 ", $799.40 , $445.38 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $399.70 , $- , $- ," $2,873.10 ", $799.40
27762,6010010230,Hospital Chargemaster,Cltx med ankle fx w/mnpj,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 "," $1,665.16 ", $799.40 , $445.38 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $399.70 , $- , $- ," $2,873.10 ", $799.40
27810,6010010237,Hospital Chargemaster,Treatment of ankle fracture,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 "," $1,665.16 ", $799.40 , $445.38 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $399.70 , $- , $- ," $2,873.10 ", $799.40
27818,6010010239,Hospital Chargemaster,Treatment of ankle fracture,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 "," $1,665.16 ", $799.40 , $445.38 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $399.70 , $- , $- ," $2,873.10 ", $799.40
28455,6010010253,Hospital Chargemaster,Treat midfoot fracture each,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 "," $1,665.16 ", $799.40 , $445.38 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $399.70 , $- , $- ," $2,873.10 ", $799.40
27825,6010010242,Hospital Chargemaster,Treat lower leg fracture,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,442.00 "," $1,665.16 ", $799.40 , $445.38 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $399.70 , $- , $- ," $2,873.10 ", $799.40
25624,6010010174,Hospital Chargemaster,Treat wrist bone fracture,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,442.00 "," $1,665.16 ", $571.90 , $318.63 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 ", $817.00 , $817.00 , $817.00 , $817.00 ," $1,665.16 ", $285.95 , $- , $- ," $2,873.10 ", $571.90
25248,6010010162,Hospital Chargemaster,Remove forearm foreign body,Outpatient,Outpatient Default Percent / Case Rate,450, $812.00 , $336.00 ," $1,442.00 "," $1,665.16 ", $568.40 , $316.68 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 ", $812.00 , $812.00 , $812.00 , $812.00 ," $1,665.16 ", $284.20 , $- , $- ," $2,873.10 ", $568.40
24535,6010010148,Hospital Chargemaster,Treat humerus fracture,Outpatient,Outpatient Default Percent / Case Rate,450, $770.00 , $336.00 ," $1,236.00 "," $1,665.16 ", $539.00 , $300.30 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 ", $770.00 , $770.00 , $770.00 , $770.00 ," $1,665.16 ", $269.50 , $- , $- ," $2,873.10 ", $539.00
24620,6010010155,Hospital Chargemaster,Treat elbow fracture,Outpatient,Outpatient Default Percent / Case Rate,450, $761.00 , $336.00 ," $1,442.00 "," $1,665.16 ", $532.70 , $296.79 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 ", $761.00 , $761.00 , $761.00 , $761.00 ," $1,665.16 ", $266.35 , $- , $- ," $2,873.10 ", $532.70
26070,6010010183,Hospital Chargemaster,Explore/treat hand joint,Outpatient,Outpatient Default Percent / Case Rate,450, $719.00 , $336.00 ," $1,442.00 "," $1,665.16 ", $503.30 , $280.41 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 ", $719.00 , $719.00 , $719.00 , $719.00 ," $1,665.16 ", $251.65 , $- , $- ," $2,873.10 ", $503.30
24655,6010010158,Hospital Chargemaster,Treat radius fracture,Outpatient,Outpatient Default Percent / Case Rate,450, $513.00 , $336.00 ," $1,236.00 "," $1,665.16 ", $359.10 , $200.07 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 ", $513.00 , $513.00 , $513.00 , $513.00 ," $1,665.16 ", $179.55 , $- , $- ," $2,873.10 ", $359.10
25565,6010010169,Hospital Chargemaster,Treat fracture radius & ulna,Outpatient,Outpatient Default Percent / Case Rate,450, $197.00 , $336.00 ," $1,442.00 "," $1,665.16 ", $137.90 , $76.83 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 ", $197.00 , $197.00 , $197.00 , $197.00 ," $1,665.16 ", $68.95 , $- , $- ," $2,873.10 ", $137.90
26742,6010010198,Hospital Chargemaster,Treat finger fracture each,Outpatient,Outpatient Default Percent / Case Rate,450, $197.00 , $336.00 ," $1,442.00 "," $1,665.16 ", $137.90 , $76.83 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 ", $197.00 , $197.00 , $197.00 , $197.00 ," $1,665.16 ", $68.95 , $- , $- ," $2,873.10 ", $137.90
25635,6010010175,Hospital Chargemaster,Treat wrist bone fracture,Outpatient,Outpatient Default Percent / Case Rate,450, $135.00 , $336.00 ," $1,236.00 "," $1,665.16 ", $94.50 , $52.65 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 ", $135.00 , $135.00 , $135.00 , $135.00 ," $1,665.16 ", $47.25 , $- , $- ," $2,873.10 ", $94.50
32551,6010010309,Hospital Chargemaster,Insertion of chest tube,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,442.00 "," $1,681.14 "," $1,015.00 ", $565.50 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 ", $528.00 , $528.00 , $528.00 , $528.00 ," $1,681.14 ", $507.50 , $- , $- ," $2,392.46 "," $1,015.00 "
36569,6010010331,Hospital Chargemaster,Insj picc 5 yr+ w/o imaging,Outpatient,Outpatient Default Percent / Case Rate,450, $643.00 , $336.00 ," $1,236.00 "," $1,681.14 ", $450.10 , $250.77 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $1,681.14 ", $225.05 , $- , $- ," $2,540.00 ", $450.10
10121,6010010015,Hospital Chargemaster,Remove foreign body,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,442.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,348.50 "," $1,348.50 "," $1,348.50 "," $1,348.50 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
11404,6010010032,Hospital Chargemaster,Exc tr-ext b9+marg 3.1-4 cm,Outpatient,Outpatient Default Percent / Case Rate,450," $1,483.00 ", $336.00 ," $1,236.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
24200,6010010143,Hospital Chargemaster,Removal of arm foreign body,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 , $941.01 ," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
11044,6010010024,Hospital Chargemaster,Deb bone 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,450," $2,540.00 ", $336.00 ," $1,442.00 "," $1,682.11 "," $1,778.00 ", $990.60 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,004.00 "," $1,004.00 "," $1,004.00 "," $1,004.00 "," $1,682.11 ", $889.00 , $- , $- ," $3,009.07 "," $1,778.00 "
28193,6010010247,Hospital Chargemaster,Removal of foot foreign body,Outpatient,Outpatient Default Percent / Case Rate,450, $835.00 , $336.00 ," $2,591.48 "," $1,682.11 ", $584.50 , $325.65 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,599.36 "," $1,557.95 "," $1,766.22 "," $1,715.75 ", $835.00 , $835.00 , $835.00 , $835.00 ," $1,682.11 ", $292.25 , $- , $- ," $3,009.07 ", $584.50
20520,6010010106,Hospital Chargemaster,Removal of foreign body,Outpatient,Outpatient Default Percent / Case Rate,450," $1,483.00 ", $336.00 ," $1,442.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $740.30 , $740.30 , $740.30 , $740.30 ," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
27327,6010010216,Hospital Chargemaster,Exc thigh/knee les sc < 3 cm,Outpatient,Outpatient Default Percent / Case Rate,450, $604.00 , $336.00 ," $1,442.00 "," $1,682.11 ", $422.80 , $235.56 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $604.00 , $604.00 , $604.00 , $604.00 ," $1,682.11 ", $211.40 , $- , $- ," $3,009.07 ", $422.80
21930,6010010125,Hospital Chargemaster,Exc back les sc < 3 cm,Outpatient,Outpatient Default Percent / Case Rate,450, $512.00 , $336.00 ," $1,442.00 "," $1,682.11 ", $358.40 , $199.68 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $512.00 , $512.00 , $512.00 , $512.00 ," $1,682.11 ", $179.20 , $- , $- ," $3,009.07 ", $358.40
23931,6010010142,Hospital Chargemaster,Drainage of arm bursa,Outpatient,Outpatient Default Percent / Case Rate,450, $902.00 , $336.00 ," $1,442.00 "," $1,682.11 ", $631.40 , $351.78 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $505.00 , $505.00 , $505.00 , $505.00 ," $1,682.11 ", $315.70 , $- , $- ," $3,009.07 ", $631.40
19020,6010010101,Hospital Chargemaster,Incision of breast lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $431.00 , $336.00 ," $1,442.00 "," $1,682.11 ", $301.70 , $168.09 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $431.00 , $431.00 , $431.00 , $431.00 ," $1,682.11 ", $150.85 , $- , $- ," $3,009.07 ", $301.70
11422,6010010034,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $400.00 , $400.00 , $400.00 , $400.00 ," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
10140,6010010016,Hospital Chargemaster,Drainage of hematoma/fluid,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,236.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,348.50 "," $1,348.50 "," $1,348.50 "," $1,348.50 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
11420,6010010033,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 0.5/<,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,442.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $290.00 , $290.00 , $290.00 , $290.00 ," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
31238,6010010299,Hospital Chargemaster,Nasal/sinus endoscopy surg,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,442.00 "," $1,788.65 "," $1,015.00 ", $565.50 ," $2,995.49 "," $2,055.97 "," $2,045.01 "," $1,788.65 "," $1,788.65 ", $844.48 , $822.61 ," $1,878.08 "," $1,824.42 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,788.65 ", $507.50 , $- , $- ," $2,995.49 "," $1,015.00 "
31525,6010010303,Hospital Chargemaster,Dx laryngoscopy excl nb,Outpatient,Outpatient Default Percent / Case Rate,450," $3,600.00 ", $336.00 ," $1,442.00 "," $1,788.65 "," $2,520.00 "," $1,404.00 "," $2,995.49 "," $2,055.97 "," $2,045.01 "," $1,788.65 "," $1,788.65 ", $844.48 , $822.61 ," $1,878.08 "," $1,824.42 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,788.65 "," $1,260.00 ", $- , $- ," $2,995.49 "," $2,520.00 "
31622,6010010308,Hospital Chargemaster,Dx bronchoscope/wash,Outpatient,Outpatient Default Percent / Case Rate,450," $2,305.00 ", $336.00 ," $1,442.00 "," $1,788.65 "," $1,613.50 ", $898.95 ," $2,995.49 "," $2,055.97 "," $2,045.01 "," $1,788.65 "," $1,788.65 ", $844.48 , $822.61 ," $1,878.08 "," $1,824.42 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,788.65 ", $806.75 , $- , $- ," $2,995.49 "," $1,613.50 "
13160,6010010090,Hospital Chargemaster,Late closure of wound,Outpatient,Outpatient Default Percent / Case Rate,450," $2,540.00 ", $336.00 ," $1,442.00 "," $2,047.65 "," $1,778.00 ", $990.60 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 "," $1,133.44 "," $1,104.09 "," $2,150.03 "," $2,088.60 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,047.65 ", $889.00 , $- , $- ," $3,388.54 "," $1,778.00 "
20102,6010010104,Hospital Chargemaster,Explore wound abdomen,Outpatient,Outpatient Default Percent / Case Rate,450," $3,042.00 ", $336.00 ," $2,506.61 "," $2,047.65 "," $2,129.40 "," $1,186.38 "," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 "," $1,064.70 ", $- , $- ," $3,388.54 "," $2,129.40 "
12037,6010010066,Hospital Chargemaster,Intmd rpr s/tr/ext >30.0 cm,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,442.00 "," $2,047.65 "," $1,015.00 ", $565.50 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 "," $1,133.44 "," $1,104.09 "," $2,150.03 "," $2,088.60 ", $740.30 , $740.30 , $740.30 , $740.30 ," $2,047.65 ", $507.50 , $- , $- ," $3,388.54 "," $1,015.00 "
12047,6010010072,Hospital Chargemaster,Intmd rpr n-hf/genit >30.0cm,Outpatient,Outpatient Default Percent / Case Rate,450," $1,091.00 ", $336.00 ," $1,442.00 "," $2,047.65 ", $763.70 , $425.49 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 "," $1,133.44 "," $1,104.09 "," $2,150.03 "," $2,088.60 ", $740.30 , $740.30 , $740.30 , $740.30 ," $2,047.65 ", $381.85 , $- , $- ," $3,388.54 ", $763.70
27372,6010010217,Hospital Chargemaster,Removal of foreign body,Outpatient,Outpatient Default Percent / Case Rate,450," $1,915.00 ", $336.00 ," $2,976.70 "," $2,834.62 "," $1,340.50 ", $746.85 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $2,528.96 "," $2,463.48 "," $2,976.35 "," $2,891.31 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $2,834.62 ", $670.25 , $- , $- ," $5,202.81 "," $1,340.50 "
23930,6010010141,Hospital Chargemaster,Drainage of arm lesion,Outpatient,Outpatient Default Percent / Case Rate,450," $2,430.00 ", $336.00 ," $1,236.00 "," $2,834.62 "," $1,701.00 ", $947.70 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $2,834.62 "," $2,834.62 ", $844.48 , $822.61 ," $2,976.35 "," $2,891.31 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,834.62 ", $850.50 , $- , $- ," $3,009.07 "," $1,701.00 "
11012,6010010021,Hospital Chargemaster,Deb skin bone at fx site,Outpatient,Outpatient Default Percent / Case Rate,450," $2,629.00 ", $336.00 ," $1,442.00 "," $2,834.62 "," $1,840.30 "," $1,025.31 "," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 ", $105.28 , $102.55 ," $2,976.35 "," $2,891.31 ", $740.30 , $740.30 , $740.30 , $740.30 ," $2,834.62 ", $920.15 , $- , $- ," $5,202.81 "," $1,840.30 "
24201,6010010144,Hospital Chargemaster,Removal of arm foreign body,Outpatient,Outpatient Default Percent / Case Rate,450, $645.00 , $336.00 ," $1,442.00 "," $2,834.62 ", $451.50 , $251.55 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,133.44 "," $1,104.09 "," $2,976.35 "," $2,891.31 ", $645.00 , $645.00 , $645.00 , $645.00 ," $2,834.62 ", $225.75 , $- , $- ," $5,202.81 ", $451.50
11770,6010010044,Hospital Chargemaster,Remove pilonidal cyst simple,Outpatient,Outpatient Default Percent / Case Rate,450, $258.00 , $336.00 ," $2,060.00 "," $2,834.62 ", $180.60 , $100.62 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,294.72 "," $1,261.20 "," $2,976.35 "," $2,891.31 ", $258.00 , $258.00 , $258.00 , $258.00 ," $2,834.62 ", $90.30 , $- , $- ," $5,202.81 ", $180.60
10180,6010010018,Hospital Chargemaster,Complex drainage wound,Outpatient,Outpatient Default Percent / Case Rate,450, $218.00 , $336.00 ," $1,442.00 "," $2,834.62 ", $152.60 , $85.02 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,133.44 "," $1,104.09 "," $2,976.35 "," $2,891.31 ", $202.74 , $202.74 , $202.74 , $202.74 ," $2,834.62 ", $76.30 , $- , $- ," $5,202.81 ", $152.60
25606,6010010172,Hospital Chargemaster,Treat fx distal radial,Outpatient,Outpatient Default Percent / Case Rate,450," $2,545.00 ", $336.00 ," $2,060.00 "," $3,385.65 "," $1,781.50 ", $992.55 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,294.72 "," $1,261.20 "," $3,554.93 "," $3,453.36 "," $2,545.00 "," $2,545.00 "," $2,545.00 "," $2,545.00 "," $3,385.65 ", $890.75 , $- , $- ," $5,738.89 "," $1,781.50 "
26951,6010010206,Hospital Chargemaster,Amputation of finger/thumb,Outpatient,Outpatient Default Percent / Case Rate,450," $2,540.00 ", $336.00 ," $1,442.00 "," $3,385.65 "," $1,778.00 ", $990.60 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,133.44 "," $1,104.09 "," $3,554.93 "," $3,453.36 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $3,385.65 ", $889.00 , $- , $- ," $5,738.89 "," $1,778.00 "
27310,6010010215,Hospital Chargemaster,Exploration of knee joint,Outpatient,Outpatient Default Percent / Case Rate,450," $1,989.00 ", $336.00 ," $2,591.48 "," $3,385.65 "," $1,392.30 ", $775.71 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,599.36 "," $1,557.95 "," $3,554.93 "," $3,453.36 "," $1,989.00 "," $1,989.00 "," $1,989.00 "," $1,989.00 "," $3,385.65 ", $696.15 , $- , $- ," $5,738.89 "," $1,392.30 "
26370,6010010185,Hospital Chargemaster,Repair finger/hand tendon,Outpatient,Outpatient Default Percent / Case Rate,450," $1,712.00 ", $336.00 ," $2,591.48 "," $3,385.65 "," $1,198.40 ", $667.68 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,599.36 "," $1,557.95 "," $3,554.93 "," $3,453.36 "," $1,712.00 "," $1,712.00 "," $1,712.00 "," $1,712.00 "," $3,385.65 ", $599.20 , $- , $- ," $5,738.89 "," $1,198.40 "
26952,6010010207,Hospital Chargemaster,Amputation of finger/thumb,Outpatient,Outpatient Default Percent / Case Rate,450," $1,409.00 ", $336.00 ," $2,591.48 "," $3,385.65 ", $986.30 , $549.51 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,599.36 "," $1,557.95 "," $3,554.93 "," $3,453.36 "," $1,409.00 "," $1,409.00 "," $1,409.00 "," $1,409.00 "," $3,385.65 ", $493.15 , $- , $- ," $5,738.89 ", $986.30
27610,6010010225,Hospital Chargemaster,Explore/treat ankle joint,Outpatient,Outpatient Default Percent / Case Rate,450," $1,357.00 ", $336.00 ," $1,442.00 "," $3,385.65 ", $949.90 , $529.23 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,133.44 "," $1,104.09 "," $3,554.93 "," $3,453.36 "," $1,357.00 "," $1,357.00 "," $1,357.00 "," $1,357.00 "," $3,385.65 ", $474.95 , $- , $- ," $5,738.89 ", $949.90
28020,6010010244,Hospital Chargemaster,Exploration of foot joint,Outpatient,Outpatient Default Percent / Case Rate,450, $813.00 , $336.00 ," $1,442.00 "," $3,385.65 ", $569.10 , $317.07 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,133.44 "," $1,104.09 "," $3,554.93 "," $3,453.36 ", $813.00 , $813.00 , $813.00 , $813.00 ," $3,385.65 ", $284.55 , $- , $- ," $5,738.89 ", $569.10
26765,6010010201,Hospital Chargemaster,Treat finger fracture each,Outpatient,Outpatient Default Percent / Case Rate,450, $683.00 , $336.00 ," $2,591.48 "," $3,385.65 ", $478.10 , $266.37 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,599.36 "," $1,557.95 "," $3,554.93 "," $3,453.36 ", $683.00 , $683.00 , $683.00 , $683.00 ," $3,385.65 ", $239.05 , $- , $- ," $5,738.89 ", $478.10
28240,6010010248,Hospital Chargemaster,Release of big toe,Outpatient,Outpatient Default Percent / Case Rate,450, $666.00 , $336.00 ," $1,442.00 "," $3,385.65 ", $466.20 , $259.74 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,133.44 "," $1,104.09 "," $3,554.93 "," $3,453.36 ", $666.00 , $666.00 , $666.00 , $666.00 ," $3,385.65 ", $233.10 , $- , $- ," $5,738.89 ", $466.20
36558,6010010329,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,442.00 "," $3,422.34 ", $799.40 , $445.38 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $887.00 , $887.00 , $887.00 , $887.00 ," $3,422.34 ", $399.70 , $- , $- ," $5,778.66 ", $799.40
36555,6010010327,Hospital Chargemaster,Insert non-tunnel cv cath,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,236.00 "," $3,422.34 "," $1,015.00 ", $565.50 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $378.00 , $378.00 , $378.00 , $378.00 ," $3,422.34 ", $507.50 , $- , $- ," $3,593.46 "," $1,015.00 "
36556,6010010328,Hospital Chargemaster,Insert non-tunnel cv cath,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,236.00 "," $3,422.34 "," $1,015.00 ", $565.50 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $368.00 , $368.00 , $368.00 , $368.00 ," $3,422.34 ", $507.50 , $- , $- ," $3,593.46 "," $1,015.00 "
36563,6010010330,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,450," $7,624.75 ", $336.00 ," $2,060.00 "," $5,701.02 "," $5,337.33 "," $2,973.65 "," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 "," $1,294.72 "," $1,261.20 "," $5,986.07 "," $5,815.04 "," $1,125.00 "," $1,125.00 "," $1,125.00 "," $1,125.00 "," $5,701.02 "," $2,668.66 ", $- , $- ," $9,574.18 "," $5,337.33 "
27822,6010010240,Hospital Chargemaster,Treatment of ankle fracture,Outpatient,Outpatient Default Percent / Case Rate,450," $3,548.00 ", $336.00 ," $2,060.00 "," $7,488.26 "," $2,483.60 "," $1,383.72 "," $12,468.57 "," $8,557.88 "," $8,512.26 "," $7,488.26 "," $7,488.26 "," $1,294.72 "," $1,261.20 "," $7,862.67 "," $7,638.02 "," $3,548.00 "," $3,548.00 "," $3,548.00 "," $3,548.00 "," $7,488.26 "," $1,241.80 ", $- , $- ," $12,468.57 "," $2,483.60 "
23532,6010010129,Hospital Chargemaster,Treat clavicle dislocation,Outpatient,Outpatient Default Percent / Case Rate,450," $2,544.00 ", $336.00 ," $2,591.48 "," $7,488.26 "," $1,780.80 ", $992.16 ," $12,468.57 "," $8,557.88 "," $8,512.26 "," $7,488.26 "," $7,488.26 "," $1,599.36 "," $1,557.95 "," $7,862.67 "," $7,638.02 "," $2,544.00 "," $2,544.00 "," $2,544.00 "," $2,544.00 "," $7,488.26 ", $890.40 , $- , $- ," $12,468.57 "," $1,780.80 "
27650,6010010226,Hospital Chargemaster,Repair achilles tendon,Outpatient,Outpatient Default Percent / Case Rate,450," $2,382.00 ", $336.00 ," $2,060.00 "," $7,488.26 "," $1,667.40 ", $928.98 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $7,488.26 "," $7,488.26 "," $1,294.72 "," $1,261.20 "," $7,862.67 "," $7,638.02 "," $2,382.00 "," $2,382.00 "," $2,382.00 "," $2,382.00 "," $7,488.26 ", $833.70 , $- , $- ," $7,862.67 "," $1,667.40 "
20690,6010010117,Hospital Chargemaster,Apply bone fixation device,Outpatient,Outpatient Default Percent / Case Rate,450, $335.00 , $336.00 ," $1,442.00 "," $7,488.26 ", $234.50 , $130.65 ," $12,468.57 "," $8,557.88 "," $8,512.26 "," $7,488.26 "," $7,488.26 "," $1,133.44 "," $1,104.09 "," $7,862.67 "," $7,638.02 ", $335.00 , $335.00 , $335.00 , $335.00 ," $7,488.26 ", $117.25 , $- , $- ," $12,468.57 ", $234.50
33210,6010010314,Hospital Chargemaster,Insert electrd/pm cath sngl,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $2,591.48 "," $9,753.71 ", $799.40 , $445.38 ," $16,197.41 "," $11,117.20 "," $11,057.93 "," $9,753.71 "," $9,753.71 ", $844.48 , $822.61 ," $10,241.39 "," $9,948.78 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $9,753.71 ", $399.70 , $- , $- ," $16,197.41 ", $799.40
23615,6010010136,Hospital Chargemaster,Treat humerus fracture,Outpatient,Outpatient Default Percent / Case Rate,450," $2,006.00 ", $336.00 ," $2,591.48 "," $14,741.45 "," $1,404.20 ", $782.34 ," $23,437.94 "," $16,086.78 "," $16,001.02 "," $14,741.45 "," $14,741.45 "," $1,599.36 "," $1,557.95 "," $15,478.53 "," $15,036.28 "," $2,006.00 "," $2,006.00 "," $2,006.00 "," $2,006.00 "," $14,741.45 ", $702.10 , $- , $- ," $23,437.94 "," $1,404.20 "
64402,6010010431,Hospital Chargemaster,N block inj facial,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $2,542.04 ", See APC Packaged Rates , $571.90 , $318.63 , $788.32 , $791.75 , $314.63 , See APC Packaged Rates , See APC Packaged Rates , $548.21 , $548.21 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , Not Applicable , $285.95 ," $2,542.04 ", $571.90
64413,6010010433,Hospital Chargemaster,N block inj cervical plexus,Outpatient,Outpatient Default Percent / Case Rate,450, $900.00 , $336.00 ," $2,542.04 ", See APC Packaged Rates , $630.00 , $351.00 , $868.41 , $872.19 , $314.63 , See APC Packaged Rates , See APC Packaged Rates , $603.90 , $603.90 , See APC Packaged Rates , See APC Packaged Rates , $837.00 , $837.00 , $837.00 , $837.00 , See APC Packaged Rates , $315.00 , Not Applicable , $314.63 ," $2,542.04 ", $630.00
54700,6010010411,Hospital Chargemaster,Drainage of scrotum,Outpatient,Outpatient Default Percent / Case Rate,450," $2,629.00 ", $336.00 ," $1,442.00 "," $2,140.58 "," $1,840.30 "," $1,025.31 "," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 "," $1,133.44 "," $1,104.09 "," $2,247.61 "," $2,183.39 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,140.58 ", $920.15 , $- , $- ," $3,805.91 "," $1,840.30 "
46045,6010010381,Hospital Chargemaster,Incision of rectal abscess,Outpatient,Outpatient Default Percent / Case Rate,450," $2,629.00 ", $336.00 ," $1,442.00 "," $2,920.64 "," $1,840.30 "," $1,025.31 "," $5,107.19 "," $3,505.36 "," $3,486.67 "," $2,920.64 "," $2,920.64 "," $1,133.44 "," $1,104.09 "," $3,066.68 "," $2,979.06 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,920.64 ", $920.15 , $- , $- ," $5,107.19 "," $1,840.30 "
69120,6010010454,Hospital Chargemaster,Removal of external ear,Outpatient,Outpatient Default Percent / Case Rate,450," $2,540.00 ", $336.00 ," $1,442.00 "," $6,080.31 "," $1,778.00 ", $990.60 ," $9,678.56 "," $6,642.94 "," $6,607.52 "," $6,080.31 "," $6,080.31 "," $1,133.44 "," $1,104.09 "," $6,384.32 "," $6,201.91 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $6,080.31 ", $889.00 , $- , $- ," $9,678.56 "," $1,778.00 "
41252,6010010352,Hospital Chargemaster,Repair tongue laceration,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,442.00 ", $252.93 ," $1,015.00 ", $565.50 , $450.95 , $309.51 , $307.86 , $252.93 , $252.93 ," $1,133.44 "," $1,104.09 ", $265.57 , $257.99 ," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,450.00 ", $252.93 , $507.50 , $- , $- ," $1,450.00 "," $1,015.00 "
69145,6010010455,Hospital Chargemaster,Remove ear canal lesion(s),Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,442.00 "," $2,834.62 "," $1,015.00 ", $565.50 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,133.44 "," $1,104.09 "," $2,976.35 "," $2,891.31 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $2,834.62 ", $507.50 , $- , $- ," $5,202.81 "," $1,015.00 "
43020,6010010363,Hospital Chargemaster,Incision of esophagus,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,194.80 "," $1,617.20 "," $1,015.00 ", $565.50 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 "," $1,294.72 "," $1,261.20 "," $1,698.06 "," $1,649.55 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,617.20 ", $507.50 , $- , $- ," $2,798.18 "," $1,015.00 "
40650,6010010342,Hospital Chargemaster,Repair lip,Outpatient,Outpatient Default Percent / Case Rate,450," $1,300.00 ", $336.00 ," $2,060.00 ", $540.69 , $910.00 , $507.00 ," $1,065.66 ", $731.42 , $727.52 , $540.69 , $540.69 ," $1,294.72 "," $1,261.20 ", $567.73 , $551.50 ," $1,300.00 "," $1,300.00 "," $1,300.00 "," $1,300.00 ", $540.69 , $455.00 , $- , $- ," $2,060.00 ", $910.00
45331,6010010376,Hospital Chargemaster,Sigmoidoscopy and biopsy,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,236.00 ", $948.73 ," $1,015.00 ", $565.50 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $844.48 , $822.61 , $996.17 , $967.71 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $948.73 , $507.50 , $- , $- ," $1,629.53 "," $1,015.00 "
45915,6010010378,Hospital Chargemaster,Remove rectal obstruction,Outpatient,Outpatient Default Percent / Case Rate,450," $2,933.00 ", $336.00 ," $1,236.00 "," $1,239.71 "," $2,053.10 "," $1,143.87 "," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 ", $844.48 , $822.61 ," $1,301.70 "," $1,264.51 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,239.71 "," $1,026.55 ", $- , $- ," $2,143.42 "," $2,053.10 "
67930,6010010448,Hospital Chargemaster,Repair eyelid wound,Outpatient,Outpatient Default Percent / Case Rate,450," $1,615.00 ", $336.00 ," $1,442.00 "," $2,392.31 "," $1,130.50 ", $629.85 ," $3,965.46 "," $2,721.72 "," $2,707.21 "," $2,392.31 "," $2,392.31 ", $844.48 , $822.61 ," $2,511.93 "," $2,440.16 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,392.31 ", $565.25 , $- , $- ," $3,965.46 "," $1,130.50 "
46040,6010010380,Hospital Chargemaster,Incision of rectal abscess,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $2,060.00 "," $1,239.71 "," $1,015.00 ", $565.50 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,294.72 "," $1,261.20 "," $1,301.70 "," $1,264.51 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,239.71 ", $507.50 , $- , $- ," $2,143.42 "," $1,015.00 "
41800,6010010354,Hospital Chargemaster,Drainage of gum lesion,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $134.80 , $799.40 , $445.38 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $844.48 , $822.61 , $141.54 , $137.50 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $134.80 , $399.70 , $- , $- ," $1,236.00 ", $799.40
56420,6010010416,Hospital Chargemaster,Drainage of gland abscess,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $203.67 , $799.40 , $445.38 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $844.48 , $822.61 , $213.85 , $207.74 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $203.67 , $399.70 , $- , $- ," $1,236.00 ", $799.40
42700,6010010359,Hospital Chargemaster,Drainage of tonsil abscess,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $252.93 , $799.40 , $445.38 , $450.95 , $309.51 , $307.86 , $252.93 , $252.93 , $844.48 , $822.61 , $265.57 , $257.99 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $252.93 , $399.70 , $- , $- ," $1,236.00 ", $799.40
54450,6010010410,Hospital Chargemaster,Preputial stretching,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $318.13 , $799.40 , $445.38 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $844.48 , $822.61 , $334.03 , $324.49 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $318.13 , $399.70 , $- , $- ," $1,236.00 ", $799.40
45300,6010010375,Hospital Chargemaster,Proctosigmoidoscopy dx,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $948.73 , $799.40 , $445.38 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $105.28 , $102.55 , $996.17 , $967.71 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $948.73 , $399.70 , $- , $- ," $1,629.53 ", $799.40
46608,6010010387,Hospital Chargemaster,Anoscopy remove for body,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $948.73 , $799.40 , $445.38 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $844.48 , $822.61 , $996.17 , $967.71 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $948.73 , $399.70 , $- , $- ," $1,629.53 ", $799.40
43200,6010010364,Hospital Chargemaster,Esophagoscopy flexible brush,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $967.36 , $799.40 , $445.38 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $967.36 , $399.70 , $- , $- ," $1,665.99 ", $799.40
43450,6010010368,Hospital Chargemaster,Dilate esophagus 1/mult pass,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $967.36 , $799.40 , $445.38 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $967.36 , $399.70 , $- , $- ," $1,665.99 ", $799.40
46614,6010010388,Hospital Chargemaster,Anoscopy control bleeding,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 "," $1,239.71 ", $799.40 , $445.38 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 ", $105.28 , $102.55 ," $1,301.70 "," $1,264.51 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,239.71 ", $399.70 , $- , $- ," $2,143.42 ", $799.40
55100,6010010413,Hospital Chargemaster,Drainage of scrotum abscess,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
43215,6010010365,Hospital Chargemaster,Esophagoscopy flex remove fb,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 "," $1,941.77 ", $799.40 , $445.38 ," $3,245.02 "," $2,227.24 "," $2,215.37 "," $1,941.77 "," $1,941.77 ", $844.48 , $822.61 ," $2,038.86 "," $1,980.61 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,941.77 ", $399.70 , $- , $- ," $3,245.02 ", $799.40
99291,6010010006,Hospital Chargemaster,Critical Care Init 30-74 Min,Outpatient,Outpatient Default Percent / Case Rate,450," $2,211.00 ", $336.00 ," $1,821.86 ", $890.51 ," $1,547.70 ", $862.29 ," $3,645.69 "," $2,255.28 "," $2,178.27 ", $890.51 , $890.51 , $836.55 , $811.17 , $935.03 , $908.32 ," $1,078.51 "," $1,078.51 "," $1,106.30 "," $1,106.30 ", $890.51 , $884.40 , $- , $- ," $3,645.69 "," $1,547.70 "
59409,6010010425,Hospital Chargemaster,Obstetrical care,Outpatient,Outpatient Default Percent / Case Rate,450," $1,105.00 ", $336.00 ," $1,236.00 "," $3,136.64 ", $773.50 , $430.95 ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 ", $741.46 , $741.46 ," $3,293.47 "," $3,199.37 "," $1,105.00 "," $1,105.00 "," $1,105.00 "," $1,105.00 "," $3,136.64 ", $386.75 , $- , $- ," $5,165.58 ", $773.50
64445,6010010435,Hospital Chargemaster,N block inj sciatic sng,Outpatient,Outpatient Default Percent / Case Rate,450, $900.00 , $336.00 ," $1,236.00 ", $759.14 , $630.00 , $351.00 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $194.20 , $188.30 , $797.10 , $774.33 , $900.00 , $900.00 , $900.00 , $900.00 , $759.14 , $315.00 , $- , $- ," $1,309.97 ", $630.00
41250,6010010350,Hospital Chargemaster,Repair tongue laceration,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,442.00 ", $324.46 , $571.90 , $318.63 , $232.95 , $159.88 , $159.03 , $324.46 , $324.46 ," $1,133.44 "," $1,104.09 ", $340.68 , $330.95 , $817.00 , $817.00 , $817.00 , $817.00 , $324.46 , $285.95 , $- , $- ," $1,442.00 ", $571.90
99285,6010010005,Hospital Chargemaster,ED High Severity&Threat Func,Outpatient,Outpatient Default Percent / Case Rate,450, $940.00 , $336.00 , $908.46 , $624.24 , $658.00 , $366.60 ," $2,587.86 "," $1,600.89 "," $1,546.23 ", $624.24 , $624.24 , $532.35 , $516.20 , $655.45 , $636.72 , $754.60 , $754.60 , $774.03 , $774.03 , $624.24 , $769.05 , $- , $- ," $2,587.86 ", $658.00
54220,6010010407,Hospital Chargemaster,Treatment of penis lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $770.00 , $336.00 ," $1,236.00 ", $318.13 , $539.00 , $300.30 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $844.48 , $822.61 , $334.03 , $324.49 , $770.00 , $770.00 , $770.00 , $770.00 , $318.13 , $269.50 , $- , $- ," $1,236.00 ", $539.00
46700,6010010389,Hospital Chargemaster,Repair of anal stricture,Outpatient,Outpatient Default Percent / Case Rate,450, $753.00 , $336.00 ," $2,060.00 "," $2,920.64 ", $527.10 , $293.67 ," $5,107.19 "," $3,505.36 "," $3,486.67 "," $2,920.64 "," $2,920.64 "," $1,294.72 "," $1,261.20 "," $3,066.68 "," $2,979.06 ", $753.00 , $753.00 , $753.00 , $753.00 ," $2,920.64 ", $263.55 , $- , $- ," $5,107.19 ", $527.10
53600,6010010406,Hospital Chargemaster,Dilate urethra stricture,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,236.00 ", $318.13 , $571.90 , $318.63 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $740.30 , $740.30 , $740.30 , $740.30 , $318.13 , $285.95 , $- , $- ," $1,236.00 ", $571.90
67700,6010010446,Hospital Chargemaster,Drainage of eyelid abscess,Outpatient,Outpatient Default Percent / Case Rate,450, $996.00 , $336.00 ," $1,236.00 ", $312.73 , $697.20 , $388.44 , $620.23 , $425.70 , $423.43 , $312.73 , $312.73 , $105.28 , $102.55 , $328.37 , $318.99 , $740.30 , $740.30 , $740.30 , $740.30 , $312.73 , $348.60 , $- , $- ," $1,236.00 ", $697.20
64420,6010010434,Hospital Chargemaster,N block inj intercost sng,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $160.48 , $155.61 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
49450,6010010393,Hospital Chargemaster,Replace g/c tube perc,Outpatient,Outpatient Default Percent / Case Rate,450," $2,102.00 ", $336.00 ," $1,236.00 ", $967.36 ," $1,471.40 ", $819.78 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $740.30 , $740.30 , $740.30 , $740.30 , $967.36 , $735.70 , $- , $- ," $1,665.99 "," $1,471.40 "
55000,6010010412,Hospital Chargemaster,Drainage of hydrocele,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 , $673.21 , $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,267.38 ", $571.90
49900,6010010394,Hospital Chargemaster,Repair of abdominal wall,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,194.80 ", See APC Packaged Rates ," $1,015.00 ", $565.50 ," $2,679.96 "," $1,839.41 "," $1,829.60 ", See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $740.30 , $740.30 , $740.30 , $740.30 , See APC Packaged Rates , $507.50 , $- , $- ," $2,679.96 "," $1,015.00 "
51045,6010010395,Hospital Chargemaster,Incise bladder/drain ureter,Outpatient,Outpatient Default Percent / Case Rate,450, $699.00 , $336.00 ," $2,591.48 "," $2,140.58 ", $489.30 , $272.61 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 "," $1,599.36 "," $1,557.95 "," $2,247.61 "," $2,183.39 ", $699.00 , $699.00 , $699.00 , $699.00 ," $2,140.58 ", $244.65 , $- , $- ," $3,805.91 ", $489.30
69420,6010010460,Hospital Chargemaster,Incision of eardrum,Outpatient,Outpatient Default Percent / Case Rate,450, $685.00 , $336.00 ," $2,060.00 ", $252.93 , $479.50 , $267.15 , $450.95 , $309.51 , $307.86 , $252.93 , $252.93 , $844.48 , $822.61 , $265.57 , $257.99 , $685.00 , $685.00 , $685.00 , $685.00 , $252.93 , $239.75 , $- , $- ," $2,060.00 ", $479.50
43247,6010010367,Hospital Chargemaster,Egd remove foreign body,Outpatient,Outpatient Default Percent / Case Rate,450, $619.00 , $336.00 ," $1,442.00 ", $967.36 , $433.30 , $241.41 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 ," $1,133.44 "," $1,104.09 "," $1,015.72 ", $986.70 , $619.00 , $619.00 , $619.00 , $619.00 , $967.36 , $216.65 , $- , $- ," $1,665.99 ", $433.30
40830,6010010347,Hospital Chargemaster,Repair mouth laceration,Outpatient,Outpatient Default Percent / Case Rate,450, $590.00 , $336.00 , $486.16 , $252.93 , $413.00 , $230.10 , $450.95 , $309.51 , $307.86 , $252.93 , $252.93 , $844.48 , $822.61 , $265.57 , $257.99 , $590.00 , $590.00 , $590.00 , $590.00 , $252.93 , $206.50 , $- , $- , $844.48 , $413.00
45999,6010010379,Hospital Chargemaster,Rectum surgery procedure,Outpatient,Outpatient Default Percent / Case Rate,450, $590.00 , $336.00 , $486.16 , $948.73 , $413.00 , $230.10 , $569.29 , $571.77 , $314.63 , $948.73 , $948.73 , $395.89 , $395.89 , $996.17 , $967.71 , $590.00 , $590.00 , $590.00 , $590.00 , $948.73 , $206.50 , $- , $- , $996.17 , $413.00
37195,6010010337,Hospital Chargemaster,Thrombolytic therapy stroke,Outpatient,Outpatient Default Percent / Case Rate,450, $588.00 , $336.00 , $484.51 , $381.19 , $411.60 , $229.32 , $630.87 , $433.00 , $430.69 , $381.19 , $381.19 , $394.55 , $394.55 , $400.25 , $388.81 , $588.00 , $588.00 , $588.00 , $588.00 , $381.19 , $205.80 , $- , $- , $630.87 , $411.60
99284,6010010004,Hospital Chargemaster,ED Visit High/Urgent Severity,Outpatient,Outpatient Default Percent / Case Rate,450, $650.00 , $336.00 , $908.46 , $434.89 , $455.00 , $253.50 ," $1,775.33 "," $1,098.25 "," $1,060.75 ", $434.89 , $434.89 , $395.46 , $383.46 , $456.64 , $443.59 , $572.41 , $572.41 , $587.15 , $587.15 , $434.89 , $769.05 , $- , $- ," $1,775.33 ", $455.00
65235,6010010445,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,450, $544.00 , $336.00 ," $1,442.00 "," $2,482.64 ", $380.80 , $212.16 ," $4,194.02 "," $2,878.59 "," $2,863.25 "," $2,482.64 "," $2,482.64 "," $1,133.44 "," $1,104.09 "," $2,606.77 "," $2,532.29 ", $544.00 , $544.00 , $544.00 , $544.00 ," $2,482.64 ", $190.40 , $- , $- ," $4,194.02 ", $380.80
37212,6010010338,Hospital Chargemaster,Thrombolytic venous therapy,Outpatient,Outpatient Default Percent / Case Rate,450," $3,450.00 ", $336.00 ," $1,236.00 "," $3,422.34 "," $2,415.00 "," $1,345.50 "," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $400.00 , $400.00 , $400.00 , $400.00 ," $3,422.34 "," $1,207.50 ", $- , $- ," $5,778.66 "," $2,415.00 "
99283,6010010003,Hospital Chargemaster,ED Visit Moderate Severity,Outpatient,Outpatient Default Percent / Case Rate,450, $397.00 , $336.00 , $603.58 , $276.67 , $277.90 , $154.83 ," $1,098.54 ", $679.58 , $656.37 , $276.67 , $276.67 , $288.99 , $280.22 , $290.50 , $282.20 , $397.00 , $397.00 , $397.00 , $397.00 , $276.67 , $489.50 , $- , $- ," $1,098.54 ", $277.90
51700,6010010397,Hospital Chargemaster,Irrigation of bladder,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", $318.13 , $312.20 , $173.94 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $386.01 , $386.01 , $395.95 , $395.95 , $318.13 , $156.10 , $- , $- ," $1,236.00 ", $312.20
54235,6010010408,Hospital Chargemaster,Penile injection,Outpatient,Outpatient Default Percent / Case Rate,450, $770.00 , $336.00 , $634.48 , $318.13 , $539.00 , $300.30 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $179.62 , $174.17 , $334.03 , $324.49 , $386.01 , $386.01 , $395.95 , $395.95 , $318.13 , $269.50 , $- , $- , $634.48 , $539.00
37780,6010010340,Hospital Chargemaster,Revision of leg vein,Outpatient,Outpatient Default Percent / Case Rate,450, $373.00 , $336.00 ," $2,060.00 "," $3,422.34 ", $261.10 , $145.47 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 ", $373.00 , $373.00 , $373.00 , $373.00 ," $3,422.34 ", $130.55 , $- , $- ," $3,593.46 ", $261.10
42000,6010010356,Hospital Chargemaster,Drainage mouth roof lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $363.00 , $336.00 ," $1,442.00 ", $252.93 , $254.10 , $141.57 , $450.95 , $309.51 , $307.86 , $252.93 , $252.93 ," $1,133.44 "," $1,104.09 ", $265.57 , $257.99 , $363.00 , $363.00 , $363.00 , $363.00 , $252.93 , $127.05 , $- , $- ," $1,442.00 ", $254.10
64505,6010010439,Hospital Chargemaster,N block spenopalatine gangl,Outpatient,Outpatient Default Percent / Case Rate,450, $645.00 , $336.00 ," $1,236.00 ", $312.35 , $451.50 , $251.55 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $199.70 , $193.64 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $225.75 , $- , $- ," $1,236.00 ", $451.50
67938,6010010449,Hospital Chargemaster,Remove eyelid foreign body,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", $312.73 , $312.20 , $173.94 , $620.23 , $425.70 , $423.43 , $312.73 , $312.73 , $105.28 , $102.55 , $328.37 , $318.99 , $343.81 , $343.81 , $343.81 , $343.81 , $312.73 , $156.10 , $- , $- ," $1,236.00 ", $312.20
69000,6010010450,Hospital Chargemaster,Drain external ear lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", $743.95 , $312.20 , $173.94 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $156.10 , $- , $- ," $1,267.38 ", $312.20
65210,6010010442,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 , $367.50 , $324.46 , $312.20 , $173.94 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $343.81 , $343.81 , $343.81 , $343.81 , $324.46 , $156.10 , $- , $- , $761.64 , $312.20
40800,6010010344,Hospital Chargemaster,Drainage of mouth lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 , $673.21 , $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $285.95 , $- , $- ," $1,267.38 ", $571.90
43752,6010010369,Hospital Chargemaster,Nasal/orogastric w/tube plmt,Outpatient,Outpatient Default Percent / Case Rate,450, $489.00 , $336.00 ," $1,442.00 ", $324.46 , $342.30 , $190.71 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $334.00 , $334.00 , $334.00 , $334.00 , $324.46 , $171.15 , $- , $- ," $1,442.00 ", $342.30
56405,6010010415,Hospital Chargemaster,I & d of vulva/perineum,Outpatient,Outpatient Default Percent / Case Rate,450," $1,630.00 ", $336.00 ," $1,442.00 ", $337.17 ," $1,141.00 ", $635.70 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 ," $1,133.44 "," $1,104.09 ", $354.03 , $343.92 , $331.00 , $331.00 , $331.00 , $331.00 , $337.17 , $570.50 , $- , $- ," $1,442.00 "," $1,141.00 "
62273,6010010429,Hospital Chargemaster,Inject epidural patch,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $759.14 , $799.40 , $445.38 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $844.48 , $822.61 , $797.10 , $774.33 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $759.14 , $399.70 , $- , $- ," $1,309.97 ", $799.40
46083,6010010383,Hospital Chargemaster,Incise external hemorrhoid,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", $318.13 , $312.20 , $173.94 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $317.00 , $317.00 , $317.00 , $317.00 , $318.13 , $156.10 , $- , $- ," $1,236.00 ", $312.20
46050,6010010382,Hospital Chargemaster,Incision of anal abscess,Outpatient,Outpatient Default Percent / Case Rate,450," $1,450.00 ", $336.00 ," $1,236.00 ", $948.73 ," $1,015.00 ", $565.50 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $844.48 , $822.61 , $996.17 , $967.71 , $279.00 , $279.00 , $279.00 , $279.00 , $948.73 , $507.50 , $- , $- ," $1,629.53 "," $1,015.00 "
43753,6010010370,Hospital Chargemaster,Tx gastro intub w/asp,Outpatient,Outpatient Default Percent / Case Rate,450, $271.00 , $336.00 ," $1,236.00 ", $316.40 , $189.70 , $105.69 , $551.96 , $378.84 , $376.82 , $316.40 , $316.40 , $105.28 , $102.55 , $332.22 , $322.72 , $271.00 , $271.00 , $271.00 , $271.00 , $316.40 , $94.85 , $- , $- ," $1,236.00 ", $189.70
43754,6010010371,Hospital Chargemaster,Dx gastr intub w/asp spec,Outpatient,Outpatient Default Percent / Case Rate,450, $271.00 , $336.00 ," $1,236.00 ", $316.40 , $189.70 , $105.69 , $551.96 , $378.84 , $376.82 , $316.40 , $316.40 , $105.28 , $102.55 , $332.22 , $322.72 , $271.00 , $271.00 , $271.00 , $271.00 , $316.40 , $94.85 , $- , $- ," $1,236.00 ", $189.70
69090,6010010453,Hospital Chargemaster,Pierce earlobes,Outpatient,Outpatient Default Percent / Case Rate,450, $271.00 , $336.00 , $223.30 , See APC Packaged Rates , $189.70 , $105.69 , $89.74 , $61.59 , $61.26 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $271.00 , $271.00 , $271.00 , $271.00 , See APC Packaged Rates , $94.85 , $- , $- , $336.00 , $189.70
65222,6010010444,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,450, $271.00 , $336.00 , $223.30 , $134.80 , $189.70 , $105.69 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $271.00 , $271.00 , $271.00 , $271.00 , $134.80 , $94.85 , $- , $- , $336.00 , $189.70
69200,6010010456,Hospital Chargemaster,Clear outer ear canal,Outpatient,Outpatient Default Percent / Case Rate,450, $271.00 , $336.00 , $223.30 , $134.80 , $189.70 , $105.69 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $271.00 , $271.00 , $271.00 , $271.00 , $134.80 , $94.85 , $- , $- , $336.00 , $189.70
41599,6010010353,Hospital Chargemaster,Tongue and mouth surgery,Outpatient,Outpatient Default Percent / Case Rate,450, $271.00 , $336.00 , $223.30 , $252.93 , $189.70 , $105.69 , $261.49 , $262.63 , $314.63 , $252.93 , $252.93 , $181.84 , $181.84 , $265.57 , $257.99 , $271.00 , $271.00 , $271.00 , $271.00 , $252.93 , $94.85 , $- , $- , $336.00 , $189.70
99282,6010010002,Hospital Chargemaster,ED Visit Low/Moder Severity,Outpatient,Outpatient Default Percent / Case Rate,450, $267.00 , $336.00 , $374.92 , $157.03 , $186.90 , $104.13 , $630.39 , $389.97 , $376.65 , $157.03 , $157.03 , $197.73 , $191.73 , $164.88 , $160.17 , $267.00 , $267.00 , $267.00 , $267.00 , $157.03 , $349.16 , $- , $- , $630.39 , $186.90
51720,6010010403,Hospital Chargemaster,Treatment of bladder lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $589.00 , $336.00 , $485.34 , $318.13 , $412.30 , $229.71 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $386.01 , $386.01 , $395.95 , $395.95 , $318.13 , $206.15 , $- , $- , $506.26 , $412.30
62270,6010010427,Hospital Chargemaster,Spinal fluid tap diagnostic,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $759.14 , $799.40 , $445.38 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $177.96 , $172.56 , $797.10 , $774.33 , $237.00 , $237.00 , $237.00 , $237.00 , $759.14 , $399.70 , $- , $- ," $1,309.97 ", $799.40
58100,6010010422,Hospital Chargemaster,Biopsy of uterus lining,Outpatient,Outpatient Default Percent / Case Rate,450, $232.00 , $336.00 ," $1,236.00 ", $203.67 , $162.40 , $90.48 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $105.28 , $102.55 , $213.85 , $207.74 , $232.00 , $232.00 , $232.00 , $232.00 , $203.67 , $81.20 , $- , $- ," $1,236.00 ", $162.40
64405,6010010432,Hospital Chargemaster,N block inj occipital,Outpatient,Outpatient Default Percent / Case Rate,450," $1,032.00 ", $336.00 ," $1,236.00 ", $312.35 , $722.40 , $402.48 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $185.94 , $180.29 , $327.96 , $318.59 , $740.30 , $740.30 , $740.30 , $740.30 , $312.35 , $361.20 , $- , $- ," $1,236.00 ", $722.40
57500,6010010421,Hospital Chargemaster,Biopsy of cervix,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $757.92 , $799.40 , $445.38 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $105.28 , $102.55 , $795.81 , $773.07 , $228.00 , $228.00 , $228.00 , $228.00 , $757.92 , $399.70 , $- , $- ," $1,236.00 ", $799.40
51703,6010010400,Hospital Chargemaster,Insert bladder cath complex,Outpatient,Outpatient Default Percent / Case Rate,450, $269.00 , $336.00 ," $1,236.00 ", $166.91 , $188.30 , $104.91 , $297.41 , $204.13 , $203.04 , $166.91 , $166.91 , $196.14 , $190.19 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $94.15 , $- , $- ," $1,236.00 ", $188.30
51705,6010010401,Hospital Chargemaster,Change of bladder tube,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,236.00 ", $318.13 , $571.90 , $318.63 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $221.00 , $221.00 , $221.00 , $221.00 , $318.13 , $285.95 , $- , $- ," $1,236.00 ", $571.90
46320,6010010384,Hospital Chargemaster,Removal of hemorrhoid clot,Outpatient,Outpatient Default Percent / Case Rate,450, $212.00 , $336.00 ," $1,236.00 "," $1,239.71 ", $148.40 , $82.68 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 ", $105.28 , $102.55 ," $1,301.70 "," $1,264.51 ", $212.00 , $212.00 , $212.00 , $212.00 ," $1,239.71 ", $74.20 , $- , $- ," $2,143.42 ", $148.40
64450,6010010437,Hospital Chargemaster,N block other peripheral,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,236.00 ", $759.14 , $571.90 , $318.63 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $168.83 , $163.71 , $797.10 , $774.33 , $208.00 , $208.00 , $208.00 , $208.00 , $759.14 , $285.95 , $- , $- ," $1,309.97 ", $571.90
58301,6010010423,Hospital Chargemaster,Remove intrauterine device,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,236.00 ", $337.17 , $571.90 , $318.63 , $362.99 , $249.14 , $247.81 , $337.17 , $337.17 , $164.50 , $159.51 , $354.03 , $343.92 , $203.00 , $203.00 , $203.00 , $203.00 , $337.17 , $285.95 , $- , $- ," $1,236.00 ", $571.90
64400,6010010430,Hospital Chargemaster,N block inj trigeminal,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,236.00 ", $312.35 , $571.90 , $318.63 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $157.25 , $152.48 , $327.96 , $318.59 , $194.00 , $194.00 , $194.00 , $194.00 , $312.35 , $285.95 , $- , $- ," $1,236.00 ", $571.90
42809,6010010360,Hospital Chargemaster,Remove pharynx foreign body,Outpatient,Outpatient Default Percent / Case Rate,450, $475.00 , $336.00 ," $1,236.00 ", $324.46 , $332.50 , $185.25 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $185.14 , $185.14 , $185.14 , $185.14 , $324.46 , $166.25 , $- , $- ," $1,236.00 ", $332.50
69220,6010010459,Hospital Chargemaster,Clean out mastoid cavity,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , $214.68 , $167.30 , $93.21 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $185.14 , $185.14 , $185.14 , $185.14 , $214.68 , $83.65 , $- , $- , $386.01 , $167.30
57160,6010010417,Hospital Chargemaster,Insert pessary/other device,Outpatient,Outpatient Default Percent / Case Rate,450, $177.00 , $336.00 , $145.85 , $203.67 , $123.90 , $69.03 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $105.28 , $102.55 , $213.85 , $207.74 , $177.00 , $177.00 , $177.00 , $177.00 , $203.67 , $61.95 , $- , $- , $362.99 , $123.90
43762,6010010372,Hospital Chargemaster,Rplc gtube no revj trc,Outpatient,Outpatient Default Percent / Case Rate,450," $1,142.00 ", $336.00 ," $1,236.00 ", $318.13 , $799.40 , $445.38 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 ," $1,133.44 "," $1,104.09 ", $334.03 , $324.49 , $174.00 , $174.00 , $174.00 , $174.00 , $318.13 , $399.70 , $- , $- ," $1,236.00 ", $799.40
99281,6010010001,Hospital Chargemaster,ED Visit Limited/Minor Prob,Outpatient,Outpatient Default Percent / Case Rate,450, $163.00 , $336.00 , $225.57 , $86.72 , $114.10 , $63.57 , $343.52 , $212.51 , $205.25 , $86.72 , $86.72 , $76.05 , $73.74 , $91.05 , $88.45 , $163.00 , $163.00 , $163.00 , $163.00 , $86.72 , $349.16 , $- , $- , $349.16 , $114.10
65205,6010010441,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,450, $271.00 , $336.00 , $223.30 , $134.80 , $189.70 , $105.69 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $129.00 , $129.00 , $129.00 , $129.00 , $134.80 , $94.85 , $- , $- , $336.00 , $189.70
65220,6010010443,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,450, $271.00 , $336.00 , $223.30 , $324.46 , $189.70 , $105.69 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $124.00 , $124.00 , $124.00 , $124.00 , $324.46 , $94.85 , $- , $- , $761.64 , $189.70
46600,6010010386,Hospital Chargemaster,Diagnostic anoscopy spx,Outpatient,Outpatient Default Percent / Case Rate,450, $116.00 , $336.00 ," $1,236.00 ", $134.80 , $81.20 , $45.24 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $116.00 , $116.00 , $116.00 , $116.00 , $134.80 , $40.60 , $- , $- ," $1,236.00 ", $81.20
64447,6010010436,Hospital Chargemaster,N block inj fem single,Outpatient,Outpatient Default Percent / Case Rate,450," $1,032.00 ", $336.00 , $850.37 , $759.14 , $722.40 , $402.48 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $164.53 , $159.53 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $361.20 , $- , $- ," $1,309.97 ", $722.40
51702,6010010399,Hospital Chargemaster,Insert temp bladder cath,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 ," $1,236.00 ", $134.80 , $167.30 , $93.21 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $73.01 , $70.79 , $141.54 , $137.50 , $98.00 , $98.00 , $98.00 , $98.00 , $134.80 , $83.65 , $- , $- ," $1,236.00 ", $167.30
69210,6010010458,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 ," $1,236.00 ", $66.55 , $167.30 , $93.21 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $160.37 , $160.37 , $69.87 , $67.88 , $97.00 , $97.00 , $97.00 , $97.00 , $66.55 , $83.65 , $- , $- ," $1,236.00 ", $167.30
49082,6010010391,Hospital Chargemaster,Abd paracentesis,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,442.00 ", $967.36 , $571.90 , $318.63 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $93.00 , $93.00 , $93.00 , $93.00 , $967.36 , $285.95 , $- , $- ," $1,665.99 ", $571.90
49083,6010010392,Hospital Chargemaster,Abd paracentesis w/imaging,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,442.00 ", $967.36 , $571.90 , $318.63 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $93.00 , $93.00 , $93.00 , $93.00 , $967.36 , $285.95 , $- , $- ," $1,665.99 ", $571.90
51798,6010010404,Hospital Chargemaster,Us urine capacity measure,Outpatient,Outpatient Default Percent / Case Rate,450, $209.00 , $336.00 , $172.22 , $66.55 , $146.30 , $81.51 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $140.24 , $140.24 , $69.87 , $67.88 , $87.77 , $87.77 , $90.03 , $90.03 , $66.55 , $73.15 , $- , $- , $336.00 , $146.30
51701,6010010398,Hospital Chargemaster,Insert bladder catheter,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 ," $1,236.00 ", $134.80 , $167.30 , $93.21 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $66.83 , $64.80 , $141.54 , $137.50 , $88.00 , $88.00 , $88.00 , $88.00 , $134.80 , $83.65 , $- , $- ," $1,236.00 ", $167.30
45005,6010010374,Hospital Chargemaster,Drainage of rectal abscess,Outpatient,Outpatient Default Percent / Case Rate,450, $76.00 , $336.00 ," $1,442.00 "," $1,239.71 ", $53.20 , $29.64 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,133.44 "," $1,104.09 "," $1,301.70 "," $1,264.51 ", $76.00 , $76.00 , $76.00 , $76.00 ," $1,239.71 ", $26.60 , $- , $- ," $2,143.42 ", $53.20
69209,6010010457,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,450, $200.00 , $336.00 ," $1,236.00 ", $66.55 , $140.00 , $78.00 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $134.20 , $134.20 , $69.87 , $67.88 , $25.00 , $25.00 , $25.00 , $25.00 , $66.55 , $70.00 , $- , $- ," $1,236.00 ", $140.00
11732,6010010038,Hospital Chargemaster,Remove nail plate add-on,Outpatient,Outpatient Default Percent / Case Rate,450, $446.00 , $336.00 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $56.49 , $38.77 , $38.57 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
11045,6010010025,Hospital Chargemaster,Deb subq tissue add-on,Outpatient,Outpatient Default Percent / Case Rate,450, $390.00 , $336.00 ," $1,236.00 ", See APC Packaged Rates , $273.00 , $152.10 , $84.75 , $58.17 , $57.86 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $362.70 , $362.70 , $362.70 , $362.70 , See APC Packaged Rates , $136.50 , $- , $- ," $1,236.00 ", $273.00
11046,6010010026,Hospital Chargemaster,Deb musc/fascia add-on,Outpatient,Outpatient Default Percent / Case Rate,450, $715.00 , $336.00 ," $1,236.00 ", See APC Packaged Rates , $500.50 , $278.85 , $179.86 , $123.45 , $122.79 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $664.95 , $664.95 , $664.95 , $664.95 , See APC Packaged Rates , $250.25 , $- , $- ," $1,236.00 ", $500.50
64480,6010010438,Hospital Chargemaster,Inj foramen epidural add-on,Outpatient,Outpatient Default Percent / Case Rate,450, $590.00 , $336.00 ," $1,236.00 ", See APC Packaged Rates , $413.00 , $230.10 , $201.34 , $138.19 , $137.46 , See APC Packaged Rates , See APC Packaged Rates , $198.03 , $192.03 , See APC Packaged Rates , See APC Packaged Rates , $548.70 , $548.70 , $548.70 , $548.70 , See APC Packaged Rates , $206.50 , $- , $- ," $1,236.00 ", $413.00
13102,6010010080,Hospital Chargemaster,Cmplx rpr trunk addl 5cm/<,Outpatient,Outpatient Default Percent / Case Rate,450, $590.00 , $336.00 ," $1,236.00 ", See APC Packaged Rates , $413.00 , $230.10 , $241.38 , $165.67 , $164.79 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $548.70 , $548.70 , $548.70 , $548.70 , See APC Packaged Rates , $206.50 , $- , $- ," $1,236.00 ", $413.00
13122,6010010083,Hospital Chargemaster,Cmplx rpr s/a/l addl 5 cm/>,Outpatient,Outpatient Default Percent / Case Rate,450, $950.00 , $336.00 ," $1,236.00 ", See APC Packaged Rates , $665.00 , $370.50 , $278.51 , $191.16 , $190.14 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $883.50 , $883.50 , $883.50 , $883.50 , See APC Packaged Rates , $332.50 , $- , $- ," $1,236.00 ", $665.00
11047,6010010027,Hospital Chargemaster,Deb bone add-on,Outpatient,Outpatient Default Percent / Case Rate,450," $1,422.00 ", $336.00 ," $1,236.00 ", See APC Packaged Rates , $995.40 , $554.58 , $318.48 , $218.59 , $217.42 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates ," $1,322.46 "," $1,322.46 "," $1,322.46 "," $1,322.46 ", See APC Packaged Rates , $497.70 , $- , $- ," $1,322.46 ", $995.40
13133,6010010086,Hospital Chargemaster,Cmplx rpr f/c/c/m/n/ax/g/h/f,Outpatient,Outpatient Default Percent / Case Rate,450, $817.00 , $336.00 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $425.53 , $292.06 , $290.51 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
64999,6010010440,Hospital Chargemaster,Nervous system surgery,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $312.35 , $- , $- , $- , $- , $314.63 , $312.35 , $312.35 , $- , $- , $327.96 , $318.59 , $- , $- , $- , $- , $312.35 , $- , $- , $- ," $1,236.00 ", $-
13153,6010010089,Hospital Chargemaster,Cmplx rpr e/n/e/l addl 5cm/<,Outpatient,Outpatient Default Percent / Case Rate,450, $590.00 , $336.00 ," $2,060.00 ", See APC Packaged Rates , $413.00 , $230.10 , $458.99 , $315.03 , $313.35 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates , $548.70 , $548.70 , $548.70 , $548.70 , See APC Packaged Rates , $206.50 , $- , $- ," $2,060.00 ", $413.00
36406,6010010322,Hospital Chargemaster,Bl draw <3 yrs other vein,Outpatient,Outpatient Default Percent / Case Rate,450, $47.00 , $336.00 , $38.73 , See APC Packaged Rates , $32.90 , $18.33 , $27.83 , $19.10 , $19.00 , See APC Packaged Rates , See APC Packaged Rates , $21.29 , $20.65 , See APC Packaged Rates , See APC Packaged Rates , $43.71 , $43.71 , $43.71 , $43.71 , See APC Packaged Rates , $16.45 , $- , $- , $336.00 , $32.90
36000,6010010319,Hospital Chargemaster,Place needle in vein,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , See APC Packaged Rates , $167.30 , $93.21 , $30.17 , $20.71 , $20.60 , See APC Packaged Rates , See APC Packaged Rates , $160.37 , $160.37 , See APC Packaged Rates , See APC Packaged Rates , $222.27 , $222.27 , $222.27 , $222.27 , See APC Packaged Rates , $83.65 , $- , $- , $336.00 , $167.30
36410,6010010323,Hospital Chargemaster,Non-routine bl draw 3/> yrs,Outpatient,Outpatient Default Percent / Case Rate,450, $9.65 , $336.00 , $7.95 , See APC Packaged Rates , $6.76 , $3.76 , $30.17 , $20.71 , $20.60 , See APC Packaged Rates , See APC Packaged Rates , $21.29 , $20.65 , See APC Packaged Rates , See APC Packaged Rates , $8.97 , $8.97 , $8.97 , $8.97 , See APC Packaged Rates , $3.38 , $- , $- , $336.00 , $6.76
36400,6010010321,Hospital Chargemaster,Bl draw < 3 yrs fem/jugular,Outpatient,Outpatient Default Percent / Case Rate,450, $239.00 , $336.00 , $196.94 , See APC Packaged Rates , $167.30 , $93.21 , $59.07 , $40.55 , $40.33 , See APC Packaged Rates , See APC Packaged Rates , $44.34 , $43.00 , See APC Packaged Rates , See APC Packaged Rates , $222.27 , $222.27 , $222.27 , $222.27 , See APC Packaged Rates , $83.65 , $- , $- , $336.00 , $167.30
99292,6010010007,Hospital Chargemaster,Critical Care Addl 30 Min,Outpatient,Outpatient Default Percent / Case Rate,450, $345.00 , $336.00 , $284.28 , See APC Packaged Rates , $241.50 , $134.55 , $788.62 , $487.85 , $471.20 , See APC Packaged Rates , See APC Packaged Rates , $250.80 , $243.19 , See APC Packaged Rates , See APC Packaged Rates , $320.85 , $320.85 , $320.85 , $320.85 , See APC Packaged Rates , $138.00 , $- , $- , $788.62 , $241.50
11762,6010010042,Hospital Chargemaster,Reconstruction of nail bed,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 "," $2,047.65 ", $- , $- ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $105.28 , $102.55 ," $2,150.03 "," $2,088.60 ", $- , $- , $- , $- ," $2,047.65 ", $- , $- , $- ," $3,388.54 ", $-
12021,6010010060,Hospital Chargemaster,Closure of split wound,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $413.21 , $- , $- , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $- , $- , $- , $- , $413.21 , $- , $- , $- ," $1,236.00 ", $-
14040,6010010091,Hospital Chargemaster,Tis trnfr f/c/c/m/n/a/g/h/f,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 "," $2,047.65 ", $- , $- ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 "," $1,133.44 "," $1,104.09 "," $2,150.03 "," $2,088.60 ", $- , $- , $- , $- ," $2,047.65 ", $- , $- , $- ," $3,388.54 ", $-
15240,6010010092,Hospital Chargemaster,Skin full grft face/genit/hf,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,060.00 "," $2,047.65 ", $- , $- ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 "," $1,294.72 "," $1,261.20 "," $2,150.03 "," $2,088.60 ", $- , $- , $- , $- ," $2,047.65 ", $- , $- , $- ," $3,388.54 ", $-
15574,6010010093,Hospital Chargemaster,Pedcle fh/ch/ch/m/n/ax/g/h/f,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,060.00 "," $2,047.65 ", $- , $- ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 "," $1,294.72 "," $1,261.20 "," $2,150.03 "," $2,088.60 ", $- , $- , $- , $- ," $2,047.65 ", $- , $- , $- ," $3,388.54 ", $-
17999,6010010100,Hospital Chargemaster,Skin tissue procedure,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $214.68 , $- , $- , $- , $- , $314.63 , $214.68 , $214.68 , $- , $- , $225.42 , $218.98 , $- , $- , $- , $- , $214.68 , $- , $- , $- ," $1,236.00 ", $-
19328,6010010102,Hospital Chargemaster,Removal of breast implant,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 "," $3,775.12 ", $- , $- ," $6,160.38 "," $4,228.21 "," $4,205.67 "," $3,775.12 "," $3,775.12 ", $844.48 , $822.61 ," $3,963.88 "," $3,850.62 ", $- , $- , $- , $- ," $3,775.12 ", $- , $- , $- ," $6,160.38 ", $-
20950,6010010118,Hospital Chargemaster,Fluid pressure muscle,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $743.95 , $- , $- ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $- , $- , $781.15 , $758.83 , $- , $- , $- , $- , $743.95 , $- , $- , $- ," $1,267.38 ", $-
21337,6010010121,Hospital Chargemaster,Closed tx septal&nose fx,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 "," $3,270.58 ", $- , $- ," $4,881.17 "," $3,350.22 "," $3,332.36 "," $3,270.58 "," $3,270.58 "," $1,133.44 "," $1,104.09 "," $3,434.11 "," $3,335.99 ", $- , $- , $- , $- ," $3,270.58 ", $- , $- , $- ," $4,881.17 ", $-
21462,6010010122,Hospital Chargemaster,Treat lower jaw fracture,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,739.80 "," $6,080.31 ", $- , $- ," $9,678.56 "," $6,642.94 "," $6,607.52 "," $6,080.31 "," $6,080.31 "," $1,823.36 "," $1,776.15 "," $6,384.32 "," $6,201.91 ", $- , $- , $- , $- ," $6,080.31 ", $- , $- , $- ," $9,678.56 ", $-
21490,6010010124,Hospital Chargemaster,Repair dislocated jaw,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,060.00 "," $3,270.58 ", $- , $- ," $4,881.17 "," $3,350.22 "," $3,332.36 "," $3,270.58 "," $3,270.58 "," $1,294.72 "," $1,261.20 "," $3,434.11 "," $3,335.99 ", $- , $- , $- , $- ," $3,270.58 ", $- , $- , $- ," $4,881.17 ", $-
23525,6010010128,Hospital Chargemaster,Treat clavicle dislocation,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $246.41 , $- , $- , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 , $- , $- , $- , $- , $246.41 , $- , $- , $- ," $1,236.00 ", $-
24565,6010010150,Hospital Chargemaster,Treat humerus fracture,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 "," $1,665.16 ", $- , $- ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 ", $- , $- , $- , $- ," $1,665.16 ", $- , $- , $- ," $2,873.10 ", $-
24577,6010010152,Hospital Chargemaster,Treat humerus fracture,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 "," $1,665.16 ", $- , $- ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 ", $- , $- , $- , $- ," $1,665.16 ", $- , $- , $- ," $2,873.10 ", $-
24605,6010010154,Hospital Chargemaster,Treat elbow dislocation,Outpatient,Outpatient Default Percent / Case Rate,450," $2,345.00 ", $336.00 ," $1,442.00 "," $1,665.16 "," $1,641.50 ", $914.55 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 "," $2,345.00 "," $2,345.00 "," $2,345.00 "," $2,345.00 "," $1,665.16 ", $820.75 , $- , $- ," $2,873.10 "," $1,641.50 "
25000,6010010161,Hospital Chargemaster,Incision of tendon sheath,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,060.00 "," $1,665.16 ", $- , $- ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,294.72 "," $1,261.20 "," $1,748.42 "," $1,698.46 ", $- , $- , $- , $- ," $1,665.16 ", $- , $- , $- ," $2,873.10 ", $-
25270,6010010163,Hospital Chargemaster,Repair forearm tendon/muscle,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,591.48 "," $3,385.65 ", $- , $- ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,599.36 "," $1,557.95 "," $3,554.93 "," $3,453.36 ", $- , $- , $- , $- ," $3,385.65 ", $- , $- , $- ," $5,738.89 ", $-
25535,6010010167,Hospital Chargemaster,Treat fracture of ulna,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $246.41 , $- , $- , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 , $- , $- , $- , $- , $246.41 , $- , $- , $- ," $1,236.00 ", $-
25660,6010010177,Hospital Chargemaster,Treat wrist dislocation,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $246.41 , $- , $- , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 , $- , $- , $- , $- , $246.41 , $- , $- , $- ," $1,236.00 ", $-
25690,6010010179,Hospital Chargemaster,Treat wrist dislocation,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 "," $1,665.16 ", $- , $- ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 ", $- , $- , $- , $- ," $1,665.16 ", $- , $- , $- ," $2,873.10 ", $-
25999,6010010180,Hospital Chargemaster,Forearm or wrist surgery,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $246.41 , $- , $- , $- , $- , $314.63 , $246.41 , $246.41 , $- , $- , $258.73 , $251.34 , $- , $- , $- , $- , $246.41 , $- , $- , $- ," $1,236.00 ", $-
26011,6010010182,Hospital Chargemaster,Drainage of finger abscess,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 "," $1,682.11 ", $- , $- ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 ", $- , $- , $- , $- ," $1,682.11 ", $- , $- , $- ," $3,009.07 ", $-
26236,6010010184,Hospital Chargemaster,Partial removal finger bone,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,060.00 "," $1,665.16 ", $- , $- ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,294.72 "," $1,261.20 "," $1,748.42 "," $1,698.46 ", $- , $- , $- , $- ," $1,665.16 ", $- , $- , $- ," $2,873.10 ", $-
26432,6010010188,Hospital Chargemaster,Repair finger tendon,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,060.00 "," $1,665.16 ", $- , $- ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,294.72 "," $1,261.20 "," $1,748.42 "," $1,698.46 ", $- , $- , $- , $- ," $1,665.16 ", $- , $- , $- ," $2,873.10 ", $-
26705,6010010195,Hospital Chargemaster,Treat knuckle dislocation,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 "," $1,665.16 ", $- , $- ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 ", $- , $- , $- , $- ," $1,665.16 ", $- , $- , $- ," $2,873.10 ", $-
26785,6010010204,Hospital Chargemaster,Treat finger dislocation,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 "," $3,385.65 ", $- , $- ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,133.44 "," $1,104.09 "," $3,554.93 "," $3,453.36 ", $- , $- , $- , $- ," $3,385.65 ", $- , $- , $- ," $5,738.89 ", $-
26910,6010010205,Hospital Chargemaster,Amputate metacarpal bone,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,060.00 "," $3,385.65 ", $- , $- ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,294.72 "," $1,261.20 "," $3,554.93 "," $3,453.36 ", $- , $- , $- , $- ," $3,385.65 ", $- , $- , $- ," $5,738.89 ", $-
27299,6010010213,Hospital Chargemaster,Pelvis/hip joint surgery,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $246.41 , $- , $- , $- , $- , $314.63 , $246.41 , $246.41 , $- , $- , $258.73 , $251.34 , $- , $- , $- , $- , $246.41 , $- , $- , $- ," $1,236.00 ", $-
27301,6010010214,Hospital Chargemaster,Drain thigh/knee lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,060.00 "," $2,834.62 ", $- , $- ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,294.72 "," $1,261.20 "," $2,976.35 "," $2,891.31 ", $- , $- , $- , $- ," $2,834.62 ", $- , $- , $- ," $5,202.81 ", $-
27510,6010010219,Hospital Chargemaster,Treatment of thigh fracture,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 "," $1,665.16 ", $- , $- ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 ", $- , $- , $- , $- ," $1,665.16 ", $- , $- , $- ," $2,873.10 ", $-
27599,6010010224,Hospital Chargemaster,Leg surgery procedure,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $246.41 , $- , $- , $- , $- , $314.63 , $246.41 , $246.41 , $- , $- , $258.73 , $251.34 , $- , $- , $- , $- , $246.41 , $- , $- , $- ," $1,236.00 ", $-
27768,6010010231,Hospital Chargemaster,Cltx post ankle fx w/mnpj,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 "," $1,665.16 ", $- , $- ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $105.28 , $102.55 ," $1,748.42 "," $1,698.46 ", $- , $- , $- , $- ," $1,665.16 ", $- , $- , $- ," $2,873.10 ", $-
28192,6010010246,Hospital Chargemaster,Removal of foot foreign body,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 "," $1,682.11 ", $- , $- ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $- , $- , $- , $- ," $1,682.11 ", $- , $- , $- ," $3,009.07 ", $-
28435,6010010251,Hospital Chargemaster,Treatment of ankle fracture,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 "," $1,665.16 ", $- , $- ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 ", $- , $- , $- , $- ," $1,665.16 ", $- , $- , $- ," $2,873.10 ", $-
28540,6010010260,Hospital Chargemaster,Treat foot dislocation,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $246.41 , $- , $- , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $- , $- , $- , $- , $246.41 , $- , $- , $- ," $1,236.00 ", $-
30000,6010010290,Hospital Chargemaster,Drainage of nose lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $252.93 , $- , $- , $450.95 , $309.51 , $307.86 , $252.93 , $252.93 , $105.28 , $102.55 , $265.57 , $257.99 , $- , $- , $- , $- , $252.93 , $- , $- , $- ," $1,236.00 ", $-
30906,6010010297,Hospital Chargemaster,Repeat control of nosebleed,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $252.93 , $- , $- , $450.95 , $309.51 , $307.86 , $252.93 , $252.93 , $844.48 , $822.61 , $265.57 , $257.99 , $- , $- , $- , $- , $252.93 , $- , $- , $- ," $1,236.00 ", $-
30999,6010010298,Hospital Chargemaster,Nasal surgery procedure,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $252.93 , $- , $- , $- , $- , $314.63 , $252.93 , $252.93 , $- , $- , $265.57 , $257.99 , $- , $- , $- , $- , $252.93 , $- , $- , $- ," $1,236.00 ", $-
31505,6010010302,Hospital Chargemaster,Diagnostic laryngoscopy,Outpatient,Outpatient Default Percent / Case Rate,450, $235.00 , $336.00 , $193.64 , $196.80 , $164.50 , $91.65 , $358.71 , $246.20 , $244.89 , $196.80 , $196.80 , $105.28 , $102.55 , $206.64 , $200.73 , $235.00 , $235.00 , $235.00 , $235.00 , $196.80 , $82.25 , $- , $- , $358.71 , $164.50
31530,6010010304,Hospital Chargemaster,Laryngoscopy w/fb removal,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 "," $1,788.65 ", $- , $- ," $2,995.49 "," $2,055.97 "," $2,045.01 "," $1,788.65 "," $1,788.65 "," $1,133.44 "," $1,104.09 "," $1,878.08 "," $1,824.42 ", $- , $- , $- , $- ," $1,788.65 ", $- , $- , $- ," $2,995.49 ", $-
32556,6010010311,Hospital Chargemaster,Insert cath pleura w/o image,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 "," $1,941.77 ", $- , $- ," $3,245.02 "," $2,227.24 "," $2,215.37 "," $1,941.77 "," $1,941.77 ", $105.28 , $102.55 ," $2,038.86 "," $1,980.61 ", $- , $- , $- , $- ," $1,941.77 ", $- , $- , $- ," $3,245.02 ", $-
33010,6010010312,Hospital Chargemaster,Drainage of heart sac,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,542.04 ", See APC Packaged Rates , $- , $- , $- , $- , $314.63 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , Not Applicable , $- ," $2,542.04 ", $-
33011,6010010313,Hospital Chargemaster,Repeat drainage of heart sac,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,542.04 ", See APC Packaged Rates , $- , $- , $- , $- , $314.63 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , Not Applicable , $- ," $2,542.04 ", $-
33216,6010010315,Hospital Chargemaster,Insert 1 electrode pm-defib,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,591.48 "," $9,753.71 ", $- , $- ," $16,197.41 "," $11,117.20 "," $11,057.93 "," $9,753.71 "," $9,753.71 ", $844.48 , $822.61 ," $10,241.39 "," $9,948.78 ", $- , $- , $- , $- ," $9,753.71 ", $- , $- , $- ," $16,197.41 ", $-
33274,6010010316,Hospital Chargemaster,Tcat insj/rpl perm ldls pm,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,591.48 "," $19,200.22 ", $- , $- ," $33,418.83 "," $22,937.23 "," $22,814.94 "," $19,200.22 "," $19,200.22 "," $1,294.72 "," $1,261.20 "," $20,160.23 "," $19,584.22 ", $- , $- , $- , $- ," $19,200.22 ", $- , $- , $- ," $33,418.83 ", $-
35206,6010010317,Hospital Chargemaster,Repair blood vessel lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,591.48 "," $3,422.34 ", $- , $- ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,133.44 "," $1,104.09 "," $3,593.46 "," $3,490.79 ", $- , $- , $- , $- ," $3,422.34 ", $- , $- , $- ," $5,778.66 ", $-
35226,6010010318,Hospital Chargemaster,Repair blood vessel lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,591.48 ", $743.95 , $- , $- ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 ," $1,294.72 "," $1,261.20 ", $781.15 , $758.83 , $- , $- , $- , $- , $743.95 , $- , $- , $- ," $2,591.48 ", $-
36140,6010010320,Hospital Chargemaster,Intro ndl icath upr/lxtr art,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", See APC Packaged Rates , $- , $- , $290.58 , $199.44 , $198.38 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- ," $1,236.00 ", $-
36620,6010010335,Hospital Chargemaster,Insertion catheter artery,Outpatient,Outpatient Default Percent / Case Rate,450, $50.00 , $336.00 ," $1,236.00 ", See APC Packaged Rates , $35.00 , $19.50 , $141.01 , $96.78 , $96.27 , See APC Packaged Rates , See APC Packaged Rates , $129.47 , $125.54 , See APC Packaged Rates , See APC Packaged Rates , $46.50 , $46.50 , $46.50 , $46.50 , See APC Packaged Rates , $17.50 , $- , $- ," $1,236.00 ", $35.00
37618,6010010339,Hospital Chargemaster,Ligation of extremity artery,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 , $- , See APC Packaged Rates , $- , $- ," $1,256.55 ", $862.44 , $857.85 , See APC Packaged Rates , See APC Packaged Rates ," $1,133.44 "," $1,104.09 ", See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- ," $1,256.55 ", $-
37799,6010010341,Hospital Chargemaster,Vascular surgery procedure,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 ", $646.21 , $- , $- , $- , $- , $314.63 , $646.21 , $646.21 , $- , $- , $678.52 , $659.13 , $- , $- , $- , $- , $646.21 , $- , $- , $- ," $1,442.00 ", $-
40799,6010010343,Hospital Chargemaster,Lip surgery procedure,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 , $- , $252.93 , $- , $- , $- , $- , $314.63 , $252.93 , $252.93 , $- , $- , $265.57 , $257.99 , $- , $- , $- , $- , $252.93 , $- , $- , $- , $336.00 , $-
40801,6010010345,Hospital Chargemaster,Drainage of mouth lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 ", $540.69 , $- , $- ," $1,065.66 ", $731.42 , $727.52 , $540.69 , $540.69 ," $1,133.44 "," $1,104.09 ", $567.73 , $551.50 , $- , $- , $- , $- , $540.69 , $- , $- , $- ," $1,442.00 ", $-
40804,6010010346,Hospital Chargemaster,Removal foreign body mouth,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 , $- , $967.36 , $- , $- ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $105.28 , $102.55 ," $1,015.72 ", $986.70 , $- , $- , $- , $- , $967.36 , $- , $- , $- ," $1,665.99 ", $-
40831,6010010348,Hospital Chargemaster,Repair mouth laceration,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $540.69 , $- , $- ," $1,065.66 ", $731.42 , $727.52 , $540.69 , $540.69 , $844.48 , $822.61 , $567.73 , $551.50 , $- , $- , $- , $- , $540.69 , $- , $- , $- ," $1,236.00 ", $-
41000,6010010349,Hospital Chargemaster,Drainage of mouth lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $540.69 , $- , $- ," $1,065.66 ", $731.42 , $727.52 , $540.69 , $540.69 , $844.48 , $822.61 , $567.73 , $551.50 , $- , $- , $- , $- , $540.69 , $- , $- , $- ," $1,236.00 ", $-
41251,6010010351,Hospital Chargemaster,Repair tongue laceration,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 ", $252.93 , $- , $- , $450.95 , $309.51 , $307.86 , $252.93 , $252.93 ," $1,133.44 "," $1,104.09 ", $265.57 , $257.99 , $- , $- , $- , $- , $252.93 , $- , $- , $- ," $1,442.00 ", $-
41899,6010010355,Hospital Chargemaster,Dental surgery procedure,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $252.93 , $- , $- , $- , $- , $314.63 , $252.93 , $252.93 , $- , $- , $265.57 , $257.99 , $- , $- , $- , $- , $252.93 , $- , $- , $- ," $1,236.00 ", $-
42180,6010010357,Hospital Chargemaster,Repair palate,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $540.69 , $- , $- ," $1,065.66 ", $731.42 , $727.52 , $540.69 , $540.69 , $844.48 , $822.61 , $567.73 , $551.50 , $- , $- , $- , $- , $540.69 , $- , $- , $- ," $1,236.00 ", $-
42699,6010010358,Hospital Chargemaster,Salivary surgery procedure,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $252.93 , $- , $- , $- , $- , $314.63 , $252.93 , $252.93 , $- , $- , $265.57 , $257.99 , $- , $- , $- , $- , $252.93 , $- , $- , $- ," $1,236.00 ", $-
42960,6010010361,Hospital Chargemaster,Control throat bleeding,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $540.69 , $- , $- ," $1,065.66 ", $731.42 , $727.52 , $540.69 , $540.69 , $844.48 , $822.61 , $567.73 , $551.50 , $- , $- , $- , $- , $540.69 , $- , $- , $- ," $1,236.00 ", $-
42999,6010010362,Hospital Chargemaster,Throat surgery procedure,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $252.93 , $- , $- , $- , $- , $314.63 , $252.93 , $252.93 , $- , $- , $265.57 , $257.99 , $- , $- , $- , $- , $252.93 , $- , $- , $- ," $1,236.00 ", $-
43220,6010010366,Hospital Chargemaster,Esophagoscopy balloon <30mm,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 "," $1,941.77 ", $- , $- ," $3,245.02 "," $2,227.24 "," $2,215.37 "," $1,941.77 "," $1,941.77 ", $844.48 , $822.61 ," $2,038.86 "," $1,980.61 ", $- , $- , $- , $- ," $1,941.77 ", $- , $- , $- ," $3,245.02 ", $-
44799,6010010373,Hospital Chargemaster,Unlisted px small intestine,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $967.36 , $- , $- , $- , $- , $314.63 , $967.36 , $967.36 , $- , $- ," $1,015.72 ", $986.70 , $- , $- , $- , $- , $967.36 , $- , $- , $- ," $1,236.00 ", $-
45900,6010010377,Hospital Chargemaster,Reduction of rectal prolapse,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $948.73 , $- , $- ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $844.48 , $822.61 , $996.17 , $967.71 , $- , $- , $- , $- , $948.73 , $- , $- , $- ," $1,629.53 ", $-
46500,6010010385,Hospital Chargemaster,Injection into hemorrhoid(s),Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 , $- , $948.73 , $- , $- ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $105.28 , $102.55 , $996.17 , $967.71 , $- , $- , $- , $- , $948.73 , $- , $- , $- ," $1,629.53 ", $-
46999,6010010390,Hospital Chargemaster,Anus surgery procedure,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $948.73 , $- , $- , $- , $- , $314.63 , $948.73 , $948.73 , $- , $- , $996.17 , $967.71 , $- , $- , $- , $- , $948.73 , $- , $- , $- ," $1,236.00 ", $-
51102,6010010396,Hospital Chargemaster,Drain bl w/cath insertion,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 "," $2,140.58 ", $- , $- ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $105.28 , $102.55 ," $2,247.61 "," $2,183.39 ", $- , $- , $- , $- ," $2,140.58 ", $- , $- , $- ," $3,805.91 ", $-
51710,6010010402,Hospital Chargemaster,Change of bladder tube,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $687.79 , $- , $- ," $1,229.98 ", $844.21 , $839.71 , $687.79 , $687.79 , $844.48 , $822.61 , $722.18 , $701.54 , $- , $- , $- , $- , $687.79 , $- , $- , $- ," $1,236.00 ", $-
52281,6010010405,Hospital Chargemaster,Cystoscopy and treatment,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 "," $2,140.58 ", $- , $- ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 "," $1,133.44 "," $1,104.09 "," $2,247.61 "," $2,183.39 ", $- , $- , $- , $- ," $2,140.58 ", $- , $- , $- ," $3,805.91 ", $-
55899,6010010414,Hospital Chargemaster,Genital surgery procedure,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 ", $318.13 , $- , $- , $- , $- , $314.63 , $318.13 , $318.13 , $- , $- , $334.03 , $324.49 , $- , $- , $- , $- , $318.13 , $- , $- , $- ," $1,442.00 ", $-
57180,6010010418,Hospital Chargemaster,Treat vaginal bleeding,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 , $- , $203.67 , $- , $- , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $844.48 , $822.61 , $213.85 , $207.74 , $- , $- , $- , $- , $203.67 , $- , $- , $- , $844.48 , $-
57200,6010010419,Hospital Chargemaster,Repair of vagina,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 "," $3,136.64 ", $- , $- ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 ", $844.48 , $822.61 ," $3,293.47 "," $3,199.37 ", $- , $- , $- , $- ," $3,136.64 ", $- , $- , $- ," $5,165.58 ", $-
57415,6010010420,Hospital Chargemaster,Remove vaginal foreign body,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,442.00 "," $3,136.64 ", $- , $- ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 ", $105.28 , $102.55 ," $3,293.47 "," $3,199.37 ", $- , $- , $- , $- ," $3,136.64 ", $- , $- , $- ," $5,165.58 ", $-
58999,6010010424,Hospital Chargemaster,Genital surgery procedure,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $203.67 , $- , $- , $- , $- , $314.63 , $203.67 , $203.67 , $- , $- , $213.85 , $207.74 , $- , $- , $- , $- , $203.67 , $- , $- , $- ," $1,236.00 ", $-
59812,6010010426,Hospital Chargemaster,Treatment of miscarriage,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $2,739.80 "," $3,136.64 ", $- , $- ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 "," $1,133.44 "," $1,104.09 "," $3,293.47 "," $3,199.37 ", $- , $- , $- , $- ," $3,136.64 ", $- , $- , $- ," $5,165.58 ", $-
62272,6010010428,Hospital Chargemaster,Drain cerebro spinal fluid,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $759.14 , $- , $- ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $844.48 , $822.61 , $797.10 , $774.33 , $- , $- , $- , $- , $759.14 , $- , $- , $- ," $1,309.97 ", $-
67715,6010010447,Hospital Chargemaster,Incision of eyelid fold,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 "," $2,392.31 ", $- , $- ," $3,965.46 "," $2,721.72 "," $2,707.21 "," $2,392.31 "," $2,392.31 ", $844.48 , $822.61 ," $2,511.93 "," $2,440.16 ", $- , $- , $- , $- ," $2,392.31 ", $- , $- , $- ," $3,965.46 ", $-
69005,6010010451,Hospital Chargemaster,Drain external ear lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 "," $1,682.11 ", $- , $- ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $- , $- ," $1,766.22 "," $1,715.75 ", $- , $- , $- , $- ," $1,682.11 ", $- , $- , $- ," $3,009.07 ", $-
69020,6010010452,Hospital Chargemaster,Drain outer ear canal lesion,Outpatient,Outpatient Default Percent / Case Rate,450, $- , $336.00 ," $1,236.00 ", $743.95 , $- , $- ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $- , $- , $- , $- , $743.95 , $- , $- , $- ," $1,267.38 ", $-
G0168,6010010462,Hospital Chargemaster,Wound Closure by Adhesive,Outpatient,Outpatient Default Percent / Case Rate,450, $86.00 , $336.00 , $70.86 , See APC Packaged Rates , $60.20 , $33.54 , $82.98 , $83.34 , $314.63 , See APC Packaged Rates , See APC Packaged Rates , $57.71 , $57.71 , See APC Packaged Rates , See APC Packaged Rates , $79.98 , $79.98 , $79.98 , $79.98 , See APC Packaged Rates , $30.10 , $- , $- , $336.00 , $60.20
92950,6010010463,Hospital Chargemaster,Heart/Lung Resuscitation CPR,Outpatient,Outpatient Default Percent / Case Rate,450, $531.00 , $336.00 , $437.54 , $316.40 , $371.70 , $207.09 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $684.45 , $663.68 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $185.85 , $- , $- , $684.45 , $371.70
92960,6010010464,Hospital Chargemaster,Cardioversion-ER,Outpatient,Outpatient Default Percent / Case Rate,450," $1,120.00 ", $336.00 , $922.88 , $671.60 , $784.00 , $436.80 ," $1,292.64 "," $1,010.27 "," $1,106.60 ", $671.60 , $671.60 , $323.29 , $313.49 , $705.18 , $685.03 , $867.68 , $867.68 , $890.03 , $890.03 , $671.60 , $392.00 , $- , $- ," $1,292.64 ", $784.00
23620,6010010465,Hospital Chargemaster,Treat Humerus Fracture,Outpatient,Outpatient Default Percent / Case Rate,450, $368.00 , $336.00 ," $1,236.00 ", $246.41 , $257.60 , $143.52 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 , $368.00 , $368.00 , $368.00 , $368.00 , $246.41 , $128.80 , $- , $- ," $1,236.00 ", $257.60
25630,6010010466,Hospital Chargemaster,Treat Wrist Bone Fracture,Outpatient,Outpatient Default Percent / Case Rate,450, $435.00 , $336.00 ," $1,236.00 ", $246.41 , $304.50 , $169.65 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $152.25 , $- , $- ," $1,236.00 ", $304.50
27246,6010010467,Hospital Chargemaster,Treat Thigh Fracture,Outpatient,Outpatient Default Percent / Case Rate,450, $365.00 , $336.00 ," $1,236.00 ", $246.41 , $255.50 , $142.35 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 , $365.00 , $365.00 , $365.00 , $365.00 , $246.41 , $127.75 , $- , $- ," $1,236.00 ", $255.50
27520,6010010468,Hospital Chargemaster,Treat Kneecap Fracture,Outpatient,Outpatient Default Percent / Case Rate,450, $459.00 , $336.00 ," $1,236.00 ", $246.41 , $321.30 , $179.01 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 , $459.00 , $459.00 , $459.00 , $459.00 , $246.41 , $160.65 , $- , $- ," $1,236.00 ", $321.30
27842,6010010469,Hospital Chargemaster,Treat Ankle Dislocation,Outpatient,Outpatient Default Percent / Case Rate,450," $2,384.00 ", $336.00 ," $1,236.00 "," $1,665.16 "," $1,668.80 ", $929.76 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $834.40 , $- , $- ," $2,873.10 "," $1,668.80 "
27767,6010010470,Hospital Chargemaster,Cltx post ankle fx,Outpatient,Outpatient Default Percent / Case Rate,450, $645.00 , $336.00 ," $1,236.00 ", $246.41 , $451.50 , $251.55 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $225.75 , $- , $- ," $1,236.00 ", $451.50
,6010090001,Hospital Chargemaster,Direct Admit,Outpatient,Outpatient Default Percent / Case Rate,450, $0.01 , $336.00 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $0.01 , $0.01 , $314.63 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 ," $1,632.00 ", $0.00 ," $1,632.00 ", $0.01
,6010090002,Hospital Chargemaster,Left Before Triage,Outpatient,Outpatient Default Percent / Case Rate,450, $0.01 , $336.00 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $0.01 , $0.01 , $314.63 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 ," $1,632.00 ", $0.00 ," $1,632.00 ", $0.01
,6010090003,Hospital Chargemaster,Triage Only,Outpatient,Outpatient Default Percent / Case Rate,450, $0.01 , $336.00 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $0.01 , $0.01 , $314.63 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 ," $1,632.00 ", $0.00 ," $1,632.00 ", $0.01
,6010090004,Hospital Chargemaster,PVT MD/Not Seen by ED MD,Outpatient,Outpatient Default Percent / Case Rate,450, $0.01 , $336.00 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $0.01 , $0.01 , $314.63 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 ," $1,632.00 ", $0.00 ," $1,632.00 ", $0.01
,6010090005,Hospital Chargemaster,Same Day Visit,Outpatient,Outpatient Default Percent / Case Rate,450, $0.01 , $336.00 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $0.01 , $0.01 , $314.63 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 ," $1,632.00 ", $0.00 ," $1,632.00 ", $0.01
,6010090006,Hospital Chargemaster,Suture Removal,Outpatient,Outpatient Default Percent / Case Rate,450, $0.01 , $336.00 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $0.01 , $0.01 , $314.63 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 ," $1,632.00 ", $0.00 ," $1,632.00 ", $0.01
,6010090007,Hospital Chargemaster,Wound Check,Outpatient,Outpatient Default Percent / Case Rate,450, $0.01 , $336.00 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $0.01 , $0.01 , $314.63 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 ," $1,632.00 ", $0.00 ," $1,632.00 ", $0.01
,6010090008,Hospital Chargemaster,IV Therapy Only,Outpatient,Outpatient Default Percent / Case Rate,450, $0.01 , $336.00 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $0.01 , $0.01 , $314.63 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 ," $1,632.00 ", $0.00 ," $1,632.00 ", $0.01
94060,5310010010,Hospital Chargemaster,Evaluation Of Wheezing,Outpatient,Outpatient Default Percent / Case Rate,460, $567.00 , $311.85 , $467.21 , $316.40 , $396.90 , $221.13 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $197.73 , $191.73 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $198.45 , $- , $- , $619.47 , $396.90
94070,5310010011,Hospital Chargemaster,Evaluation Of Wheezing,Outpatient,Outpatient Default Percent / Case Rate,460, $567.00 , $311.85 , $467.21 , $316.40 , $396.90 , $221.13 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $292.03 , $283.17 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $198.45 , $- , $- , $619.47 , $396.90
94621,5310010023,Hospital Chargemaster,Cardiopulm Exercise Testing,Outpatient,Outpatient Default Percent / Case Rate,460, $517.00 , $284.35 , $426.01 , $316.40 , $361.90 , $201.63 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $197.73 , $191.73 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $180.95 , $- , $- , $619.47 , $361.90
94726,5310010037,Hospital Chargemaster,Pulm Funct Tst Plethysmograp,Outpatient,Outpatient Default Percent / Case Rate,460, $349.00 , $191.95 , $287.58 , $316.40 , $244.30 , $136.11 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $107.92 , $104.65 , $332.22 , $322.72 , $349.00 , $349.00 , $349.00 , $349.00 , $316.40 , $122.15 , $- , $- , $619.47 , $244.30
94762,5310010044,Hospital Chargemaster,Measure Blood Oxygen Level,Outpatient,Outpatient Default Percent / Case Rate,460, $303.00 , $166.65 , $249.67 , $166.91 , $212.10 , $118.17 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $146.02 , $141.59 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $106.05 , $- , $- , $333.79 , $212.10
94799,5310010045,Hospital Chargemaster,Pulmonary Service/Procedure,Outpatient,Outpatient Default Percent / Case Rate,460, $190.00 , $104.50 , $156.56 , $166.91 , $133.00 , $74.10 , $183.33 , $184.13 , $97.85 , $166.91 , $166.91 , $- , $- , $175.26 , $170.25 , $190.00 , $190.00 , $190.00 , $190.00 , $166.91 , $66.50 , $- , $- , $190.00 , $133.00
94010,5310010003,Hospital Chargemaster,Breathing Capacity Test,Outpatient,Outpatient Default Percent / Case Rate,460, $214.00 , $117.70 , $176.34 , $166.91 , $149.80 , $83.46 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $106.47 , $103.24 , $175.26 , $170.25 , $214.00 , $214.00 , $214.00 , $214.00 , $166.91 , $74.90 , $- , $- , $333.79 , $149.80
94727,5310010038,Hospital Chargemaster,Pulm Function Test By Gas,Outpatient,Outpatient Default Percent / Case Rate,460, $205.00 , $112.75 , $168.92 , $166.91 , $143.50 , $79.95 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $77.95 , $75.58 , $175.26 , $170.25 , $205.00 , $205.00 , $205.00 , $205.00 , $166.91 , $71.75 , $- , $- , $333.79 , $143.50
94618,5310010022,Hospital Chargemaster,Pulmonary Stress Testing,Outpatient,Outpatient Default Percent / Case Rate,460, $493.00 , $271.15 , $406.23 , $134.80 , $345.10 , $192.27 , $261.44 , $204.33 , $223.81 , $134.80 , $134.80 , $30.19 , $29.27 , $141.54 , $137.50 , $172.35 , $172.35 , $176.79 , $176.79 , $134.80 , $172.55 , $- , $- , $406.23 , $345.10
94200,5310010013,Hospital Chargemaster,Lung Function Test (Mbc/Mvv),Outpatient,Outpatient Default Percent / Case Rate,460, $128.00 , $70.40 , $105.47 , $66.55 , $89.60 , $49.92 , $261.44 , $204.33 , $223.81 , $66.55 , $66.55 , $60.84 , $58.99 , $69.87 , $67.88 , $112.83 , $112.83 , $115.74 , $115.74 , $66.55 , $44.80 , $- , $- , $261.44 , $89.60
94760,5310010042,Hospital Chargemaster,Measure Blood Oxygen Level,Outpatient,Outpatient Default Percent / Case Rate,460, $70.00 , $38.50 , $57.68 , See APC Packaged Rates , $49.00 , $27.30 , $9.51 , $7.43 , $8.14 , See APC Packaged Rates , See APC Packaged Rates , $33.46 , $32.45 , See APC Packaged Rates , See APC Packaged Rates , $65.10 , $65.10 , $65.10 , $65.10 , See APC Packaged Rates , $24.50 , $- , $- , $65.10 , $49.00
94761,5310010043,Hospital Chargemaster,Measure Blood Oxygen Level,Outpatient,Outpatient Default Percent / Case Rate,460, $0.75 , $0.41 , $0.62 , See APC Packaged Rates , $0.53 , $0.29 , $16.40 , $12.82 , $14.04 , See APC Packaged Rates , See APC Packaged Rates , $85.18 , $82.59 , See APC Packaged Rates , See APC Packaged Rates , $0.70 , $0.70 , $0.70 , $0.70 , See APC Packaged Rates , $0.26 , $- , $- , $85.18 , $0.53
94729,5310010040,Hospital Chargemaster,Co/Membane Diffuse Capacity,Outpatient,Outpatient Default Percent / Case Rate,460, $180.00 , $99.00 , $148.32 , See APC Packaged Rates , $126.00 , $70.20 , $179.06 , $139.95 , $153.29 , See APC Packaged Rates , See APC Packaged Rates , $117.89 , $114.31 , See APC Packaged Rates , See APC Packaged Rates , $167.40 , $167.40 , $167.40 , $167.40 , See APC Packaged Rates , $63.00 , $- , $- , $179.06 , $126.00
94760,5000010025,Hospital Chargemaster,Pulse Oximetry,Outpatient,Outpatient Default Percent / Case Rate,460, $70.00 , $38.50 , $57.68 , See APC Packaged Rates , $49.00 , $27.30 , $9.51 , $7.43 , $8.14 , See APC Packaged Rates , See APC Packaged Rates , $33.46 , $32.45 , See APC Packaged Rates , See APC Packaged Rates , $65.10 , $65.10 , $65.10 , $65.10 , See APC Packaged Rates , $24.50 , $- , $- , $65.10 , $49.00
94761,65302466,Hospital Chargemaster,Measure Blood Oxygen Level,Outpatient,Outpatient Default Percent / Case Rate,460, $200.00 , $110.00 , $164.80 , See APC Packaged Rates , $140.00 , $78.00 , $16.40 , $12.82 , $14.04 , See APC Packaged Rates , See APC Packaged Rates , $85.18 , $82.59 , See APC Packaged Rates , See APC Packaged Rates , $186.00 , $186.00 , $186.00 , $186.00 , See APC Packaged Rates , $70.00 , $- , $- , $186.00 , $140.00
92557,5430010009,Hospital Chargemaster,Comprehensive hearing test,Outpatient,Outpatient Default Percent / Case Rate,470, $577.00 , $317.35 , $475.45 , $166.91 , $403.90 , $225.03 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $419.80 , $407.06 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $201.95 , $- , $- , $475.45 , $403.90
92587,5430010020,Hospital Chargemaster,Evoked auditory test limited,Outpatient,Outpatient Default Percent / Case Rate,470, $197.00 , $108.35 , $162.33 , $316.40 , $137.90 , $76.83 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $- , $- , $332.22 , $322.72 , $197.00 , $197.00 , $197.00 , $197.00 , $316.40 , $68.95 , $- , $- , $619.47 , $137.90
92588,5430010021,Hospital Chargemaster,Evoked auditory tst complete,Outpatient,Outpatient Default Percent / Case Rate,470, $197.00 , $108.35 , $162.33 , $316.40 , $137.90 , $76.83 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $- , $- , $332.22 , $322.72 , $197.00 , $197.00 , $197.00 , $197.00 , $316.40 , $68.95 , $- , $- , $619.47 , $137.90
92567,5430010012,Hospital Chargemaster,Tympanometry,Outpatient,Outpatient Default Percent / Case Rate,470, $112.00 , $61.60 , $92.29 , $40.47 , $78.40 , $43.68 , $78.86 , $61.63 , $67.51 , $40.47 , $40.47 , $81.81 , $79.32 , $42.49 , $41.28 , $52.40 , $52.40 , $53.75 , $53.75 , $40.47 , $39.20 , $- , $- , $92.29 , $78.40
92630,5430010030,Hospital Chargemaster,Aud rehab pre-ling hear loss,Outpatient,Outpatient Default Percent / Case Rate,470, $130.00 , $71.50 , $107.12 , See APC Packaged Rates , $91.00 , $50.70 , $125.44 , $125.98 , $66.95 , See APC Packaged Rates , See APC Packaged Rates , $87.23 , $87.23 , See APC Packaged Rates , See APC Packaged Rates , $120.90 , $120.90 , $120.90 , $120.90 , See APC Packaged Rates , $45.50 , $- , $- , $125.98 , $91.00
92586,5000010013,Hospital Chargemaster,Newborn Hearing Screen,Outpatient,Outpatient Default Percent / Case Rate,470, $197.00 , $108.35 , $162.33 , See APC Packaged Rates , $137.90 , $76.83 , $333.79 , $260.88 , $285.75 , See APC Packaged Rates , See APC Packaged Rates , $132.19 , $132.19 , See APC Packaged Rates , See APC Packaged Rates , $197.00 , $197.00 , $197.00 , $197.00 , See APC Packaged Rates , $68.95 , Not Applicable , $68.95 , $333.79 , $137.90
92572,5430010015,Hospital Chargemaster,Staggered spondaic word test,Outpatient,Outpatient Default Percent / Case Rate,470, $215.00 , $118.25 , $177.16 , $166.91 , $150.50 , $83.85 , $674.58 , $428.79 , $421.01 , $166.91 , $166.91 , $- , $- , $175.26 , $170.25 , $215.00 , $215.00 , $215.00 , $215.00 , $166.91 , $75.25 , $- , $- , $674.58 , $150.50
92579,5430010017,Hospital Chargemaster,Visual audiometry (vra),Outpatient,Outpatient Default Percent / Case Rate,470, $179.00 , $98.45 , $147.50 , $166.91 , $125.30 , $69.81 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $- , $- , $175.26 , $170.25 , $179.00 , $179.00 , $179.00 , $179.00 , $166.91 , $62.65 , $- , $- , $333.79 , $125.30
92583,5430010019,Hospital Chargemaster,Select picture audiometry,Outpatient,Outpatient Default Percent / Case Rate,470, $52.00 , $28.60 , $42.85 , $66.55 , $36.40 , $20.28 , $78.86 , $61.63 , $67.51 , $66.55 , $66.55 , $- , $- , $69.87 , $67.88 , $52.00 , $52.00 , $52.00 , $52.00 , $66.55 , $18.20 , $- , $- , $78.86 , $36.40
92592,5430110001,Hospital Chargemaster,Hearing Aid Check - Monaural,Outpatient,Outpatient Default Percent / Case Rate,470, $20.00 , $11.00 , $16.48 , See APC Packaged Rates , $14.00 , $7.80 , $72.96 , $57.02 , $62.46 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $20.00 , $20.00 , $20.00 , $20.00 , See APC Packaged Rates , $7.00 , $- , $- , $72.96 , $14.00
92593,5430110002,Hospital Chargemaster,Hearing Aid Check - Binaural,Outpatient,Outpatient Default Percent / Case Rate,470, $30.00 , $16.50 , $24.72 , See APC Packaged Rates , $21.00 , $11.70 , $120.08 , $93.85 , $102.80 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $30.00 , $30.00 , $30.00 , $30.00 , See APC Packaged Rates , $10.50 , $- , $- , $120.08 , $21.00
92590,5430010022,Hospital Chargemaster,Hearing aid exam one ear,Outpatient,Outpatient Default Percent / Case Rate,471, $150.00 , $82.50 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 , $182.43 , $142.58 , $156.17 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $47.08 , $47.08 , $48.30 , $48.30 , See APC Packaged Rates , $52.50 , $- , $- , $182.43 , $105.00
92551,5430010004,Hospital Chargemaster,Pure tone hearing test air,Outpatient,Outpatient Default Percent / Case Rate,471, $60.00 , $33.00 , $49.44 , See APC Packaged Rates , $42.00 , $23.40 , $45.34 , $35.44 , $38.82 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $14.12 , $14.12 , $14.49 , $14.49 , See APC Packaged Rates , $21.00 , $- , $- , $49.44 , $42.00
92621,5430010027,Hospital Chargemaster,Auditory function + 15 min,Outpatient,Outpatient Default Percent / Case Rate,471, $50.00 , $27.50 , $41.20 , See APC Packaged Rates , $35.00 , $19.50 , $68.32 , $53.39 , $58.49 , See APC Packaged Rates , See APC Packaged Rates , $30.56 , $29.63 , See APC Packaged Rates , See APC Packaged Rates , $46.50 , $46.50 , $46.50 , $46.50 , See APC Packaged Rates , $17.50 , $- , $- , $68.32 , $35.00
92587,5000010017,Hospital Chargemaster,Screening OAE (Infant),Outpatient,Outpatient Default Percent / Case Rate,471, $197.00 , $108.35 , $162.33 , $316.40 , $137.90 , $76.83 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $- , $- , $332.22 , $322.72 , $197.00 , $197.00 , $197.00 , $197.00 , $316.40 , $68.95 , $- , $- , $619.47 , $137.90
92568,5430010001,Hospital Chargemaster,Acoustic refl threshold tst,Outpatient,Outpatient Default Percent / Case Rate,471, $76.00 , $41.80 , $62.62 , $40.47 , $53.20 , $29.64 , $78.86 , $61.63 , $67.51 , $40.47 , $40.47 , $- , $- , $42.49 , $41.28 , $51.92 , $51.92 , $53.26 , $53.26 , $40.47 , $26.60 , $- , $- , $78.86 , $53.20
92585,5430010002,Hospital Chargemaster,Auditor evoke potent compre,Outpatient,Outpatient Default Percent / Case Rate,471, $147.00 , $80.85 , $121.13 , See APC Packaged Rates , $102.90 , $57.33 , $619.47 , $484.15 , $530.32 , See APC Packaged Rates , See APC Packaged Rates , $98.64 , $98.64 , See APC Packaged Rates , See APC Packaged Rates , $147.00 , $147.00 , $147.00 , $147.00 , See APC Packaged Rates , $51.45 , Not Applicable , $51.45 , $619.47 , $102.90
92552,5430010005,Hospital Chargemaster,Pure tone audiometry air,Outpatient,Outpatient Default Percent / Case Rate,471, $101.00 , $55.55 , $83.22 , $134.80 , $70.70 , $39.39 , $261.44 , $204.33 , $223.81 , $134.80 , $134.80 , $- , $- , $141.54 , $137.50 , $101.00 , $101.00 , $101.00 , $101.00 , $134.80 , $35.35 , $- , $- , $261.44 , $70.70
92555,5430010007,Hospital Chargemaster,Speech threshold audiometry,Outpatient,Outpatient Default Percent / Case Rate,471, $61.00 , $33.55 , $50.26 , $40.47 , $42.70 , $23.79 , $159.37 , $101.30 , $99.46 , $40.47 , $40.47 , $- , $- , $42.49 , $41.28 , $52.40 , $52.40 , $53.75 , $53.75 , $40.47 , $21.35 , $- , $- , $159.37 , $42.70
92556,5430010008,Hospital Chargemaster,Speech audiometry complete,Outpatient,Outpatient Default Percent / Case Rate,471, $82.00 , $45.10 , $67.57 , $66.55 , $57.40 , $31.98 , $159.37 , $101.30 , $99.46 , $66.55 , $66.55 , $- , $- , $69.87 , $67.88 , $61.60 , $61.60 , $63.18 , $63.18 , $66.55 , $28.70 , $- , $- , $159.37 , $57.40
92582,5430010018,Hospital Chargemaster,Conditioning play audiometry,Outpatient,Outpatient Default Percent / Case Rate,471, $270.00 , $148.50 , $222.48 , $166.91 , $189.00 , $105.30 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $- , $- , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $94.50 , $- , $- , $333.79 , $189.00
V5014,5430110004,Hospital Chargemaster,Hearing Aid Repair,Outpatient,Outpatient Default Percent / Case Rate,471, $233.00 , $128.15 , $191.99 , See APC Packaged Rates , $163.10 , $90.87 , $196.58 , $98.61 , $89.02 , See APC Packaged Rates , See APC Packaged Rates , $156.34 , $156.34 , See APC Packaged Rates , See APC Packaged Rates , $172.41 , $- , $- , $- , See APC Packaged Rates , $81.55 , $- , $- , $196.58 , $163.10
92620,5430010026,Hospital Chargemaster,Auditory function 60 min,Outpatient,Outpatient Default Percent / Case Rate,472, $297.00 , $163.35 , $244.73 , $166.91 , $207.90 , $115.83 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $123.06 , $119.33 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $103.95 , $- , $- , $333.79 , $207.90
92591,5430010023,Hospital Chargemaster,Hearing aid exam both ears,Outpatient,Outpatient Default Percent / Case Rate,472, $150.00 , $82.50 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 , $232.93 , $182.05 , $199.40 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $34.36 , $34.36 , $35.24 , $35.24 , See APC Packaged Rates , $52.50 , $- , $- , $232.93 , $105.00
,5430110028,Hospital Chargemaster,Hearing Aid Service,Outpatient,Outpatient Default Percent / Case Rate,479, $81.43 , $44.79 , $65.14 , See APC Packaged Rates , $57.00 , $31.76 , $78.57 , $78.91 , $41.94 , See APC Packaged Rates , See APC Packaged Rates , $54.64 , $54.64 , See APC Packaged Rates , See APC Packaged Rates , $75.73 , $75.73 , $75.73 , $75.73 , See APC Packaged Rates , $28.50 , $397.00 , $28.50 , $397.00 , $57.00
C8928,5510010011,Hospital Chargemaster,"Tte w or w/o fol w/con,stres",Outpatient,Outpatient Default Percent / Case Rate,480," $2,130.00 "," $1,171.50 "," $1,755.12 ", $855.31 ," $1,491.00 ", $830.70 ," $1,698.41 "," $1,327.40 "," $1,453.97 ", $855.31 , $855.31 ," $1,429.23 "," $1,429.23 ", $898.07 , $872.41 ," $1,345.91 "," $1,345.91 "," $1,380.56 "," $1,380.56 ", $855.31 , $745.50 , $- , $- ," $1,755.12 "," $1,491.00 "
C8929,5510010012,Hospital Chargemaster,"Tte w or wo fol wcon,doppler",Outpatient,Outpatient Default Percent / Case Rate,480," $1,662.00 ", $914.10 ," $1,369.49 ", $855.31 ," $1,163.40 ", $648.18 ," $1,698.41 "," $1,327.40 "," $1,453.97 ", $855.31 , $855.31 ," $1,115.20 "," $1,115.20 ", $898.07 , $872.41 ," $1,260.54 "," $1,260.54 "," $1,292.99 "," $1,292.99 ", $855.31 , $581.70 , $- , $- ," $1,698.41 "," $1,163.40 "
93352,5510010010,Hospital Chargemaster,Admin ecg contrast agent,Outpatient,Outpatient Default Percent / Case Rate,480, $80.00 , $44.00 , $65.92 , See APC Packaged Rates , $56.00 , $31.20 , $127.42 , $99.59 , $109.09 , See APC Packaged Rates , See APC Packaged Rates , $102.00 , $98.91 , See APC Packaged Rates , See APC Packaged Rates , $74.40 , $74.40 , $74.40 , $74.40 , See APC Packaged Rates , $28.00 , $- , $- , $127.42 , $56.00
93350,5510010008,Hospital Chargemaster,Stress tte only,Outpatient,Outpatient Default Percent / Case Rate,480, $989.00 , $543.95 , $814.94 , $577.66 , $692.30 , $385.71 ," $1,221.45 ", $954.63 ," $1,045.66 ", $577.66 , $577.66 , $225.11 , $218.28 , $606.54 , $589.21 , $746.62 , $746.62 , $765.85 , $765.85 , $577.66 , $346.15 , $- , $- ," $1,221.45 ", $692.30
93306,5510010002,Hospital Chargemaster,Tte w/doppler complete,Outpatient,Outpatient Default Percent / Case Rate,480," $1,662.00 ", $914.10 ," $1,369.49 ", $577.66 ," $1,163.40 ", $648.18 ," $1,221.45 ", $954.63 ," $1,045.66 ", $577.66 , $577.66 , $522.19 , $506.35 , $606.54 , $589.21 , $746.62 , $746.62 , $765.85 , $765.85 , $577.66 , $581.70 , $- , $- ," $1,369.49 "," $1,163.40 "
93351,5510010009,Hospital Chargemaster,Stress tte complete,Outpatient,Outpatient Default Percent / Case Rate,480," $1,415.00 ", $778.25 ," $1,165.96 ", $577.66 , $990.50 , $551.85 ," $1,221.45 ", $954.63 ," $1,045.66 ", $577.66 , $577.66 , $417.57 , $404.90 , $606.54 , $589.21 , $746.62 , $746.62 , $765.85 , $765.85 , $577.66 , $495.25 , $- , $- ," $1,221.45 ", $990.50
93307,5510010003,Hospital Chargemaster,Tte w/o doppler complete,Outpatient,Outpatient Default Percent / Case Rate,480, $989.00 , $543.95 , $814.94 , $275.09 , $692.30 , $385.71 , $566.08 , $442.42 , $484.61 , $275.09 , $275.09 , $456.30 , $442.46 , $288.84 , $280.59 , $406.23 , $406.23 , $416.70 , $416.70 , $275.09 , $346.15 , $- , $- , $814.94 , $692.30
93308,5510010004,Hospital Chargemaster,Tte f-up or lmtd,Outpatient,Outpatient Default Percent / Case Rate,480, $597.00 , $328.35 , $491.93 , $275.09 , $417.90 , $232.83 , $566.08 , $442.42 , $484.61 , $275.09 , $275.09 , $142.97 , $138.64 , $288.84 , $280.59 , $357.77 , $357.77 , $366.99 , $366.99 , $275.09 , $208.95 , $- , $- , $566.08 , $417.90
93321,5510010006,Hospital Chargemaster,Doppler echo exam heart,Outpatient,Outpatient Default Percent / Case Rate,480, $196.00 , $107.80 , $161.50 , See APC Packaged Rates , $137.20 , $76.44 , $75.81 , $59.25 , $64.90 , See APC Packaged Rates , See APC Packaged Rates , $142.97 , $138.64 , See APC Packaged Rates , See APC Packaged Rates , $182.28 , $182.28 , $182.28 , $182.28 , See APC Packaged Rates , $68.60 , $- , $- , $182.28 , $137.20
93325,5510010007,Hospital Chargemaster,Doppler color flow add-on,Outpatient,Outpatient Default Percent / Case Rate,480, $506.00 , $278.30 , $416.94 , See APC Packaged Rates , $354.20 , $197.34 , $85.45 , $66.78 , $73.15 , See APC Packaged Rates , See APC Packaged Rates , $368.08 , $356.91 , See APC Packaged Rates , See APC Packaged Rates , $470.58 , $470.58 , $470.58 , $470.58 , See APC Packaged Rates , $177.10 , $- , $- , $470.58 , $354.20
93320,5510010005,Hospital Chargemaster,Doppler echo exam heart,Outpatient,Outpatient Default Percent / Case Rate,480, $354.00 , $194.70 , $291.70 , See APC Packaged Rates , $247.80 , $138.06 , $136.46 , $106.65 , $116.82 , See APC Packaged Rates , See APC Packaged Rates , $215.98 , $209.43 , See APC Packaged Rates , See APC Packaged Rates , $329.22 , $329.22 , $329.22 , $329.22 , See APC Packaged Rates , $123.90 , $- , $- , $329.22 , $247.80
93308,5510010024,Hospital Chargemaster,Tte F-Up Or Lmtd w Contrast,Outpatient,Outpatient Default Percent / Case Rate,480, $597.00 , $328.35 , $491.93 , $275.09 , $417.90 , $232.83 , $566.08 , $442.42 , $484.61 , $275.09 , $275.09 , $142.97 , $138.64 , $288.84 , $280.59 , $357.77 , $357.77 , $366.99 , $366.99 , $275.09 , $208.95 , $- , $- , $566.08 , $417.90
G2066,5510010080,Hospital Chargemaster,Interag Device Remote 30D,Outpatient,Outpatient Default Percent / Case Rate,480, $50.00 , $27.50 , $41.20 , $44.52 , $35.00 , $19.50 , $85.30 , $66.67 , $73.02 , $44.52 , $44.52 , $33.55 , $33.55 , $46.74 , $45.41 , $50.00 , $50.00 , $50.00 , $50.00 , $44.52 , $17.50 , $- , $- , $85.30 , $35.00
93296,5510010082,Hospital Chargemaster,Rem Interrog Evl Pm/Ids,Outpatient,Outpatient Default Percent / Case Rate,480, $50.00 , $27.50 , $41.20 , $44.52 , $35.00 , $19.50 , $91.23 , $71.30 , $78.10 , $44.52 , $44.52 , $98.70 , $95.71 , $46.74 , $45.41 , $50.00 , $50.00 , $50.00 , $50.00 , $44.52 , $17.50 , $- , $- , $98.70 , $35.00
93306,5510010085,Hospital Chargemaster,Tte W/Doppler Complete,Outpatient,Outpatient Default Percent / Case Rate,480," $1,313.00 ", $722.15 ," $1,081.91 ", $577.66 , $919.10 , $512.07 ," $1,221.45 ", $954.63 ," $1,045.66 ", $577.66 , $577.66 , $522.19 , $506.35 , $606.54 , $589.21 , $746.62 , $746.62 , $765.85 , $765.85 , $577.66 , $459.55 , $- , $- ," $1,221.45 ", $919.10
93017,5510010013,Hospital Chargemaster,Cardiovascular stress test,Outpatient,Outpatient Default Percent / Case Rate,482, $560.00 , $308.00 , $461.44 , $316.40 , $392.00 , $218.40 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $334.62 , $324.47 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $196.00 , $- , $- , $619.47 , $392.00
C8925,5510010015,Hospital Chargemaster,"2d tee w or w/o fol w/con,in",Outpatient,Outpatient Default Percent / Case Rate,483," $1,662.00 ", $914.10 ," $1,369.49 ", $855.31 ," $1,163.40 ", $648.18 ," $1,603.66 "," $1,610.64 ", $855.96 , $855.31 , $855.31 ," $1,115.20 "," $1,115.20 ", $898.07 , $872.41 ," $1,345.91 "," $1,345.91 "," $1,380.56 "," $1,380.56 ", $855.31 , $581.70 , $- , $- ," $1,610.64 "," $1,163.40 "
93312,5510010014,Hospital Chargemaster,Echo transesophageal,Outpatient,Outpatient Default Percent / Case Rate,483," $1,415.00 ", $778.25 ," $1,165.96 ", $577.66 , $990.50 , $551.85 ," $1,221.45 ", $954.63 ," $1,045.66 ", $577.66 , $577.66 , $483.68 , $469.00 , $606.54 , $589.21 , $746.62 , $746.62 , $765.85 , $765.85 , $577.66 , $495.25 , $- , $- ," $1,221.45 ", $990.50
93312,5510010084,Hospital Chargemaster,Echo transesophageal,Outpatient,Outpatient Default Percent / Case Rate,483," $1,415.00 ", $778.25 ," $1,165.96 ", $577.66 , $990.50 , $551.85 ," $1,221.45 ", $954.63 ," $1,045.66 ", $577.66 , $577.66 , $483.68 , $469.00 , $606.54 , $589.21 , $746.62 , $746.62 , $765.85 , $765.85 , $577.66 , $495.25 , $- , $- ," $1,221.45 ", $990.50
92960,5510010016,Hospital Chargemaster,Cardioversion electric ext,Outpatient,Outpatient Default Percent / Case Rate,489, $560.00 , $308.00 , $461.44 , $671.60 , $392.00 , $218.40 ," $1,292.64 "," $1,010.27 "," $1,106.60 ", $671.60 , $671.60 , $323.29 , $313.49 , $705.18 , $685.03 , $867.68 , $867.68 , $890.03 , $890.03 , $671.60 , $196.00 , $- , $- ," $1,292.64 ", $392.00
99455,6500010024,Hospital Chargemaster,Work related disability exam,Outpatient,Outpatient Default Percent / Case Rate,510, $33.00 , $18.15 , $27.19 , See APC Packaged Rates , $23.10 , $12.87 , $31.84 , $31.98 , $17.00 , See APC Packaged Rates , See APC Packaged Rates , $22.14 , $22.14 , See APC Packaged Rates , See APC Packaged Rates , $30.69 , $30.69 , $30.69 , $30.69 , See APC Packaged Rates , Not Reimbursed , $- , $- , $31.98 , $23.10
99291,6500010015,Hospital Chargemaster,Critical care first hour,Outpatient,Outpatient Default Percent / Case Rate,510, $659.00 , $362.45 , $543.02 , $890.51 , $461.30 , $257.01 ," $3,645.69 "," $2,255.28 "," $2,178.27 ", $890.51 , $890.51 , $836.55 , $811.17 , $935.03 , $908.32 ," $1,078.51 "," $1,078.51 "," $1,106.30 "," $1,106.30 ", $890.51 , Not Reimbursed , $- , $- ," $3,645.69 ", $461.30
99495,6500010025,Hospital Chargemaster,Trans care mgmt 14 day disch,Outpatient,Outpatient Default Percent / Case Rate,510, $85.00 , $46.75 , $70.04 , $142.05 , $59.50 , $33.15 , $284.43 , $222.30 , $243.50 , $142.05 , $142.05 , $57.04 , $57.04 , $149.15 , $144.89 , $85.00 , $85.00 , $85.00 , $85.00 , $142.05 , Not Reimbursed , $- , $- , $284.43 , $59.50
99496,6500010026,Hospital Chargemaster,Trans care mgmt 7 day disch,Outpatient,Outpatient Default Percent / Case Rate,510, $93.00 , $51.15 , $76.63 , $142.05 , $65.10 , $36.27 , $284.43 , $222.30 , $243.50 , $142.05 , $142.05 , $62.40 , $62.40 , $149.15 , $144.89 , $93.00 , $93.00 , $93.00 , $93.00 , $142.05 , Not Reimbursed , $- , $- , $284.43 , $65.10
99497,6500010027,Hospital Chargemaster,Advncd care plan 30 min,Outpatient,Outpatient Default Percent / Case Rate,510, $90.00 , $49.50 , $74.16 , $89.46 , $63.00 , $35.10 , $187.56 , $146.59 , $160.57 , $89.46 , $89.46 , $60.39 , $60.39 , $93.93 , $91.24 , $90.00 , $90.00 , $90.00 , $90.00 , $89.46 , Not Reimbursed , $- , $- , $187.56 , $63.00
99211,6500019211,Hospital Chargemaster,Office Visit Establish Level 1,Outpatient,Outpatient Default Percent / Case Rate,510, $124.00 , $68.20 , $102.18 , See APC Packaged Rates , $86.80 , $48.36 , $180.56 , $54.48 , $74.62 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- , $180.56 , $86.80
99212,6500019212,Hospital Chargemaster,Office Visit Establish Level 2,Outpatient,Outpatient Default Percent / Case Rate,510, $114.00 , $62.70 , $93.94 , See APC Packaged Rates , $79.80 , $44.46 , $500.70 , $151.07 , $206.91 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- , $500.70 , $79.80
99202,6500019202,Hospital Chargemaster,Office Visit New Level 2,Outpatient,Outpatient Default Percent / Case Rate,510, $147.00 , $80.85 , $121.13 , See APC Packaged Rates , $102.90 , $57.33 , $996.65 , $300.70 , $411.87 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- , $996.65 , $102.90
99213,6500019213,Hospital Chargemaster,Office Visit Establish Level 3,Outpatient,Outpatient Default Percent / Case Rate,510, $139.00 , $76.45 , $114.54 , See APC Packaged Rates , $97.30 , $54.21 ," $1,001.28 ", $302.10 , $413.78 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- ," $1,001.28 ", $97.30
99203,6500019203,Hospital Chargemaster,Office Visit New Level 3,Outpatient,Outpatient Default Percent / Case Rate,510, $237.00 , $130.35 , $195.29 , See APC Packaged Rates , $165.90 , $92.43 ," $1,494.85 ", $451.01 , $617.75 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- ," $1,494.85 ", $165.90
99214,6500019214,Hospital Chargemaster,Office Visit Establish Level 4,Outpatient,Outpatient Default Percent / Case Rate,510, $212.00 , $116.60 , $174.69 , See APC Packaged Rates , $148.40 , $82.68 ," $1,543.79 ", $465.78 , $637.97 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- ," $1,543.79 ", $148.40
99215,6500019215,Hospital Chargemaster,Office Visit Establish Level 5,Outpatient,Outpatient Default Percent / Case Rate,510, $273.00 , $150.15 , $224.95 , See APC Packaged Rates , $191.10 , $106.47 ," $2,176.35 ", $656.62 , $899.38 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- ," $2,176.35 ", $191.10
99204,6500019204,Hospital Chargemaster,Office Visit New Level 4,Outpatient,Outpatient Default Percent / Case Rate,510, $352.00 , $193.60 , $290.05 , See APC Packaged Rates , $246.40 , $137.28 ," $2,530.46 ", $763.46 ," $1,045.72 ", See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- ," $2,530.46 ", $246.40
99205,6500019205,Hospital Chargemaster,Office Visit New Level 5,Outpatient,Outpatient Default Percent / Case Rate,510, $434.00 , $238.70 , $357.62 , See APC Packaged Rates , $303.80 , $169.26 ," $3,302.60 ", $996.42 ," $1,364.80 ", See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- ," $3,302.60 ", $303.80
99242,6500010012,Hospital Chargemaster,Office consultation,Outpatient,Outpatient Default Percent / Case Rate,510, $126.00 , $69.30 , $103.82 , See APC Packaged Rates , $88.20 , $49.14 , $121.58 , $122.11 , $64.89 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- , $122.11 , $88.20
99243,6500010013,Hospital Chargemaster,Office consultation,Outpatient,Outpatient Default Percent / Case Rate,510, $158.00 , $86.90 , $130.19 , See APC Packaged Rates , $110.60 , $61.62 , $152.45 , $153.12 , $81.37 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- , $153.12 , $110.60
99245,6500010014,Hospital Chargemaster,Office consultation,Outpatient,Outpatient Default Percent / Case Rate,510, $273.00 , $150.15 , $224.95 , See APC Packaged Rates , $191.10 , $106.47 , $263.42 , $264.56 , $140.60 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- , $264.56 , $191.10
90714,6500011863,Hospital Chargemaster,Td Vacc No Presv 7 yrs+ im,Outpatient,Outpatient Default Percent / Case Rate,510, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $25.27 , $25.27 , $25.27 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , Not Reimbursed , $27.70 , $0.00 , $27.70 , $0.01
99498,6500010028,Hospital Chargemaster,Advncd care plan addl 30 min,Outpatient,Outpatient Default Percent / Case Rate,510, $70.00 , $38.50 , $57.68 , See APC Packaged Rates , $49.00 , $27.30 , $264.32 , $206.58 , $226.28 , See APC Packaged Rates , See APC Packaged Rates , $46.97 , $46.97 , See APC Packaged Rates , See APC Packaged Rates , $65.10 , $65.10 , $65.10 , $65.10 , See APC Packaged Rates , Not Reimbursed , $- , $- , $264.32 , $49.00
99292,6500010016,Hospital Chargemaster,Critical care addl 30 min,Outpatient,Outpatient Default Percent / Case Rate,510, $329.00 , $180.95 , $271.10 , See APC Packaged Rates , $230.30 , $128.31 , $788.62 , $487.85 , $471.20 , See APC Packaged Rates , See APC Packaged Rates , $250.80 , $243.19 , See APC Packaged Rates , See APC Packaged Rates , $305.97 , $305.97 , $305.97 , $305.97 , See APC Packaged Rates , Not Reimbursed , $- , $- , $788.62 , $230.30
99354,6500010017,Hospital Chargemaster,Prolong e&m/psyctx serv o/p,Outpatient,Outpatient Default Percent / Case Rate,510, $161.00 , $88.55 , $132.66 , See APC Packaged Rates , $112.70 , $62.79 , $155.35 , $156.03 , $82.92 , See APC Packaged Rates , See APC Packaged Rates , $108.03 , $108.03 , See APC Packaged Rates , See APC Packaged Rates , $149.73 , $149.73 , $149.73 , $149.73 , See APC Packaged Rates , Not Reimbursed , $- , $- , $156.03 , $112.70
99355,6500010018,Hospital Chargemaster,Prolong e&m/psyctx serv o/p,Outpatient,Outpatient Default Percent / Case Rate,510, $270.00 , $148.50 , $222.48 , See APC Packaged Rates , $189.00 , $105.30 , $260.52 , $261.66 , $139.06 , See APC Packaged Rates , See APC Packaged Rates , $181.17 , $181.17 , See APC Packaged Rates , See APC Packaged Rates , $251.10 , $251.10 , $251.10 , $251.10 , See APC Packaged Rates , Not Reimbursed , $- , $- , $261.66 , $189.00
99215,5000010030,Hospital Chargemaster,Lactation Clinic - New,Outpatient,Outpatient Default Percent / Case Rate,510, $113.00 , $62.15 , $93.11 , See APC Packaged Rates , $79.10 , $44.07 ," $2,176.35 ", $656.62 , $899.38 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- ," $2,176.35 ", $79.10
99213,5000010031,Hospital Chargemaster,Lactation Clinic - Subsequent,Outpatient,Outpatient Default Percent / Case Rate,510, $97.00 , $53.35 , $79.93 , See APC Packaged Rates , $67.90 , $37.83 ," $1,001.28 ", $302.10 , $413.78 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- ," $1,001.28 ", $67.90
G0248,5950110001,Hospital Chargemaster,Demonstrate Use Home INR Mon,Outpatient,Outpatient Default Percent / Case Rate,510, $458.00 , $251.90 , $377.39 , $142.05 , $320.60 , $178.62 , $284.43 , $222.30 , $243.50 , $142.05 , $142.05 , $307.32 , $307.32 , $149.15 , $144.89 , $183.99 , $183.99 , $188.73 , $188.73 , $142.05 , Not Reimbursed , $- , $- , $377.39 , $320.60
99241,6500010011,Hospital Chargemaster,Office consultation,Outpatient,Outpatient Default Percent / Case Rate,510, $24.00 , $13.20 , $19.78 , See APC Packaged Rates , $16.80 , $9.36 , $23.16 , $23.26 , $12.36 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $24.00 , $24.00 , $24.00 , $24.00 , See APC Packaged Rates , Not Reimbursed , $- , $- , $24.00 , $16.80
99368,6500010019,Hospital Chargemaster,Team conf w/o pat by hc pro,Outpatient,Outpatient Default Percent / Case Rate,510, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , Not Reimbursed , $- , $- , $- , $-
99401,6500010020,Hospital Chargemaster,Preventive counseling indiv,Outpatient,Outpatient Default Percent / Case Rate,510, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , Not Reimbursed , $- , $- , $- , $-
99402,6500010021,Hospital Chargemaster,Preventive counseling indiv,Outpatient,Outpatient Default Percent / Case Rate,510, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , Not Reimbursed , $- , $- , $- , $-
99403,6500010022,Hospital Chargemaster,Preventive counseling indiv,Outpatient,Outpatient Default Percent / Case Rate,510, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , Not Reimbursed , $- , $- , $- , $-
99404,6500010023,Hospital Chargemaster,Preventive counseling indiv,Outpatient,Outpatient Default Percent / Case Rate,510, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , Not Reimbursed , $- , $- , $- , $-
Q0091,6500011853,Hospital Chargemaster,Obtaining screen pap smear,Outpatient,Outpatient Default Percent / Case Rate,510, $118.00 , $64.90 , $97.23 , $29.53 , $82.60 , $46.02 , $42.15 , $32.94 , $36.08 , $29.53 , $29.53 , $79.18 , $79.18 , $31.01 , $30.12 , $30.54 , $30.54 , $31.32 , $31.32 , $29.53 , Not Reimbursed , $20.60 , $20.60 , $97.23 , $82.60
96110,6500011881,Hospital Chargemaster,Developmental Screen W/Score,Outpatient,Outpatient Default Percent / Case Rate,510, $46.00 , $25.30 , $37.90 , See APC Packaged Rates , $32.20 , $17.94 , $38.45 , $30.05 , $32.92 , See APC Packaged Rates , See APC Packaged Rates , $22.77 , $22.08 , See APC Packaged Rates , See APC Packaged Rates , $46.00 , $46.00 , $46.00 , $46.00 , See APC Packaged Rates , Not Reimbursed , $- , $- , $46.00 , $32.20
99173,6500011888,Hospital Chargemaster,Visual Acuity Screen,Outpatient,Outpatient Default Percent / Case Rate,510, $37.00 , $20.35 , $30.49 , See APC Packaged Rates , $25.90 , $14.43 , $10.89 , $8.51 , $9.32 , See APC Packaged Rates , See APC Packaged Rates , $7.21 , $6.99 , See APC Packaged Rates , See APC Packaged Rates , $18.85 , $18.85 , $19.33 , $19.33 , See APC Packaged Rates , Not Reimbursed , $- , $- , $30.49 , $25.90
99212,6500011917,Hospital Chargemaster,Tele Office Visit Estab Lvl 2,Outpatient,Outpatient Default Percent / Case Rate,510, $114.00 , $62.70 , $93.94 , See APC Packaged Rates , $79.80 , $44.46 , $500.70 , $151.07 , $206.91 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- , $500.70 , $79.80
99213,6500011918,Hospital Chargemaster,Tele Office Visit Estab Lvl 3,Outpatient,Outpatient Default Percent / Case Rate,510, $139.00 , $76.45 , $114.54 , See APC Packaged Rates , $97.30 , $54.21 ," $1,001.28 ", $302.10 , $413.78 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- ," $1,001.28 ", $97.30
99214,6500011919,Hospital Chargemaster,Tele Office Visit Estab Lvl 4,Outpatient,Outpatient Default Percent / Case Rate,510, $212.00 , $116.60 , $174.69 , See APC Packaged Rates , $148.40 , $82.68 ," $1,543.79 ", $465.78 , $637.97 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- ," $1,543.79 ", $148.40
99215,6500011920,Hospital Chargemaster,Tele Office Visit Estab Lvl 5,Outpatient,Outpatient Default Percent / Case Rate,510, $273.00 , $150.15 , $224.95 , See APC Packaged Rates , $191.10 , $106.47 ," $2,176.35 ", $656.62 , $899.38 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- ," $2,176.35 ", $191.10
99244,6500019244,Hospital Chargemaster,Office Consultation,Outpatient,Outpatient Default Percent / Case Rate,510, $236.00 , $129.80 , $194.46 , See APC Packaged Rates , $165.20 , $92.04 , $227.72 , $228.71 , $121.54 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , Not Reimbursed , $- , $- , $228.71 , $165.20
Q0091,6500021853,Hospital Chargemaster,Obtaining screen pap smear,Outpatient,Outpatient Default Percent / Case Rate,510, $118.00 , $64.90 , $97.23 , $29.53 , $82.60 , $46.02 , $42.15 , $32.94 , $36.08 , $29.53 , $29.53 , $79.18 , $79.18 , $31.01 , $30.12 , $30.54 , $30.54 , $31.32 , $31.32 , $29.53 , Not Reimbursed , $20.60 , $20.60 , $97.23 , $82.60
Q3014,650011895,Hospital Chargemaster,Tele Facility Fee,Outpatient,Outpatient Default Percent / Case Rate,510, $50.00 , $27.50 , $41.20 , See APC Packaged Rates , $35.00 , $19.50 , $48.25 , $48.46 , $25.75 , See APC Packaged Rates , See APC Packaged Rates , $33.55 , $33.55 , See APC Packaged Rates , See APC Packaged Rates , $46.50 , $46.50 , $46.50 , $46.50 , See APC Packaged Rates , Not Reimbursed , $- , $- , $48.46 , $35.00
20600,7104010600,Hospital Chargemaster,Drain/inj joint/bursa w/o us,Outpatient,Outpatient Default Percent / Case Rate,510, $305.00 , $167.75 ," $1,236.00 ", $312.35 , $213.50 , $118.95 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $96.34 , $93.41 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , Not Reimbursed , $- , $- ," $1,236.00 ", $213.50
17000,7104017000,Hospital Chargemaster,Destruct premalg lesion,Outpatient,Outpatient Default Percent / Case Rate,510, $248.00 , $136.40 ," $1,236.00 ", $214.68 , $173.60 , $96.72 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $170.00 , $170.00 , $170.00 , $170.00 , $214.68 , Not Reimbursed , $- , $- ," $1,236.00 ", $173.60
17110,7104017110,Hospital Chargemaster,Destruct B9 Lesion 1-14,Outpatient,Outpatient Default Percent / Case Rate,510, $325.00 , $178.75 ," $1,236.00 ", $214.68 , $227.50 , $126.75 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $185.14 , $185.14 , $185.14 , $185.14 , $214.68 , Not Reimbursed , $- , $- ," $1,236.00 ", $227.50
20605,7140110605,Hospital Chargemaster,Drain/inj joint/bursa w/o us,Outpatient,Outpatient Default Percent / Case Rate,510, $307.00 , $168.85 ," $1,236.00 ", $312.35 , $214.90 , $119.73 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $99.24 , $96.23 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , Not Reimbursed , $- , $- ," $1,236.00 ", $214.90
20610,7140110610,Hospital Chargemaster,Drain/inj joint/bursa w/o us,Outpatient,Outpatient Default Percent / Case Rate,510, $356.00 , $195.80 ," $1,236.00 ", $312.35 , $249.20 , $138.84 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , Not Reimbursed , $- , $- ," $1,236.00 ", $249.20
29125,7140119125,Hospital Chargemaster,Apply Forearm Splint,Outpatient,Outpatient Default Percent / Case Rate,510, $173.00 , $95.15 , $142.55 , $134.80 , $121.10 , $67.47 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $116.00 , $116.00 , $116.00 , $116.00 , $134.80 , Not Reimbursed , $- , $- , $232.95 , $121.10
29130,7140119130,Hospital Chargemaster,Application of finger splint,Outpatient,Outpatient Default Percent / Case Rate,510, $105.00 , $57.75 , $86.52 , $134.80 , $73.50 , $40.95 , $122.28 , $83.93 , $83.48 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $110.05 , $110.05 , $112.89 , $112.89 , $134.80 , Not Reimbursed , $- , $- , $147.89 , $73.50
69200,7140119200,Hospital Chargemaster,Clear outer ear canal,Outpatient,Outpatient Default Percent / Case Rate,510, $251.00 , $138.05 , $206.82 , $134.80 , $175.70 , $97.89 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $271.00 , $271.00 , $271.00 , $271.00 , $134.80 , Not Reimbursed , $- , $- , $271.00 , $175.70
69209,7140119209,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,510, $78.00 , $42.90 ," $1,236.00 ", $66.55 , $54.60 , $30.42 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $52.34 , $52.34 , $69.87 , $67.88 , $25.00 , $25.00 , $25.00 , $25.00 , $66.55 , Not Reimbursed , $- , $- ," $1,236.00 ", $54.60
69210,7140119210,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,510, $145.00 , $79.75 ," $1,236.00 ", $66.55 , $101.50 , $56.55 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $97.30 , $97.30 , $69.87 , $67.88 , $97.00 , $97.00 , $97.00 , $97.00 , $66.55 , Not Reimbursed , $- , $- ," $1,236.00 ", $101.50
29580,7140119580,Hospital Chargemaster,Application of paste boot,Outpatient,Outpatient Default Percent / Case Rate,510, $190.00 , $104.50 , $156.56 , $168.90 , $133.00 , $74.10 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , Not Reimbursed , $- , $- , $294.51 , $133.00
98925,6500011883,Hospital Chargemaster,Osteopath Manj 1-2 Regions,Outpatient,Outpatient Default Percent / Case Rate,530, $64.00 , $35.20 , $52.74 , $31.89 , $44.80 , $24.96 , $61.75 , $62.02 , $32.96 , $31.89 , $31.89 , $42.94 , $42.94 , $33.48 , $32.52 , $39.85 , $39.85 , $40.87 , $40.87 , $31.89 , $22.40 , $- , $- , $62.02 , $44.80
98926,6500018926,Hospital Chargemaster,Osteopath manj 3-4 regions,Outpatient,Outpatient Default Percent / Case Rate,530, $83.00 , $45.65 , $68.39 , $31.89 , $58.10 , $32.37 , $122.97 , $78.16 , $76.74 , $31.89 , $31.89 , $55.69 , $55.69 , $33.48 , $32.52 , $39.85 , $39.85 , $40.87 , $40.87 , $31.89 , $29.05 , $- , $- , $122.97 , $58.10
98927,6500018927,Hospital Chargemaster,Osteopath manj 5-6 regions,Outpatient,Outpatient Default Percent / Case Rate,530, $70.00 , $38.50 , $57.68 , $31.89 , $49.00 , $27.30 , $122.97 , $78.16 , $76.74 , $31.89 , $31.89 , $46.97 , $46.97 , $33.48 , $32.52 , $39.85 , $39.85 , $40.87 , $40.87 , $31.89 , $24.50 , $- , $- , $122.97 , $49.00
98928,6500018928,Hospital Chargemaster,Osteopath manj 7-8 regions,Outpatient,Outpatient Default Percent / Case Rate,530, $74.00 , $40.70 , $60.98 , $31.89 , $51.80 , $28.86 , $122.97 , $78.16 , $76.74 , $31.89 , $31.89 , $49.65 , $49.65 , $33.48 , $32.52 , $39.85 , $39.85 , $40.87 , $40.87 , $31.89 , $25.90 , $- , $- , $122.97 , $51.80
98929,6500018929,Hospital Chargemaster,Osteopath manj 9-10 regions,Outpatient,Outpatient Default Percent / Case Rate,530, $80.00 , $44.00 , $65.92 , $31.89 , $56.00 , $31.20 , $77.19 , $77.53 , $41.20 , $31.89 , $31.89 , $53.68 , $53.68 , $33.48 , $32.52 , $39.85 , $39.85 , $40.87 , $40.87 , $31.89 , $28.00 , $- , $- , $77.53 , $56.00
71551,5170010019,Hospital Chargemaster,MRI chest w/dye,Outpatient,Outpatient Default Percent / Case Rate,610," $2,321.00 "," $1,276.55 "," $1,912.50 ", $855.31 ," $1,624.70 ", $905.19 ," $2,799.56 "," $1,449.22 "," $1,422.33 ", $855.31 , $855.31 ," $1,102.58 "," $1,069.13 ", $898.07 , $872.41 ," $1,235.84 "," $1,235.84 "," $1,267.65 "," $1,267.65 ", $855.31 , $437.00 ," $1,037.63 ", $437.00 ," $2,799.56 "," $1,624.70 "
72157,5170010029,Hospital Chargemaster,MRI chest spine w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,610," $2,587.00 "," $1,422.85 "," $2,131.69 ", $440.24 ," $1,810.90 "," $1,008.93 "," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,131.69 "," $1,810.90 "
72158,5170010030,Hospital Chargemaster,MRI lumbar spine w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,610," $2,889.00 "," $1,588.95 "," $2,380.54 ", $440.24 ," $2,022.30 "," $1,126.71 "," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,380.54 "," $2,022.30 "
72156,5170010028,Hospital Chargemaster,MRI neck spine w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,610," $2,831.00 "," $1,557.05 "," $2,332.74 ", $440.24 ," $1,981.70 "," $1,104.09 "," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,332.74 "," $1,981.70 "
70543,5170010003,Hospital Chargemaster,MRI orbt/fac/nck w/o &w/dye,Outpatient,Outpatient Default Percent / Case Rate,610," $2,234.00 "," $1,228.70 "," $1,840.82 ", $440.24 ," $1,563.80 ", $871.26 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,422.63 "," $2,349.12 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,422.63 "," $1,563.80 "
71552,5170010020,Hospital Chargemaster,MRI chest w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,610," $2,436.00 "," $1,339.80 "," $2,007.26 ", $440.24 ," $1,705.20 ", $950.04 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,321.75 "," $1,281.64 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,007.26 "," $1,705.20 "
72197,5170010034,Hospital Chargemaster,MRI pelvis w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,610," $2,336.00 "," $1,284.80 "," $1,924.86 ", $440.24 ," $1,635.20 ", $911.04 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,426.81 "," $2,353.18 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,426.81 "," $1,635.20 "
74183,5170010052,Hospital Chargemaster,MRI abdomen w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,610," $2,466.00 "," $1,356.30 "," $2,031.98 ", $440.24 ," $1,726.20 ", $961.74 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,426.81 "," $2,353.18 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,426.81 "," $1,726.20 "
72147,5170010025,Hospital Chargemaster,MRI chest spine w/dye,Outpatient,Outpatient Default Percent / Case Rate,610," $2,507.00 "," $1,378.85 "," $2,065.77 ", $440.24 ," $1,754.90 ", $977.73 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,065.77 "," $1,754.90 "
70542,5170010002,Hospital Chargemaster,MRI orbit/face/neck w/dye,Outpatient,Outpatient Default Percent / Case Rate,610," $3,069.00 "," $1,687.95 "," $2,528.86 ", $440.24 ," $2,148.30 "," $1,196.91 "," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,308.50 "," $1,268.80 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,528.86 "," $2,148.30 "
72149,5170010027,Hospital Chargemaster,MRI lumbar spine w/dye,Outpatient,Outpatient Default Percent / Case Rate,610," $1,981.00 "," $1,089.55 "," $1,632.34 ", $440.24 ," $1,386.70 ", $772.59 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $437.00 , $578.82 , $437.00 ," $1,633.34 "," $1,386.70 "
72196,5170010033,Hospital Chargemaster,MRI pelvis w/dye,Outpatient,Outpatient Default Percent / Case Rate,610," $2,082.00 "," $1,145.10 "," $1,715.57 ", $440.24 ," $1,457.40 ", $811.98 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,361.27 "," $1,319.97 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $437.00 , $578.82 , $437.00 ," $1,715.57 "," $1,457.40 "
72142,5170010023,Hospital Chargemaster,MRI neck spine w/dye,Outpatient,Outpatient Default Percent / Case Rate,610," $2,530.00 "," $1,391.50 "," $2,084.72 ", $440.24 ," $1,771.00 ", $986.70 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,084.72 "," $1,771.00 "
74182,5170010051,Hospital Chargemaster,MRI abdomen w/dye,Outpatient,Outpatient Default Percent / Case Rate,610," $1,882.00 "," $1,035.10 "," $1,550.77 ", $440.24 ," $1,317.40 ", $733.98 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,311.27 "," $1,271.48 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $437.00 , $578.82 , $437.00 ," $1,561.69 "," $1,317.40 "
70336,5170010000,Hospital Chargemaster,MRI jaw joint,Outpatient,Outpatient Default Percent / Case Rate,610," $1,470.00 ", $808.50 ," $1,211.28 ", $275.09 ," $1,029.00 ", $573.30 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,361.27 "," $1,029.00 "
70540,5170010001,Hospital Chargemaster,MRI orbit/face/neck w/o dye,Outpatient,Outpatient Default Percent / Case Rate,610," $2,354.00 "," $1,294.70 "," $1,939.70 ", $275.09 ," $1,647.80 ", $918.06 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,939.70 "," $1,647.80 "
71550,5170010018,Hospital Chargemaster,MRI chest w/o dye,Outpatient,Outpatient Default Percent / Case Rate,610," $1,601.00 ", $880.55 ," $1,319.22 ", $275.09 ," $1,120.70 ", $624.39 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,361.27 "," $1,120.70 "
72141,5170010022,Hospital Chargemaster,MRI neck spine w/o dye,Outpatient,Outpatient Default Percent / Case Rate,610," $1,749.00 ", $961.95 ," $1,441.18 ", $275.09 ," $1,224.30 ", $682.11 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,441.18 "," $1,224.30 "
72146,5170010024,Hospital Chargemaster,MRI chest spine w/o dye,Outpatient,Outpatient Default Percent / Case Rate,610," $1,760.00 ", $968.00 ," $1,450.24 ", $275.09 ," $1,232.00 ", $686.40 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,511.27 "," $1,465.41 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,511.27 "," $1,232.00 "
72148,5170010026,Hospital Chargemaster,MRI lumbar spine w/o dye,Outpatient,Outpatient Default Percent / Case Rate,610," $1,773.00 ", $975.15 ," $1,460.95 ", $275.09 ," $1,241.10 ", $691.47 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,511.27 "," $1,465.41 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,511.27 "," $1,241.10 "
72195,5170010032,Hospital Chargemaster,MRI pelvis w/o dye,Outpatient,Outpatient Default Percent / Case Rate,610," $1,706.00 ", $938.30 ," $1,405.74 ", $275.09 ," $1,194.20 ", $665.34 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,094.23 "," $1,061.03 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,405.74 "," $1,194.20 "
74181,5170010050,Hospital Chargemaster,MRI abdomen w/o dye,Outpatient,Outpatient Default Percent / Case Rate,610," $1,718.00 ", $944.90 ," $1,415.63 ", $275.09 ," $1,202.60 ", $670.02 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,415.63 "," $1,202.60 "
73723,5170040048,Hospital Chargemaster,MRI joint lwr extr wo&w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,610," $2,892.00 "," $1,590.60 "," $2,383.01 ", $440.24 ," $2,024.40 "," $1,127.88 "," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,422.63 "," $2,349.12 ", $462.26 , $449.05 , $418.00 , $418.00 , $418.00 , $418.00 , $440.24 , $437.00 , $578.82 , $418.00 ," $2,422.63 "," $2,024.40 "
73723,5170050048,Hospital Chargemaster,MRI joint lwr extr wo&w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,610," $2,892.00 "," $1,590.60 "," $2,383.01 ", $440.24 ," $2,024.40 "," $1,127.88 "," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,422.63 "," $2,349.12 ", $462.26 , $449.05 , $418.00 , $418.00 , $418.00 , $418.00 , $440.24 , $437.00 , $578.82 , $418.00 ," $2,422.63 "," $2,024.40 "
73220,5170040038,Hospital Chargemaster,MRI uppr extr wo&w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,610," $2,932.00 "," $1,612.60 "," $2,415.97 ", $440.24 ," $2,052.40 "," $1,143.48 "," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,361.27 "," $1,319.97 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,415.97 "," $2,052.40 "
73720,5170040045,Hospital Chargemaster,MRI lwr extr wo&w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,610," $2,552.00 "," $1,403.60 "," $2,102.85 ", $440.24 ," $1,786.40 ", $995.28 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,361.27 "," $1,319.97 ", $462.26 , $449.05 , $418.00 , $418.00 , $418.00 , $418.00 , $440.24 , $437.00 , $578.82 , $418.00 ," $2,102.85 "," $1,786.40 "
73220,5170050038,Hospital Chargemaster,MRI uppr extr wo&w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,610," $2,932.00 "," $1,612.60 "," $2,415.97 ", $440.24 ," $2,052.40 "," $1,143.48 "," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,361.27 "," $1,319.97 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,415.97 "," $2,052.40 "
73720,5170050045,Hospital Chargemaster,MRI lwr extr wo&w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,610," $2,552.00 "," $1,403.60 "," $2,102.85 ", $440.24 ," $1,786.40 ", $995.28 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,361.27 "," $1,319.97 ", $462.26 , $449.05 , $418.00 , $418.00 , $418.00 , $418.00 , $440.24 , $437.00 , $578.82 , $418.00 ," $2,102.85 "," $1,786.40 "
73223,5170040041,Hospital Chargemaster,MRI joint upr extr wo&w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,610," $2,884.00 "," $1,586.20 "," $2,376.42 ", $440.24 ," $2,018.80 "," $1,124.76 "," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,422.63 "," $2,349.12 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,422.63 "," $2,018.80 "
73223,5170050041,Hospital Chargemaster,MRI joint upr extr wo&w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,610," $2,884.00 "," $1,586.20 "," $2,376.42 ", $440.24 ," $2,018.80 "," $1,124.76 "," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,422.63 "," $2,349.12 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,422.63 "," $2,018.80 "
73225,5170040042,Hospital Chargemaster,MRA angio upr extr wo&w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,610," $2,308.00 "," $1,269.40 "," $1,901.79 ", See APC Packaged Rates ," $1,615.60 ", $900.12 ," $1,939.90 "," $1,004.21 ", $985.57 , See APC Packaged Rates , See APC Packaged Rates ," $1,018.06 ", $987.17 , See APC Packaged Rates , See APC Packaged Rates , $588.93 , $588.93 , $604.09 , $604.09 , See APC Packaged Rates , $437.00 , $461.66 , $437.00 ," $1,939.90 "," $1,615.60 "
73225,5170050042,Hospital Chargemaster,MRA angio upr extr wo&w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,610," $2,308.00 "," $1,269.40 "," $1,901.79 ", See APC Packaged Rates ," $1,615.60 ", $900.12 ," $1,939.90 "," $1,004.21 ", $985.57 , See APC Packaged Rates , See APC Packaged Rates ," $1,018.06 ", $987.17 , See APC Packaged Rates , See APC Packaged Rates , $588.93 , $588.93 , $604.09 , $604.09 , See APC Packaged Rates , $437.00 , $461.66 , $437.00 ," $1,939.90 "," $1,615.60 "
73722,5170040047,Hospital Chargemaster,MRI joint of lwr extr w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,610," $2,314.00 "," $1,272.70 "," $1,906.74 ", $855.31 ," $1,619.80 ", $902.46 ," $2,799.56 "," $1,449.22 "," $1,422.33 ", $855.31 , $855.31 ," $1,308.50 "," $1,268.80 ", $898.07 , $872.41 , $318.00 , $318.00 , $318.00 , $318.00 , $855.31 , $437.00 ," $1,037.63 ", $318.00 ," $2,799.56 "," $1,619.80 "
73722,5170050047,Hospital Chargemaster,MRI joint of lwr extr w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,610," $2,314.00 "," $1,272.70 "," $1,906.74 ", $855.31 ," $1,619.80 ", $902.46 ," $2,799.56 "," $1,449.22 "," $1,422.33 ", $855.31 , $855.31 ," $1,308.50 "," $1,268.80 ", $898.07 , $872.41 , $318.00 , $318.00 , $318.00 , $318.00 , $855.31 , $437.00 ," $1,037.63 ", $318.00 ," $2,799.56 "," $1,619.80 "
73219,5170040037,Hospital Chargemaster,MRI upper extr w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,532.00 ", $842.60 ," $1,262.37 ", $440.24 ," $1,072.40 ", $597.48 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,308.50 "," $1,268.80 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $437.00 , $578.82 , $437.00 ," $1,561.69 "," $1,072.40 "
73219,5170050037,Hospital Chargemaster,MRI upper extr w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,532.00 ", $842.60 ," $1,262.37 ", $440.24 ," $1,072.40 ", $597.48 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,308.50 "," $1,268.80 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $437.00 , $578.82 , $437.00 ," $1,561.69 "," $1,072.40 "
73222,5170040040,Hospital Chargemaster,MRI joint upr extrem w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,544.00 ", $849.20 ," $1,272.26 ", $855.31 ," $1,080.80 ", $602.16 ," $2,799.56 "," $1,449.22 "," $1,422.33 ", $855.31 , $855.31 ," $1,308.50 "," $1,268.80 ", $898.07 , $872.41 ," $1,235.84 "," $1,235.84 "," $1,267.65 "," $1,267.65 ", $855.31 , $437.00 ," $1,037.63 ", $437.00 ," $2,799.56 "," $1,080.80 "
73222,5170050040,Hospital Chargemaster,MRI joint upr extrem w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,544.00 ", $849.20 ," $1,272.26 ", $855.31 ," $1,080.80 ", $602.16 ," $2,799.56 "," $1,449.22 "," $1,422.33 ", $855.31 , $855.31 ," $1,308.50 "," $1,268.80 ", $898.07 , $872.41 ," $1,235.84 "," $1,235.84 "," $1,267.65 "," $1,267.65 ", $855.31 , $437.00 ," $1,037.63 ", $437.00 ," $2,799.56 "," $1,080.80 "
73719,5170040044,Hospital Chargemaster,MRI lower extr w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,600.00 ", $880.00 ," $1,318.40 ", $440.24 ," $1,120.00 ", $624.00 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,308.50 "," $1,268.80 ", $462.26 , $449.05 , $313.00 , $313.00 , $313.00 , $313.00 , $440.24 , $437.00 , $578.82 , $313.00 ," $1,561.69 "," $1,120.00 "
73719,5170050044,Hospital Chargemaster,MRI lower extr w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,600.00 ", $880.00 ," $1,318.40 ", $440.24 ," $1,120.00 ", $624.00 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,308.50 "," $1,268.80 ", $462.26 , $449.05 , $313.00 , $313.00 , $313.00 , $313.00 , $440.24 , $437.00 , $578.82 , $313.00 ," $1,561.69 "," $1,120.00 "
73221,5170040039,Hospital Chargemaster,MRI joint upr extrem wo dye LT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,626.00 ", $894.30 ," $1,339.82 ", $275.09 ," $1,138.20 ", $634.14 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,361.27 "," $1,138.20 "
73718,5170040043,Hospital Chargemaster,MRI lower extr wo dye LT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,582.00 ", $870.10 ," $1,303.57 ", $275.09 ," $1,107.40 ", $616.98 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,090.74 "," $1,057.65 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,303.57 "," $1,107.40 "
73721,5170040046,Hospital Chargemaster,MRI jnt of lwr extre wo dye LT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,645.00 ", $904.75 ," $1,355.48 ", $275.09 ," $1,151.50 ", $641.55 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $262.00 , $262.00 , $262.00 , $262.00 , $275.09 , $437.00 , $345.84 , $262.00 ," $1,361.27 "," $1,151.50 "
73221,5170050039,Hospital Chargemaster,MRI joint upr extrem wo dye RT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,626.00 ", $894.30 ," $1,339.82 ", $275.09 ," $1,138.20 ", $634.14 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,361.27 "," $1,138.20 "
73718,5170050043,Hospital Chargemaster,MRI lower extr wo dye RT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,582.00 ", $870.10 ," $1,303.57 ", $275.09 ," $1,107.40 ", $616.98 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,090.74 "," $1,057.65 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,303.57 "," $1,107.40 "
73721,5170050046,Hospital Chargemaster,MRI jnt of lwr extre wo dye RT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,645.00 ", $904.75 ," $1,355.48 ", $275.09 ," $1,151.50 ", $641.55 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $262.00 , $262.00 , $262.00 , $262.00 , $275.09 , $437.00 , $345.84 , $262.00 ," $1,361.27 "," $1,151.50 "
73218,5170040036,Hospital Chargemaster,MRI upper extr wo dye LT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,523.00 ", $837.65 ," $1,254.95 ", $275.09 ," $1,066.10 ", $593.97 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,090.74 "," $1,057.65 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,254.95 "," $1,066.10 "
73218,5170050036,Hospital Chargemaster,MRI upper extr wo dye RT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,523.00 ", $837.65 ," $1,254.95 ", $275.09 ," $1,066.10 ", $593.97 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,090.74 "," $1,057.65 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,254.95 "," $1,066.10 "
71555,5170010021,Hospital Chargemaster,MRI angio chest w or w/o dye,Outpatient,Outpatient Default Percent / Case Rate,610," $2,288.00 "," $1,258.40 "," $1,885.31 ", See APC Packaged Rates ," $1,601.60 ", $892.32 ," $1,928.54 ", $998.33 , $979.80 , See APC Packaged Rates , See APC Packaged Rates ," $1,431.17 "," $1,387.74 ", See APC Packaged Rates , See APC Packaged Rates , $562.38 , $562.38 , $576.86 , $576.86 , See APC Packaged Rates , $437.00 , $458.96 , $437.00 ," $1,928.54 "," $1,601.60 "
73725,5170040049,Hospital Chargemaster,MRA ang lwr ext w or wo dye LT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,522.00 ", $837.10 ," $1,254.13 ", See APC Packaged Rates ," $1,065.40 ", $593.58 ," $1,942.17 "," $1,005.38 ", $986.72 , See APC Packaged Rates , See APC Packaged Rates ," $1,361.27 "," $1,319.97 ", See APC Packaged Rates , See APC Packaged Rates , $858.82 , $858.82 , $880.93 , $880.93 , See APC Packaged Rates , $437.00 , $462.20 , $437.00 ," $1,942.17 "," $1,065.40 "
73725,5170050049,Hospital Chargemaster,MRA ang lwr ext w or wo dye RT,Outpatient,Outpatient Default Percent / Case Rate,610," $1,522.00 ", $837.10 ," $1,254.13 ", See APC Packaged Rates ," $1,065.40 ", $593.58 ," $1,942.17 "," $1,005.38 ", $986.72 , See APC Packaged Rates , See APC Packaged Rates ," $1,361.27 "," $1,319.97 ", See APC Packaged Rates , See APC Packaged Rates , $858.82 , $858.82 , $880.93 , $880.93 , See APC Packaged Rates , $437.00 , $462.20 , $437.00 ," $1,942.17 "," $1,065.40 "
73725,5170060049,Hospital Chargemaster,MR Ang Lwr Ext w or wo Dye Bi,Outpatient,Outpatient Default Percent / Case Rate,610," $1,522.00 ", $837.10 ," $1,254.13 ", See APC Packaged Rates ," $1,065.40 ", $593.58 ," $1,942.17 "," $1,005.38 ", $986.72 , See APC Packaged Rates , See APC Packaged Rates ," $1,361.27 "," $1,319.97 ", See APC Packaged Rates , See APC Packaged Rates , $858.82 , $858.82 , $880.93 , $880.93 , See APC Packaged Rates , $437.00 , $462.20 , $437.00 ," $1,942.17 "," $1,065.40 "
70553,5170010012,Hospital Chargemaster,MRI brain stem w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,611," $3,294.00 "," $1,811.70 "," $2,714.26 ", $440.24 ," $2,305.80 "," $1,284.66 "," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,714.26 "," $2,305.80 "
70552,5170010011,Hospital Chargemaster,MRI brain stem w/dye,Outpatient,Outpatient Default Percent / Case Rate,611," $2,942.00 "," $1,618.10 "," $2,424.21 ", $440.24 ," $2,059.40 "," $1,147.38 "," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,424.21 "," $2,059.40 "
70551,5170010010,Hospital Chargemaster,MRI brain stem w/o dye,Outpatient,Outpatient Default Percent / Case Rate,611," $1,705.00 ", $937.75 ," $1,404.92 ", $275.09 ," $1,193.50 ", $664.95 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,404.92 "," $1,193.50 "
70545,5170010005,Hospital Chargemaster,MRA angiography head w/dye,Outpatient,Outpatient Default Percent / Case Rate,615," $1,470.00 ", $808.50 ," $1,211.28 ", $440.24 ," $1,029.00 ", $573.30 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,102.58 "," $1,069.13 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $437.00 , $578.82 , $437.00 ," $1,561.69 "," $1,029.00 "
70548,5170010008,Hospital Chargemaster,MRA angiography neck w/dye,Outpatient,Outpatient Default Percent / Case Rate,615," $1,850.00 "," $1,017.50 "," $1,524.40 ", $440.24 ," $1,295.00 ", $721.50 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,102.58 "," $1,069.13 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $437.00 , $578.82 , $437.00 ," $1,561.69 "," $1,295.00 "
70546,5170010006,Hospital Chargemaster,MRA angiograph head w/o&w/dye,Outpatient,Outpatient Default Percent / Case Rate,615," $2,400.00 "," $1,320.00 "," $1,977.60 ", $440.24 ," $1,680.00 ", $936.00 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,172.01 "," $2,106.11 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,172.01 "," $1,680.00 "
70549,5170010009,Hospital Chargemaster,MRA angiograph neck w/o&w/dye,Outpatient,Outpatient Default Percent / Case Rate,615," $2,302.00 "," $1,266.10 "," $1,896.85 ", $440.24 ," $1,611.40 ", $897.78 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,172.01 "," $2,106.11 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $437.00 , $578.82 , $437.00 ," $2,172.01 "," $1,611.40 "
70544,5170010004,Hospital Chargemaster,MRA angiography head w/o dye,Outpatient,Outpatient Default Percent / Case Rate,615," $1,470.00 ", $808.50 ," $1,211.28 ", $275.09 ," $1,029.00 ", $573.30 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,102.58 "," $1,069.13 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,211.28 "," $1,029.00 "
70547,5170010007,Hospital Chargemaster,MRA angiography neck w/o dye,Outpatient,Outpatient Default Percent / Case Rate,615," $1,474.00 ", $810.70 ," $1,214.58 ", $275.09 ," $1,031.80 ", $574.86 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,102.58 "," $1,069.13 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $437.00 , $345.84 , $275.09 ," $1,214.58 "," $1,031.80 "
72198,5170010035,Hospital Chargemaster,MRA angio pelvis w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,616," $2,035.00 "," $1,119.25 "," $1,676.84 ", See APC Packaged Rates ," $1,424.50 ", $793.65 ," $1,944.43 "," $1,006.56 ", $987.88 , See APC Packaged Rates , See APC Packaged Rates ," $1,028.36 ", $997.16 , See APC Packaged Rates , See APC Packaged Rates , $567.15 , $567.15 , $581.75 , $581.75 , See APC Packaged Rates , $437.00 , $462.74 , $437.00 ," $1,944.43 "," $1,424.50 "
74185,5170010053,Hospital Chargemaster,MRI angio abdom w orw/o dye,Outpatient,Outpatient Default Percent / Case Rate,618," $1,470.00 ", $808.50 ," $1,211.28 ", See APC Packaged Rates ," $1,029.00 ", $573.30 ," $1,951.26 "," $1,010.09 ", $991.35 , See APC Packaged Rates , See APC Packaged Rates ," $1,028.36 ", $997.16 , See APC Packaged Rates , See APC Packaged Rates , $569.87 , $569.87 , $584.54 , $584.54 , See APC Packaged Rates , $437.00 , $464.37 , $437.00 ," $1,951.26 "," $1,029.00 "
76390,5170010056,Hospital Chargemaster,MRI spectroscopy,Outpatient,Outpatient Default Percent / Case Rate,618," $1,311.00 ", $721.05 ," $1,080.26 ", $96.70 , $917.70 , $511.29 ," $2,346.82 "," $1,214.85 "," $1,192.31 ", $96.70 , $96.70 ," $1,431.17 "," $1,387.74 ", $101.54 , $98.64 , $679.02 , $679.02 , $696.50 , $696.50 , $96.70 , $437.00 , $558.42 , $96.70 ," $2,346.82 ", $917.70
J1453,5710011038,Hospital Chargemaster,Fosaprepitant 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $333.47 , $183.41 , $133.39 , See APC Packaged Rates , $233.43 , $130.05 , $0.79 , $0.79 , $0.79 , See APC Packaged Rates , See APC Packaged Rates , $223.76 , $223.76 , See APC Packaged Rates , See APC Packaged Rates , $310.13 , $310.13 , $310.13 , $310.13 , See APC Packaged Rates , $116.71 , $- , $- , $310.13 , $233.43
J9025,5710010230,Hospital Chargemaster,azaCITIDine 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $680.00 , $374.00 , $272.00 , $1.09 , $476.00 , $265.20 , $0.80 , $0.80 , $0.80 , $1.09 , $1.09 , $456.28 , $456.28 , $1.14 , $1.11 , $632.40 , $632.40 , $632.40 , $632.40 , $1.09 , $238.00 , $0.89 , $0.80 , $632.40 , $476.00
J1442,5710010969,Hospital Chargemaster,Filgrastim (g-csf) 1 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $1.14 , $- , $- , $0.93 , $0.93 , $0.93 , $1.14 , $1.14 , $- , $- , $1.19 , $1.16 , $- , $- , $- , $- , $1.14 , $- , $0.98 , $- , $1.19 , $-
J1442,5710010970,Hospital Chargemaster,Filgrastim (g-csf) 1 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $1.14 , $- , $- , $0.93 , $0.93 , $0.93 , $1.14 , $1.14 , $- , $- , $1.19 , $1.16 , $- , $- , $- , $- , $1.14 , $- , $0.98 , $- , $1.19 , $-
J1442,5710010971,Hospital Chargemaster,Filgrastim (g-csf) 1 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $1.14 , $- , $- , $0.93 , $0.93 , $0.93 , $1.14 , $1.14 , $- , $- , $1.19 , $1.16 , $- , $- , $- , $- , $1.14 , $- , $0.98 , $- , $1.19 , $-
J1442,5710010972,Hospital Chargemaster,Filgrastim (g-csf) 1 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $1,278.39 ", $703.11 , $511.36 , $1.14 , $894.87 , $498.57 , $0.93 , $0.93 , $0.93 , $1.14 , $1.14 , $857.80 , $857.80 , $1.19 , $1.16 ," $1,188.90 "," $1,188.90 "," $1,188.90 "," $1,188.90 ", $1.14 , $447.44 , $0.98 , $0.93 ," $1,188.90 ", $894.87
C9132,5710011152,Hospital Chargemaster,Prothrombin Cmplx KCentra IU,Outpatient,Outpatient Default Percent / Case Rate,636," $4,651.20 "," $2,558.16 "," $1,860.48 ", See APC Packaged Rates ," $3,255.84 "," $1,813.97 ", $2.85 , $2.85 , $2.85 , See APC Packaged Rates , See APC Packaged Rates ," $3,120.96 "," $3,120.96 ", See APC Packaged Rates , See APC Packaged Rates ," $4,325.62 "," $4,325.62 "," $4,325.62 "," $4,325.62 ", See APC Packaged Rates ," $1,627.92 ", Not Applicable , $2.85 ," $4,325.62 "," $3,255.84 "
C9132,5710011153,Hospital Chargemaster,Prothrombin Cmplx KCentra IU,Outpatient,Outpatient Default Percent / Case Rate,636," $2,359.51 "," $1,297.73 ", $943.80 , See APC Packaged Rates ," $1,651.66 ", $920.21 , $2.85 , $2.85 , $2.85 , See APC Packaged Rates , See APC Packaged Rates ," $1,583.23 "," $1,583.23 ", See APC Packaged Rates , See APC Packaged Rates ," $2,194.34 "," $2,194.34 "," $2,194.34 "," $2,194.34 ", See APC Packaged Rates , $825.83 , Not Applicable , $2.85 ," $2,194.34 "," $1,651.66 "
J0712,5710010454,Hospital Chargemaster,cefTAROLine Fosamil 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $4.11 , $- , $- , $3.32 , $3.32 , $3.32 , $4.11 , $4.11 , $- , $- , $4.31 , $4.19 , $- , $- , $- , $- , $4.11 , $- , $3.57 , $- , $4.31 , $-
J0881,5710010638,Hospital Chargemaster,Darbepoetin 1 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $3.69 , $- , $- , $3.72 , $3.72 , $3.72 , $3.69 , $3.69 , $- , $- , $3.88 , $3.77 , $- , $- , $- , $- , $3.69 , $- , $3.09 , $- , $3.88 , $-
J0881,5710010639,Hospital Chargemaster,Darbepoetin 1 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $3.69 , $- , $- , $3.72 , $3.72 , $3.72 , $3.69 , $3.69 , $- , $- , $3.88 , $3.77 , $- , $- , $- , $- , $3.69 , $- , $3.09 , $- , $3.88 , $-
J0881,5710010640,Hospital Chargemaster,Darbepoetin 1 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $3.69 , $- , $- , $3.72 , $3.72 , $3.72 , $3.69 , $3.69 , $- , $- , $3.88 , $3.77 , $- , $- , $- , $- , $3.69 , $- , $3.09 , $- , $3.88 , $-
J0894,5710010644,Hospital Chargemaster,Decitabine 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $4,184.83 "," $2,301.66 "," $1,673.93 ", $4.04 ," $2,929.38 "," $1,632.08 ", $4.26 , $4.26 , $4.26 , $4.04 , $4.04 ," $2,808.02 "," $2,808.02 ", $4.24 , $4.12 ," $3,891.89 "," $3,891.89 "," $3,891.89 "," $3,891.89 ", $4.04 ," $1,464.69 ", $2.88 , $2.88 ," $3,891.89 "," $2,929.38 "
J1451,5710011032,Hospital Chargemaster,Fomepizole 15 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $3,142.01 "," $1,728.11 "," $1,256.80 ", $7.00 ," $2,199.41 "," $1,225.38 ", $12.21 , $12.21 , $12.21 , $7.00 , $7.00 ," $2,108.29 "," $2,108.29 ", $7.35 , $7.14 ," $2,922.07 "," $2,922.07 "," $2,922.07 "," $2,922.07 ", $7.00 ," $1,099.70 ", $5.38 , $5.38 ," $2,922.07 "," $2,199.41 "
J3262,5710012388,Hospital Chargemaster,Tocilizumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $2,939.90 "," $1,616.95 "," $1,175.96 ", $6.50 ," $2,057.93 "," $1,146.56 ", $5.40 , $5.40 , $5.40 , $6.50 , $6.50 ," $1,972.67 "," $1,972.67 ", $6.83 , $6.63 ," $2,734.11 "," $2,734.11 "," $2,734.11 "," $2,734.11 ", $6.50 ," $1,028.97 ", $5.73 , $5.40 ," $2,734.11 "," $2,057.93 "
J3262,5710012389,Hospital Chargemaster,Tocilizumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $5,879.79 "," $3,233.88 "," $2,351.92 ", $6.50 ," $4,115.85 "," $2,293.12 ", $5.40 , $5.40 , $5.40 , $6.50 , $6.50 ," $3,945.34 "," $3,945.34 ", $6.83 , $6.63 ," $5,468.20 "," $5,468.20 "," $5,468.20 "," $5,468.20 ", $6.50 ," $2,057.93 ", $5.73 , $5.40 ," $5,468.20 "," $4,115.85 "
J3262,5710012390,Hospital Chargemaster,Tocilizumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $1,175.96 ", $646.78 , $470.38 , $6.50 , $823.17 , $458.62 , $5.40 , $5.40 , $5.40 , $6.50 , $6.50 , $789.07 , $789.07 , $6.83 , $6.63 ," $1,093.64 "," $1,093.64 "," $1,093.64 "," $1,093.64 ", $6.50 , $411.59 , $5.73 , $5.40 ," $1,093.64 ", $823.17
J0585,5710011841,Hospital Chargemaster,Onabotulinumtoxina 1 Unit Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $1,537.91 ", $845.85 , $615.16 , $7.12 ," $1,076.54 ", $599.78 , $6.08 , $6.08 , $6.08 , $7.12 , $7.12 ," $1,031.94 "," $1,031.94 ", $7.48 , $7.27 ," $1,430.26 "," $1,430.26 "," $1,430.26 "," $1,430.26 ", $7.12 , $538.27 , $6.19 , $6.08 ," $1,430.26 "," $1,076.54 "
J0585,5710011842,Hospital Chargemaster,Onabotulinumtoxina 1 Unit Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $7.12 , $- , $- , $6.08 , $6.08 , $6.08 , $7.12 , $7.12 , $- , $- , $7.48 , $7.27 , $- , $- , $- , $- , $7.12 , $- , $6.19 , $- , $7.48 , $-
J9176,5710010847,Hospital Chargemaster,Elotuzumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $5,043.06 "," $2,773.68 "," $2,017.22 ", $7.93 ," $3,530.14 "," $1,966.79 ", $6.67 , $6.67 , $6.67 , $7.93 , $7.93 ," $3,383.89 "," $3,383.89 ", $8.32 , $8.08 ," $4,690.05 "," $4,690.05 "," $4,690.05 "," $4,690.05 ", $7.93 ," $1,765.07 ", $6.86 , $6.67 ," $4,690.05 "," $3,530.14 "
J0885,5710010883,Hospital Chargemaster,Epoetin non-ESRD 1000 Unit Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $9.54 , $- , $- , $9.11 , $9.11 , $9.11 , $9.54 , $9.54 , $- , $- , $10.02 , $9.73 , $- , $- , $- , $- , $9.54 , $- , $8.22 , $- , $10.02 , $-
J0885,5710010884,Hospital Chargemaster,Epoetin non-ESRD 1000 Unit Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $1,362.98 ", $749.64 , $545.19 , $9.54 , $954.09 , $531.56 , $9.11 , $9.11 , $9.11 , $9.54 , $9.54 , $914.56 , $914.56 , $10.02 , $9.73 ," $1,267.57 "," $1,267.57 "," $1,267.57 "," $1,267.57 ", $9.54 , $477.04 , $8.22 , $8.22 ," $1,267.57 ", $954.09
J0885,5710010885,Hospital Chargemaster,Epoetin non-ESRD 1000 Unit Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $9.54 , $- , $- , $9.11 , $9.11 , $9.11 , $9.54 , $9.54 , $- , $- , $10.02 , $9.73 , $- , $- , $- , $- , $9.54 , $- , $8.22 , $- , $10.02 , $-
J0885,5710010886,Hospital Chargemaster,Epoetin non-ESRD 1000 Unit Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $9.54 , $- , $- , $9.11 , $9.11 , $9.11 , $9.54 , $9.54 , $- , $- , $10.02 , $9.73 , $- , $- , $- , $- , $9.54 , $- , $8.22 , $- , $10.02 , $-
J0885,5710010887,Hospital Chargemaster,Epoetin non-ESRD 1000 Unit Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $9.54 , $- , $- , $9.11 , $9.11 , $9.11 , $9.54 , $9.54 , $- , $- , $10.02 , $9.73 , $- , $- , $- , $- , $9.54 , $- , $8.22 , $- , $10.02 , $-
J7325,5710011210,Hospital Chargemaster,Hyaluran (Synvisc) 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $1,164.18 ", $640.30 , $465.67 , $13.15 , $814.93 , $454.03 , $10.22 , $10.22 , $10.22 , $13.15 , $13.15 , $781.16 , $781.16 , $13.81 , $13.42 ," $1,082.69 "," $1,082.69 "," $1,082.69 "," $1,082.69 ", $13.15 , $407.46 , $10.43 , $10.22 ," $1,082.69 ", $814.93
J7325,5710011211,Hospital Chargemaster,Hyaluran (Synvisc) 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $13.15 , $- , $- , $10.22 , $10.22 , $10.22 , $13.15 , $13.15 , $- , $- , $13.81 , $13.42 , $- , $- , $- , $- , $13.15 , $- , $10.43 , $- , $13.81 , $-
J2597,5710010652,Hospital Chargemaster,Desmopressin 1 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $206.91 , $113.80 , $82.76 , $11.01 , $144.84 , $80.69 , $10.45 , $10.45 , $10.45 , $11.01 , $11.01 , $138.84 , $138.84 , $11.56 , $11.23 , $192.43 , $192.43 , $192.43 , $192.43 , $11.01 , $72.42 , $9.29 , $9.29 , $192.43 , $144.84
J2597,5710010654,Hospital Chargemaster,Desmopressin 1 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $11.01 , $- , $- , $10.45 , $10.45 , $10.45 , $11.01 , $11.01 , $- , $- , $11.56 , $11.23 , $- , $- , $- , $- , $11.01 , $- , $9.29 , $- , $11.56 , $-
J2794,5710012182,Hospital Chargemaster,risperiDONE LA 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $12.93 , $- , $- , $10.53 , $10.53 , $10.53 , $12.93 , $12.93 , $- , $- , $13.57 , $13.18 , $- , $- , $- , $- , $12.93 , $- , $11.04 , $- , $13.57 , $-
J2794,5710012183,Hospital Chargemaster,risperiDONE LA 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $1,358.92 ", $747.41 , $543.57 , $12.93 , $951.24 , $529.98 , $10.53 , $10.53 , $10.53 , $12.93 , $12.93 , $911.84 , $911.84 , $13.57 , $13.18 ," $1,263.80 "," $1,263.80 "," $1,263.80 "," $1,263.80 ", $12.93 , $475.62 , $11.04 , $10.53 ," $1,263.80 ", $951.24
J2794,5710012184,Hospital Chargemaster,risperiDONE LA 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $1,945.11 "," $1,069.81 ", $778.04 , $12.93 ," $1,361.58 ", $758.59 , $10.53 , $10.53 , $10.53 , $12.93 , $12.93 ," $1,305.17 "," $1,305.17 ", $13.57 , $13.18 ," $1,808.95 "," $1,808.95 "," $1,808.95 "," $1,808.95 ", $12.93 , $680.79 , $11.04 , $10.53 ," $1,808.95 "," $1,361.58 "
J2794,5710012185,Hospital Chargemaster,risperiDONE LA 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $2,593.53 "," $1,426.44 "," $1,037.41 ", $12.93 ," $1,815.47 "," $1,011.48 ", $10.53 , $10.53 , $10.53 , $12.93 , $12.93 ," $1,740.26 "," $1,740.26 ", $13.57 , $13.18 ," $2,411.98 "," $2,411.98 "," $2,411.98 "," $2,411.98 ", $12.93 , $907.74 , $11.04 , $10.53 ," $2,411.98 "," $1,815.47 "
J9306,5710011944,Hospital Chargemaster,Pertuzumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $10,975.25 "," $6,036.39 "," $4,390.10 ", $15.87 ," $7,682.68 "," $4,280.35 ", $12.95 , $12.95 , $12.95 , $15.87 , $15.87 ," $7,364.39 "," $7,364.39 ", $16.66 , $16.19 ," $10,206.98 "," $10,206.98 "," $10,206.98 "," $10,206.98 ", $15.87 ," $3,841.34 ", $13.56 , $12.95 ," $10,206.98 "," $7,682.68 "
J9264,5710011884,Hospital Chargemaster,PACLitaxel Protein-Bnd 1mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $3,818.34 "," $2,100.09 "," $1,527.34 ", $16.48 ," $2,672.84 "," $1,489.15 ", $13.30 , $13.30 , $13.30 , $16.48 , $16.48 ," $2,562.11 "," $2,562.11 ", $17.30 , $16.81 ," $3,551.06 "," $3,551.06 "," $3,551.06 "," $3,551.06 ", $16.48 ," $1,336.42 ", $14.04 , $13.30 ," $3,551.06 "," $2,672.84 "
J1726,5710030004,Hospital Chargemaster,"Makena, 10 MG",Outpatient,Outpatient Default Percent / Case Rate,636, $9.47 , $5.21 , $3.79 , $19.68 , $6.63 , $3.69 , $31.12 , $31.12 , $31.12 , $19.68 , $19.68 , $6.35 , $6.35 , $20.67 , $20.08 , $9.47 , $9.47 , $9.47 , $9.47 , $19.68 , $3.31 , $14.76 , $3.31 , $31.12 , $6.63
J1602,5710011109,Hospital Chargemaster,Golimumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $19.69 , $- , $- , $19.00 , $19.00 , $19.00 , $19.69 , $19.69 , $- , $- , $20.67 , $20.08 , $- , $- , $- , $- , $19.69 , $- , $16.10 , $- , $20.67 , $-
J9065,5710010540,Hospital Chargemaster,Cladribine 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $21.10 , $- , $- , $19.57 , $19.57 , $19.57 , $21.10 , $21.10 , $- , $- , $22.15 , $21.52 , $- , $- , $- , $- , $21.10 , $- , $15.08 , $- , $22.15 , $-
J0897,5710010649,Hospital Chargemaster,Denosumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $6,286.51 "," $3,457.58 "," $2,514.60 ", $24.80 ," $4,400.56 "," $2,451.74 ", $20.12 , $20.12 , $20.12 , $24.80 , $24.80 ," $4,218.25 "," $4,218.25 ", $26.04 , $25.30 ," $5,846.45 "," $5,846.45 "," $5,846.45 "," $5,846.45 ", $24.80 ," $2,200.28 ", $21.21 , $20.12 ," $5,846.45 "," $4,400.56 "
J9034,5710010264,Hospital Chargemaster,Bendamustine (Bendeka) 1mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $23.00 , $- , $- , $20.27 , $20.27 , $20.27 , $23.00 , $23.00 , $- , $- , $24.15 , $23.46 , $- , $- , $- , $- , $23.00 , $- , $19.08 , $- , $24.15 , $-
J3380,5710012477,Hospital Chargemaster,Vedolizumab1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $6,600.28 "," $3,630.15 "," $2,640.11 ", $24.91 ," $4,620.20 "," $2,574.11 ", $20.30 , $20.30 , $20.30 , $24.91 , $24.91 ," $4,428.79 "," $4,428.79 ", $26.15 , $25.41 ," $6,138.26 "," $6,138.26 "," $6,138.26 "," $6,138.26 ", $24.91 ," $2,310.10 ", $21.29 , $20.30 ," $6,138.26 "," $4,620.20 "
J9017,5710010192,Hospital Chargemaster,Arsenic Trioxide 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $15.35 , $- , $- , $22.06 , $22.06 , $22.06 , $15.35 , $15.35 , $- , $- , $16.12 , $15.66 , $- , $- , $- , $- , $15.35 , $- , $- , $- , $22.06 , $-
J9033,5710010263,Hospital Chargemaster,Bendamustine (Treanda) 1mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $25.77 , $- , $- , $24.69 , $24.69 , $24.69 , $25.77 , $25.77 , $- , $- , $27.06 , $26.28 , $- , $- , $- , $- , $25.77 , $- , $20.69 , $- , $27.06 , $-
J9033,5710010265,Hospital Chargemaster,Bendamustine (Treanda) 1mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $25.77 , $- , $- , $24.69 , $24.69 , $24.69 , $25.77 , $25.77 , $- , $- , $27.06 , $26.28 , $- , $- , $- , $- , $25.77 , $- , $20.69 , $- , $27.06 , $-
J0289,5710010153,Hospital Chargemaster,Amphotericin B Liposome 10 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $33.65 , $- , $- , $26.56 , $26.56 , $26.56 , $33.65 , $33.65 , $- , $- , $35.33 , $34.32 , $- , $- , $- , $- , $33.65 , $- , $29.47 , $- , $35.33 , $-
J9299,5710011796,Hospital Chargemaster,Nivolumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $33.79 , $- , $- , $28.56 , $28.56 , $28.56 , $33.79 , $33.79 , $- , $- , $35.48 , $34.46 , $- , $- , $- , $- , $33.79 , $- , $29.25 , $- , $35.48 , $-
J9299,5710011797,Hospital Chargemaster,Nivolumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $13,558.68 "," $7,457.27 "," $5,423.47 ", $33.79 ," $9,491.08 "," $5,287.89 ", $28.56 , $28.56 , $28.56 , $33.79 , $33.79 ," $9,097.87 "," $9,097.87 ", $35.48 , $34.46 ," $12,609.57 "," $12,609.57 "," $12,609.57 "," $12,609.57 ", $33.79 ," $4,745.54 ", $29.25 , $28.56 ," $12,609.57 "," $9,491.08 "
J9299,5710011798,Hospital Chargemaster,Nivolumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $33.79 , $- , $- , $28.56 , $28.56 , $28.56 , $33.79 , $33.79 , $- , $- , $35.48 , $34.46 , $- , $- , $- , $- , $33.79 , $- , $29.25 , $- , $35.48 , $-
J9293,5710011667,Hospital Chargemaster,mitoXANTRONE 5 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $30.77 , $- , $- , $28.69 , $28.69 , $28.69 , $30.77 , $30.77 , $- , $- , $32.31 , $31.38 , $- , $- , $- , $- , $30.77 , $- , $29.40 , $- , $32.31 , $-
J9293,5710011668,Hospital Chargemaster,mitoXANTRONE 5 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $30.77 , $- , $- , $28.69 , $28.69 , $28.69 , $30.77 , $30.77 , $- , $- , $32.31 , $31.38 , $- , $- , $- , $- , $30.77 , $- , $29.40 , $- , $32.31 , $-
J2182,5710011548,Hospital Chargemaster,Mepolizumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $7,204.65 "," $3,962.56 "," $2,881.86 ", $33.12 ," $5,043.26 "," $2,809.81 ", $28.70 , $28.70 , $28.70 , $33.12 , $33.12 ," $4,834.32 "," $4,834.32 ", $34.77 , $33.78 ," $6,700.32 "," $6,700.32 "," $6,700.32 "," $6,700.32 ", $33.12 ," $2,521.63 ", $28.69 , $28.69 ," $6,700.32 "," $5,043.26 "
J9070,5710010612,Hospital Chargemaster,Cyclophosphamide 100 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $2,101.35 "," $1,155.74 ", $840.54 , $34.13 ," $1,470.95 ", $819.53 , $29.67 , $29.67 , $29.67 , $34.13 , $34.13 ," $1,410.01 "," $1,410.01 ", $35.83 , $34.81 ," $1,954.26 "," $1,954.26 "," $1,954.26 "," $1,954.26 ", $34.13 , $735.47 , $27.47 , $27.47 ," $1,954.26 "," $1,470.95 "
J9070,5710010613,Hospital Chargemaster,Cyclophosphamide 100 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $34.13 , $- , $- , $29.67 , $29.67 , $29.67 , $34.13 , $34.13 , $- , $- , $35.83 , $34.81 , $- , $- , $- , $- , $34.13 , $- , $27.47 , $- , $35.83 , $-
J9070,5710010614,Hospital Chargemaster,Cyclophosphamide 100 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $933.94 , $513.67 , $373.58 , $34.13 , $653.76 , $364.24 , $29.67 , $29.67 , $29.67 , $34.13 , $34.13 , $626.67 , $626.67 , $35.83 , $34.81 , $868.56 , $868.56 , $868.56 , $868.56 , $34.13 , $326.88 , $27.47 , $27.47 , $868.56 , $653.76
J9354,5710010075,Hospital Chargemaster,Ado-Trastuzumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $8,315.43 "," $4,573.49 "," $3,326.17 ", $40.02 ," $5,820.80 "," $3,243.02 ", $32.79 , $32.79 , $32.79 , $40.02 , $40.02 ," $5,579.65 "," $5,579.65 ", $42.02 , $40.82 ," $7,733.35 "," $7,733.35 "," $7,733.35 "," $7,733.35 ", $40.02 ," $2,910.40 ", $34.15 , $32.79 ," $7,733.35 "," $5,820.80 "
J9354,5710010076,Hospital Chargemaster,Ado-Trastuzumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $10,435.04 "," $5,739.27 "," $4,174.02 ", $40.02 ," $7,304.53 "," $4,069.67 ", $32.79 , $32.79 , $32.79 , $40.02 , $40.02 ," $7,001.91 "," $7,001.91 ", $42.02 , $40.82 ," $9,704.59 "," $9,704.59 "," $9,704.59 "," $9,704.59 ", $40.02 ," $3,652.26 ", $34.15 , $32.79 ," $9,704.59 "," $7,304.53 "
J9214,5710011272,Hospital Chargemaster,Interferon Alfa-2b 1 MU Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $38.91 , $- , $- , $34.35 , $34.35 , $34.35 , $38.91 , $38.91 , $- , $- , $40.85 , $39.69 , $- , $- , $- , $- , $38.91 , $- , $32.74 , $- , $40.85 , $-
J9214,5710011273,Hospital Chargemaster,Interferon Alfa-2b 1 MU Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $38.91 , $- , $- , $34.35 , $34.35 , $34.35 , $38.91 , $38.91 , $- , $- , $40.85 , $39.69 , $- , $- , $- , $- , $38.91 , $- , $32.74 , $- , $40.85 , $-
J9214,5710011274,Hospital Chargemaster,Interferon Alfa-2b 1 MU Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $38.91 , $- , $- , $34.35 , $34.35 , $34.35 , $38.91 , $38.91 , $- , $- , $40.85 , $39.69 , $- , $- , $- , $- , $38.91 , $- , $32.74 , $- , $40.85 , $-
J2792,5710012158,Hospital Chargemaster,Rho(D) Immune Glob 100 units,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $36.77 , $- , $- , $36.37 , $36.37 , $36.37 , $36.77 , $36.77 , $- , $- , $38.61 , $37.51 , $- , $- , $- , $- , $36.77 , $- , $31.52 , $- , $38.61 , $-
J2792,5710012159,Hospital Chargemaster,Rho(D) Immune Glob 100 units,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $36.77 , $- , $- , $36.37 , $36.37 , $36.37 , $36.77 , $36.77 , $- , $- , $38.61 , $37.51 , $- , $- , $- , $- , $36.77 , $- , $31.52 , $- , $38.61 , $-
J2792,5710012160,Hospital Chargemaster,Rho(D) Immune Glob 100 units,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $36.77 , $- , $- , $36.37 , $36.37 , $36.37 , $36.77 , $36.77 , $- , $- , $38.61 , $37.51 , $- , $- , $- , $- , $36.77 , $- , $31.52 , $- , $38.61 , $-
J2357,5710011834,Hospital Chargemaster,Omalizumab 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $1,711.80 ", $941.49 , $684.72 , $44.09 ," $1,198.26 ", $667.60 , $37.70 , $37.70 , $37.70 , $44.09 , $44.09 ," $1,148.62 "," $1,148.62 ", $46.30 , $44.98 ," $1,591.97 "," $1,591.97 "," $1,591.97 "," $1,591.97 ", $44.09 , $599.13 , $37.51 , $37.51 ," $1,591.97 "," $1,198.26 "
J2357,5710011835,Hospital Chargemaster,Omalizumab 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $842.22 , $463.22 , $336.89 , $44.09 , $589.55 , $328.47 , $37.70 , $37.70 , $37.70 , $44.09 , $44.09 , $565.13 , $565.13 , $46.30 , $44.98 , $783.26 , $783.26 , $783.26 , $783.26 , $44.09 , $294.78 , $37.51 , $37.51 , $783.26 , $589.55
J9047,5710010413,Hospital Chargemaster,Carfilzomib 1 mg Injl,Outpatient,Outpatient Default Percent / Case Rate,636," $6,576.73 "," $3,617.20 "," $2,630.69 ", $48.11 ," $4,603.71 "," $2,564.92 ", $39.20 , $39.20 , $39.20 , $48.11 , $48.11 ," $4,412.99 "," $4,412.99 ", $50.52 , $49.08 ," $6,116.36 "," $6,116.36 "," $6,116.36 "," $6,116.36 ", $48.11 ," $2,301.86 ", $41.11 , $39.20 ," $6,116.36 "," $4,603.71 "
J1572,5710011235,Hospital Chargemaster,Immune Glob Flebogamma 500 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $43.08 , $- , $- , $40.38 , $40.38 , $40.38 , $43.08 , $43.08 , $- , $- , $45.24 , $43.94 , $- , $- , $- , $- , $43.08 , $- , $35.89 , $- , $45.24 , $-
J1572,5710011236,Hospital Chargemaster,Immune Glob Flebogamma 500 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $43.08 , $- , $- , $40.38 , $40.38 , $40.38 , $43.08 , $43.08 , $- , $- , $45.24 , $43.94 , $- , $- , $- , $- , $43.08 , $- , $35.89 , $- , $45.24 , $-
J1572,5710011237,Hospital Chargemaster,Immune Glob Flebogamma 500 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $43.08 , $- , $- , $40.38 , $40.38 , $40.38 , $43.08 , $43.08 , $- , $- , $45.24 , $43.94 , $- , $- , $- , $- , $43.08 , $- , $35.89 , $- , $45.24 , $-
J1572,5710011238,Hospital Chargemaster,Immune Glob Flebogamma 500 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $43.08 , $- , $- , $40.38 , $40.38 , $40.38 , $43.08 , $43.08 , $- , $- , $45.24 , $43.94 , $- , $- , $- , $- , $43.08 , $- , $35.89 , $- , $45.24 , $-
J1572,5710011239,Hospital Chargemaster,Immune Glob Flebogamma 500 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $43.08 , $- , $- , $40.38 , $40.38 , $40.38 , $43.08 , $43.08 , $- , $- , $45.24 , $43.94 , $- , $- , $- , $- , $43.08 , $- , $35.89 , $- , $45.24 , $-
J1572,5710011240,Hospital Chargemaster,Immune Glob Flebogamma 500 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $43.08 , $- , $- , $40.38 , $40.38 , $40.38 , $43.08 , $43.08 , $- , $- , $45.24 , $43.94 , $- , $- , $- , $- , $43.08 , $- , $35.89 , $- , $45.24 , $-
J1572,5710011241,Hospital Chargemaster,Immune Glob Flebogamma 500 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $43.08 , $- , $- , $40.38 , $40.38 , $40.38 , $43.08 , $43.08 , $- , $- , $45.24 , $43.94 , $- , $- , $- , $- , $43.08 , $- , $35.89 , $- , $45.24 , $-
J1561,5710011249,Hospital Chargemaster,Immune Globulin Gamunex 500mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $56.44 , $- , $- , $42.19 , $42.19 , $42.19 , $56.44 , $56.44 , $- , $- , $59.27 , $57.57 , $- , $- , $- , $- , $56.44 , $- , $46.51 , $- , $59.27 , $-
J1561,5710011250,Hospital Chargemaster,Immune Globulin Gamunex 500mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $56.44 , $- , $- , $42.19 , $42.19 , $42.19 , $56.44 , $56.44 , $- , $- , $59.27 , $57.57 , $- , $- , $- , $- , $56.44 , $- , $46.51 , $- , $59.27 , $-
J1561,5710011251,Hospital Chargemaster,Immune Globulin Gamunex 500mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $56.44 , $- , $- , $42.19 , $42.19 , $42.19 , $56.44 , $56.44 , $- , $- , $59.27 , $57.57 , $- , $- , $- , $- , $56.44 , $- , $46.51 , $- , $59.27 , $-
J1561,5710011252,Hospital Chargemaster,Immune Globulin Gamunex 500mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $56.44 , $- , $- , $42.19 , $42.19 , $42.19 , $56.44 , $56.44 , $- , $- , $59.27 , $57.57 , $- , $- , $- , $- , $56.44 , $- , $46.51 , $- , $59.27 , $-
J1561,5710011253,Hospital Chargemaster,Immune Globulin Gamunex 500mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $56.44 , $- , $- , $42.19 , $42.19 , $42.19 , $56.44 , $56.44 , $- , $- , $59.27 , $57.57 , $- , $- , $- , $- , $56.44 , $- , $46.51 , $- , $59.27 , $-
J1561,5710011254,Hospital Chargemaster,Immune Globulin Gamunex 500mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $56.44 , $- , $- , $42.19 , $42.19 , $42.19 , $56.44 , $56.44 , $- , $- , $59.27 , $57.57 , $- , $- , $- , $- , $56.44 , $- , $46.51 , $- , $59.27 , $-
J1569,5710011242,Hospital Chargemaster,Immune Glob Gammagard 500 mg,Outpatient,Outpatient Default Percent / Case Rate,636," $5,678.86 "," $3,123.37 "," $2,271.54 ", $52.08 ," $3,975.20 "," $2,214.76 ", $43.20 , $43.20 , $43.20 , $52.08 , $52.08 ," $3,810.52 "," $3,810.52 ", $54.68 , $53.12 ," $5,281.34 "," $5,281.34 "," $5,281.34 "," $5,281.34 ", $52.08 ," $1,987.60 ", $46.67 , $43.20 ," $5,281.34 "," $3,975.20 "
J1569,5710011243,Hospital Chargemaster,Immune Glob Gammagard 500 mg,Outpatient,Outpatient Default Percent / Case Rate,636," $7,428.97 "," $4,085.93 "," $2,971.59 ", $52.08 ," $5,200.28 "," $2,897.30 ", $43.20 , $43.20 , $43.20 , $52.08 , $52.08 ," $4,984.84 "," $4,984.84 ", $54.68 , $53.12 ," $6,908.94 "," $6,908.94 "," $6,908.94 "," $6,908.94 ", $52.08 ," $2,600.14 ", $46.67 , $43.20 ," $6,908.94 "," $5,200.28 "
J1569,5710011244,Hospital Chargemaster,Immune Glob Gammagard 500 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $52.08 , $- , $- , $43.20 , $43.20 , $43.20 , $52.08 , $52.08 , $- , $- , $54.68 , $53.12 , $- , $- , $- , $- , $52.08 , $- , $46.67 , $- , $54.68 , $-
J1569,5710011245,Hospital Chargemaster,Immune Glob Gammagard 500 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $52.08 , $- , $- , $43.20 , $43.20 , $43.20 , $52.08 , $52.08 , $- , $- , $54.68 , $53.12 , $- , $- , $- , $- , $52.08 , $- , $46.67 , $- , $54.68 , $-
J1569,5710011246,Hospital Chargemaster,Immune Glob Gammagard 500 mg,Outpatient,Outpatient Default Percent / Case Rate,636," $1,859.27 "," $1,022.60 ", $743.71 , $52.08 ," $1,301.49 ", $725.12 , $43.20 , $43.20 , $43.20 , $52.08 , $52.08 ," $1,247.57 "," $1,247.57 ", $54.68 , $53.12 ," $1,729.12 "," $1,729.12 "," $1,729.12 "," $1,729.12 ", $52.08 , $650.74 , $46.67 , $43.20 ," $1,729.12 "," $1,301.49 "
J1569,5710011247,Hospital Chargemaster,Immune Glob Gammagard 500 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $52.08 , $- , $- , $43.20 , $43.20 , $43.20 , $52.08 , $52.08 , $- , $- , $54.68 , $53.12 , $- , $- , $- , $- , $52.08 , $- , $46.67 , $- , $54.68 , $-
Q5103,5710011261,Hospital Chargemaster,inFLIXimab-DYYB Biosimil 10mg,Outpatient,Outpatient Default Percent / Case Rate,636," $2,091.28 "," $1,150.20 "," $1,723.21 ", $48.21 ," $1,463.90 ", $815.60 , $43.72 , $43.72 , $43.72 , $48.21 , $48.21 ," $1,403.25 "," $1,403.25 ", $50.62 , $49.18 ," $1,944.89 "," $1,944.89 "," $1,944.89 "," $1,944.89 ", $48.21 , $731.95 , $- , $- ," $1,944.89 "," $1,463.90 "
J9041,5710010300,Hospital Chargemaster,Bortezomib (Velcade) 0.1mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $4,087.65 "," $2,248.21 "," $1,635.06 ", $52.87 ," $2,861.36 "," $1,594.18 ", $44.97 , $44.97 , $44.97 , $52.87 , $52.87 ," $2,742.81 "," $2,742.81 ", $55.51 , $53.93 ," $3,801.51 "," $3,801.51 "," $3,801.51 "," $3,801.51 ", $52.87 ," $1,430.68 ", $44.79 , $44.79 ," $3,801.51 "," $2,861.36 "
J2560,5710011958,Hospital Chargemaster,PHENobarbital up to 120 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $158.71 , $87.29 , $63.48 , $47.08 , $111.10 , $61.90 , $47.33 , $47.33 , $47.33 , $47.08 , $47.08 , $106.49 , $106.49 , $49.43 , $48.02 , $147.60 , $147.60 , $147.60 , $147.60 , $47.08 , $55.55 , $42.24 , $42.24 , $147.60 , $111.10
J2560,5710011959,Hospital Chargemaster,PHENobarbital up to 120 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $61.15 , $33.63 , $24.46 , $47.08 , $42.81 , $23.85 , $47.33 , $47.33 , $47.33 , $47.08 , $47.08 , $41.03 , $41.03 , $49.43 , $48.02 , $56.87 , $56.87 , $56.87 , $56.87 , $47.08 , $21.40 , $42.24 , $21.40 , $56.87 , $42.81
J1745,5710011260,Hospital Chargemaster,inFLIXimab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $2,977.94 "," $1,637.87 "," $1,191.18 ", $46.28 ," $2,084.56 "," $1,161.40 ", $47.62 , $47.62 , $47.62 , $46.28 , $46.28 ," $1,998.20 "," $1,998.20 ", $48.59 , $47.20 ," $2,769.48 "," $2,769.48 "," $2,769.48 "," $2,769.48 ", $46.28 ," $1,042.28 ", $- , $- ," $2,769.48 "," $2,084.56 "
J9280,5710011663,Hospital Chargemaster,mitoMYcin 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $1,804.94 ", $992.72 , $721.98 , $45.22 ," $1,263.46 ", $703.93 , $49.88 , $49.88 , $49.88 , $45.22 , $45.22 ," $1,211.11 "," $1,211.11 ", $47.48 , $46.12 ," $1,678.59 "," $1,678.59 "," $1,678.59 "," $1,678.59 ", $45.22 , $631.73 , $50.66 , $45.22 ," $1,678.59 "," $1,263.46 "
J9280,5710011664,Hospital Chargemaster,mitoMYcin 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $1,353.96 ", $744.68 , $541.58 , $45.22 , $947.77 , $528.04 , $49.88 , $49.88 , $49.88 , $45.22 , $45.22 , $908.51 , $908.51 , $47.48 , $46.12 ," $1,259.18 "," $1,259.18 "," $1,259.18 "," $1,259.18 ", $45.22 , $473.89 , $50.66 , $45.22 ," $1,259.18 ", $947.77
J9280,5710011665,Hospital Chargemaster,mitoMYcin 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $45.22 , $- , $- , $49.88 , $49.88 , $49.88 , $45.22 , $45.22 , $- , $- , $47.48 , $46.12 , $- , $- , $- , $- , $45.22 , $- , $50.66 , $- , $50.66 , $-
J9271,5710011916,Hospital Chargemaster,Pembrolizumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $10,982.56 "," $6,040.41 "," $4,393.02 ", $61.75 ," $7,687.79 "," $4,283.20 ", $50.85 , $50.85 , $50.85 , $61.75 , $61.75 ," $7,369.30 "," $7,369.30 ", $64.84 , $62.99 ," $10,213.78 "," $10,213.78 "," $10,213.78 "," $10,213.78 ", $61.75 ," $3,843.90 ", $52.30 , $50.85 ," $10,213.78 "," $7,687.79 "
J1740,5710011215,Hospital Chargemaster,Ibandronate Sodium 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $51.00 , $51.00 , $51.00 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $29.27 , $- , $51.00 , $-
J9285,5710011830,Hospital Chargemaster,Olaratumab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $60.95 , $- , $- , $52.07 , $52.07 , $52.07 , $60.95 , $60.95 , $- , $- , $64.00 , $62.17 , $- , $- , $- , $- , $60.95 , $- , $52.07 , $- , $64.00 , $-
J9285,5710011831,Hospital Chargemaster,Olaratumab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $60.95 , $- , $- , $52.07 , $52.07 , $52.07 , $60.95 , $60.95 , $- , $- , $64.00 , $62.17 , $- , $- , $- , $- , $60.95 , $- , $52.07 , $- , $64.00 , $-
J0775,5710010591,Hospital Chargemaster,Collagenase Clost Hist 0.01 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $66.32 , $- , $- , $52.39 , $52.39 , $52.39 , $66.32 , $66.32 , $- , $- , $69.64 , $67.65 , $- , $- , $- , $- , $66.32 , $- , $56.60 , $- , $69.64 , $-
J9395,5710011042,Hospital Chargemaster,Fulvestrant 25 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $4,749.44 "," $2,612.19 "," $1,899.78 ", $18.70 ," $3,324.61 "," $1,852.28 ", $52.74 , $52.74 , $52.74 , $18.70 , $18.70 ," $3,186.87 "," $3,186.87 ", $19.64 , $19.08 ," $4,416.98 "," $4,416.98 "," $4,416.98 "," $4,416.98 ", $18.70 ," $1,662.30 ", $15.65 , $15.65 ," $4,416.98 "," $3,324.61 "
J9145,5710010636,Hospital Chargemaster,Daratumumab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $67.37 , $- , $- , $56.29 , $56.29 , $56.29 , $67.37 , $67.37 , $- , $- , $70.74 , $68.72 , $- , $- , $- , $- , $67.37 , $- , $57.22 , $- , $70.74 , $-
J9145,5710010637,Hospital Chargemaster,Daratumumab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $67.37 , $- , $- , $56.29 , $56.29 , $56.29 , $67.37 , $67.37 , $- , $- , $70.74 , $68.72 , $- , $- , $- , $- , $67.37 , $- , $57.22 , $- , $70.74 , $-
J0129,5710010031,Hospital Chargemaster,Abatacept 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $52.99 , $- , $- , $58.10 , $58.10 , $58.10 , $52.99 , $52.99 , $- , $- , $55.64 , $54.05 , $- , $- , $- , $- , $52.99 , $- , $- , $- , $58.10 , $-
J9308,5710012146,Hospital Chargemaster,Ramucirumab 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $73.38 , $- , $- , $60.71 , $60.71 , $60.71 , $73.38 , $73.38 , $- , $- , $77.05 , $74.85 , $- , $- , $- , $- , $73.38 , $- , $63.56 , $- , $77.05 , $-
J9308,5710012147,Hospital Chargemaster,Ramucirumab 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $73.38 , $- , $- , $60.71 , $60.71 , $60.71 , $73.38 , $73.38 , $- , $- , $77.05 , $74.85 , $- , $- , $- , $- , $73.38 , $- , $63.56 , $- , $77.05 , $-
J9055,5710010483,Hospital Chargemaster,Cetuximab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $78.08 , $- , $- , $64.29 , $64.29 , $64.29 , $78.08 , $78.08 , $- , $- , $81.99 , $79.65 , $- , $- , $- , $- , $78.08 , $- , $67.62 , $- , $81.99 , $-
J9055,5710010484,Hospital Chargemaster,Cetuximab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $78.08 , $- , $- , $64.29 , $64.29 , $64.29 , $78.08 , $78.08 , $- , $- , $81.99 , $79.65 , $- , $- , $- , $- , $78.08 , $- , $67.62 , $- , $81.99 , $-
J1930,5710011352,Hospital Chargemaster,Lanreotide 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $79.18 , $- , $- , $68.48 , $68.48 , $68.48 , $79.18 , $79.18 , $- , $- , $83.13 , $80.76 , $- , $- , $- , $- , $79.18 , $- , $66.18 , $- , $83.13 , $-
J9305,5710011917,Hospital Chargemaster,PEMEtrexed 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $1,936.11 "," $1,064.86 ", $774.44 , $87.71 ," $1,355.28 ", $755.08 , $71.81 , $71.81 , $71.81 , $87.71 , $87.71 ," $1,299.13 "," $1,299.13 ", $92.10 , $89.46 ," $1,800.58 "," $1,800.58 "," $1,800.58 "," $1,800.58 ", $87.71 , $677.64 , $76.04 , $71.81 ," $1,800.58 "," $1,355.28 "
J9305,5710011918,Hospital Chargemaster,PEMEtrexed 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $9,587.44 "," $5,273.09 "," $3,834.98 ", $87.71 ," $6,711.21 "," $3,739.10 ", $71.81 , $71.81 , $71.81 , $87.71 , $87.71 ," $6,433.17 "," $6,433.17 ", $92.10 , $89.46 ," $8,916.32 "," $8,916.32 "," $8,916.32 "," $8,916.32 ", $87.71 ," $3,355.60 ", $76.04 , $71.81 ," $8,916.32 "," $6,711.21 "
J9173,5710010836,Hospital Chargemaster,Durvalumab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $89.97 , $- , $- , $76.02 , $76.02 , $76.02 , $89.97 , $89.97 , $- , $- , $94.47 , $91.77 , $- , $- , $- , $- , $89.97 , $- , $76.86 , $- , $94.47 , $-
J9173,5710010837,Hospital Chargemaster,Durvalumab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $9,485.95 "," $5,217.27 "," $3,794.38 ", $89.97 ," $6,640.17 "," $3,699.52 ", $76.02 , $76.02 , $76.02 , $89.97 , $89.97 ," $6,365.07 "," $6,365.07 ", $94.47 , $91.77 ," $8,821.93 "," $8,821.93 "," $8,821.93 "," $8,821.93 ", $89.97 ," $3,320.08 ", $76.86 , $76.02 ," $8,821.93 "," $6,640.17 "
J9035,5710010286,Hospital Chargemaster,Bevacizumab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $2,032.20 "," $1,117.71 ", $812.88 , $82.42 ," $1,422.54 ", $792.56 , $76.36 , $76.36 , $76.36 , $82.42 , $82.42 ," $1,363.61 "," $1,363.61 ", $86.54 , $84.07 ," $1,889.95 "," $1,889.95 "," $1,889.95 "," $1,889.95 ", $82.42 , $711.27 , $67.86 , $67.86 ," $1,889.95 "," $1,422.54 "
J9035,5710010287,Hospital Chargemaster,Bevacizumab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $8,128.79 "," $4,470.83 "," $3,251.52 ", $82.42 ," $5,690.15 "," $3,170.23 ", $76.36 , $76.36 , $76.36 , $82.42 , $82.42 ," $5,454.42 "," $5,454.42 ", $86.54 , $84.07 ," $7,559.77 "," $7,559.77 "," $7,559.77 "," $7,559.77 ", $82.42 ," $2,845.08 ", $67.86 , $67.86 ," $7,559.77 "," $5,690.15 "
J1364,5710010901,Hospital Chargemaster,Erythromycin Lacto 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $76.85 , $76.85 , $76.85 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $75.25 , $- , $76.85 , $-
J9022,5710010212,Hospital Chargemaster,Atezolizumab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $18,881.63 "," $10,384.90 "," $7,552.65 ", $93.35 ," $13,217.14 "," $7,363.84 ", $78.28 , $78.28 , $78.28 , $93.35 , $93.35 ," $12,669.57 "," $12,669.57 ", $98.02 , $95.22 ," $17,559.92 "," $17,559.92 "," $17,559.92 "," $17,559.92 ", $93.35 ," $6,608.57 ", $79.58 , $78.28 ," $17,559.92 "," $13,217.14 "
J2796,5710012198,Hospital Chargemaster,romiPLOStim 10 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $5,139.22 "," $2,826.57 "," $2,055.69 ", $97.70 ," $3,597.45 "," $2,004.30 ", $78.43 , $78.43 , $78.43 , $97.70 , $97.70 ," $3,448.42 "," $3,448.42 ", $102.59 , $99.66 ," $4,779.47 "," $4,779.47 "," $4,779.47 "," $4,779.47 ", $97.70 ," $1,798.73 ", $83.62 , $78.43 ," $4,779.47 "," $3,597.45 "
J2796,5710012199,Hospital Chargemaster,romiPLOStim 10 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $97.70 , $- , $- , $78.43 , $78.43 , $78.43 , $97.70 , $97.70 , $- , $- , $102.59 , $99.66 , $- , $- , $- , $- , $97.70 , $- , $83.62 , $- , $102.59 , $-
J2997,5710010098,Hospital Chargemaster,Alteplase Recombinant 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $17,600.72 "," $9,680.40 "," $7,040.29 ", $102.72 ," $12,320.50 "," $6,864.28 ", $87.15 , $87.15 , $87.15 , $102.72 , $102.72 ," $11,810.08 "," $11,810.08 ", $107.85 , $104.77 ," $16,368.67 "," $16,368.67 "," $16,368.67 "," $16,368.67 ", $102.72 ," $6,160.25 ", $87.67 , $87.15 ," $16,368.67 "," $12,320.50 "
J2997,5710010099,Hospital Chargemaster,Alteplase Recombinant 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $102.72 , $- , $- , $87.15 , $87.15 , $87.15 , $102.72 , $102.72 , $- , $- , $107.85 , $104.77 , $- , $- , $- , $- , $102.72 , $- , $87.67 , $- , $107.85 , $-
J2997,5710010100,Hospital Chargemaster,Alteplase Recombinant 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $390.30 , $214.67 , $156.12 , $102.72 , $273.21 , $152.22 , $87.15 , $87.15 , $87.15 , $102.72 , $102.72 , $261.89 , $261.89 , $107.85 , $104.77 , $362.98 , $362.98 , $362.98 , $362.98 , $102.72 , $136.61 , $87.67 , $87.15 , $362.98 , $273.21
J9312,5710012188,Hospital Chargemaster,riTUXimab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $2,395.78 "," $1,317.68 ", $958.31 , $101.77 ," $1,677.05 ", $934.35 , $92.56 , $92.56 , $92.56 , $101.77 , $101.77 ," $1,607.57 "," $1,607.57 ", $106.86 , $103.80 ," $2,228.08 "," $2,228.08 "," $2,228.08 "," $2,228.08 ", $101.77 , $838.52 , $85.63 , $85.63 ," $2,228.08 "," $1,677.05 "
J9312,5710012189,Hospital Chargemaster,riTUXimab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $11,007.62 "," $6,054.19 "," $4,403.05 ", $101.77 ," $7,705.33 "," $4,292.97 ", $92.56 , $92.56 , $92.56 , $101.77 , $101.77 ," $7,386.11 "," $7,386.11 ", $106.86 , $103.80 ," $10,237.09 "," $10,237.09 "," $10,237.09 "," $10,237.09 ", $101.77 ," $3,852.67 ", $85.63 , $85.63 ," $10,237.09 "," $7,705.33 "
J9355,5710012407,Hospital Chargemaster,Trastuzumab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $3,973.97 "," $2,185.68 "," $1,589.59 ", $105.13 ," $2,781.78 "," $1,549.85 ", $99.68 , $99.68 , $99.68 , $105.13 , $105.13 ," $2,666.53 "," $2,666.53 ", $110.39 , $107.23 ," $3,695.79 "," $3,695.79 "," $3,695.79 "," $3,695.79 ", $105.13 ," $1,390.89 ", $86.41 , $86.41 ," $3,695.79 "," $2,781.78 "
J9207,5710011315,Hospital Chargemaster,Ixabepilone 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $131.24 , $- , $- , $101.19 , $101.19 , $101.19 , $131.24 , $131.24 , $- , $- , $137.80 , $133.87 , $- , $- , $- , $- , $131.24 , $- , $114.19 , $- , $137.80 , $-
J9207,5710011316,Hospital Chargemaster,Ixabepilone 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $131.24 , $- , $- , $101.19 , $101.19 , $101.19 , $131.24 , $131.24 , $- , $- , $137.80 , $133.87 , $- , $- , $- , $- , $131.24 , $- , $114.19 , $- , $137.80 , $-
J9179,5710010893,Hospital Chargemaster,Eribulin mesylate 0.1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $3,090.28 "," $1,699.65 "," $1,236.11 ", $145.07 ," $2,163.20 "," $1,205.21 ", $117.66 , $117.66 , $117.66 , $145.07 , $145.07 ," $2,073.58 "," $2,073.58 ", $152.32 , $147.97 ," $2,873.96 "," $2,873.96 "," $2,873.96 "," $2,873.96 ", $145.07 ," $1,081.60 ", $127.44 , $117.66 ," $2,873.96 "," $2,163.20 "
J9303,5710011898,Hospital Chargemaster,Panitumumab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $152.62 , $- , $- , $123.55 , $123.55 , $123.55 , $152.62 , $152.62 , $- , $- , $160.25 , $155.67 , $- , $- , $- , $- , $152.62 , $- , $130.41 , $- , $160.25 , $-
J9303,5710011899,Hospital Chargemaster,Panitumumab 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $10,793.80 "," $5,936.59 "," $4,317.52 ", $152.62 ," $7,555.66 "," $4,209.58 ", $123.55 , $123.55 , $123.55 , $152.62 , $152.62 ," $7,242.64 "," $7,242.64 ", $160.25 , $155.67 ," $10,038.23 "," $10,038.23 "," $10,038.23 "," $10,038.23 ", $152.62 ," $3,777.83 ", $130.41 , $123.55 ," $10,038.23 "," $7,555.66 "
J3101,5710012327,Hospital Chargemaster,Tenecteplase 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $157.72 , $- , $- , $129.26 , $129.26 , $129.26 , $157.72 , $157.72 , $- , $- , $165.61 , $160.87 , $- , $- , $- , $- , $157.72 , $- , $134.62 , $- , $165.61 , $-
J7323,5710011158,Hospital Chargemaster,Hyaluronan (Euflexxa) /dose,Outpatient,Outpatient Default Percent / Case Rate,636, $866.82 , $476.75 , $346.73 , $162.50 , $606.77 , $338.06 , $140.31 , $140.31 , $140.31 , $162.50 , $162.50 , $581.64 , $581.64 , $170.62 , $165.75 , $806.14 , $806.14 , $806.14 , $806.14 , $162.50 , $303.39 , $135.24 , $135.24 , $806.14 , $606.77
J9228,5710011286,Hospital Chargemaster,Ipilimumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $185.71 , $- , $- , $157.38 , $157.38 , $157.38 , $185.71 , $185.71 , $- , $- , $195.00 , $189.42 , $- , $- , $- , $- , $185.71 , $- , $160.70 , $- , $195.00 , $-
J9228,5710011287,Hospital Chargemaster,Ipilimumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $185.71 , $- , $- , $157.38 , $157.38 , $157.38 , $185.71 , $185.71 , $- , $- , $195.00 , $189.42 , $- , $- , $- , $- , $185.71 , $- , $160.70 , $- , $195.00 , $-
J0517,5710010266,Hospital Chargemaster,Benralizumab 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $10,314.41 "," $5,672.93 "," $4,125.76 ", $199.93 ," $7,220.09 "," $4,022.62 ", $191.66 , $191.66 , $191.66 , $199.93 , $199.93 ," $6,920.97 "," $6,920.97 ", $209.93 , $203.93 ," $9,592.40 "," $9,592.40 "," $9,592.40 "," $9,592.40 ", $199.93 ," $3,610.04 ", $167.44 , $167.44 ," $9,592.40 "," $7,220.09 "
J9042,5710010301,Hospital Chargemaster,Brentuximab Vedotin 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $17,854.00 "," $9,819.70 "," $7,141.60 ", $221.63 ," $12,497.80 "," $6,963.06 ", $175.28 , $175.28 , $175.28 , $221.63 , $221.63 ," $11,980.03 "," $11,980.03 ", $232.71 , $226.06 ," $16,604.22 "," $16,604.22 "," $16,604.22 "," $16,604.22 ", $221.63 ," $6,248.90 ", $196.55 , $175.28 ," $16,604.22 "," $12,497.80 "
J9043,5710010368,Hospital Chargemaster,Cabazitaxel 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $221.24 , $- , $- , $181.51 , $181.51 , $181.51 , $221.24 , $221.24 , $- , $- , $232.30 , $225.66 , $- , $- , $- , $- , $221.24 , $- , $191.31 , $- , $232.30 , $-
J1190,5710010674,Hospital Chargemaster,Dexrazoxane 250 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $225.14 , $- , $- , $199.93 , $199.93 , $199.93 , $225.14 , $225.14 , $- , $- , $236.39 , $229.64 , $- , $- , $- , $- , $225.14 , $- , $189.84 , $- , $236.39 , $-
J1190,5710010675,Hospital Chargemaster,Dexrazoxane 250 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $225.14 , $- , $- , $199.93 , $199.93 , $199.93 , $225.14 , $225.14 , $- , $- , $236.39 , $229.64 , $- , $- , $- , $- , $225.14 , $- , $189.84 , $- , $236.39 , $-
J2353,5710011817,Hospital Chargemaster,Octreotide Depot 1 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $240.40 , $- , $- , $205.88 , $205.88 , $205.88 , $240.40 , $240.40 , $- , $- , $252.42 , $245.21 , $- , $- , $- , $- , $240.40 , $- , $206.56 , $- , $252.42 , $-
J2353,5710011818,Hospital Chargemaster,Octreotide Depot 1 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $240.40 , $- , $- , $205.88 , $205.88 , $205.88 , $240.40 , $240.40 , $- , $- , $252.42 , $245.21 , $- , $- , $- , $- , $240.40 , $- , $206.56 , $- , $252.42 , $-
J2353,5710011819,Hospital Chargemaster,Octreotide Depot 1 mg,Outpatient,Outpatient Default Percent / Case Rate,636," $12,772.28 "," $7,024.75 "," $5,108.91 ", $240.40 ," $8,940.60 "," $4,981.19 ", $205.88 , $205.88 , $205.88 , $240.40 , $240.40 ," $8,570.20 "," $8,570.20 ", $252.42 , $245.21 ," $11,878.22 "," $11,878.22 "," $11,878.22 "," $11,878.22 ", $240.40 ," $4,470.30 ", $206.56 , $205.88 ," $11,878.22 "," $8,940.60 "
J1610,5710011096,Hospital Chargemaster,Glucagon HCl 1 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $422.80 , $232.54 , $169.12 , $201.03 , $295.96 , $164.89 , $211.79 , $211.79 , $211.79 , $201.03 , $201.03 , $283.70 , $283.70 , $211.08 , $205.05 , $393.20 , $393.20 , $393.20 , $393.20 , $201.03 , $147.98 , $166.77 , $147.98 , $393.20 , $295.96
J1610,5710011097,Hospital Chargemaster,Glucagon HCl 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $747.28 , $411.00 , $298.91 , $201.03 , $523.10 , $291.44 , $211.79 , $211.79 , $211.79 , $201.03 , $201.03 , $501.42 , $501.42 , $211.08 , $205.05 , $694.97 , $694.97 , $694.97 , $694.97 , $201.03 , $261.55 , $166.77 , $166.77 , $694.97 , $523.10
J9217,5710011363,Hospital Chargemaster,Leuprolide Acet Depot 7.5mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $162.82 , $- , $- , $224.45 , $224.45 , $224.45 , $162.82 , $162.82 , $- , $- , $170.96 , $166.07 , $- , $- , $- , $- , $162.82 , $- , $200.73 , $- , $224.45 , $-
J9217,5710011364,Hospital Chargemaster,Leuprolide Acet Depot 7.5mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $162.82 , $- , $- , $224.45 , $224.45 , $224.45 , $162.82 , $162.82 , $- , $- , $170.96 , $166.07 , $- , $- , $- , $- , $162.82 , $- , $200.73 , $- , $224.45 , $-
J9217,5710011365,Hospital Chargemaster,Leuprolide Acet Depot 7.5mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $162.82 , $- , $- , $224.45 , $224.45 , $224.45 , $162.82 , $162.82 , $- , $- , $170.96 , $166.07 , $- , $- , $- , $- , $162.82 , $- , $200.73 , $- , $224.45 , $-
J9217,5710011366,Hospital Chargemaster,Leuprolide Acet Depot 7.5mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $162.82 , $- , $- , $224.45 , $224.45 , $224.45 , $162.82 , $162.82 , $- , $- , $170.96 , $166.07 , $- , $- , $- , $- , $162.82 , $- , $200.73 , $- , $224.45 , $-
J9217,5710011368,Hospital Chargemaster,Leuprolide Acet Depot 7.5mg,Outpatient,Outpatient Default Percent / Case Rate,636," $11,171.86 "," $6,144.52 "," $4,468.74 ", $162.82 ," $7,820.30 "," $4,357.03 ", $224.45 , $224.45 , $224.45 , $162.82 , $162.82 ," $7,496.32 "," $7,496.32 ", $170.96 , $166.07 ," $10,389.83 "," $10,389.83 "," $10,389.83 "," $10,389.83 ", $162.82 ," $3,910.15 ", $200.73 , $162.82 ," $10,389.83 "," $7,820.30 "
J9217,5710011370,Hospital Chargemaster,Leuprolide Acet Depot 7.5mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $162.82 , $- , $- , $224.45 , $224.45 , $224.45 , $162.82 , $162.82 , $- , $- , $170.96 , $166.07 , $- , $- , $- , $- , $162.82 , $- , $200.73 , $- , $224.45 , $-
J9217,5710011371,Hospital Chargemaster,Leuprolide Acet Depot 7.5mg,Outpatient,Outpatient Default Percent / Case Rate,636," $20,938.84 "," $11,516.36 "," $8,375.54 ", $162.82 ," $14,657.19 "," $8,166.15 ", $224.45 , $224.45 , $224.45 , $162.82 , $162.82 ," $14,049.96 "," $14,049.96 ", $170.96 , $166.07 ," $19,473.12 "," $19,473.12 "," $19,473.12 "," $19,473.12 ", $162.82 ," $7,328.59 ", $200.73 , $162.82 ," $19,473.12 "," $14,657.19 "
J9217,5710011372,Hospital Chargemaster,Leuprolide Acet Depot 7.5mg,Outpatient,Outpatient Default Percent / Case Rate,636," $4,507.00 "," $2,478.85 "," $1,802.80 ", $162.82 ," $3,154.90 "," $1,757.73 ", $224.45 , $224.45 , $224.45 , $162.82 , $162.82 ," $3,024.20 "," $3,024.20 ", $170.96 , $166.07 ," $4,191.51 "," $4,191.51 "," $4,191.51 "," $4,191.51 ", $162.82 ," $1,577.45 ", $200.73 , $162.82 ," $4,191.51 "," $3,154.90 "
J1744,5710011225,Hospital Chargemaster,Icatibant 30 mg/3 mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $239.93 , $- , $- , $193.16 , $193.16 , $193.16 , $239.93 , $239.93 , $- , $- , $251.92 , $244.73 , $- , $- , $- , $- , $239.93 , $- , $- , $- , $251.92 , $-
Q5111,5710011914,Hospital Chargemaster,Pegfilgrast-cbqv Udenyca 0.5mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $260.31 , $- , $- , $286.67 , $286.67 , $286.67 , $260.31 , $260.31 , $- , $- , $273.32 , $265.51 , $- , $- , $- , $- , $260.31 , $- , $- , $- , $286.67 , $-
J2783,5710012151,Hospital Chargemaster,Rasburicase 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $368.80 , $- , $- , $300.94 , $300.94 , $300.94 , $368.80 , $368.80 , $- , $- , $387.24 , $376.18 , $- , $- , $- , $- , $368.80 , $- , $321.67 , $- , $387.24 , $-
J2783,5710012152,Hospital Chargemaster,Rasburicase 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $368.80 , $- , $- , $300.94 , $300.94 , $300.94 , $368.80 , $368.80 , $- , $- , $387.24 , $376.18 , $- , $- , $- , $- , $368.80 , $- , $321.67 , $- , $387.24 , $-
Q2050,5710010822,Hospital Chargemaster,Doxorubicin HCl Liposomal 10mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $273.95 , $- , $- , $315.73 , $315.73 , $315.73 , $273.95 , $273.95 , $- , $- , $287.65 , $279.43 , $- , $- , $- , $- , $273.95 , $- , $200.52 , $- , $315.73 , $-
J3315,5710012436,Hospital Chargemaster,Triptorelin Pamoate 3.75mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $444.71 , $- , $- , $385.61 , $385.61 , $385.61 , $444.71 , $444.71 , $- , $- , $466.94 , $453.60 , $- , $- , $- , $- , $444.71 , $- , $337.01 , $- , $466.94 , $-
J3315,5710012437,Hospital Chargemaster,Triptorelin Pamoate 3.75mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $444.71 , $- , $- , $385.61 , $385.61 , $385.61 , $444.71 , $444.71 , $- , $- , $466.94 , $453.60 , $- , $- , $- , $- , $444.71 , $- , $337.01 , $- , $466.94 , $-
J3315,5710012438,Hospital Chargemaster,Triptorelin Pamoate 3.75mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $444.71 , $- , $- , $385.61 , $385.61 , $385.61 , $444.71 , $444.71 , $- , $- , $466.94 , $453.60 , $- , $- , $- , $- , $444.71 , $- , $337.01 , $- , $466.94 , $-
J2770,5710012136,Hospital Chargemaster,Quinuprist/Dalfoprist 500mg In,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $520.52 , $- , $- , $458.04 , $458.04 , $458.04 , $520.52 , $520.52 , $- , $- , $546.55 , $530.93 , $- , $- , $- , $- , $520.52 , $- , $428.19 , $- , $546.55 , $-
J9340,5710012362,Hospital Chargemaster,Thiotepa 15 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $358.01 , $- , $- , $475.39 , $475.39 , $475.39 , $358.01 , $358.01 , $- , $- , $375.92 , $365.18 , $- , $- , $- , $- , $358.01 , $- , $305.45 , $- , $475.39 , $-
J1670,5710012341,Hospital Chargemaster,Tetanus Imm Glob 250 Unit Syr,Outpatient,Outpatient Default Percent / Case Rate,636," $1,418.82 ", $780.35 , $567.53 , $517.05 , $993.17 , $553.34 , $476.57 , $476.57 , $476.57 , $517.05 , $517.05 , $952.03 , $952.03 , $542.90 , $527.39 ," $1,319.50 "," $1,319.50 "," $1,319.50 "," $1,319.50 ", $517.05 , $496.59 , $482.08 , $476.57 ," $1,319.50 ", $993.17
J9202,5710011110,Hospital Chargemaster,Goserelin 3.6 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $614.80 , $- , $- , $503.59 , $503.59 , $503.59 , $614.80 , $614.80 , $- , $- , $645.54 , $627.10 , $- , $- , $- , $- , $614.80 , $- , $543.16 , $- , $645.54 , $-
J9202,5710011111,Hospital Chargemaster,Goserelin 3.6 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $614.80 , $- , $- , $503.59 , $503.59 , $503.59 , $614.80 , $614.80 , $- , $- , $645.54 , $627.10 , $- , $- , $- , $- , $614.80 , $- , $543.16 , $- , $645.54 , $-
J1950,5710011367,Hospital Chargemaster,Leuprolide Acet Depot 3.75mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- ," $1,646.26 ", $- , $- ," $1,347.56 "," $1,347.56 "," $1,347.56 "," $1,646.26 "," $1,646.26 ", $- , $- ," $1,728.58 "," $1,679.19 ", $- , $- , $- , $- ," $1,646.26 ", $- ," $1,366.01 ", $- ," $1,728.58 ", $-
J1950,5710011369,Hospital Chargemaster,Leuprolide Acet Depot 3.75 mg,Outpatient,Outpatient Default Percent / Case Rate,636," $3,746.80 "," $2,060.74 "," $1,498.72 "," $1,646.26 "," $2,622.76 "," $1,461.25 "," $1,347.56 "," $1,347.56 "," $1,347.56 "," $1,646.26 "," $1,646.26 "," $2,514.10 "," $2,514.10 "," $1,728.58 "," $1,679.19 "," $3,484.52 "," $3,484.52 "," $3,484.52 "," $3,484.52 "," $1,646.26 "," $1,311.38 "," $1,366.01 "," $1,311.38 "," $3,484.52 "," $2,622.76 "
J9357,5710012463,Hospital Chargemaster,Valrubicin 200 mg intravesical,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- ," $1,668.51 ", $- , $- ," $1,403.17 "," $1,403.17 "," $1,403.17 "," $1,668.51 "," $1,668.51 ", $- , $- ," $1,751.93 "," $1,701.88 ", $- , $- , $- , $- ," $1,668.51 ", $- ," $1,435.66 ", $- ," $1,751.93 ", $-
J3240,5710012369,Hospital Chargemaster,Thyrotropin Alfa 0.9 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- ," $2,150.64 ", $- , $- ," $1,740.23 "," $1,740.23 "," $1,740.23 "," $2,150.64 "," $2,150.64 ", $- , $- ," $2,258.18 "," $2,193.66 ", $- , $- , $- , $- ," $2,150.64 ", $- ," $1,858.04 ", $- ," $2,258.18 ", $-
J9050,5710010417,Hospital Chargemaster,Carmustine 100 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- ," $1,445.03 ", $- , $- ," $2,016.27 "," $2,016.27 "," $2,016.27 "," $1,445.03 "," $1,445.03 ", $- , $- ," $1,517.28 "," $1,473.93 ", $- , $- , $- , $- ," $1,445.03 ", $- ," $1,099.82 ", $- ," $2,016.27 ", $-
J9268,5710011935,Hospital Chargemaster,Pentostatin 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- ," $2,201.47 ", $- , $- ," $2,060.28 "," $2,060.28 "," $2,060.28 "," $2,201.47 "," $2,201.47 ", $- , $- ," $2,311.54 "," $2,245.50 ", $- , $- , $- , $- ," $2,201.47 ", $- ," $1,934.45 ", $- ," $2,311.54 ", $-
J2993,5710012156,Hospital Chargemaster,Reteplase 10 Unit Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- ," $2,934.07 ", $- , $- ," $2,833.37 "," $2,833.37 "," $2,833.37 "," $2,934.07 "," $2,934.07 ", $- , $- ," $3,080.78 "," $2,992.75 ", $- , $- , $- , $- ," $2,934.07 ", $- ," $1,851.83 ", $- ," $3,080.78 ", $-
J2507,5710011915,Hospital Chargemaster,Pegloticase 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- ," $3,465.98 ", $- , $- ," $2,801.08 "," $2,801.08 "," $2,801.08 "," $3,465.98 "," $3,465.98 ", $- , $- ," $3,639.28 "," $3,535.30 ", $- , $- , $- , $- ," $3,465.98 ", $- ," $2,968.61 ", $- ," $3,639.28 ", $-
J2505,5710011912,Hospital Chargemaster,Pegfilgrastim 6 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $12,469.45 "," $6,858.20 "," $4,987.78 ", See APC Packaged Rates ," $8,728.62 "," $4,863.09 "," $3,571.68 "," $3,571.68 "," $3,571.68 ", See APC Packaged Rates , See APC Packaged Rates ," $8,367.00 "," $8,367.00 ", See APC Packaged Rates , See APC Packaged Rates ," $11,596.59 "," $11,596.59 "," $11,596.59 "," $11,596.59 ", See APC Packaged Rates ," $4,364.31 ", Not Applicable ," $3,571.68 "," $11,596.59 "," $8,728.62 "
J2505,5710011913,Hospital Chargemaster,Pegfilgrastim 6 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $14,622.22 "," $8,042.22 "," $5,848.89 ", See APC Packaged Rates ," $10,235.55 "," $5,702.67 "," $3,571.68 "," $3,571.68 "," $3,571.68 ", See APC Packaged Rates , See APC Packaged Rates ," $9,811.51 "," $9,811.51 ", See APC Packaged Rates , See APC Packaged Rates ," $13,598.66 "," $13,598.66 "," $13,598.66 "," $13,598.66 ", See APC Packaged Rates ," $5,117.78 ", Not Applicable ," $3,571.68 "," $13,598.66 "," $10,235.55 "
J1162,5710010744,Hospital Chargemaster,Digoxin Immune FAB per vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- ," $4,832.38 ", $- , $- ," $3,972.14 "," $3,972.14 "," $3,972.14 "," $4,832.38 "," $4,832.38 ", $- , $- ," $5,074.00 "," $4,929.03 ", $- , $- , $- , $- ," $4,832.38 ", $- ," $4,128.19 ", $- ," $5,074.00 ", $-
J0600,5710010841,Hospital Chargemaster,Edetate Ca Disodium 1000mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- ," $6,682.37 ", $- , $- ," $5,594.42 "," $5,594.42 "," $5,594.42 "," $6,682.37 "," $6,682.37 ", $- , $- ," $7,016.48 "," $6,816.01 ", $- , $- , $- , $- ," $6,682.37 ", $- ," $5,708.59 ", $- ," $7,016.48 ", $-
J7307,5710030012,Hospital Chargemaster,Etonogestrel Implant System,Outpatient,Outpatient Default Percent / Case Rate,636," $2,812.00 "," $1,546.60 "," $1,124.80 ", See APC Packaged Rates ," $1,968.40 "," $1,096.68 "," $1,065.69 "," $1,065.69 "," $1,065.69 ", See APC Packaged Rates , See APC Packaged Rates ," $1,886.85 "," $1,886.85 ", See APC Packaged Rates , See APC Packaged Rates , $981.56 , $981.56 ," $1,006.88 "," $1,006.88 ", See APC Packaged Rates , $984.20 ," $1,236.77 ", $981.56 ," $1,968.40 "," $1,968.40 "
J7296,5710030008,Hospital Chargemaster,"Kyleena, 19.5 MG",Outpatient,Outpatient Default Percent / Case Rate,636," $2,000.00 "," $1,100.00 ", $800.00 , See APC Packaged Rates ," $1,400.00 ", $780.00 ," $1,087.00 "," $1,087.00 "," $1,087.00 ", See APC Packaged Rates , See APC Packaged Rates ," $1,342.00 "," $1,342.00 ", See APC Packaged Rates , See APC Packaged Rates , $953.51 , $953.51 , $978.11 , $978.11 , See APC Packaged Rates , $700.00 ," $1,199.14 ", $700.00 ," $1,400.00 "," $1,400.00 "
J7298,5710030009,Hospital Chargemaster,"Mirena, 52 MG",Outpatient,Outpatient Default Percent / Case Rate,636," $2,568.00 "," $1,412.40 "," $1,027.20 ", See APC Packaged Rates ," $1,797.60 "," $1,001.52 "," $1,087.00 "," $1,087.00 "," $1,087.00 ", See APC Packaged Rates , See APC Packaged Rates ," $1,723.13 "," $1,723.13 ", See APC Packaged Rates , See APC Packaged Rates , $953.51 , $953.51 , $978.11 , $978.11 , See APC Packaged Rates , $898.80 ," $1,199.14 ", $898.80 ," $1,797.60 "," $1,797.60 "
J7300,5710030010,Hospital Chargemaster,Intraut Copper Contraceptive,Outpatient,Outpatient Default Percent / Case Rate,636, $906.00 , $498.30 , $362.40 , See APC Packaged Rates , $634.20 , $353.34 ," $1,008.33 "," $1,008.33 "," $1,008.33 ", See APC Packaged Rates , See APC Packaged Rates , $607.93 , $607.93 , See APC Packaged Rates , See APC Packaged Rates , $884.50 , $884.50 , $906.00 , $906.00 , See APC Packaged Rates , $317.10 ," $1,092.90 ", $317.10 ," $1,092.90 ", $634.20
J7301,5710030011,Hospital Chargemaster,"Skyla, 13.5 MG",Outpatient,Outpatient Default Percent / Case Rate,636," $1,000.00 ", $550.00 , $400.00 , See APC Packaged Rates , $700.00 , $390.00 , $905.11 , $905.11 , $905.11 , See APC Packaged Rates , See APC Packaged Rates , $671.00 , $671.00 , See APC Packaged Rates , See APC Packaged Rates , $793.96 , $793.96 , $814.44 , $814.44 , See APC Packaged Rates , $350.00 , $998.48 , $350.00 , $998.48 , $700.00
90375,5710012137,Hospital Chargemaster,Rabies Immune Glob 150 Unit,Outpatient,Outpatient Default Percent / Case Rate,636, $406.00 , $223.30 , $334.54 , $312.90 , $284.20 , $158.34 , $273.04 , $273.04 , $273.04 , $312.90 , $312.90 , $272.43 , $272.43 , $328.54 , $319.15 , $273.04 , $273.04 , $280.08 , $280.08 , $312.90 , $142.10 , $308.67 , $142.10 , $334.54 , $284.20
90375,5710012138,Hospital Chargemaster,Rabies Immune Glob 150 Unit,Outpatient,Outpatient Default Percent / Case Rate,636, $406.00 , $223.30 , $334.54 , $312.90 , $284.20 , $158.34 , $273.04 , $273.04 , $273.04 , $312.90 , $312.90 , $272.43 , $272.43 , $328.54 , $319.15 , $273.04 , $273.04 , $280.08 , $280.08 , $312.90 , $142.10 , $308.67 , $142.10 , $334.54 , $284.20
90375,5710012139,Hospital Chargemaster,Rabies Immune Glob 150 Unit,Outpatient,Outpatient Default Percent / Case Rate,636, $406.00 , $223.30 , $334.54 , $312.90 , $284.20 , $158.34 , $273.04 , $273.04 , $273.04 , $312.90 , $312.90 , $272.43 , $272.43 , $328.54 , $319.15 , $273.04 , $273.04 , $280.08 , $280.08 , $312.90 , $142.10 , $308.67 , $142.10 , $334.54 , $284.20
90375,5710012140,Hospital Chargemaster,Rabies Immune Glob 150 Unit,Outpatient,Outpatient Default Percent / Case Rate,636, $406.00 , $223.30 , $334.54 , $312.90 , $284.20 , $158.34 , $273.04 , $273.04 , $273.04 , $312.90 , $312.90 , $272.43 , $272.43 , $328.54 , $319.15 , $273.04 , $273.04 , $280.08 , $280.08 , $312.90 , $142.10 , $308.67 , $142.10 , $334.54 , $284.20
90651,5710011151,Hospital Chargemaster,HPV 9-Valent Vaccine,Outpatient,Outpatient Default Percent / Case Rate,636, $246.00 , $135.30 , $202.70 , See APC Packaged Rates , $172.20 , $95.94 , $273.37 , $273.37 , $273.37 , See APC Packaged Rates , See APC Packaged Rates , $165.07 , $165.07 , See APC Packaged Rates , See APC Packaged Rates , $169.51 , $169.51 , $173.88 , $173.88 , See APC Packaged Rates , $86.10 , $304.17 , $86.10 , $304.17 , $172.20
90651,5710031151,Hospital Chargemaster,9vhpv vaccine 2/3 dose im,Outpatient,Outpatient Default Percent / Case Rate,636, $246.00 , $135.30 , $202.70 , See APC Packaged Rates , $172.20 , $95.94 , $273.37 , $273.37 , $273.37 , See APC Packaged Rates , See APC Packaged Rates , $165.07 , $165.07 , See APC Packaged Rates , See APC Packaged Rates , $169.51 , $169.51 , $173.88 , $173.88 , See APC Packaged Rates , $86.10 , $304.17 , $86.10 , $304.17 , $172.20
90651,5710032483,Hospital Chargemaster,9 vh vacc 2/3 Doses Im No Chrg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $273.37 , $273.37 , $273.37 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $169.51 , $169.51 , $173.88 , $173.88 , See APC Packaged Rates , $- , $304.17 , $- , $304.17 , $-
90681,5710032488,Hospital Chargemaster,Rv1 vac 2 dose live oral NoChg,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $149.32 , $149.32 , $149.32 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $- , $- , $149.32 , $0.01
90681,5710032489,Hospital Chargemaster,Rv1 vacc 2 dose live oral,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $149.32 , $149.32 , $149.32 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $- , $- , $149.32 , $0.01
J1642,5710011137,Hospital Chargemaster,Heparin Flush 10 unit Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $8.93 , $4.91 , $3.57 , See APC Packaged Rates , $6.25 , $3.48 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $5.99 , $5.99 , See APC Packaged Rates , See APC Packaged Rates , $8.30 , $8.30 , $8.30 , $8.30 , See APC Packaged Rates , $3.13 , $0.02 , $0.01 , $8.30 , $6.25
J1642,5710011138,Hospital Chargemaster,Heparin Flush 10 unit Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.02 , $- , $0.02 , $-
J1642,5710011139,Hospital Chargemaster,Heparin Flush 10 unit Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $9.46 , $5.20 , $3.78 , See APC Packaged Rates , $6.62 , $3.69 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $6.35 , $6.35 , See APC Packaged Rates , See APC Packaged Rates , $8.80 , $8.80 , $8.80 , $8.80 , See APC Packaged Rates , $3.31 , $0.02 , $0.01 , $8.80 , $6.62
J1071,5710012339,Hospital Chargemaster,Testosterone Cypionate 1mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $53.21 , $29.27 , $21.28 , See APC Packaged Rates , $37.25 , $20.75 , $0.03 , $0.03 , $0.03 , See APC Packaged Rates , See APC Packaged Rates , $35.70 , $35.70 , See APC Packaged Rates , See APC Packaged Rates , $49.49 , $49.49 , $49.49 , $49.49 , See APC Packaged Rates , $18.62 , $- , $- , $49.49 , $37.25
J0133,5710010068,Hospital Chargemaster,Acyclovir 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.05 , $0.05 , $0.05 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.05 , $-
J0133,5710010069,Hospital Chargemaster,Acyclovir 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $47.94 , $26.37 , $19.18 , See APC Packaged Rates , $33.56 , $18.70 , $0.05 , $0.05 , $0.05 , See APC Packaged Rates , See APC Packaged Rates , $32.17 , $32.17 , See APC Packaged Rates , See APC Packaged Rates , $44.58 , $44.58 , $44.58 , $44.58 , See APC Packaged Rates , $16.78 , $- , $- , $44.58 , $33.56
J2795,5710012204,Hospital Chargemaster,Ropivacaine HCl 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.07 , $0.07 , $0.07 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.07 , $- , $0.07 , $-
J2795,5710012205,Hospital Chargemaster,Ropivacaine HCl 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $71.88 , $39.53 , $28.75 , See APC Packaged Rates , $50.32 , $28.03 , $0.07 , $0.07 , $0.07 , See APC Packaged Rates , See APC Packaged Rates , $48.23 , $48.23 , See APC Packaged Rates , See APC Packaged Rates , $66.85 , $66.85 , $66.85 , $66.85 , See APC Packaged Rates , $25.16 , $0.07 , $0.07 , $66.85 , $50.32
J0461,5710010221,Hospital Chargemaster,Atropine 0.5 mg/0.5mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,636, $23.21 , $12.77 , $9.28 , See APC Packaged Rates , $16.25 , $9.05 , $0.09 , $0.09 , $0.09 , See APC Packaged Rates , See APC Packaged Rates , $15.57 , $15.57 , See APC Packaged Rates , See APC Packaged Rates , $21.59 , $21.59 , $21.59 , $21.59 , See APC Packaged Rates , $8.12 , $0.09 , $0.09 , $21.59 , $16.25
J0461,5710010222,Hospital Chargemaster,Atropine 1 mg/10 mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,636, $22.95 , $12.62 , $9.18 , See APC Packaged Rates , $16.07 , $8.95 , $0.09 , $0.09 , $0.09 , See APC Packaged Rates , See APC Packaged Rates , $15.40 , $15.40 , See APC Packaged Rates , See APC Packaged Rates , $21.34 , $21.34 , $21.34 , $21.34 , See APC Packaged Rates , $8.03 , $0.09 , $0.09 , $21.34 , $16.07
J0461,5710010223,Hospital Chargemaster,Atropine 0.8 mg/2 mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.09 , $0.09 , $0.09 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.09 , $- , $0.09 , $-
J0461,5710010224,Hospital Chargemaster,Atropine 0.4 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $20.20 , $11.11 , $8.08 , See APC Packaged Rates , $14.14 , $7.88 , $0.09 , $0.09 , $0.09 , See APC Packaged Rates , See APC Packaged Rates , $13.55 , $13.55 , See APC Packaged Rates , See APC Packaged Rates , $18.79 , $18.79 , $18.79 , $18.79 , See APC Packaged Rates , $7.07 , $0.09 , $0.09 , $18.79 , $14.14
J0461,5710010225,Hospital Chargemaster,Atropine 1 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.09 , $0.09 , $0.09 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.09 , $- , $0.09 , $-
J0461,5710010229,Hospital Chargemaster,Atropine Pedi 0.25 mg/5 mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.09 , $0.09 , $0.09 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.09 , $- , $0.09 , $-
J2405,5710011846,Hospital Chargemaster,Ondansetron HCl 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.09 , $0.09 , $0.09 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.08 , $- , $0.09 , $-
J2405,5710011847,Hospital Chargemaster,Ondansetron HCl 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.09 , $0.09 , $0.09 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.08 , $- , $0.09 , $-
J2405,5710011848,Hospital Chargemaster,Ondansetron HCl 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $1.43 , $0.79 , $0.57 , See APC Packaged Rates , $1.00 , $0.56 , $0.09 , $0.09 , $0.09 , See APC Packaged Rates , See APC Packaged Rates , $0.96 , $0.96 , See APC Packaged Rates , See APC Packaged Rates , $1.33 , $1.33 , $1.33 , $1.33 , See APC Packaged Rates , $0.50 , $0.08 , $0.08 , $1.33 , $1.00
J1953,5710011380,Hospital Chargemaster,levETIRAcetam 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $9.81 , $5.40 , $3.92 , See APC Packaged Rates , $6.87 , $3.83 , $0.12 , $0.12 , $0.12 , See APC Packaged Rates , See APC Packaged Rates , $6.58 , $6.58 , See APC Packaged Rates , See APC Packaged Rates , $9.12 , $9.12 , $9.12 , $9.12 , See APC Packaged Rates , $3.43 , $0.09 , $0.09 , $9.12 , $6.87
J1953,5710011381,Hospital Chargemaster,levETIRAcetam 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $151.80 , $83.49 , $60.72 , See APC Packaged Rates , $106.26 , $59.20 , $0.12 , $0.12 , $0.12 , See APC Packaged Rates , See APC Packaged Rates , $101.86 , $101.86 , See APC Packaged Rates , See APC Packaged Rates , $141.17 , $141.17 , $141.17 , $141.17 , See APC Packaged Rates , $53.13 , $0.09 , $0.09 , $141.17 , $106.26
J1953,5710011382,Hospital Chargemaster,levETIRAcetam 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $91.09 , $50.10 , $36.44 , See APC Packaged Rates , $63.76 , $35.53 , $0.12 , $0.12 , $0.12 , See APC Packaged Rates , See APC Packaged Rates , $61.12 , $61.12 , See APC Packaged Rates , See APC Packaged Rates , $84.71 , $84.71 , $84.71 , $84.71 , See APC Packaged Rates , $31.88 , $0.09 , $0.09 , $84.71 , $63.76
J9263,5710011858,Hospital Chargemaster,Oxaliplatin 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $612.00 , $336.60 , $244.80 , See APC Packaged Rates , $428.40 , $238.68 , $0.12 , $0.12 , $0.12 , See APC Packaged Rates , See APC Packaged Rates , $410.65 , $410.65 , See APC Packaged Rates , See APC Packaged Rates , $569.16 , $569.16 , $569.16 , $569.16 , See APC Packaged Rates , $214.20 , $0.07 , $0.07 , $569.16 , $428.40
J9263,5710011859,Hospital Chargemaster,Oxaliplatin 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $111.17 , $61.14 , $44.47 , See APC Packaged Rates , $77.82 , $43.36 , $0.12 , $0.12 , $0.12 , See APC Packaged Rates , See APC Packaged Rates , $74.60 , $74.60 , See APC Packaged Rates , See APC Packaged Rates , $103.39 , $103.39 , $103.39 , $103.39 , See APC Packaged Rates , $38.91 , $0.07 , $0.07 , $103.39 , $77.82
J1100,5710010665,Hospital Chargemaster,Dexamethasone Sod Phos 1mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $15.96 , $8.78 , $6.38 , See APC Packaged Rates , $11.17 , $6.22 , $0.13 , $0.13 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $10.71 , $10.71 , See APC Packaged Rates , See APC Packaged Rates , $14.84 , $14.84 , $14.84 , $14.84 , See APC Packaged Rates , $5.59 , $0.12 , $0.12 , $14.84 , $11.17
J1100,5710010666,Hospital Chargemaster,Dexamethasone Sod Phos 1mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $3.49 , $1.92 , $1.40 , See APC Packaged Rates , $2.44 , $1.36 , $0.13 , $0.13 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $2.34 , $2.34 , See APC Packaged Rates , See APC Packaged Rates , $3.25 , $3.25 , $3.25 , $3.25 , See APC Packaged Rates , $1.22 , $0.12 , $0.12 , $3.25 , $2.44
J1100,5710010667,Hospital Chargemaster,Dexamethasone Sod Phos 1mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $6.27 , $3.45 , $2.51 , See APC Packaged Rates , $4.39 , $2.45 , $0.13 , $0.13 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $4.21 , $4.21 , See APC Packaged Rates , See APC Packaged Rates , $5.83 , $5.83 , $5.83 , $5.83 , See APC Packaged Rates , $2.19 , $0.12 , $0.12 , $5.83 , $4.39
J1100,5710010668,Hospital Chargemaster,Dexamethasone Sod Phos 1mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.13 , $0.13 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.12 , $- , $0.13 , $-
J1100,5710010669,Hospital Chargemaster,Dexamethasone Sod Phos 1mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $5.97 , $3.28 , $2.39 , See APC Packaged Rates , $4.18 , $2.33 , $0.13 , $0.13 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $4.01 , $4.01 , See APC Packaged Rates , See APC Packaged Rates , $5.55 , $5.55 , $5.55 , $5.55 , See APC Packaged Rates , $2.09 , $0.12 , $0.12 , $5.55 , $4.18
J2250,5710011631,Hospital Chargemaster,Midazolam HCl per 1 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.13 , $0.13 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.11 , $- , $0.13 , $-
J2250,5710011632,Hospital Chargemaster,Midazolam HCl per 1 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.13 , $0.13 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.11 , $- , $0.13 , $-
J2250,5710011633,Hospital Chargemaster,Midazolam HCl per 1 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.13 , $0.13 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.11 , $- , $0.13 , $-
J2250,5710011634,Hospital Chargemaster,Midazolam HCl per 1 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.13 , $0.13 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.11 , $- , $0.13 , $-
J2250,5710011635,Hospital Chargemaster,Midazolam HCl per 1 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.13 , $0.13 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.11 , $- , $0.13 , $-
J2250,5710011636,Hospital Chargemaster,Midazolam HCl per 1 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $2.44 , $1.34 , $0.98 , See APC Packaged Rates , $1.71 , $0.95 , $0.13 , $0.13 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $1.64 , $1.64 , See APC Packaged Rates , See APC Packaged Rates , $2.27 , $2.27 , $2.27 , $2.27 , See APC Packaged Rates , $0.85 , $0.11 , $0.11 , $2.27 , $1.71
J2250,5710011637,Hospital Chargemaster,Midazolam HCl per 1 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.13 , $0.13 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.11 , $- , $0.13 , $-
J2250,5710011638,Hospital Chargemaster,Midazolam HCl per 1 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.13 , $0.13 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.11 , $- , $0.13 , $-
J2250,5710011639,Hospital Chargemaster,Midazolam HCl per 1 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.13 , $0.13 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.11 , $- , $0.13 , $-
J0878,5710010635,Hospital Chargemaster,DAPTOmycin 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $1,136.00 ", $624.80 , $454.40 , See APC Packaged Rates , $795.20 , $443.04 , $0.16 , $0.16 , $0.16 , See APC Packaged Rates , See APC Packaged Rates , $762.26 , $762.26 , See APC Packaged Rates , See APC Packaged Rates ," $1,056.48 "," $1,056.48 "," $1,056.48 "," $1,056.48 ", See APC Packaged Rates , $397.60 , $0.05 , $0.05 ," $1,056.48 ", $795.20
J9267,5710011883,Hospital Chargemaster,PACLitaxel 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $83.28 , $45.80 , $33.31 , See APC Packaged Rates , $58.30 , $32.48 , $0.16 , $0.16 , $0.16 , See APC Packaged Rates , See APC Packaged Rates , $55.88 , $55.88 , See APC Packaged Rates , See APC Packaged Rates , $77.45 , $77.45 , $77.45 , $77.45 , See APC Packaged Rates , $29.15 , $0.12 , $0.12 , $77.45 , $58.30
J1756,5710011296,Hospital Chargemaster,Iron Sucrose 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $138.53 , $76.19 , $55.41 , See APC Packaged Rates , $96.97 , $54.03 , $0.22 , $0.22 , $0.22 , See APC Packaged Rates , See APC Packaged Rates , $92.95 , $92.95 , See APC Packaged Rates , See APC Packaged Rates , $128.83 , $128.83 , $128.83 , $128.83 , See APC Packaged Rates , $48.49 , $0.22 , $0.22 , $128.83 , $96.97
J1756,5710011297,Hospital Chargemaster,Iron Sucrose 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.22 , $0.22 , $0.22 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.22 , $- , $0.22 , $-
J1756,5710011298,Hospital Chargemaster,Iron Sucrose 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.22 , $0.22 , $0.22 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.22 , $- , $0.22 , $-
J3475,5710011501,Hospital Chargemaster,Magnesium Sulfate 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.42 , $0.42 , $0.42 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.42 , $-
J3475,5710011502,Hospital Chargemaster,Magnesium Sulfate 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.42 , $0.42 , $0.42 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.42 , $-
J3475,5710011503,Hospital Chargemaster,Magnesium Sulfate 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.42 , $0.42 , $0.42 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.42 , $-
J3475,5710011504,Hospital Chargemaster,Magnesium Sulfate 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.42 , $0.42 , $0.42 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.42 , $-
J3475,5710011505,Hospital Chargemaster,Magnesium Sulfate 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $4.03 , $2.22 , $1.61 , See APC Packaged Rates , $2.82 , $1.57 , $0.42 , $0.42 , $0.42 , See APC Packaged Rates , See APC Packaged Rates , $2.70 , $2.70 , See APC Packaged Rates , See APC Packaged Rates , $3.75 , $3.75 , $3.75 , $3.75 , See APC Packaged Rates , $1.41 , $- , $- , $3.75 , $2.82
J3475,5710011506,Hospital Chargemaster,Magnesium Sulfate 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $24.67 , $13.57 , $9.87 , See APC Packaged Rates , $17.27 , $9.62 , $0.42 , $0.42 , $0.42 , See APC Packaged Rates , See APC Packaged Rates , $16.55 , $16.55 , See APC Packaged Rates , See APC Packaged Rates , $22.94 , $22.94 , $22.94 , $22.94 , See APC Packaged Rates , $8.63 , $- , $- , $22.94 , $17.27
J3475,5710011507,Hospital Chargemaster,Magnesium Sulfate 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $14.36 , $7.90 , $5.74 , See APC Packaged Rates , $10.05 , $5.60 , $0.42 , $0.42 , $0.42 , See APC Packaged Rates , See APC Packaged Rates , $9.64 , $9.64 , See APC Packaged Rates , See APC Packaged Rates , $13.35 , $13.35 , $13.35 , $13.35 , See APC Packaged Rates , $5.03 , $- , $- , $13.35 , $10.05
J3475,5710011508,Hospital Chargemaster,Magnesium Sulfate 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $18.53 , $10.19 , $7.41 , See APC Packaged Rates , $12.97 , $7.23 , $0.42 , $0.42 , $0.42 , See APC Packaged Rates , See APC Packaged Rates , $12.43 , $12.43 , See APC Packaged Rates , See APC Packaged Rates , $17.23 , $17.23 , $17.23 , $17.23 , See APC Packaged Rates , $6.49 , $- , $- , $17.23 , $12.97
J3475,5710011509,Hospital Chargemaster,Magnesium Sulfate 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $20.68 , $11.37 , $8.27 , See APC Packaged Rates , $14.48 , $8.07 , $0.42 , $0.42 , $0.42 , See APC Packaged Rates , See APC Packaged Rates , $13.88 , $13.88 , See APC Packaged Rates , See APC Packaged Rates , $19.23 , $19.23 , $19.23 , $19.23 , See APC Packaged Rates , $7.24 , $- , $- , $19.23 , $14.48
J3475,5710011510,Hospital Chargemaster,Magnesium Sulfate 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.42 , $0.42 , $0.42 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.42 , $-
J3475,5710011511,Hospital Chargemaster,Magnesium Sulfate 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $18.85 , $10.37 , $7.54 , See APC Packaged Rates , $13.20 , $7.35 , $0.42 , $0.42 , $0.42 , See APC Packaged Rates , See APC Packaged Rates , $12.65 , $12.65 , See APC Packaged Rates , See APC Packaged Rates , $17.53 , $17.53 , $17.53 , $17.53 , See APC Packaged Rates , $6.60 , $- , $- , $17.53 , $13.20
J0282,5710010121,Hospital Chargemaster,Amiodarone 30 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $43.38 , $23.86 , $17.35 , See APC Packaged Rates , $30.37 , $16.92 , $0.46 , $0.46 , $0.46 , See APC Packaged Rates , See APC Packaged Rates , $29.11 , $29.11 , See APC Packaged Rates , See APC Packaged Rates , $40.34 , $40.34 , $40.34 , $40.34 , See APC Packaged Rates , $15.18 , $0.81 , $0.46 , $40.34 , $30.37
J0282,5710010122,Hospital Chargemaster,Amiodarone 30 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $3.82 , $2.10 , $1.53 , See APC Packaged Rates , $2.67 , $1.49 , $0.46 , $0.46 , $0.46 , See APC Packaged Rates , See APC Packaged Rates , $2.56 , $2.56 , See APC Packaged Rates , See APC Packaged Rates , $3.55 , $3.55 , $3.55 , $3.55 , See APC Packaged Rates , $1.34 , $0.81 , $0.46 , $3.55 , $2.67
J0282,5710010123,Hospital Chargemaster,Amiodarone 30 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.46 , $0.46 , $0.46 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.81 , $- , $0.81 , $-
J0282,5710010124,Hospital Chargemaster,Amiodarone 30 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.46 , $0.46 , $0.46 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.81 , $- , $0.81 , $-
J0282,5710012670,Hospital Chargemaster,Amiodarone 30 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.46 , $0.46 , $0.46 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.81 , $- , $0.81 , $-
J0131,5710010045,Hospital Chargemaster,Acetaminophen 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $120.66 , $66.36 , $48.26 , See APC Packaged Rates , $84.46 , $47.06 , $0.54 , $0.54 , $0.54 , See APC Packaged Rates , See APC Packaged Rates , $80.96 , $80.96 , See APC Packaged Rates , See APC Packaged Rates , $112.21 , $112.21 , $112.21 , $112.21 , See APC Packaged Rates , $42.23 , $- , $- , $112.21 , $84.46
J1050,5710011523,Hospital Chargemaster,medroxyPROGESTER Acet 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $638.78 , $351.33 , $255.51 , See APC Packaged Rates , $447.15 , $249.12 , $0.56 , $0.56 , $0.56 , See APC Packaged Rates , See APC Packaged Rates , $428.62 , $428.62 , See APC Packaged Rates , See APC Packaged Rates , $594.07 , $594.07 , $594.07 , $594.07 , See APC Packaged Rates , $223.57 , $0.57 , $0.56 , $594.07 , $447.15
J1050,5710011524,Hospital Chargemaster,medroxyPROGESTER Acet 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.56 , $0.56 , $0.56 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.57 , $- , $0.57 , $-
J0153,5710010070,Hospital Chargemaster,Adenosine 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $40.80 , $22.44 , $16.32 , See APC Packaged Rates , $28.56 , $15.91 , $0.57 , $0.57 , $0.57 , See APC Packaged Rates , See APC Packaged Rates , $27.38 , $27.38 , See APC Packaged Rates , See APC Packaged Rates , $37.94 , $37.94 , $37.94 , $37.94 , See APC Packaged Rates , $14.28 , $- , $- , $37.94 , $28.56
J0153,5710010071,Hospital Chargemaster,Adenosine 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $66.30 , $36.47 , $26.52 , See APC Packaged Rates , $46.41 , $25.86 , $0.57 , $0.57 , $0.57 , See APC Packaged Rates , See APC Packaged Rates , $44.49 , $44.49 , See APC Packaged Rates , See APC Packaged Rates , $61.66 , $61.66 , $61.66 , $61.66 , See APC Packaged Rates , $23.21 , $- , $- , $61.66 , $46.41
J0153,5710010072,Hospital Chargemaster,Adenosine 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.57 , $0.57 , $0.57 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.57 , $-
J0153,5710010073,Hospital Chargemaster,Adenosine 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $27.92 , $15.36 , $11.17 , See APC Packaged Rates , $19.54 , $10.89 , $0.57 , $0.57 , $0.57 , See APC Packaged Rates , See APC Packaged Rates , $18.73 , $18.73 , See APC Packaged Rates , See APC Packaged Rates , $25.97 , $25.97 , $25.97 , $25.97 , See APC Packaged Rates , $9.77 , $- , $- , $25.97 , $19.54
J0153,5710010074,Hospital Chargemaster,Adenosine Diagnostic 90 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.57 , $0.57 , $0.57 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.57 , $-
J0696,5710010463,Hospital Chargemaster,Ceftriaxone Sodium 250 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.63 , $0.63 , $0.63 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.48 , $- , $0.63 , $-
J0696,5710010464,Hospital Chargemaster,Ceftriaxone Sodium 250 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.63 , $0.63 , $0.63 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.48 , $- , $0.63 , $-
J0696,5710010465,Hospital Chargemaster,Ceftriaxone Sodium 250 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $3.81 , $2.10 , $1.52 , See APC Packaged Rates , $2.67 , $1.49 , $0.63 , $0.63 , $0.63 , See APC Packaged Rates , See APC Packaged Rates , $2.56 , $2.56 , See APC Packaged Rates , See APC Packaged Rates , $3.54 , $3.54 , $3.54 , $3.54 , See APC Packaged Rates , $1.33 , $0.48 , $0.48 , $3.54 , $2.67
J0696,5710010467,Hospital Chargemaster,Ceftriaxone Sodium 250 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $2.41 , $1.33 , $0.96 , See APC Packaged Rates , $1.69 , $0.94 , $0.63 , $0.63 , $0.63 , See APC Packaged Rates , See APC Packaged Rates , $1.62 , $1.62 , See APC Packaged Rates , See APC Packaged Rates , $2.24 , $2.24 , $2.24 , $2.24 , See APC Packaged Rates , $0.84 , $0.48 , $0.48 , $2.24 , $1.69
J0696,5710010468,Hospital Chargemaster,Ceftriaxone Sodium 250 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $7.32 , $4.03 , $2.93 , See APC Packaged Rates , $5.12 , $2.85 , $0.63 , $0.63 , $0.63 , See APC Packaged Rates , See APC Packaged Rates , $4.91 , $4.91 , See APC Packaged Rates , See APC Packaged Rates , $6.81 , $6.81 , $6.81 , $6.81 , See APC Packaged Rates , $2.56 , $0.48 , $0.48 , $6.81 , $5.12
J0696,5710010469,Hospital Chargemaster,Ceftriaxone Sodium 250 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.63 , $0.63 , $0.63 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.48 , $- , $0.63 , $-
J0696,5710010470,Hospital Chargemaster,Ceftriaxone Sodium 250 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $2.47 , $1.36 , $0.99 , See APC Packaged Rates , $1.73 , $0.96 , $0.63 , $0.63 , $0.63 , See APC Packaged Rates , See APC Packaged Rates , $1.66 , $1.66 , See APC Packaged Rates , See APC Packaged Rates , $2.30 , $2.30 , $2.30 , $2.30 , See APC Packaged Rates , $0.86 , $0.48 , $0.48 , $2.30 , $1.73
J1200,5710010772,Hospital Chargemaster,diphenhydrAMINE 50 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $2.81 , $1.55 , $1.12 , See APC Packaged Rates , $1.97 , $1.10 , $0.65 , $0.65 , $0.65 , See APC Packaged Rates , See APC Packaged Rates , $1.89 , $1.89 , See APC Packaged Rates , See APC Packaged Rates , $2.61 , $2.61 , $2.61 , $2.61 , See APC Packaged Rates , $0.98 , $1.06 , $0.65 , $2.61 , $1.97
J1885,5710030022,Hospital Chargemaster,Ketorolac tromethamin inj 15mg,Outpatient,Outpatient Default Percent / Case Rate,636, $33.00 , $18.15 , $13.20 , See APC Packaged Rates , $23.10 , $12.87 , $0.67 , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $22.14 , $22.14 , See APC Packaged Rates , See APC Packaged Rates , $30.69 , $30.69 , $30.69 , $30.69 , See APC Packaged Rates , $11.55 , $0.55 , $0.55 , $30.69 , $23.10
J9100,5710010622,Hospital Chargemaster,Cytarabine 100 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.68 , $0.68 , $0.68 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.88 , $- , $0.88 , $-
J1650,5710010863,Hospital Chargemaster,Enoxaparin Sodium 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $50.90 , $28.00 , $20.36 , See APC Packaged Rates , $35.63 , $19.85 , $0.69 , $0.69 , $0.69 , See APC Packaged Rates , See APC Packaged Rates , $34.15 , $34.15 , See APC Packaged Rates , See APC Packaged Rates , $47.34 , $47.34 , $47.34 , $47.34 , See APC Packaged Rates , $17.82 , $- , $- , $47.34 , $35.63
J1650,5710010864,Hospital Chargemaster,Enoxaparin Sodium 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $65.38 , $35.96 , $26.15 , See APC Packaged Rates , $45.77 , $25.50 , $0.69 , $0.69 , $0.69 , See APC Packaged Rates , See APC Packaged Rates , $43.87 , $43.87 , See APC Packaged Rates , See APC Packaged Rates , $60.80 , $60.80 , $60.80 , $60.80 , See APC Packaged Rates , $22.88 , $- , $- , $60.80 , $45.77
J1650,5710010865,Hospital Chargemaster,Enoxaparin Sodium 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $81.73 , $44.95 , $32.69 , See APC Packaged Rates , $57.21 , $31.87 , $0.69 , $0.69 , $0.69 , See APC Packaged Rates , See APC Packaged Rates , $54.84 , $54.84 , See APC Packaged Rates , See APC Packaged Rates , $76.01 , $76.01 , $76.01 , $76.01 , See APC Packaged Rates , $28.61 , $- , $- , $76.01 , $57.21
J1650,5710010866,Hospital Chargemaster,Enoxaparin 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $16.33 , $8.98 , $6.53 , See APC Packaged Rates , $11.43 , $6.37 , $0.69 , $0.69 , $0.69 , See APC Packaged Rates , See APC Packaged Rates , $10.96 , $10.96 , See APC Packaged Rates , See APC Packaged Rates , $15.19 , $15.19 , $15.19 , $15.19 , See APC Packaged Rates , $5.72 , $- , $- , $15.19 , $11.43
J1650,5710010867,Hospital Chargemaster,Enoxaparin Sodium 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $21.32 , $11.73 , $8.53 , See APC Packaged Rates , $14.92 , $8.31 , $0.69 , $0.69 , $0.69 , See APC Packaged Rates , See APC Packaged Rates , $14.31 , $14.31 , See APC Packaged Rates , See APC Packaged Rates , $19.83 , $19.83 , $19.83 , $19.83 , See APC Packaged Rates , $7.46 , $- , $- , $19.83 , $14.92
J1650,5710010868,Hospital Chargemaster,Enoxaparin Sodium 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $32.16 , $17.69 , $12.86 , See APC Packaged Rates , $22.51 , $12.54 , $0.69 , $0.69 , $0.69 , See APC Packaged Rates , See APC Packaged Rates , $21.58 , $21.58 , See APC Packaged Rates , See APC Packaged Rates , $29.91 , $29.91 , $29.91 , $29.91 , See APC Packaged Rates , $11.26 , $- , $- , $29.91 , $22.51
J1650,5710010869,Hospital Chargemaster,Enoxaparin Sodium 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $43.58 , $23.97 , $17.43 , See APC Packaged Rates , $30.51 , $17.00 , $0.69 , $0.69 , $0.69 , See APC Packaged Rates , See APC Packaged Rates , $29.24 , $29.24 , See APC Packaged Rates , See APC Packaged Rates , $40.53 , $40.53 , $40.53 , $40.53 , See APC Packaged Rates , $15.25 , $- , $- , $40.53 , $30.51
J2060,5710011481,Hospital Chargemaster,LORazepam 2 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $2.95 , $1.62 , $1.18 , See APC Packaged Rates , $2.07 , $1.15 , $0.75 , $0.75 , $0.75 , See APC Packaged Rates , See APC Packaged Rates , $1.98 , $1.98 , See APC Packaged Rates , See APC Packaged Rates , $2.74 , $2.74 , $2.74 , $2.74 , See APC Packaged Rates , $1.03 , $0.72 , $0.72 , $2.74 , $2.07
J2060,5710011482,Hospital Chargemaster,LORazepam 2 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.75 , $0.75 , $0.75 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.72 , $- , $0.75 , $-
J2060,5710011483,Hospital Chargemaster,LORazepam 2 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.75 , $0.75 , $0.75 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.72 , $- , $0.75 , $-
J9181,5710010929,Hospital Chargemaster,Etoposide 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $23.89 , $13.14 , $9.56 , See APC Packaged Rates , $16.72 , $9.32 , $0.77 , $0.77 , $0.77 , See APC Packaged Rates , See APC Packaged Rates , $16.03 , $16.03 , See APC Packaged Rates , See APC Packaged Rates , $22.22 , $22.22 , $22.22 , $22.22 , See APC Packaged Rates , $8.36 , $0.76 , $0.76 , $22.22 , $16.72
J3010,5710010955,Hospital Chargemaster,fentaNYL Citrate 0.1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.78 , $0.78 , $0.78 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.78 , $-
J3010,5710010956,Hospital Chargemaster,fentaNYL Citrate 0.1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.78 , $0.78 , $0.78 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.78 , $-
J3010,5710010957,Hospital Chargemaster,fentaNYL Citrate 0.1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.78 , $0.78 , $0.78 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.78 , $-
J3010,5710010958,Hospital Chargemaster,fentaNYL Citrate 0.1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.78 , $0.78 , $0.78 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.78 , $-
J3010,5710010959,Hospital Chargemaster,fentaNYL Citrate 0.1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.78 , $0.78 , $0.78 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.78 , $-
J3010,5710010960,Hospital Chargemaster,fentaNYL Citrate 0.1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $3.21 , $1.77 , $1.28 , See APC Packaged Rates , $2.25 , $1.25 , $0.78 , $0.78 , $0.78 , See APC Packaged Rates , See APC Packaged Rates , $2.15 , $2.15 , See APC Packaged Rates , See APC Packaged Rates , $2.99 , $2.99 , $2.99 , $2.99 , See APC Packaged Rates , $1.12 , $- , $- , $2.99 , $2.25
J3010,5710010961,Hospital Chargemaster,fentaNYL Citrate 0.1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $32.21 , $17.72 , $12.88 , See APC Packaged Rates , $22.55 , $12.56 , $0.78 , $0.78 , $0.78 , See APC Packaged Rates , See APC Packaged Rates , $21.61 , $21.61 , See APC Packaged Rates , See APC Packaged Rates , $29.96 , $29.96 , $29.96 , $29.96 , See APC Packaged Rates , $11.27 , $- , $- , $29.96 , $22.55
J1940,5710011047,Hospital Chargemaster,Furosemide 20 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $10.32 , $5.68 , $4.13 , See APC Packaged Rates , $7.22 , $4.02 , $0.79 , $0.79 , $0.79 , See APC Packaged Rates , See APC Packaged Rates , $6.92 , $6.92 , See APC Packaged Rates , See APC Packaged Rates , $9.60 , $9.60 , $9.60 , $9.60 , See APC Packaged Rates , $3.61 , $0.52 , $0.52 , $9.60 , $7.22
J1940,5710011048,Hospital Chargemaster,Furosemide 20 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $7.11 , $3.91 , $2.84 , See APC Packaged Rates , $4.98 , $2.77 , $0.79 , $0.79 , $0.79 , See APC Packaged Rates , See APC Packaged Rates , $4.77 , $4.77 , See APC Packaged Rates , See APC Packaged Rates , $6.61 , $6.61 , $6.61 , $6.61 , See APC Packaged Rates , $2.49 , $0.52 , $0.52 , $6.61 , $4.98
J1940,5710011049,Hospital Chargemaster,Furosemide 20 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $8.22 , $4.52 , $3.29 , See APC Packaged Rates , $5.75 , $3.21 , $0.79 , $0.79 , $0.79 , See APC Packaged Rates , See APC Packaged Rates , $5.52 , $5.52 , See APC Packaged Rates , See APC Packaged Rates , $7.64 , $7.64 , $7.64 , $7.64 , See APC Packaged Rates , $2.88 , $0.52 , $0.52 , $7.64 , $5.75
J9171,5710010792,Hospital Chargemaster,DOCEtaxel 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.85 , $0.85 , $0.85 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.46 , $- , $0.85 , $-
J9171,5710010793,Hospital Chargemaster,DOCEtaxel 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.85 , $0.85 , $0.85 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.46 , $- , $0.85 , $-
J9171,5710010794,Hospital Chargemaster,DOCEtaxel 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.85 , $0.85 , $0.85 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.46 , $- , $0.85 , $-
J9171,5710010795,Hospital Chargemaster,DOCEtaxel 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $1,109.25 ", $610.09 , $443.70 , See APC Packaged Rates , $776.48 , $432.61 , $0.85 , $0.85 , $0.85 , See APC Packaged Rates , See APC Packaged Rates , $744.31 , $744.31 , See APC Packaged Rates , See APC Packaged Rates ," $1,031.60 "," $1,031.60 "," $1,031.60 "," $1,031.60 ", See APC Packaged Rates , $388.24 , $0.46 , $0.46 ," $1,031.60 ", $776.48
J9171,5710010796,Hospital Chargemaster,DOCEtaxel 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.85 , $0.85 , $0.85 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.46 , $- , $0.85 , $-
J2185,5710011550,Hospital Chargemaster,Meropenem 100 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $26.88 , $14.78 , $10.75 , See APC Packaged Rates , $18.82 , $10.48 , $0.86 , $0.86 , $0.86 , See APC Packaged Rates , See APC Packaged Rates , $18.04 , $18.04 , See APC Packaged Rates , See APC Packaged Rates , $25.00 , $25.00 , $25.00 , $25.00 , See APC Packaged Rates , $9.41 , $0.74 , $0.74 , $25.00 , $18.82
J2185,5710011551,Hospital Chargemaster,Meropenem 100 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $14.79 , $8.13 , $5.92 , See APC Packaged Rates , $10.35 , $5.77 , $0.86 , $0.86 , $0.86 , See APC Packaged Rates , See APC Packaged Rates , $9.92 , $9.92 , See APC Packaged Rates , See APC Packaged Rates , $13.75 , $13.75 , $13.75 , $13.75 , See APC Packaged Rates , $5.18 , $0.74 , $0.74 , $13.75 , $10.35
J2185,5710011552,Hospital Chargemaster,Meropenem/NS 1 gm/50 mL Bag,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.86 , $0.86 , $0.86 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.74 , $- , $0.86 , $-
J0290,5710010154,Hospital Chargemaster,Ampicillin Sodium 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.71 , $- , $0.92 , $-
J0290,5710010155,Hospital Chargemaster,Ampicillin Sodium 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $22.03 , $12.12 , $8.81 , See APC Packaged Rates , $15.42 , $8.59 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , See APC Packaged Rates , $14.78 , $14.78 , See APC Packaged Rates , See APC Packaged Rates , $20.49 , $20.49 , $20.49 , $20.49 , See APC Packaged Rates , $7.71 , $0.71 , $0.71 , $20.49 , $15.42
J0290,5710010156,Hospital Chargemaster,Ampicillin Sodium 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.71 , $- , $0.92 , $-
J0290,5710010157,Hospital Chargemaster,Ampicillin Sodium 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $42.71 , $23.49 , $17.08 , See APC Packaged Rates , $29.90 , $16.66 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , See APC Packaged Rates , $28.66 , $28.66 , See APC Packaged Rates , See APC Packaged Rates , $39.72 , $39.72 , $39.72 , $39.72 , See APC Packaged Rates , $14.95 , $0.71 , $0.71 , $39.72 , $29.90
J0290,5710010158,Hospital Chargemaster,Ampicillin Sodium 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $11.25 , $6.19 , $4.50 , See APC Packaged Rates , $7.88 , $4.39 , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , See APC Packaged Rates , $7.55 , $7.55 , See APC Packaged Rates , See APC Packaged Rates , $10.46 , $10.46 , $10.46 , $10.46 , See APC Packaged Rates , $3.94 , $0.71 , $0.71 , $10.46 , $7.88
J0290,5710010159,Hospital Chargemaster,Ampicillin Sodium 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.71 , $- , $0.92 , $-
J0290,5710010160,Hospital Chargemaster,Ampicillin Sodium 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.92 , $0.92 , $0.92 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.71 , $- , $0.92 , $-
J2354,5710011813,Hospital Chargemaster,Octreotide 25 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $31.57 , $17.36 , $12.63 , See APC Packaged Rates , $22.10 , $12.31 , $0.95 , $0.95 , $0.95 , See APC Packaged Rates , See APC Packaged Rates , $21.18 , $21.18 , See APC Packaged Rates , See APC Packaged Rates , $29.36 , $29.36 , $29.36 , $29.36 , See APC Packaged Rates , $11.05 , $0.97 , $0.95 , $29.36 , $22.10
J2354,5710011814,Hospital Chargemaster,Octreotide 25 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.95 , $0.95 , $0.95 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.97 , $- , $0.97 , $-
J2354,5710011815,Hospital Chargemaster,Octreotide 25 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $126.71 , $69.69 , $50.68 , See APC Packaged Rates , $88.70 , $49.42 , $0.95 , $0.95 , $0.95 , See APC Packaged Rates , See APC Packaged Rates , $85.02 , $85.02 , See APC Packaged Rates , See APC Packaged Rates , $117.84 , $117.84 , $117.84 , $117.84 , See APC Packaged Rates , $44.35 , $0.97 , $0.95 , $117.84 , $88.70
J2354,5710011816,Hospital Chargemaster,Octreotide 25 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.95 , $0.95 , $0.95 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.97 , $- , $0.97 , $-
J0690,5710010428,Hospital Chargemaster,ceFAZolin Sodium 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.97 , $0.97 , $0.97 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.77 , $- , $0.97 , $-
J0690,5710010429,Hospital Chargemaster,ceFAZolin Sodium 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.97 , $0.97 , $0.97 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.77 , $- , $0.97 , $-
J0690,5710010430,Hospital Chargemaster,ceFAZolin Sodium 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $19.09 , $10.50 , $7.64 , See APC Packaged Rates , $13.36 , $7.45 , $0.97 , $0.97 , $0.97 , See APC Packaged Rates , See APC Packaged Rates , $12.81 , $12.81 , See APC Packaged Rates , See APC Packaged Rates , $17.75 , $17.75 , $17.75 , $17.75 , See APC Packaged Rates , $6.68 , $0.77 , $0.77 , $17.75 , $13.36
J0690,5710010431,Hospital Chargemaster,ceFAZolin Sodium 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.97 , $0.97 , $0.97 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.77 , $- , $0.97 , $-
J0690,5710010432,Hospital Chargemaster,ceFAZolin Sodium 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.97 , $0.97 , $0.97 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.77 , $- , $0.97 , $-
J0690,5710010433,Hospital Chargemaster,ceFAZolin 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.97 , $0.97 , $0.97 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.77 , $- , $0.97 , $-
J0690,5710010434,Hospital Chargemaster,ceFAZolin 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $32.56 , $17.91 , $13.02 , See APC Packaged Rates , $22.79 , $12.70 , $0.97 , $0.97 , $0.97 , See APC Packaged Rates , See APC Packaged Rates , $21.85 , $21.85 , See APC Packaged Rates , See APC Packaged Rates , $30.28 , $30.28 , $30.28 , $30.28 , See APC Packaged Rates , $11.40 , $0.77 , $0.77 , $30.28 , $22.79
J0744,5710010527,Hospital Chargemaster,Ciprofloxacin 200 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $6.10 , $3.36 , $2.44 , See APC Packaged Rates , $4.27 , $2.38 , $1.00 , $1.00 , $1.00 , See APC Packaged Rates , See APC Packaged Rates , $4.09 , $4.09 , See APC Packaged Rates , See APC Packaged Rates , $5.67 , $5.67 , $5.67 , $5.67 , See APC Packaged Rates , $2.14 , $0.95 , $0.95 , $5.67 , $4.27
J0744,5710010528,Hospital Chargemaster,Ciprofloxacin 200 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $10.08 , $5.54 , $4.03 , See APC Packaged Rates , $7.06 , $3.93 , $1.00 , $1.00 , $1.00 , See APC Packaged Rates , See APC Packaged Rates , $6.76 , $6.76 , See APC Packaged Rates , See APC Packaged Rates , $9.37 , $9.37 , $9.37 , $9.37 , See APC Packaged Rates , $3.53 , $0.95 , $0.95 , $9.37 , $7.06
J0132,5710010054,Hospital Chargemaster,Acetylcysteine 100 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $479.40 , $263.67 , $191.76 , See APC Packaged Rates , $335.58 , $186.97 , $1.06 , $1.06 , $1.06 , See APC Packaged Rates , See APC Packaged Rates , $321.68 , $321.68 , See APC Packaged Rates , See APC Packaged Rates , $445.84 , $445.84 , $445.84 , $445.84 , See APC Packaged Rates , $167.79 , $- , $- , $445.84 , $335.58
J9351,5710012399,Hospital Chargemaster,Topotecan HCl 0.1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.28 , $1.28 , $1.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.90 , $- , $1.28 , $-
J0278,5710010106,Hospital Chargemaster,Amikacin 100 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.30 , $1.30 , $1.30 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.91 , $- , $1.30 , $-
J0278,5710010107,Hospital Chargemaster,Amikacin 100 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.30 , $1.30 , $1.30 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.91 , $- , $1.30 , $-
J1652,5710011033,Hospital Chargemaster,Fondaparinux Sodium 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.46 , $1.46 , $1.46 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.47 , $- , $1.47 , $-
J1652,5710011034,Hospital Chargemaster,Fondaparinux Sodium 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $132.87 , $73.08 , $53.15 , See APC Packaged Rates , $93.01 , $51.82 , $1.46 , $1.46 , $1.46 , See APC Packaged Rates , See APC Packaged Rates , $89.16 , $89.16 , See APC Packaged Rates , See APC Packaged Rates , $123.57 , $123.57 , $123.57 , $123.57 , See APC Packaged Rates , $46.50 , $1.47 , $1.46 , $123.57 , $93.01
J1652,5710011035,Hospital Chargemaster,Fondaparinux Sodium 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.46 , $1.46 , $1.46 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.47 , $- , $1.47 , $-
J1652,5710011036,Hospital Chargemaster,Fondaparinux Sodium 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $267.14 , $146.93 , $106.86 , See APC Packaged Rates , $187.00 , $104.18 , $1.46 , $1.46 , $1.46 , See APC Packaged Rates , See APC Packaged Rates , $179.25 , $179.25 , See APC Packaged Rates , See APC Packaged Rates , $248.44 , $248.44 , $248.44 , $248.44 , See APC Packaged Rates , $93.50 , $1.47 , $1.46 , $248.44 , $187.00
J2260,5710011643,Hospital Chargemaster,Milrinone 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $7.96 , $4.38 , $3.18 , See APC Packaged Rates , $5.57 , $3.10 , $1.51 , $1.51 , $1.51 , See APC Packaged Rates , See APC Packaged Rates , $5.34 , $5.34 , See APC Packaged Rates , See APC Packaged Rates , $7.40 , $7.40 , $7.40 , $7.40 , See APC Packaged Rates , $2.79 , $1.61 , $1.51 , $7.40 , $5.57
J3485,5710012540,Hospital Chargemaster,Zidovudine 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.51 , $1.51 , $1.51 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.51 , $- , $1.51 , $-
J9178,5710010878,Hospital Chargemaster,epiRUBicin HCl 2 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.53 , $1.53 , $1.53 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.46 , $- , $1.53 , $-
J9178,5710010879,Hospital Chargemaster,epiRUBicin HCl 2 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.53 , $1.53 , $1.53 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.46 , $- , $1.53 , $-
J9190,5710010999,Hospital Chargemaster,Fluorouracil 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $15.30 , $8.42 , $6.12 , See APC Packaged Rates , $10.71 , $5.97 , $1.53 , $1.53 , $1.53 , See APC Packaged Rates , See APC Packaged Rates , $10.27 , $10.27 , See APC Packaged Rates , See APC Packaged Rates , $14.23 , $14.23 , $14.23 , $14.23 , See APC Packaged Rates , $5.36 , $2.13 , $1.53 , $14.23 , $10.71
J9190,5710011000,Hospital Chargemaster,Fluorouracil 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $32.77 , $18.02 , $13.11 , See APC Packaged Rates , $22.94 , $12.78 , $1.53 , $1.53 , $1.53 , See APC Packaged Rates , See APC Packaged Rates , $21.99 , $21.99 , See APC Packaged Rates , See APC Packaged Rates , $30.48 , $30.48 , $30.48 , $30.48 , See APC Packaged Rates , $11.47 , $2.13 , $1.53 , $30.48 , $22.94
J9190,5710011001,Hospital Chargemaster,Fluorouracil 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.53 , $1.53 , $1.53 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.13 , $- , $2.13 , $-
J9190,5710011002,Hospital Chargemaster,Fluorouracil 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $59.84 , $32.91 , $23.94 , See APC Packaged Rates , $41.89 , $23.34 , $1.53 , $1.53 , $1.53 , See APC Packaged Rates , See APC Packaged Rates , $40.15 , $40.15 , See APC Packaged Rates , See APC Packaged Rates , $55.65 , $55.65 , $55.65 , $55.65 , See APC Packaged Rates , $20.94 , $2.13 , $1.53 , $55.65 , $41.89
J0692,5710010436,Hospital Chargemaster,Cefepime 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $15.30 , $8.42 , $6.12 , See APC Packaged Rates , $10.71 , $5.97 , $1.69 , $1.69 , $1.69 , See APC Packaged Rates , See APC Packaged Rates , $10.27 , $10.27 , See APC Packaged Rates , See APC Packaged Rates , $14.23 , $14.23 , $14.23 , $14.23 , See APC Packaged Rates , $5.36 , $1.76 , $1.69 , $14.23 , $10.71
J0692,5710010437,Hospital Chargemaster,Cefepime 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $25.50 , $14.03 , $10.20 , See APC Packaged Rates , $17.85 , $9.95 , $1.69 , $1.69 , $1.69 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $1.76 , $1.69 , $23.72 , $17.85
J0692,5710010438,Hospital Chargemaster,Cefepime 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.69 , $1.69 , $1.69 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.76 , $- , $1.76 , $-
J0692,5710010439,Hospital Chargemaster,Cefepime 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.69 , $1.69 , $1.69 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.76 , $- , $1.76 , $-
J0692,5710010466,Hospital Chargemaster,Ceftriaxone Sodium 250 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.69 , $1.69 , $1.69 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.76 , $- , $1.76 , $-
J7502,5710010617,Hospital Chargemaster,cycloSPORINE 25 mg Oral,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.79 , $1.79 , $1.79 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.43 , $- , $2.43 , $-
J7502,5710010619,Hospital Chargemaster,"cycloSPORINE, Mod 25mg Oral",Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.79 , $1.79 , $1.79 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.43 , $- , $2.43 , $-
J1580,5710011080,Hospital Chargemaster,Gentamicin up to 80 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.79 , $1.79 , $1.79 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.41 , $- , $1.79 , $-
J1580,5710011081,Hospital Chargemaster,Gentamicin up to 80 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.79 , $1.79 , $1.79 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.41 , $- , $1.79 , $-
J1580,5710011082,Hospital Chargemaster,Gentamicin up to 80 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.79 , $1.79 , $1.79 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.41 , $- , $1.79 , $-
J1580,5710011087,Hospital Chargemaster,Gentamicin up to 80 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $10.20 , $5.61 , $4.08 , See APC Packaged Rates , $7.14 , $3.98 , $1.79 , $1.79 , $1.79 , See APC Packaged Rates , See APC Packaged Rates , $6.84 , $6.84 , See APC Packaged Rates , See APC Packaged Rates , $9.49 , $9.49 , $9.49 , $9.49 , See APC Packaged Rates , $3.57 , $1.41 , $1.41 , $9.49 , $7.14
J1580,5710011088,Hospital Chargemaster,Gentamicin up to 80 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $8.24 , $4.53 , $3.30 , See APC Packaged Rates , $5.77 , $3.21 , $1.79 , $1.79 , $1.79 , See APC Packaged Rates , See APC Packaged Rates , $5.53 , $5.53 , See APC Packaged Rates , See APC Packaged Rates , $7.66 , $7.66 , $7.66 , $7.66 , See APC Packaged Rates , $2.88 , $1.41 , $1.41 , $7.66 , $5.77
J3420,5710011198,Hospital Chargemaster,Hydroxocobalamin 1000 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.84 , $1.84 , $1.84 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.80 , $- , $1.84 , $-
J0697,5710010473,Hospital Chargemaster,cefUROXime sodium 750 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.94 , $1.94 , $1.94 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.99 , $- , $1.99 , $-
J0713,5710010455,Hospital Chargemaster,Ceftazidime per 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.95 , $1.95 , $1.95 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.96 , $- , $1.96 , $-
J0713,5710010456,Hospital Chargemaster,Ceftazidime per 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.95 , $1.95 , $1.95 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.96 , $- , $1.96 , $-
J0713,5710010458,Hospital Chargemaster,Ceftazidime per 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $14.70 , $8.09 , $5.88 , See APC Packaged Rates , $10.29 , $5.73 , $1.95 , $1.95 , $1.95 , See APC Packaged Rates , See APC Packaged Rates , $9.86 , $9.86 , See APC Packaged Rates , See APC Packaged Rates , $13.67 , $13.67 , $13.67 , $13.67 , See APC Packaged Rates , $5.15 , $1.96 , $1.95 , $13.67 , $10.29
J0713,5710010459,Hospital Chargemaster,Ceftazidime per 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $28.05 , $15.43 , $11.22 , See APC Packaged Rates , $19.64 , $10.94 , $1.95 , $1.95 , $1.95 , See APC Packaged Rates , See APC Packaged Rates , $18.82 , $18.82 , See APC Packaged Rates , See APC Packaged Rates , $26.09 , $26.09 , $26.09 , $26.09 , See APC Packaged Rates , $9.82 , $1.96 , $1.95 , $26.09 , $19.64
J0713,5710010460,Hospital Chargemaster,Ceftazidime per 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.95 , $1.95 , $1.95 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.96 , $- , $1.96 , $-
J0713,5710010461,Hospital Chargemaster,Ceftazidime per 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.95 , $1.95 , $1.95 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.96 , $- , $1.96 , $-
J1170,5710011188,Hospital Chargemaster,Hydromorphone Inj up to 4 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $6.55 , $3.60 , $2.62 , See APC Packaged Rates , $4.59 , $2.55 , $1.98 , $1.98 , $1.98 , See APC Packaged Rates , See APC Packaged Rates , $4.40 , $4.40 , See APC Packaged Rates , See APC Packaged Rates , $6.09 , $6.09 , $6.09 , $6.09 , See APC Packaged Rates , $2.29 , $2.75 , $1.98 , $6.09 , $4.59
J1170,5710011189,Hospital Chargemaster,Hydromorphone Inj up to 4 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.98 , $1.98 , $1.98 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.75 , $- , $2.75 , $-
J1170,5710011190,Hospital Chargemaster,Hydromorphone Inj up to 4 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $6.90 , $3.80 , $2.76 , See APC Packaged Rates , $4.83 , $2.69 , $1.98 , $1.98 , $1.98 , See APC Packaged Rates , See APC Packaged Rates , $4.63 , $4.63 , See APC Packaged Rates , See APC Packaged Rates , $6.42 , $6.42 , $6.42 , $6.42 , See APC Packaged Rates , $2.42 , $2.75 , $1.98 , $6.42 , $4.83
J1170,5710011193,Hospital Chargemaster,Hydromorphone Inj up to 4 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.98 , $1.98 , $1.98 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.75 , $- , $2.75 , $-
J1170,5710011194,Hospital Chargemaster,Hydromorphone Inj up to 4 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.98 , $1.98 , $1.98 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.75 , $- , $2.75 , $-
J1170,5710011195,Hospital Chargemaster,Hydromorphone Inj up to 4 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.98 , $1.98 , $1.98 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.75 , $- , $2.75 , $-
J1170,5710011196,Hospital Chargemaster,Hydromorphone Inj up to 4 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.98 , $1.98 , $1.98 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.75 , $- , $2.75 , $-
J1170,5710011197,Hospital Chargemaster,Hydromorphone Inj up to 4 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.98 , $1.98 , $1.98 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.75 , $- , $2.75 , $-
J2710,5710011750,Hospital Chargemaster,Neostigmine 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.98 , $1.98 , $1.98 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.13 , $- , $2.13 , $-
J2710,5710011751,Hospital Chargemaster,Neostigmine 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.98 , $1.98 , $1.98 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.13 , $- , $2.13 , $-
J2710,5710011752,Hospital Chargemaster,Neostigmine 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $4.81 , $2.65 , $1.92 , See APC Packaged Rates , $3.37 , $1.88 , $1.98 , $1.98 , $1.98 , See APC Packaged Rates , See APC Packaged Rates , $3.23 , $3.23 , See APC Packaged Rates , See APC Packaged Rates , $4.47 , $4.47 , $4.47 , $4.47 , See APC Packaged Rates , $1.68 , $2.13 , $1.68 , $4.47 , $3.37
J0706,5710010369,Hospital Chargemaster,Caffeine Citrate 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $61.20 , $33.66 , $24.48 , See APC Packaged Rates , $42.84 , $23.87 , $2.00 , $2.00 , $2.00 , See APC Packaged Rates , See APC Packaged Rates , $41.07 , $41.07 , See APC Packaged Rates , See APC Packaged Rates , $56.92 , $56.92 , $56.92 , $56.92 , See APC Packaged Rates , $21.42 , $2.26 , $2.00 , $56.92 , $42.84
J8530,5710010611,Hospital Chargemaster,Cyclophosphamide 25 mg Oral,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $2.02 , $2.02 , $2.02 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.88 , $- , $2.02 , $-
J2916,5710012277,Hospital Chargemaster,Sod Ferr Gluc/Sucr 12.5mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $81.09 , $44.60 , $32.44 , See APC Packaged Rates , $56.76 , $31.63 , $2.09 , $2.09 , $2.09 , See APC Packaged Rates , See APC Packaged Rates , $54.41 , $54.41 , See APC Packaged Rates , See APC Packaged Rates , $75.41 , $75.41 , $75.41 , $75.41 , See APC Packaged Rates , $28.38 , $1.92 , $1.92 , $75.41 , $56.76
J9209,5710011559,Hospital Chargemaster,Mesna 200 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $2.13 , $2.13 , $2.13 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.73 , $- , $2.13 , $-
J0330,5710012299,Hospital Chargemaster,Succinylcholine up to 20mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $48.51 , $26.68 , $19.40 , See APC Packaged Rates , $33.96 , $18.92 , $2.19 , $2.19 , $2.19 , See APC Packaged Rates , See APC Packaged Rates , $32.55 , $32.55 , See APC Packaged Rates , See APC Packaged Rates , $45.11 , $45.11 , $45.11 , $45.11 , See APC Packaged Rates , $16.98 , $1.87 , $1.87 , $45.11 , $33.96
J0330,5710012300,Hospital Chargemaster,Succinylcholine up to 20mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $2.19 , $2.19 , $2.19 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.87 , $- , $2.19 , $-
J0330,5710012659,Hospital Chargemaster,Succinylcholine to 20 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $6.29 , $3.46 , $2.52 , See APC Packaged Rates , $4.40 , $2.45 , $2.19 , $2.19 , $2.19 , See APC Packaged Rates , See APC Packaged Rates , $4.22 , $4.22 , See APC Packaged Rates , See APC Packaged Rates , $5.85 , $5.85 , $5.85 , $5.85 , See APC Packaged Rates , $2.20 , $1.87 , $1.87 , $5.85 , $4.40
J0698,5710010442,Hospital Chargemaster,cefoTAXime Sodium per gm,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $2.33 , $2.33 , $2.33 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $6.04 , $- , $6.04 , $-
J0698,5710010443,Hospital Chargemaster,cefoTAXime Sodium per gm,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $2.33 , $2.33 , $2.33 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $6.04 , $- , $6.04 , $-
J3411,5710012357,Hospital Chargemaster,Thiamine HCl 100 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $25.29 , $13.91 , $10.12 , See APC Packaged Rates , $17.70 , $9.86 , $2.53 , $2.53 , $2.53 , See APC Packaged Rates , See APC Packaged Rates , $16.97 , $16.97 , See APC Packaged Rates , See APC Packaged Rates , $23.52 , $23.52 , $23.52 , $23.52 , See APC Packaged Rates , $8.85 , $- , $- , $23.52 , $17.70
J9206,5710011293,Hospital Chargemaster,Irinotecan 20 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $129.65 , $71.31 , $51.86 , See APC Packaged Rates , $90.76 , $50.56 , $2.54 , $2.54 , $2.54 , See APC Packaged Rates , See APC Packaged Rates , $87.00 , $87.00 , See APC Packaged Rates , See APC Packaged Rates , $120.57 , $120.57 , $120.57 , $120.57 , See APC Packaged Rates , $45.38 , $2.45 , $2.45 , $120.57 , $90.76
J9206,5710011294,Hospital Chargemaster,Irinotecan 20 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $40.80 , $22.44 , $16.32 , See APC Packaged Rates , $28.56 , $15.91 , $2.54 , $2.54 , $2.54 , See APC Packaged Rates , See APC Packaged Rates , $27.38 , $27.38 , See APC Packaged Rates , See APC Packaged Rates , $37.94 , $37.94 , $37.94 , $37.94 , See APC Packaged Rates , $14.28 , $2.45 , $2.45 , $37.94 , $28.56
J0295,5710010161,Hospital Chargemaster,Ampicillin Sod/Sulbactam 1.5gm,Outpatient,Outpatient Default Percent / Case Rate,636, $19.45 , $10.70 , $7.78 , See APC Packaged Rates , $13.62 , $7.59 , $2.64 , $2.64 , $2.64 , See APC Packaged Rates , See APC Packaged Rates , $13.05 , $13.05 , See APC Packaged Rates , See APC Packaged Rates , $18.09 , $18.09 , $18.09 , $18.09 , See APC Packaged Rates , $6.81 , $2.73 , $2.64 , $18.09 , $13.62
J0295,5710010162,Hospital Chargemaster,Ampicillin Sod/Sulbactam 1.5gm,Outpatient,Outpatient Default Percent / Case Rate,636, $37.23 , $20.48 , $14.89 , See APC Packaged Rates , $26.06 , $14.52 , $2.64 , $2.64 , $2.64 , See APC Packaged Rates , See APC Packaged Rates , $24.98 , $24.98 , See APC Packaged Rates , See APC Packaged Rates , $34.62 , $34.62 , $34.62 , $34.62 , See APC Packaged Rates , $13.03 , $2.73 , $2.64 , $34.62 , $26.06
J9000,5710010820,Hospital Chargemaster,Doxorubicin HCl 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $2.70 , $2.70 , $2.70 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $2.70 , $-
J9000,5710010821,Hospital Chargemaster,Doxorubicin HCl 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $84.99 , $46.74 , $34.00 , See APC Packaged Rates , $59.49 , $33.15 , $2.70 , $2.70 , $2.70 , See APC Packaged Rates , See APC Packaged Rates , $57.03 , $57.03 , See APC Packaged Rates , See APC Packaged Rates , $79.04 , $79.04 , $79.04 , $79.04 , See APC Packaged Rates , $29.75 , $- , $- , $79.04 , $59.49
J9045,5710010408,Hospital Chargemaster,CARBOplatin 50 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $2.76 , $2.76 , $2.76 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.61 , $- , $2.76 , $-
J9045,5710010409,Hospital Chargemaster,CARBOplatin 50 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $79.82 , $43.90 , $31.93 , See APC Packaged Rates , $55.87 , $31.13 , $2.76 , $2.76 , $2.76 , See APC Packaged Rates , See APC Packaged Rates , $53.56 , $53.56 , See APC Packaged Rates , See APC Packaged Rates , $74.23 , $74.23 , $74.23 , $74.23 , See APC Packaged Rates , $27.94 , $2.61 , $2.61 , $74.23 , $55.87
J9045,5710010410,Hospital Chargemaster,CARBOplatin 50 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $2.76 , $2.76 , $2.76 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.61 , $- , $2.76 , $-
J3370,5710012470,Hospital Chargemaster,Vancomycin 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $2.77 , $2.77 , $2.77 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $2.77 , $-
J3370,5710012471,Hospital Chargemaster,Vancomycin 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $20.59 , $11.32 , $8.24 , See APC Packaged Rates , $14.41 , $8.03 , $2.77 , $2.77 , $2.77 , See APC Packaged Rates , See APC Packaged Rates , $13.82 , $13.82 , See APC Packaged Rates , See APC Packaged Rates , $19.15 , $19.15 , $19.15 , $19.15 , See APC Packaged Rates , $7.21 , $- , $- , $19.15 , $14.41
J3370,5710012472,Hospital Chargemaster,Vancomycin 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $2.77 , $2.77 , $2.77 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $2.77 , $-
J0640,5710011358,Hospital Chargemaster,Leucovorin Calcium 50 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $51.00 , $28.05 , $20.40 , See APC Packaged Rates , $35.70 , $19.89 , $2.80 , $2.80 , $2.80 , See APC Packaged Rates , See APC Packaged Rates , $34.22 , $34.22 , See APC Packaged Rates , See APC Packaged Rates , $47.43 , $47.43 , $47.43 , $47.43 , See APC Packaged Rates , $17.85 , $4.44 , $2.80 , $47.43 , $35.70
J0640,5710011359,Hospital Chargemaster,Leucovorin Calcium 50 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $2.80 , $2.80 , $2.80 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $4.44 , $- , $4.44 , $-
J0640,5710011360,Hospital Chargemaster,Leucovorin Calcium 50 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $48.32 , $26.58 , $19.33 , See APC Packaged Rates , $33.82 , $18.84 , $2.80 , $2.80 , $2.80 , See APC Packaged Rates , See APC Packaged Rates , $32.42 , $32.42 , See APC Packaged Rates , See APC Packaged Rates , $44.94 , $44.94 , $44.94 , $44.94 , See APC Packaged Rates , $16.91 , $4.44 , $2.80 , $44.94 , $33.82
J0640,5710011361,Hospital Chargemaster,Leucovorin Calcium 50 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $2.80 , $2.80 , $2.80 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $4.44 , $- , $4.44 , $-
J0640,5710011362,Hospital Chargemaster,Leucovorin Calcium 50 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $2.80 , $2.80 , $2.80 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $4.44 , $- , $4.44 , $-
J0595,5710010364,Hospital Chargemaster,Butorphanol tartrate 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $11.18 , $6.15 , $4.47 , See APC Packaged Rates , $7.83 , $4.36 , $2.89 , $2.89 , $2.89 , See APC Packaged Rates , See APC Packaged Rates , $7.50 , $7.50 , See APC Packaged Rates , See APC Packaged Rates , $10.40 , $10.40 , $10.40 , $10.40 , See APC Packaged Rates , $3.91 , $2.89 , $2.89 , $10.40 , $7.83
J0595,5710010365,Hospital Chargemaster,Butorphanol tartrate 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $2.89 , $2.89 , $2.89 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.89 , $- , $2.89 , $-
J0670,5710011543,Hospital Chargemaster,Mepivacaine per 10 ml,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $3.00 , $3.00 , $3.00 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.93 , $- , $3.00 , $-
J0670,5710011544,Hospital Chargemaster,Mepivacaine per 10 ml,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $3.00 , $3.00 , $3.00 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.93 , $- , $3.00 , $-
J0670,5710011545,Hospital Chargemaster,Mepivacaine per 10 ml,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $3.00 , $3.00 , $3.00 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.93 , $- , $3.00 , $-
J0670,5710011546,Hospital Chargemaster,Mepivacaine per 10 ml,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $3.00 , $3.00 , $3.00 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.93 , $- , $3.00 , $-
J0670,5710011547,Hospital Chargemaster,Mepivacaine per 10 ml,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $3.00 , $3.00 , $3.00 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.93 , $- , $3.00 , $-
J1020,5710011596,Hospital Chargemaster,methylPREDNISolone Acet 20 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $32.36 , $17.80 , $12.94 , See APC Packaged Rates , $22.65 , $12.62 , $3.46 , $3.46 , $3.46 , See APC Packaged Rates , See APC Packaged Rates , $21.71 , $21.71 , See APC Packaged Rates , See APC Packaged Rates , $30.09 , $30.09 , $30.09 , $30.09 , See APC Packaged Rates , $11.33 , $3.58 , $3.46 , $30.09 , $22.65
J3260,5710012384,Hospital Chargemaster,Tobramycin Sulf up to 80 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $3.49 , $3.49 , $3.49 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $4.12 , $- , $4.12 , $-
J3260,5710012385,Hospital Chargemaster,Tobramycin Sulf up to 80 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $3.49 , $3.49 , $3.49 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $4.12 , $- , $4.12 , $-
J2469,5710011894,Hospital Chargemaster,Palonosetron 25 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $195.08 , $107.29 , $78.03 , See APC Packaged Rates , $136.56 , $76.08 , $3.78 , $3.78 , $3.78 , See APC Packaged Rates , See APC Packaged Rates , $130.90 , $130.90 , See APC Packaged Rates , See APC Packaged Rates , $181.42 , $181.42 , $181.42 , $181.42 , See APC Packaged Rates , $68.28 , $0.86 , $0.86 , $181.42 , $136.56
J3430,5710011981,Hospital Chargemaster,Phytonadione (Vit K) 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $123.52 , $67.94 , $49.41 , See APC Packaged Rates , $86.46 , $48.17 , $3.81 , $3.81 , $3.81 , See APC Packaged Rates , See APC Packaged Rates , $82.88 , $82.88 , See APC Packaged Rates , See APC Packaged Rates , $114.87 , $114.87 , $114.87 , $114.87 , See APC Packaged Rates , $43.23 , $3.42 , $3.42 , $114.87 , $86.46
J3430,5710011982,Hospital Chargemaster,Phytonadione (Vit K) 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $44.55 , $24.50 , $17.82 , See APC Packaged Rates , $31.19 , $17.37 , $3.81 , $3.81 , $3.81 , See APC Packaged Rates , See APC Packaged Rates , $29.89 , $29.89 , See APC Packaged Rates , See APC Packaged Rates , $41.43 , $41.43 , $41.43 , $41.43 , See APC Packaged Rates , $15.59 , $3.42 , $3.42 , $41.43 , $31.19
J9201,5710011076,Hospital Chargemaster,Gemcitabine HCl 200 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $124.08 , $68.24 , $49.63 , See APC Packaged Rates , $86.86 , $48.39 , $3.96 , $3.96 , $3.96 , See APC Packaged Rates , See APC Packaged Rates , $83.26 , $83.26 , See APC Packaged Rates , See APC Packaged Rates , $115.39 , $115.39 , $115.39 , $115.39 , See APC Packaged Rates , $43.43 , $3.85 , $3.85 , $115.39 , $86.86
J9201,5710011077,Hospital Chargemaster,Gemcitabine HCl 200 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $71.40 , $39.27 , $28.56 , See APC Packaged Rates , $49.98 , $27.85 , $3.96 , $3.96 , $3.96 , See APC Packaged Rates , See APC Packaged Rates , $47.91 , $47.91 , See APC Packaged Rates , See APC Packaged Rates , $66.40 , $66.40 , $66.40 , $66.40 , See APC Packaged Rates , $24.99 , $3.85 , $3.85 , $66.40 , $49.98
J9201,5710011078,Hospital Chargemaster,Gemcitabine HCl 200 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $3.96 , $3.96 , $3.96 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.85 , $- , $3.96 , $-
J9360,5710012498,Hospital Chargemaster,vinBLAStine 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $120.26 , $66.14 , $48.10 , See APC Packaged Rates , $84.18 , $46.90 , $3.98 , $3.98 , $3.98 , See APC Packaged Rates , See APC Packaged Rates , $80.69 , $80.69 , See APC Packaged Rates , See APC Packaged Rates , $111.84 , $111.84 , $111.84 , $111.84 , See APC Packaged Rates , $42.09 , $3.91 , $3.91 , $111.84 , $84.18
J0456,5710010238,Hospital Chargemaster,Azithromycin 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $4.03 , $4.03 , $4.03 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.63 , $- , $4.03 , $-
J0456,5710010239,Hospital Chargemaster,Azithromycin 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $9.09 , $5.00 , $3.64 , See APC Packaged Rates , $6.36 , $3.55 , $4.03 , $4.03 , $4.03 , See APC Packaged Rates , See APC Packaged Rates , $6.10 , $6.10 , See APC Packaged Rates , See APC Packaged Rates , $8.45 , $8.45 , $8.45 , $8.45 , See APC Packaged Rates , $3.18 , $2.63 , $2.63 , $8.45 , $6.36
J9130,5710010625,Hospital Chargemaster,Dacarbazine 100 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $83.77 , $46.07 , $33.51 , See APC Packaged Rates , $58.64 , $32.67 , $4.46 , $4.46 , $4.46 , See APC Packaged Rates , See APC Packaged Rates , $56.21 , $56.21 , See APC Packaged Rates , See APC Packaged Rates , $77.91 , $77.91 , $77.91 , $77.91 , See APC Packaged Rates , $29.32 , $3.62 , $3.62 , $77.91 , $58.64
J8501,5710010175,Hospital Chargemaster,Aprepitant 5 mg Oral,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $4.47 , $4.47 , $4.47 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $4.19 , $- , $4.47 , $-
J8501,5710010176,Hospital Chargemaster,Aprepitant 5 mg Oral,Outpatient,Outpatient Default Percent / Case Rate,636, $288.97 , $158.93 , $115.59 , See APC Packaged Rates , $202.28 , $112.70 , $4.47 , $4.47 , $4.47 , See APC Packaged Rates , See APC Packaged Rates , $193.90 , $193.90 , See APC Packaged Rates , See APC Packaged Rates , $268.74 , $268.74 , $268.74 , $268.74 , See APC Packaged Rates , $101.14 , $4.19 , $4.19 , $268.74 , $202.28
J9370,5710012499,Hospital Chargemaster,vinCrIStine 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $5.34 , $5.34 , $5.34 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $4.94 , $- , $5.34 , $-
J9370,5710012500,Hospital Chargemaster,vinCrIStine 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $27.26 , $14.99 , $10.90 , See APC Packaged Rates , $19.08 , $10.63 , $5.34 , $5.34 , $5.34 , See APC Packaged Rates , See APC Packaged Rates , $18.29 , $18.29 , See APC Packaged Rates , See APC Packaged Rates , $25.35 , $25.35 , $25.35 , $25.35 , See APC Packaged Rates , $9.54 , $4.94 , $4.94 , $25.35 , $19.08
Q2009,5710011040,Hospital Chargemaster,Fosphenytoin 50 mg PE Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $5.47 , $5.47 , $5.47 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $5.47 , $-
Q2009,5710011041,Hospital Chargemaster,Fosphenytoin 50 mg PE Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $57.38 , $31.56 , $22.95 , See APC Packaged Rates , $40.17 , $22.38 , $5.47 , $5.47 , $5.47 , See APC Packaged Rates , See APC Packaged Rates , $38.50 , $38.50 , See APC Packaged Rates , See APC Packaged Rates , $53.36 , $53.36 , $53.36 , $53.36 , See APC Packaged Rates , $20.08 , $- , $- , $53.36 , $40.17
J1160,5710010740,Hospital Chargemaster,Digoxin 0.5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $19.07 , $10.49 , $7.63 , See APC Packaged Rates , $13.35 , $7.44 , $5.64 , $5.64 , $5.64 , See APC Packaged Rates , See APC Packaged Rates , $12.80 , $12.80 , See APC Packaged Rates , See APC Packaged Rates , $17.74 , $17.74 , $17.74 , $17.74 , See APC Packaged Rates , $6.67 , $21.74 , $5.64 , $21.74 , $13.35
J2930,5710011598,Hospital Chargemaster,methylPREDnisolone SS 125 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $87.26 , $47.99 , $34.90 , See APC Packaged Rates , $61.08 , $34.03 , $5.64 , $5.64 , $5.64 , See APC Packaged Rates , See APC Packaged Rates , $58.55 , $58.55 , See APC Packaged Rates , See APC Packaged Rates , $81.15 , $81.15 , $81.15 , $81.15 , See APC Packaged Rates , $30.54 , $5.89 , $5.64 , $81.15 , $61.08
J2930,5710011599,Hospital Chargemaster,methylPREDnisolone SS 125 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $5.64 , $5.64 , $5.64 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $5.89 , $- , $5.89 , $-
J2930,5710011600,Hospital Chargemaster,methylPREDnisolone SS 125 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $24.05 , $13.23 , $9.62 , See APC Packaged Rates , $16.84 , $9.38 , $5.64 , $5.64 , $5.64 , See APC Packaged Rates , See APC Packaged Rates , $16.14 , $16.14 , See APC Packaged Rates , See APC Packaged Rates , $22.37 , $22.37 , $22.37 , $22.37 , See APC Packaged Rates , $8.42 , $5.89 , $5.64 , $22.37 , $16.84
J1250,5710010789,Hospital Chargemaster,DOBUTamine 250 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $5.69 , $5.69 , $5.69 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $6.80 , $- , $6.80 , $-
J1250,5710010790,Hospital Chargemaster,DOBUTamine 250 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $34.66 , $19.06 , $13.86 , See APC Packaged Rates , $24.26 , $13.52 , $5.69 , $5.69 , $5.69 , See APC Packaged Rates , See APC Packaged Rates , $23.26 , $23.26 , See APC Packaged Rates , See APC Packaged Rates , $32.23 , $32.23 , $32.23 , $32.23 , See APC Packaged Rates , $12.13 , $6.80 , $5.69 , $32.23 , $24.26
J1250,5710010791,Hospital Chargemaster,DOBUTamine 250 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $5.69 , $5.69 , $5.69 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $6.80 , $- , $6.80 , $-
J1030,5710030002,Hospital Chargemaster,Methylprednisolone 40 MG Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $9.00 , $4.95 , $3.60 , See APC Packaged Rates , $6.30 , $3.51 , $5.88 , $5.88 , $5.88 , See APC Packaged Rates , See APC Packaged Rates , $6.04 , $6.04 , See APC Packaged Rates , See APC Packaged Rates , $8.37 , $8.37 , $8.37 , $8.37 , See APC Packaged Rates , $3.15 , $5.70 , $3.15 , $8.37 , $6.30
J0702,5710010280,Hospital Chargemaster,Beta Acet 3mg &Beta NaPho 3mg,Outpatient,Outpatient Default Percent / Case Rate,636, $50.44 , $27.74 , $20.18 , See APC Packaged Rates , $35.31 , $19.67 , $6.55 , $6.55 , $6.55 , See APC Packaged Rates , See APC Packaged Rates , $33.85 , $33.85 , See APC Packaged Rates , See APC Packaged Rates , $46.91 , $46.91 , $46.91 , $46.91 , See APC Packaged Rates , $17.65 , $6.78 , $6.55 , $46.91 , $35.31
J0637,5710010422,Hospital Chargemaster,Caspofungin Acetate 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $861.16 , $473.64 , $344.46 , See APC Packaged Rates , $602.81 , $335.85 , $6.87 , $6.87 , $6.87 , See APC Packaged Rates , See APC Packaged Rates , $577.84 , $577.84 , See APC Packaged Rates , See APC Packaged Rates , $800.88 , $800.88 , $800.88 , $800.88 , See APC Packaged Rates , $301.41 , $6.57 , $6.57 , $800.88 , $602.81
J0637,5710010423,Hospital Chargemaster,Caspofungin Acetate 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $894.74 , $492.11 , $357.90 , See APC Packaged Rates , $626.32 , $348.95 , $6.87 , $6.87 , $6.87 , See APC Packaged Rates , See APC Packaged Rates , $600.37 , $600.37 , See APC Packaged Rates , See APC Packaged Rates , $832.11 , $832.11 , $832.11 , $832.11 , See APC Packaged Rates , $313.16 , $6.57 , $6.57 , $832.11 , $626.32
J0694,5710010448,Hospital Chargemaster,cefOXitin sodium 1 gm Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $15.30 , $8.42 , $6.12 , See APC Packaged Rates , $10.71 , $5.97 , $7.36 , $7.36 , $7.36 , See APC Packaged Rates , See APC Packaged Rates , $10.27 , $10.27 , See APC Packaged Rates , See APC Packaged Rates , $14.23 , $14.23 , $14.23 , $14.23 , See APC Packaged Rates , $5.36 , $4.68 , $4.68 , $14.23 , $10.71
J0694,5710010449,Hospital Chargemaster,cefOXitin sodium 1 gm Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $25.29 , $13.91 , $10.12 , See APC Packaged Rates , $17.70 , $9.86 , $7.36 , $7.36 , $7.36 , See APC Packaged Rates , See APC Packaged Rates , $16.97 , $16.97 , See APC Packaged Rates , See APC Packaged Rates , $23.52 , $23.52 , $23.52 , $23.52 , See APC Packaged Rates , $8.85 , $4.68 , $4.68 , $23.52 , $17.70
J0694,5710010450,Hospital Chargemaster,cefOXitin sodium 1 gm Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $7.36 , $7.36 , $7.36 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $4.68 , $- , $7.36 , $-
J0694,5710010451,Hospital Chargemaster,cefOXitin sodium 1 gm Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $7.36 , $7.36 , $7.36 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $4.68 , $- , $7.36 , $-
J2020,5710011453,Hospital Chargemaster,Linezolid 200 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $135.57 , $74.56 , $54.23 , See APC Packaged Rates , $94.90 , $52.87 , $7.51 , $7.51 , $7.51 , See APC Packaged Rates , See APC Packaged Rates , $90.97 , $90.97 , See APC Packaged Rates , See APC Packaged Rates , $126.08 , $126.08 , $126.08 , $126.08 , See APC Packaged Rates , $47.45 , $6.25 , $6.25 , $126.08 , $94.90
J0280,5710010118,Hospital Chargemaster,Aminophylline up to 250 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $9.02 , $9.02 , $9.02 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $6.14 , $- , $9.02 , $-
J0280,5710010119,Hospital Chargemaster,Aminophylline up to 250 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $9.02 , $9.02 , $9.02 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $6.14 , $- , $9.02 , $-
J9390,5710012501,Hospital Chargemaster,Vinorelbine Tart 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $9.46 , $9.46 , $9.46 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $8.62 , $- , $9.46 , $-
J9390,5710012502,Hospital Chargemaster,Vinorelbine Tart 10 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $229.50 , $126.23 , $91.80 , See APC Packaged Rates , $160.65 , $89.51 , $9.46 , $9.46 , $9.46 , See APC Packaged Rates , See APC Packaged Rates , $153.99 , $153.99 , See APC Packaged Rates , See APC Packaged Rates , $213.44 , $213.44 , $213.44 , $213.44 , See APC Packaged Rates , $80.33 , $8.62 , $8.62 , $213.44 , $160.65
J0270,5710010096,Hospital Chargemaster,Alprostadil 1.25 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $332.44 , $182.84 , $132.98 , See APC Packaged Rates , $232.71 , $129.65 , $9.62 , $9.62 , $9.62 , See APC Packaged Rates , See APC Packaged Rates , $223.07 , $223.07 , See APC Packaged Rates , See APC Packaged Rates , $309.17 , $309.17 , $309.17 , $309.17 , See APC Packaged Rates , $116.35 , $0.36 , $0.36 , $309.17 , $232.71
J0270,5710010097,Hospital Chargemaster,Alprostadil 500 mcg/1 mL Ampul,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $9.62 , $9.62 , $9.62 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.36 , $- , $9.62 , $-
J1040,5710011597,Hospital Chargemaster,methylPREDNISolone Acet 80 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $56.13 , $30.87 , $22.45 , See APC Packaged Rates , $39.29 , $21.89 , $11.19 , $11.19 , $11.19 , See APC Packaged Rates , See APC Packaged Rates , $37.66 , $37.66 , See APC Packaged Rates , See APC Packaged Rates , $52.20 , $52.20 , $52.20 , $52.20 , See APC Packaged Rates , $19.65 , $11.82 , $11.19 , $52.20 , $39.29
J2430,5710011895,Hospital Chargemaster,Pamidronate 30 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $11.52 , $11.52 , $11.52 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $10.55 , $- , $11.52 , $-
J2430,5710011896,Hospital Chargemaster,Pamidronate 30 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $11.52 , $11.52 , $11.52 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $10.55 , $- , $11.52 , $-
J2430,5710011897,Hospital Chargemaster,Pamidronate 30 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $11.52 , $11.52 , $11.52 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $10.55 , $- , $11.52 , $-
J2400,5710010496,Hospital Chargemaster,Chloroprocaine HCl per30mL Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $21.60 , $21.60 , $21.60 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $30.10 , $- , $30.10 , $-
J2400,5710010497,Hospital Chargemaster,Chloroprocaine Hcl per30mL Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $21.60 , $21.60 , $21.60 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $30.10 , $- , $30.10 , $-
J3486,5710012551,Hospital Chargemaster,Ziprasidone 10 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $137.23 , $75.48 , $54.89 , See APC Packaged Rates , $96.06 , $53.52 , $23.87 , $23.87 , $23.87 , See APC Packaged Rates , See APC Packaged Rates , $92.08 , $92.08 , See APC Packaged Rates , See APC Packaged Rates , $127.62 , $127.62 , $127.62 , $127.62 , See APC Packaged Rates , $48.03 , $13.38 , $13.38 , $127.62 , $96.06
J3486,5710012553,Hospital Chargemaster,Zoledronic Acid 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $459.00 , $252.45 , $183.60 , See APC Packaged Rates , $321.30 , $179.01 , $23.87 , $23.87 , $23.87 , See APC Packaged Rates , See APC Packaged Rates , $307.99 , $307.99 , See APC Packaged Rates , See APC Packaged Rates , $426.87 , $426.87 , $426.87 , $426.87 , See APC Packaged Rates , $160.65 , $13.38 , $13.38 , $426.87 , $321.30
J3486,5710012554,Hospital Chargemaster,Zoledronic Acid 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $2,137.64 "," $1,175.70 ", $855.06 , See APC Packaged Rates ," $1,496.35 ", $833.68 , $23.87 , $23.87 , $23.87 , See APC Packaged Rates , See APC Packaged Rates ," $1,434.36 "," $1,434.36 ", See APC Packaged Rates , See APC Packaged Rates ," $1,988.01 "," $1,988.01 "," $1,988.01 "," $1,988.01 ", See APC Packaged Rates , $748.17 , $13.38 , $13.38 ," $1,988.01 "," $1,496.35 "
J3486,5710012555,Hospital Chargemaster,Zoledronic Acid 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $780.94 , $429.52 , $312.38 , See APC Packaged Rates , $546.66 , $304.57 , $23.87 , $23.87 , $23.87 , See APC Packaged Rates , See APC Packaged Rates , $524.01 , $524.01 , See APC Packaged Rates , See APC Packaged Rates , $726.27 , $726.27 , $726.27 , $726.27 , See APC Packaged Rates , $273.33 , $13.38 , $13.38 , $726.27 , $546.66
J9208,5710011227,Hospital Chargemaster,Ifosfamide 1 gm Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $26.31 , $26.31 , $26.31 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $26.49 , $- , $26.49 , $-
J9208,5710011228,Hospital Chargemaster,Ifosfamide 1 gm Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $26.31 , $26.31 , $26.31 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $26.49 , $- , $26.49 , $-
J9040,5710010298,Hospital Chargemaster,Bleomycin Sulfate 15 Unit Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $26.92 , $26.92 , $26.92 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $26.80 , $- , $26.92 , $-
J9040,5710010299,Hospital Chargemaster,Bleomycin Sulfate 15 Unit Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $26.92 , $26.92 , $26.92 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $26.80 , $- , $26.92 , $-
J1327,5710010890,Hospital Chargemaster,Eptifibatide 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $2.33 , $- , $- , $30.92 , $30.92 , $30.92 , $2.33 , $2.33 , $- , $- , $2.44 , $2.37 , $- , $- , $- , $- , $2.33 , $- , $2.11 , $- , $30.92 , $-
J1327,5710010891,Hospital Chargemaster,Eptifibatide 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $2.33 , $- , $- , $30.92 , $30.92 , $30.92 , $2.33 , $2.33 , $- , $- , $2.44 , $2.37 , $- , $- , $- , $- , $2.33 , $- , $2.11 , $- , $30.92 , $-
J1335,5710010894,Hospital Chargemaster,Ertapenem Sod 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $322.65 , $177.46 , $129.06 , See APC Packaged Rates , $225.86 , $125.83 , $32.80 , $32.80 , $32.80 , See APC Packaged Rates , See APC Packaged Rates , $216.50 , $216.50 , See APC Packaged Rates , See APC Packaged Rates , $300.06 , $300.06 , $300.06 , $300.06 , See APC Packaged Rates , $112.93 , $24.48 , $24.48 , $300.06 , $225.86
J1335,5710010895,Hospital Chargemaster,Ertapenem Sod 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $32.80 , $32.80 , $32.80 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $24.48 , $- , $32.80 , $-
J3000,5710012298,Hospital Chargemaster,Streptomycin Sulfate 1 gm Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $33.32 , $33.32 , $33.32 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $32.94 , $- , $33.32 , $-
J3230,5710010502,Hospital Chargemaster,chlorproMAZINE 50 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $34.62 , $34.62 , $34.62 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $32.02 , $- , $34.62 , $-
J0285,5710010151,Hospital Chargemaster,Amphotericin B 50 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $38.93 , $38.93 , $38.93 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $41.00 , $- , $41.00 , $-
J0834,5710010598,Hospital Chargemaster,Cosyntropin 0.25 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $271.78 , $149.48 , $108.71 , See APC Packaged Rates , $190.25 , $105.99 , $39.22 , $39.22 , $39.22 , See APC Packaged Rates , See APC Packaged Rates , $182.36 , $182.36 , See APC Packaged Rates , See APC Packaged Rates , $252.76 , $252.76 , $252.76 , $252.76 , See APC Packaged Rates , $95.12 , $32.10 , $32.10 , $252.76 , $190.25
Q9957,5710011938,Hospital Chargemaster,ECHO Contr Perflutren per mL,Outpatient,Outpatient Default Percent / Case Rate,636, $675.24 , $371.38 , $270.10 , See APC Packaged Rates , $472.67 , $263.34 , $47.63 , $47.63 , $47.63 , See APC Packaged Rates , See APC Packaged Rates , $453.09 , $453.09 , See APC Packaged Rates , See APC Packaged Rates , $627.97 , $627.97 , $627.97 , $627.97 , See APC Packaged Rates , $236.33 , $46.15 , $46.15 , $627.97 , $472.67
J1110,5710010745,Hospital Chargemaster,Dihydroergotamine 1mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $55.97 , $55.97 , $55.97 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $54.93 , $- , $55.97 , $-
J2785,5710012153,Hospital Chargemaster,Regadenoson 0.1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $623.37 , $342.85 , $249.35 , See APC Packaged Rates , $436.36 , $243.11 , $59.19 , $59.19 , $59.19 , See APC Packaged Rates , See APC Packaged Rates , $418.28 , $418.28 , See APC Packaged Rates , See APC Packaged Rates , $579.73 , $579.73 , $579.73 , $579.73 , See APC Packaged Rates , $218.18 , $61.29 , $59.19 , $579.73 , $436.36
J9185,5710010987,Hospital Chargemaster,Fludarabine Phosphate 50mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $66.01 , $66.01 , $66.01 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $57.02 , $- , $66.01 , $-
J2790,5710012157,Hospital Chargemaster,Rho(D) Immune Glob 300 mcg,Outpatient,Outpatient Default Percent / Case Rate,636, $220.00 , $121.00 , $88.00 , See APC Packaged Rates , $154.00 , $85.80 , $74.30 , $74.30 , $74.30 , See APC Packaged Rates , See APC Packaged Rates , $147.62 , $147.62 , See APC Packaged Rates , See APC Packaged Rates , $204.60 , $204.60 , $204.60 , $204.60 , See APC Packaged Rates , $77.00 , $78.99 , $74.30 , $204.60 , $154.00
J2790,5710032157,Hospital Chargemaster,RHO D Immune Globulin Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $188.00 , $103.40 , $75.20 , See APC Packaged Rates , $131.60 , $73.32 , $74.30 , $74.30 , $74.30 , See APC Packaged Rates , See APC Packaged Rates , $126.15 , $126.15 , See APC Packaged Rates , See APC Packaged Rates , $174.84 , $174.84 , $174.84 , $174.84 , See APC Packaged Rates , $65.80 , $78.99 , $65.80 , $174.84 , $131.60
J3030,5710012316,Hospital Chargemaster,SUMAtriptan 6 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $858.08 , $471.94 , $343.23 , See APC Packaged Rates , $600.66 , $334.65 , $77.67 , $77.67 , $77.67 , See APC Packaged Rates , See APC Packaged Rates , $575.77 , $575.77 , See APC Packaged Rates , See APC Packaged Rates , $798.01 , $798.01 , $798.01 , $798.01 , See APC Packaged Rates , $300.33 , $168.82 , $77.67 , $798.01 , $600.66
J7321,5710011154,Hospital Chargemaster,Hyaluronan (Hyalgan) /dose,Outpatient,Outpatient Default Percent / Case Rate,636, $484.50 , $266.48 , $193.80 , See APC Packaged Rates , $339.15 , $188.96 , $79.81 , $79.81 , $79.81 , See APC Packaged Rates , See APC Packaged Rates , $325.10 , $325.10 , See APC Packaged Rates , See APC Packaged Rates , $450.59 , $450.59 , $450.59 , $450.59 , See APC Packaged Rates , $169.58 , $75.94 , $75.94 , $450.59 , $339.15
J7321,5710011155,Hospital Chargemaster,Hyaluronan (Supartz) /dose,Outpatient,Outpatient Default Percent / Case Rate,636, $587.27 , $323.00 , $234.91 , See APC Packaged Rates , $411.09 , $229.04 , $79.81 , $79.81 , $79.81 , See APC Packaged Rates , See APC Packaged Rates , $394.06 , $394.06 , See APC Packaged Rates , See APC Packaged Rates , $546.16 , $546.16 , $546.16 , $546.16 , See APC Packaged Rates , $205.54 , $75.94 , $75.94 , $546.16 , $411.09
J2805,5710012245,Hospital Chargemaster,Sincalide 5 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $212.72 , $117.00 , $85.09 , See APC Packaged Rates , $148.90 , $82.96 , $115.67 , $115.67 , $115.67 , See APC Packaged Rates , See APC Packaged Rates , $142.74 , $142.74 , See APC Packaged Rates , See APC Packaged Rates , $197.83 , $197.83 , $197.83 , $197.83 , See APC Packaged Rates , $74.45 , $115.65 , $74.45 , $197.83 , $148.90
J3490,5710011156,Hospital Chargemaster,Hyaluronan (Provisc),Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
J3490,5710011157,Hospital Chargemaster,Hyaluronan (Healon 10),Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
J3490,5710011159,Hospital Chargemaster,Hyaluronate (Healon-5),Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
Q9967,5710011275,Hospital Chargemaster,LOCM 300-399mg/ml iodine 1ml,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.10 , $-
Q9967,5710011277,Hospital Chargemaster,LOCM 300-399mg/ml per 1ml,Outpatient,Outpatient Default Percent / Case Rate,636, $145.89 , $80.24 , $120.21 , See APC Packaged Rates , $102.12 , $56.90 , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $97.89 , $97.89 , See APC Packaged Rates , See APC Packaged Rates , $135.68 , $135.68 , $135.68 , $135.68 , See APC Packaged Rates , $51.06 , $- , $- , $135.68 , $102.12
Q9967,5710011278,Hospital Chargemaster,LOCM 300-399mg/ml per 1ml,Outpatient,Outpatient Default Percent / Case Rate,636, $288.74 , $158.81 , $237.92 , See APC Packaged Rates , $202.12 , $112.61 , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $193.74 , $193.74 , See APC Packaged Rates , See APC Packaged Rates , $268.53 , $268.53 , $268.53 , $268.53 , See APC Packaged Rates , $101.06 , $- , $- , $268.53 , $202.12
Q9967,5710011280,Hospital Chargemaster,Iopamidol 200 mg per ml,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.10 , $-
Q9967,5710011281,Hospital Chargemaster,Iopamidol 300 mg per mL,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.10 , $-
Q9967,5710011282,Hospital Chargemaster,Iopromide 300 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.10 , $-
Q9967,5710011283,Hospital Chargemaster,Iopromide 300 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.10 , $-
Q9967,5710011284,Hospital Chargemaster,Iopromide 370 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.10 , $-
C9290,5710010340,Hospital Chargemaster,Bupivacaine Liposome 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.43 , $1.43 , $1.43 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $1.43 , $-
C9290,5710010341,Hospital Chargemaster,Bupivacaine Liposome 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $1,022.58 ", $562.42 , $842.61 , See APC Packaged Rates , $715.81 , $398.81 , $1.43 , $1.43 , $1.43 , See APC Packaged Rates , See APC Packaged Rates , $686.15 , $686.15 , See APC Packaged Rates , See APC Packaged Rates , $951.00 , $951.00 , $951.00 , $951.00 , See APC Packaged Rates , $357.90 , $- , $- , $951.00 , $715.81
90648,5710031120,Hospital Chargemaster,Hib prp-t vaccine 4 dose im,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $13.23 , $13.23 , $13.23 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $13.23 , $-
90648,5710032482,Hospital Chargemaster,Hib prp-t vac 4 dose Im No Chg,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $13.23 , $13.23 , $13.23 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $- , $- , $13.23 , $0.01
90714,5710012342,Hospital Chargemaster,Tetanus-Diph Tox 0.5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $25.27 , $25.27 , $25.27 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $27.70 , $0.00 , $27.70 , $0.01
90714,5710032496,Hospital Chargemaster,Td vac no presv 7 yrs Im NoChg,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $25.27 , $25.27 , $25.27 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $27.70 , $0.00 , $27.70 , $0.01
90700,5710010764,Hospital Chargemaster,DTap 0.5ML VACCINE AGE <=7YO,Outpatient,Outpatient Default Percent / Case Rate,636, $60.00 , $33.00 , $49.44 , See APC Packaged Rates , $42.00 , $23.40 , $30.01 , $30.01 , $30.01 , See APC Packaged Rates , See APC Packaged Rates , $40.26 , $40.26 , See APC Packaged Rates , See APC Packaged Rates , $55.80 , $55.80 , $55.80 , $55.80 , See APC Packaged Rates , $21.00 , $37.39 , $21.00 , $55.80 , $42.00
90700,5710010765,Hospital Chargemaster,DTap 0.5ML VACCINE AGE <=7YO,Outpatient,Outpatient Default Percent / Case Rate,636, $60.00 , $33.00 , $49.44 , See APC Packaged Rates , $42.00 , $23.40 , $30.01 , $30.01 , $30.01 , See APC Packaged Rates , See APC Packaged Rates , $40.26 , $40.26 , See APC Packaged Rates , See APC Packaged Rates , $55.80 , $55.80 , $55.80 , $55.80 , See APC Packaged Rates , $21.00 , $37.39 , $21.00 , $55.80 , $42.00
90700,5710030764,Hospital Chargemaster,Dtap vaccine < 7 yrs im,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $30.01 , $30.01 , $30.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $37.39 , $0.00 , $37.39 , $0.01
90700,5710032490,Hospital Chargemaster,Dtap vaccine < 7 yrsm No Chrg,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $30.01 , $30.01 , $30.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $37.39 , $0.00 , $37.39 , $0.01
90715,5710010766,Hospital Chargemaster,"DTaP VACCINE, >7 yrs, IM",Outpatient,Outpatient Default Percent / Case Rate,636, $39.00 , $21.45 , $32.14 , See APC Packaged Rates , $27.30 , $15.21 , $34.28 , $34.28 , $34.28 , See APC Packaged Rates , See APC Packaged Rates , $26.17 , $26.17 , See APC Packaged Rates , See APC Packaged Rates , $36.27 , $36.27 , $36.27 , $36.27 , See APC Packaged Rates , $13.65 , $- , $- , $36.27 , $27.30
90715,5710012604,Hospital Chargemaster,TDAP 0.5 ml Vaccine Age >=7YO,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $34.28 , $34.28 , $34.28 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $- , $- , $34.28 , $0.01
90633,5710032479,Hospital Chargemaster,Hepa vac ped/adl 2 dose im NC,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $39.80 , $39.80 , $39.80 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $40.06 , $0.00 , $40.06 , $0.01
90633,5710032480,Hospital Chargemaster,Hepa vacc ped/adol 2 dose im,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $39.80 , $39.80 , $39.80 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $40.06 , $0.00 , $40.06 , $0.01
90632,5710011140,Hospital Chargemaster,Hepatitis A Vaccine,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $58.44 , $58.44 , $58.44 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $58.44 , $-
90632,5710031140,Hospital Chargemaster,Hepa vaccine adult im,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $58.44 , $58.44 , $58.44 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $- , $- , $58.44 , $0.01
90696,5710010763,Hospital Chargemaster,DTaP-IPV age 4 to 6 yrs IM,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $63.74 , $63.74 , $63.74 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $136.68 , $- , $136.68 , $-
90696,5710030763,Hospital Chargemaster,Dtap-ip vac 4-6 yrs imm NoChg,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $63.74 , $63.74 , $63.74 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $136.68 , $0.00 , $136.68 , $0.01
90746,5710011144,Hospital Chargemaster,Hepatitis B Vaccine 1ml,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $69.65 , $69.65 , $69.65 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $70.38 , $- , $70.38 , $-
90746,5710011145,Hospital Chargemaster,Hepatitis B Vaccine,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $69.65 , $69.65 , $69.65 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $70.38 , $- , $70.38 , $-
90746,5710031144,Hospital Chargemaster,Hepb Vaccine 3 Dose Adult IM,Outpatient,Outpatient Default Percent / Case Rate,636, $161.00 , $88.55 , $132.66 , See APC Packaged Rates , $112.70 , $62.79 , $69.65 , $69.65 , $69.65 , See APC Packaged Rates , See APC Packaged Rates , $108.03 , $108.03 , See APC Packaged Rates , See APC Packaged Rates , $149.73 , $149.73 , $149.73 , $149.73 , See APC Packaged Rates , $56.35 , $70.38 , $56.35 , $149.73 , $112.70
90707,5710011516,Hospital Chargemaster,Measles Mumps and Rubella Vac,Outpatient,Outpatient Default Percent / Case Rate,636, $156.55 , $86.10 , $129.00 , See APC Packaged Rates , $109.59 , $61.05 , $93.96 , $93.96 , $93.96 , See APC Packaged Rates , See APC Packaged Rates , $105.05 , $105.05 , See APC Packaged Rates , See APC Packaged Rates , $145.59 , $145.59 , $145.59 , $145.59 , See APC Packaged Rates , $54.79 , $104.33 , $54.79 , $145.59 , $109.59
90707,5710032491,Hospital Chargemaster,Mmr vaccine sc No Charge,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $93.96 , $93.96 , $93.96 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $104.33 , $0.00 , $104.33 , $0.01
90698,5710010775,Hospital Chargemaster,DTaP-IPV/Hib for IM Use,Outpatient,Outpatient Default Percent / Case Rate,636, $167.00 , $91.85 , $137.61 , See APC Packaged Rates , $116.90 , $65.13 , $119.05 , $119.05 , $119.05 , See APC Packaged Rates , See APC Packaged Rates , $112.06 , $112.06 , See APC Packaged Rates , See APC Packaged Rates , $155.31 , $155.31 , $155.31 , $155.31 , See APC Packaged Rates , $58.45 , $126.66 , $58.45 , $155.31 , $116.90
90698,5710030776,Hospital Chargemaster,Dtap-ipv/hib vaccine im No Chg,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $119.05 , $119.05 , $119.05 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $126.66 , $0.00 , $126.66 , $0.01
90371,5710011141,Hospital Chargemaster,Hepatitis B Immune Globuin,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $152.54 , $- , $- , $119.09 , $119.09 , $119.09 , $152.54 , $152.54 , $- , $- , $160.16 , $155.59 , $- , $- , $- , $- , $152.54 , $- , $- , $- , $160.16 , $-
90371,5710011142,Hospital Chargemaster,Hepatitis B Immune Globuin,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $152.54 , $- , $- , $119.09 , $119.09 , $119.09 , $152.54 , $152.54 , $- , $- , $160.16 , $155.59 , $- , $- , $- , $- , $152.54 , $- , $- , $- , $160.16 , $-
90371,5710011143,Hospital Chargemaster,Hepatitis B Immune Globuin,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $152.54 , $- , $- , $119.09 , $119.09 , $119.09 , $152.54 , $152.54 , $- , $- , $160.16 , $155.59 , $- , $- , $- , $- , $152.54 , $- , $- , $- , $160.16 , $-
90732,5710011998,Hospital Chargemaster,Pneumococcal 23-Val 0.5mL Vac,Outpatient,Outpatient Default Percent / Case Rate,636, $273.03 , $150.17 , $224.98 , See APC Packaged Rates , $191.12 , $106.48 , $119.92 , $119.92 , $119.92 , See APC Packaged Rates , See APC Packaged Rates , $183.20 , $183.20 , See APC Packaged Rates , See APC Packaged Rates , $253.92 , $253.92 , $253.92 , $253.92 , See APC Packaged Rates , $95.56 , $133.47 , $95.56 , $253.92 , $191.12
90636,5710030017,Hospital Chargemaster,Hep a/hep b vacc adult im NC,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $130.65 , $130.65 , $130.65 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $121.02 , $0.00 , $130.65 , $0.01
90734,5710011534,Hospital Chargemaster,Meningococcal Vaccine IM,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $153.91 , $153.91 , $153.91 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $169.89 , $- , $169.89 , $-
90734,5710032498,Hospital Chargemaster,Mcv4 menacw vacc Im No Chg,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $153.91 , $153.91 , $153.91 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $169.89 , $0.00 , $169.89 , $0.01
90716,5710012473,Hospital Chargemaster,Varicella Zoster Vacc,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $162.72 , $162.72 , $162.72 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $181.02 , $- , $181.02 , $-
90716,5710032497,Hospital Chargemaster,Var vaccine live subsq No Chg,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $162.72 , $162.72 , $162.72 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $181.02 , $0.00 , $181.02 , $0.01
90620,5710011535,Hospital Chargemaster,Meningococcal Group B Vac,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $214.95 , $214.95 , $214.95 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $214.95 , $-
90620,5710032476,Hospital Chargemaster,Menb-4c vacc dose Im No Chg,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $214.95 , $214.95 , $214.95 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $- , $- , $214.95 , $0.01
90670,5710011997,Hospital Chargemaster,Pneumococcal 13-Val 0.5 mL Vac,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $230.14 , $230.14 , $230.14 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $241.38 , $- , $241.38 , $-
90670,5710032484,Hospital Chargemaster,Pcv13 Vacc Im No Charge,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $230.14 , $230.14 , $230.14 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $241.38 , $0.00 , $241.38 , $0.01
90670,5710032485,Hospital Chargemaster,Pcv13 vaccine im,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $230.14 , $230.14 , $230.14 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $241.38 , $0.00 , $241.38 , $0.01
90736,5710011108,Hospital Chargemaster,Zoster Vacc 19400Unit/0.65mL,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $255.20 , $255.20 , $255.20 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $261.47 , $- , $261.47 , $-
90710,5710032492,Hospital Chargemaster,Mmrv vaccinesc No Chrg,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $269.32 , $269.32 , $269.32 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $299.42 , $0.00 , $299.42 , $0.01
A9500,5155010141,Hospital Chargemaster,Tc-99M Sestamibi Psd,Outpatient,Outpatient Default Percent / Case Rate,636, $150.00 , $- , $123.60 , See APC Packaged Rates , $105.00 , $58.50 , $654.79 , $338.96 , $332.67 , See APC Packaged Rates , See APC Packaged Rates , $100.65 , $100.65 , See APC Packaged Rates , See APC Packaged Rates , $139.50 , $139.50 , $139.50 , $139.50 , See APC Packaged Rates , $52.50 , $- , $- , $654.79 , $105.00
A9503,5155010142,Hospital Chargemaster,Tc99M Medronate Psd Up To 30Mc,Outpatient,Outpatient Default Percent / Case Rate,636, $268.00 , $- , Not reimbursed , See APC Packaged Rates , $187.60 , $104.52 , $52.45 , $27.15 , $26.65 , See APC Packaged Rates , See APC Packaged Rates , $179.83 , $179.83 , See APC Packaged Rates , See APC Packaged Rates , $249.24 , $249.24 , $249.24 , $249.24 , See APC Packaged Rates , $93.80 , $- , $- , $249.24 , $187.60
A9512,5155010144,Hospital Chargemaster,Tc99M Pertechnetate Per Mci,Outpatient,Outpatient Default Percent / Case Rate,636, $36.00 , $- , $29.66 , See APC Packaged Rates , $25.20 , $14.04 , $34.74 , $34.89 , $- , See APC Packaged Rates , See APC Packaged Rates , $24.16 , $24.16 , See APC Packaged Rates , See APC Packaged Rates , $33.48 , $33.48 , $33.48 , $33.48 , See APC Packaged Rates , $12.60 , $- , $- , $34.89 , $25.20
A9516,5155010145,Hospital Chargemaster,Iodne I-123 P/100 Mic UpTo 999,Outpatient,Outpatient Default Percent / Case Rate,636, $25.00 , $- , $20.60 , See APC Packaged Rates , $17.50 , $9.75 , $729.64 , $377.70 , $370.69 , See APC Packaged Rates , See APC Packaged Rates , $16.78 , $16.78 , See APC Packaged Rates , See APC Packaged Rates , $23.25 , $23.25 , $23.25 , $23.25 , See APC Packaged Rates , $8.75 , $113.16 , $- , $729.64 , $17.50
A9537,5155010149,Hospital Chargemaster,Tc99M Mebrofenin Psd To 15 Mci,Outpatient,Outpatient Default Percent / Case Rate,636, $66.00 , $- , $54.38 , See APC Packaged Rates , $46.20 , $25.74 , $223.17 , $115.53 , $113.38 , See APC Packaged Rates , See APC Packaged Rates , $44.29 , $44.29 , See APC Packaged Rates , See APC Packaged Rates , $61.38 , $61.38 , $61.38 , $61.38 , See APC Packaged Rates , $23.10 , $- , $- , $223.17 , $46.20
A9539,5155010150,Hospital Chargemaster,Tc99M Pentetate Up To 25 Mci,Outpatient,Outpatient Default Percent / Case Rate,636, $42.00 , $- , $34.61 , See APC Packaged Rates , $29.40 , $16.38 , $126.41 , $65.44 , $64.22 , See APC Packaged Rates , See APC Packaged Rates , $28.18 , $28.18 , See APC Packaged Rates , See APC Packaged Rates , $39.06 , $39.06 , $39.06 , $39.06 , See APC Packaged Rates , $14.70 , $31.49 , $- , $126.41 , $29.40
A9540,5155010151,Hospital Chargemaster,Tc99M Maa Per Dose UpTo 10 Mci,Outpatient,Outpatient Default Percent / Case Rate,636, $33.00 , $- , $27.19 , See APC Packaged Rates , $23.10 , $12.87 , $121.03 , $62.65 , $61.49 , See APC Packaged Rates , See APC Packaged Rates , $22.14 , $22.14 , See APC Packaged Rates , See APC Packaged Rates , $30.69 , $30.69 , $30.69 , $30.69 , See APC Packaged Rates , $11.55 , $- , $- , $121.03 , $23.10
A9541,5155010152,Hospital Chargemaster,Tc99M Sulfr Colloid UpTo 20Mci,Outpatient,Outpatient Default Percent / Case Rate,636, $48.00 , $- , $39.55 , See APC Packaged Rates , $33.60 , $18.72 , $215.74 , $111.68 , $109.61 , See APC Packaged Rates , See APC Packaged Rates , $32.21 , $32.21 , See APC Packaged Rates , See APC Packaged Rates , $44.64 , $44.64 , $44.64 , $44.64 , See APC Packaged Rates , $16.80 , $247.43 , $- , $247.43 , $33.60
A9502,5155010163,Hospital Chargemaster,Myoview,Outpatient,Outpatient Default Percent / Case Rate,636, $262.00 , $- , $215.89 , See APC Packaged Rates , $183.40 , $102.18 , $393.18 , $203.54 , $199.76 , See APC Packaged Rates , See APC Packaged Rates , $175.80 , $175.80 , See APC Packaged Rates , See APC Packaged Rates , $243.66 , $243.66 , $243.66 , $243.66 , See APC Packaged Rates , $91.70 , $- , $- , $393.18 , $183.40
A9562,5155010164,Hospital Chargemaster,Technetium TC99m Mertiatide,Outpatient,Outpatient Default Percent / Case Rate,636, $573.00 , $- , Not reimbursed , See APC Packaged Rates , $401.10 , $223.47 ," $3,125.79 "," $1,618.10 "," $1,588.07 ", See APC Packaged Rates , See APC Packaged Rates , $384.48 , $384.48 , See APC Packaged Rates , See APC Packaged Rates , $532.89 , $532.89 , $532.89 , $532.89 , See APC Packaged Rates , $200.55 , $775.18 , $- ," $3,125.79 ", $401.10
P9047,5710010078,Hospital Chargemaster,Albumin Hum 25 % 50 mL IV,Outpatient,Outpatient Default Percent / Case Rate,636, $126.22 , $69.42 , $50.49 , $61.40 , $88.35 , $49.23 , $52.45 , $52.45 , $52.45 , $61.40 , $61.40 , $84.69 , $84.69 , $64.47 , $62.62 , $52.45 , $52.45 , $53.80 , $53.80 , $61.40 , $44.18 , $- , $- , $88.35 , $88.35
P9047,5710010079,Hospital Chargemaster,Albumin Hum 25 % 100 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $244.80 , $134.64 , $97.92 , $61.40 , $171.36 , $95.47 , $52.45 , $52.45 , $52.45 , $61.40 , $61.40 , $164.26 , $164.26 , $64.47 , $62.62 , $52.45 , $52.45 , $53.80 , $53.80 , $61.40 , $85.68 , $- , $- , $171.36 , $171.36
J9015,5710010086,Hospital Chargemaster,Aldesleukin 22 mm iu/1.222 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $- ," $1,246.98 ", $- ," $4,442.66 ", $- , $- ," $5,339.30 "," $5,339.30 "," $5,339.30 "," $4,442.66 "," $4,442.66 ", $- , $- ," $4,664.79 "," $4,531.51 ", $- , $- , $- , $- ," $4,442.66 ", $- ," $3,795.26 ", $- ," $5,339.30 ", $-
J0207,5710010105,Hospital Chargemaster,Amifostine 500 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- ," $1,135.69 ", $- ," $1,329.42 ", $- , $- ," $1,135.69 "," $1,135.69 "," $1,135.69 "," $1,329.42 "," $1,329.42 ", $- , $- ," $1,395.89 "," $1,356.01 ", $- , $- , $- , $- ," $1,329.42 ", $- ," $1,135.69 ", $- ," $1,395.89 ", $-
J0287,5710010152,Hospital Chargemaster,Amphotericin B Lipid Com 100mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $9.37 , $- , $11.13 , $- , $- , $9.36 , $9.36 , $9.36 , $11.13 , $11.13 , $- , $- , $11.68 , $11.35 , $- , $- , $- , $- , $11.13 , $- , $9.60 , $- , $11.68 , $-
J7192,5710010167,Hospital Chargemaster,Antihemophil Fac VIII per Unit,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $1.12 , $- , $1.67 , $- , $- , $1.38 , $1.38 , $1.38 , $1.67 , $1.67 , $- , $- , $1.75 , $1.70 , $- , $- , $- , $- , $1.67 , $- , $1.43 , $- , $1.75 , $-
J7192,5710010168,Hospital Chargemaster,Antihemophil Fac VIII per Unit,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $1.12 , $- , $1.67 , $- , $- , $1.38 , $1.38 , $1.38 , $1.67 , $1.67 , $- , $- , $1.75 , $1.70 , $- , $- , $- , $- , $1.67 , $- , $1.43 , $- , $1.75 , $-
J0840,5710010169,Hospital Chargemaster,Antivenin.Crotal Fab(Ovin) 1gm,Outpatient,Outpatient Default Percent / Case Rate,636, $- ," $2,908.21 ", $- ," $3,211.33 ", $- , $- ," $3,043.75 "," $3,043.75 "," $3,043.75 "," $3,211.33 "," $3,211.33 ", $- , $- ," $3,371.89 "," $3,275.55 ", $- , $- , $- , $- ," $3,211.33 ", $- ," $2,636.69 ", $- ," $3,371.89 ", $-
J0883,5710010178,Hospital Chargemaster,Argatroban 250 mg/2.5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $4.68 , $- , $1.41 , $- , $- , $5.20 , $5.20 , $5.20 , $1.41 , $1.41 , $- , $- , $1.48 , $1.44 , $- , $- , $- , $- , $1.41 , $- , $1.24 , $- , $5.20 , $-
J0401,5710010179,Hospital Chargemaster,ARIPiprazole 300 mg SUSER.Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $5.70 , $- , $7.03 , $- , $- , $5.70 , $5.70 , $5.70 , $7.03 , $7.03 , $- , $- , $7.38 , $7.17 , $- , $- , $- , $- , $7.03 , $- , $5.99 , $- , $7.38 , $-
J0401,5710010180,Hospital Chargemaster,ARIPiprazole 400 mg SUSER.Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $5.70 , $- , $7.03 , $- , $- , $5.70 , $5.70 , $5.70 , $7.03 , $7.03 , $- , $- , $7.38 , $7.17 , $- , $- , $- , $- , $7.03 , $- , $5.99 , $- , $7.38 , $-
J1944,5710010187,Hospital Chargemaster,ARIPiprazole Lauroxil 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $2.90 , $- , $3.50 , $- , $- , $2.85 , $2.85 , $2.85 , $3.50 , $3.50 , $- , $- , $3.68 , $3.57 , $- , $- , $- , $- , $3.50 , $- , $2.95 , $- , $3.68 , $-
J1944,5710010188,Hospital Chargemaster,ARIPiprazole Lauroxil 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $2.90 , $- , $3.50 , $- , $- , $2.85 , $2.85 , $2.85 , $3.50 , $3.50 , $- , $- , $3.68 , $3.57 , $- , $- , $- , $- , $3.50 , $- , $2.95 , $- , $3.68 , $-
J1944,5710010189,Hospital Chargemaster,ARIPiprazole Lauroxil 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $2.90 , $- , $3.50 , $- , $- , $2.85 , $2.85 , $2.85 , $3.50 , $3.50 , $- , $- , $3.68 , $3.57 , $- , $- , $- , $- , $3.50 , $- , $2.95 , $- , $3.68 , $-
J1944,5710010190,Hospital Chargemaster,ARIPiprazole Lauroxil 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $2.90 , $- , $3.50 , $- , $- , $2.85 , $2.85 , $2.85 , $3.50 , $3.50 , $- , $- , $3.68 , $3.57 , $- , $- , $- , $- , $3.50 , $- , $2.95 , $- , $3.68 , $-
J1944,5710010191,Hospital Chargemaster,ARIPiprazole Lauroxil 1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $2.90 , $- , $3.50 , $- , $- , $2.85 , $2.85 , $2.85 , $3.50 , $3.50 , $- , $- , $3.68 , $3.57 , $- , $- , $- , $- , $3.50 , $- , $2.95 , $- , $3.68 , $-
J9019,5710010199,Hospital Chargemaster,Asparaginase 10000 Unit Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $427.27 , $- , $500.15 , $- , $- , $427.27 , $427.27 , $427.27 , $500.15 , $500.15 , $- , $- , $525.16 , $510.16 , $- , $- , $- , $- , $500.15 , $- , $427.27 , $- , $525.16 , $-
J9030,5710010258,Hospital Chargemaster,BCG Live 50 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $400.53 , $2.85 , $160.21 , See APC Packaged Rates , $280.37 , $156.21 , $2.79 , $2.79 , $2.79 , See APC Packaged Rates , See APC Packaged Rates , $268.76 , $268.76 , See APC Packaged Rates , See APC Packaged Rates , $372.49 , $372.49 , $372.49 , $372.49 , See APC Packaged Rates , $140.19 , $2.83 , $2.79 , $372.49 , $280.37
J0490,5710010261,Hospital Chargemaster,Belimumab 120 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $46.84 , $- , $55.68 , $- , $- , $46.18 , $46.18 , $46.18 , $55.68 , $55.68 , $- , $- , $58.46 , $56.79 , $- , $- , $- , $- , $55.68 , $- , $48.23 , $- , $58.46 , $-
J0490,5710010262,Hospital Chargemaster,Belimumab 400 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $46.84 , $- , $55.68 , $- , $- , $46.18 , $46.18 , $46.18 , $55.68 , $55.68 , $- , $- , $58.46 , $56.79 , $- , $- , $- , $- , $55.68 , $- , $48.23 , $- , $58.46 , $-
J0515,5710010279,Hospital Chargemaster,Benztropine 2 mg/2 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $140.25 , $- , $56.10 , See APC Packaged Rates , $98.18 , $54.70 , $17.27 , $17.27 , $17.27 , See APC Packaged Rates , See APC Packaged Rates , $94.11 , $94.11 , See APC Packaged Rates , See APC Packaged Rates , $130.43 , $130.43 , $130.43 , $130.43 , See APC Packaged Rates , $49.09 , $19.02 , $- , $130.43 , $98.18
Q9991,5710010342,Hospital Chargemaster,Buprenorphine ER 100 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- ," $1,737.26 ", $- ," $2,103.30 ", $- , $- ," $1,743.48 "," $1,743.48 "," $1,743.48 "," $2,103.30 "," $2,103.30 ", $- , $- ," $2,208.46 "," $2,145.36 ", $- , $- , $- , $- ," $2,103.30 ", $- ," $1,787.03 ", $- ," $2,208.46 ", $-
Q9992,5710010343,Hospital Chargemaster,Buprenorphine ER 300 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- ," $1,737.26 ", $- ," $2,103.30 ", $- , $- ," $1,743.48 "," $1,743.48 "," $1,743.48 "," $2,103.30 "," $2,103.30 ", $- , $- ," $2,208.46 "," $2,145.36 ", $- , $- , $- , $- ," $2,103.30 ", $- , $- , $- ," $2,208.46 ", $-
J0575,5710010346,Hospital Chargemaster,Buprenorp/Nalox 12/3 mg Film,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $15.83 , $- , See APC Packaged Rates , $- , $- , $17.69 , $17.69 , $17.69 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $18.12 , $- , $18.12 , $-
J0572,5710010347,Hospital Chargemaster,Buprenorp/Nalox 2/0.5mg Film,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $4.00 , $- , See APC Packaged Rates , $- , $- , $4.47 , $4.47 , $4.47 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $7.13 , $- , $7.13 , $-
J0572,5710010348,Hospital Chargemaster,Buprenorp/Nalox 2/0.5mg Tab SL,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $4.00 , $- , See APC Packaged Rates , $- , $- , $4.47 , $4.47 , $4.47 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $7.13 , $- , $7.13 , $-
J0574,5710010350,Hospital Chargemaster,Buprenorp/Nalox 8/2 mg Film,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $7.91 , $- , See APC Packaged Rates , $- , $- , $8.84 , $8.84 , $8.84 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $11.65 , $- , $11.65 , $-
J0574,5710010351,Hospital Chargemaster,Buprenorp/Nalox 8/2 mg Tab SL,Outpatient,Outpatient Default Percent / Case Rate,636, $20.04 , $7.91 , $8.02 , See APC Packaged Rates , $14.03 , $7.82 , $8.84 , $8.84 , $8.84 , See APC Packaged Rates , See APC Packaged Rates , $13.45 , $13.45 , See APC Packaged Rates , See APC Packaged Rates , $18.64 , $18.64 , $18.64 , $18.64 , See APC Packaged Rates , $7.01 , $11.65 , $7.01 , $18.64 , $14.03
J0597,5710010366,Hospital Chargemaster,C1 Est Inhibitor 500 Unit Kit,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $54.33 , $- , $67.18 , $- , $- , $54.13 , $54.13 , $54.13 , $67.18 , $67.18 , $- , $- , $70.54 , $68.52 , $- , $- , $- , $- , $67.18 , $- , $57.40 , $- , $70.54 , $-
J0596,5710010367,Hospital Chargemaster,"C1 Est Inhib,Reco 2100 Unit Vl",Outpatient,Outpatient Default Percent / Case Rate,636, $- , $28.98 , $- , $35.08 , $- , $- , $29.11 , $29.11 , $29.11 , $35.08 , $35.08 , $- , $- , $36.84 , $35.78 , $- , $- , $- , $- , $35.08 , $- , $30.02 , $- , $36.84 , $-
J0630,5710010374,Hospital Chargemaster,Calcitonin 400 Unit/2 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636," $8,271.38 "," $2,830.55 "," $3,308.55 "," $3,629.73 "," $5,789.97 "," $3,225.84 "," $2,839.22 "," $2,839.22 "," $2,839.22 "," $3,629.73 "," $3,629.73 "," $5,550.10 "," $5,550.10 "," $3,811.21 "," $3,702.32 "," $2,839.22 "," $2,839.22 "," $2,912.47 "," $2,912.47 "," $3,629.73 "," $2,894.98 "," $2,841.59 "," $2,830.55 "," $5,789.97 "," $5,789.97 "
J0636,5710010375,Hospital Chargemaster,Calcitriol 1 mcg/1 mL Ampul,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.75 , $0.75 , $0.75 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.72 , $- , $0.75 , $-
J0610,5710010384,Hospital Chargemaster,Calcium Gluc 5 gm/50 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $3.98 , $3.98 , $3.98 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $4.29 , $- , $4.29 , $-
J0610,5710010386,Hospital Chargemaster,Calcium Gluc 4.65 mEq/10 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $24.97 , $- , $9.99 , See APC Packaged Rates , $17.48 , $9.74 , $3.98 , $3.98 , $3.98 , See APC Packaged Rates , See APC Packaged Rates , $16.75 , $16.75 , See APC Packaged Rates , See APC Packaged Rates , $23.22 , $23.22 , $23.22 , $23.22 , See APC Packaged Rates , $8.74 , $4.29 , $- , $23.22 , $17.48
J7336,5710010391,Hospital Chargemaster,Capsaicin 8%/Skin CleansKit,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $3.25 , $- , $3.78 , $- , $- , $3.25 , $3.25 , $3.25 , $3.78 , $3.78 , $- , $- , $3.97 , $3.86 , $- , $- , $- , $- , $3.78 , $- , $3.24 , $- , $3.97 , $-
J0714,5710010462,Hospital Chargemaster,cefTAZidime/Avibac 2.5 gm Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $92.28 , $- , $108.15 , $- , $- , $92.00 , $92.00 , $92.00 , $108.15 , $108.15 , $- , $- , $113.56 , $110.32 , $- , $- , $- , $- , $108.15 , $- , $92.37 , $- , $113.56 , $-
J0717,5710010480,Hospital Chargemaster,Certolizumab Pegol 400 mg Kit,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $8.18 , $- , $7.34 , $- , $- , $8.16 , $8.16 , $8.16 , $7.34 , $7.34 , $- , $- , $7.71 , $7.49 , $- , $- , $- , $- , $7.34 , $- , $6.28 , $- , $8.18 , $-
J0720,5710010489,Hospital Chargemaster,Chloramphenicol 1000 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $32.68 , $32.68 , $32.68 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $35.80 , $- , $35.80 , $-
J1205,5710010500,Hospital Chargemaster,Chlorothiazide Sod 500 mg Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $54.79 , $54.79 , $54.79 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $43.91 , $- , $54.79 , $-
J9060,5710010531,Hospital Chargemaster,Cisplatin 50 Mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $9.21 , $- , $3.68 , See APC Packaged Rates , $6.45 , $3.59 , $1.71 , $1.71 , $1.71 , See APC Packaged Rates , See APC Packaged Rates , $6.18 , $6.18 , See APC Packaged Rates , See APC Packaged Rates , $8.57 , $8.57 , $8.57 , $8.57 , See APC Packaged Rates , $3.22 , $1.86 , $- , $8.57 , $6.45
J9060,5710010532,Hospital Chargemaster,Cisplatin 100 Mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $9.21 , $- , $3.68 , See APC Packaged Rates , $6.45 , $3.59 , $1.71 , $1.71 , $1.71 , See APC Packaged Rates , See APC Packaged Rates , $6.18 , $6.18 , See APC Packaged Rates , See APC Packaged Rates , $8.57 , $8.57 , $8.57 , $8.57 , See APC Packaged Rates , $3.22 , $1.86 , $- , $8.57 , $6.45
J0735,5710010566,Hospital Chargemaster,cloNIDine/PF 1000 mcg/10 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $23.26 , $23.26 , $23.26 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $33.96 , $- , $33.96 , $-
J7189,5710010576,Hospital Chargemaster,Coag Fac VIIa 1000 mcg/1 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $1.85 , $- , $2.72 , $- , $- , $2.25 , $2.25 , $2.25 , $2.72 , $2.72 , $- , $- , $2.86 , $2.78 , $- , $- , $- , $- , $2.72 , $- , $2.31 , $- , $2.86 , $-
J7189,5710010577,Hospital Chargemaster,Coag Fac VIIa 2000 mcg/2 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $1.85 , $- , $2.72 , $- , $- , $2.25 , $2.25 , $2.25 , $2.72 , $2.72 , $- , $- , $2.86 , $2.78 , $- , $- , $- , $- , $2.72 , $- , $2.31 , $- , $2.86 , $-
J7189,5710010578,Hospital Chargemaster,Coag Fac VIIa 5000 mcg/5 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $1.85 , $- , $2.72 , $- , $- , $2.25 , $2.25 , $2.25 , $2.72 , $2.72 , $- , $- , $2.86 , $2.78 , $- , $- , $- , $- , $2.72 , $- , $2.31 , $- , $2.86 , $-
J7189,5710010579,Hospital Chargemaster,Coag Fac VIIa 8000 mcg/8 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $1.85 , $- , $2.72 , $- , $- , $2.25 , $2.25 , $2.25 , $2.72 , $2.72 , $- , $- , $2.86 , $2.78 , $- , $- , $- , $- , $2.72 , $- , $2.31 , $- , $2.86 , $-
C9046,5710010581,Hospital Chargemaster,Cocaine Nasal Soln 1 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $624.75 , $1.40 , $514.79 , $1.56 , $437.33 , $243.65 , $1.57 , $1.57 , $1.57 , $1.56 , $1.56 , $419.21 , $419.21 , $1.64 , $1.59 , $1.26 , $1.26 , $1.29 , $1.29 , $1.56 , $218.66 , $- , $- , $514.79 , $437.33
J0795,5710010596,Hospital Chargemaster,Corticorelin Ovine 100 mcg Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $9.57 , $- , $11.32 , $- , $- , $9.38 , $9.38 , $9.38 , $11.32 , $11.32 , $- , $- , $11.89 , $11.55 , $- , $- , $- , $- , $11.32 , $- , $9.67 , $- , $11.89 , $-
J7516,5710010616,Hospital Chargemaster,cycloSPORINE 250 mg/5 mL Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $61.75 , $61.75 , $61.75 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $62.23 , $- , $62.23 , $-
J9120,5710010626,Hospital Chargemaster,DACTINomycin 500 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $934.16 , $- ," $1,042.57 ", $- , $- ," $1,044.53 "," $1,044.53 "," $1,044.53 "," $1,042.57 "," $1,042.57 ", $- , $- ," $1,094.70 "," $1,063.42 ", $- , $- , $- , $- ," $1,042.57 ", $- , $838.88 , $- ," $1,094.70 ", $-
J0875,5710010627,Hospital Chargemaster,Dalbavancin HCl 500 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $15.39 , $- , $18.60 , $- , $- , $15.39 , $15.39 , $15.39 , $18.60 , $18.60 , $- , $- , $19.53 , $18.97 , $- , $- , $- , $- , $18.60 , $- , $15.89 , $- , $19.53 , $-
J9150,5710010643,Hospital Chargemaster,DAUNOrubicin 20 mg/4 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $42.52 , $- , $47.24 , $- , $- , $43.84 , $43.84 , $43.84 , $47.24 , $47.24 , $- , $- , $49.60 , $48.18 , $- , $- , $- , $- , $47.24 , $- , $41.24 , $- , $49.60 , $-
J9155,5710010646,Hospital Chargemaster,Degarelix Acetate 80 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $3.89 , $- , $4.82 , $- , $- , $3.84 , $3.84 , $3.84 , $4.82 , $4.82 , $- , $- , $5.06 , $4.92 , $- , $- , $- , $- , $4.82 , $- , $4.06 , $- , $5.06 , $-
J8540,5710010659,Hospital Chargemaster,Dexamethasone 0.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,636, $1.00 , $- , $0.40 , See APC Packaged Rates , $0.70 , $0.39 , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $- , $- , $0.93 , $0.70
J8540,5710010660,Hospital Chargemaster,Dexamethasone 1.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.10 , $-
J8540,5710010661,Hospital Chargemaster,Dexamethasone 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,636, $1.86 , $- , $0.74 , See APC Packaged Rates , $1.30 , $0.73 , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $1.25 , $1.25 , See APC Packaged Rates , See APC Packaged Rates , $1.73 , $1.73 , $1.73 , $1.73 , See APC Packaged Rates , $0.65 , $- , $- , $1.73 , $1.30
J8540,5710010662,Hospital Chargemaster,Dexamethasone 4 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,636, $3.06 , $- , $1.22 , See APC Packaged Rates , $2.14 , $1.19 , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $2.05 , $2.05 , See APC Packaged Rates , See APC Packaged Rates , $2.85 , $2.85 , $2.85 , $2.85 , See APC Packaged Rates , $1.07 , $- , $- , $2.85 , $2.14
J8540,5710010663,Hospital Chargemaster,Dexamethasone 6 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.10 , $-
J3360,5710010722,Hospital Chargemaster,diazePAM 10 mg/2 mL Cartridge,Outpatient,Outpatient Default Percent / Case Rate,636, $70.20 , $- , $28.08 , See APC Packaged Rates , $49.14 , $27.38 , $6.05 , $6.05 , $6.05 , See APC Packaged Rates , See APC Packaged Rates , $47.10 , $47.10 , See APC Packaged Rates , See APC Packaged Rates , $65.29 , $65.29 , $65.29 , $65.29 , See APC Packaged Rates , $24.57 , $7.07 , $- , $65.29 , $49.14
J3360,5710010727,Hospital Chargemaster,diazePAM 50 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $6.05 , $6.05 , $6.05 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $7.07 , $- , $7.07 , $-
J0500,5710010734,Hospital Chargemaster,Dicyclomine 20 mg/2 mL Amp,Outpatient,Outpatient Default Percent / Case Rate,636, $214.35 , $- , $85.74 , See APC Packaged Rates , $150.05 , $83.60 , $33.57 , $33.57 , $33.57 , See APC Packaged Rates , See APC Packaged Rates , $143.83 , $143.83 , See APC Packaged Rates , See APC Packaged Rates , $199.35 , $199.35 , $199.35 , $199.35 , See APC Packaged Rates , $75.02 , $- , $- , $199.35 , $150.05
J0470,5710010760,Hospital Chargemaster,Dimercaprol 300 mg/3 mL Ampul,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $60.97 , $60.97 , $60.97 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $60.97 , $-
J1212,5710010761,Hospital Chargemaster,Dimethyl Sulfoxide 50% 50 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $635.87 , $- , $745.79 , $- , $- , $635.67 , $635.67 , $635.67 , $745.79 , $745.79 , $- , $- , $783.08 , $760.71 , $- , $- , $- , $- , $745.79 , $- , $636.56 , $- , $783.08 , $-
J1245,5710010777,Hospital Chargemaster,Dipyridamole 50 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $3.36 , $3.36 , $3.36 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.65 , $- , $3.65 , $-
J1265,5710010807,Hospital Chargemaster,DOPamine 200 mg/5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.56 , $0.56 , $0.56 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.56 , $-
J1265,5710010808,Hospital Chargemaster,DOPamine 400 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.56 , $0.56 , $0.56 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.56 , $-
J1265,5710010809,Hospital Chargemaster,DOPamine/D5W 200 mg/250 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.56 , $0.56 , $0.56 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.56 , $-
J1265,5710010810,Hospital Chargemaster,DOPamine/D5W 400 mg/250 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $25.41 , $- , $10.16 , See APC Packaged Rates , $17.79 , $9.91 , $0.56 , $0.56 , $0.56 , See APC Packaged Rates , See APC Packaged Rates , $17.05 , $17.05 , See APC Packaged Rates , See APC Packaged Rates , $23.63 , $23.63 , $23.63 , $23.63 , See APC Packaged Rates , $8.89 , $- , $- , $23.63 , $17.79
J1265,5710010811,Hospital Chargemaster,DOPamine/D5W 400 mg/500 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.56 , $0.56 , $0.56 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.56 , $-
J1265,5710010812,Hospital Chargemaster,DOPamine/D5W 800 mg/500 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.56 , $0.56 , $0.56 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.56 , $-
J0171,5710010872,Hospital Chargemaster,EPINEPHrine 0.1 mg/mL 10mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $13.30 , $- , $5.32 , See APC Packaged Rates , $9.31 , $5.19 , $0.88 , $0.88 , $0.88 , See APC Packaged Rates , See APC Packaged Rates , $8.92 , $8.92 , See APC Packaged Rates , See APC Packaged Rates , $12.37 , $12.37 , $12.37 , $12.37 , See APC Packaged Rates , $4.66 , $- , $- , $12.37 , $9.31
J0171,5710010873,Hospital Chargemaster,EPINEPHrine 0.15 mg/0.3mL AUTO,Outpatient,Outpatient Default Percent / Case Rate,636, $382.50 , $- , $153.00 , See APC Packaged Rates , $267.75 , $149.18 , $0.88 , $0.88 , $0.88 , See APC Packaged Rates , See APC Packaged Rates , $256.66 , $256.66 , See APC Packaged Rates , See APC Packaged Rates , $355.73 , $355.73 , $355.73 , $355.73 , See APC Packaged Rates , $133.88 , $- , $- , $355.73 , $267.75
J0171,5710010874,Hospital Chargemaster,EPINEPHrine 0.3 mg/0.3 mL AUTO,Outpatient,Outpatient Default Percent / Case Rate,636, $382.50 , $- , $153.00 , See APC Packaged Rates , $267.75 , $149.18 , $0.88 , $0.88 , $0.88 , See APC Packaged Rates , See APC Packaged Rates , $256.66 , $256.66 , See APC Packaged Rates , See APC Packaged Rates , $355.73 , $355.73 , $355.73 , $355.73 , See APC Packaged Rates , $133.88 , $- , $- , $355.73 , $267.75
J0171,5710010875,Hospital Chargemaster,EPINEPHrine 1 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $38.15 , $- , $15.26 , See APC Packaged Rates , $26.71 , $14.88 , $0.88 , $0.88 , $0.88 , See APC Packaged Rates , See APC Packaged Rates , $25.60 , $25.60 , See APC Packaged Rates , See APC Packaged Rates , $35.48 , $35.48 , $35.48 , $35.48 , See APC Packaged Rates , $13.35 , $- , $- , $35.48 , $26.71
J0171,5710010877,Hospital Chargemaster,EPINEPHrine/NS 100mcg/10mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.88 , $0.88 , $0.88 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.88 , $-
J1325,5710010888,Hospital Chargemaster,Epoprostenol 0.5 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $16.31 , $16.31 , $16.31 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $16.26 , $- , $16.31 , $-
J1325,5710010889,Hospital Chargemaster,Epoprostenol 1.5 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $16.31 , $16.31 , $16.31 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $16.26 , $- , $16.31 , $-
J1435,5710010917,Hospital Chargemaster,Etanercept 50mg/1mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $0.24 , $- , See APC Packaged Rates , $- , $- , $0.24 , $0.24 , $0.24 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.35 , $- , $0.35 , $-
J1439,5710010962,Hospital Chargemaster,Ferric Carboxymaltose 750mg Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $1.13 , $- , $1.31 , $- , $- , $1.11 , $1.11 , $1.11 , $1.31 , $1.31 , $- , $- , $1.38 , $1.34 , $- , $- , $- , $- , $1.31 , $- , $1.12 , $- , $1.38 , $-
Q5101,5710010973,Hospital Chargemaster,Filgrast-sndz 300mcg/0.5mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $0.41 , $- , $0.37 , $- , $- , $0.47 , $0.47 , $0.47 , $0.37 , $0.37 , $- , $- , $0.39 , $0.38 , $- , $- , $- , $- , $0.37 , $- , $0.31 , $- , $0.47 , $-
Q5101,5710010974,Hospital Chargemaster,Filgrast-sndz (zarxio) 1 mcg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $0.41 , $- , $0.37 , $- , $- , $0.47 , $0.47 , $0.47 , $0.37 , $0.37 , $- , $- , $0.39 , $0.38 , $- , $- , $- , $- , $0.37 , $- , $0.31 , $- , $0.47 , $-
J9200,5710010978,Hospital Chargemaster,Floxuridine 500 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $46.44 , $46.44 , $46.44 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $69.89 , $- , $69.89 , $-
J1450,5710010984,Hospital Chargemaster,Fluconazole/NS 200mg Piggyback,Outpatient,Outpatient Default Percent / Case Rate,636, $44.19 , $- , $17.68 , See APC Packaged Rates , $30.93 , $17.23 , $3.43 , $3.43 , $3.43 , See APC Packaged Rates , See APC Packaged Rates , $29.65 , $29.65 , See APC Packaged Rates , See APC Packaged Rates , $41.10 , $41.10 , $41.10 , $41.10 , See APC Packaged Rates , $15.47 , $3.14 , $- , $41.10 , $30.93
J1450,5710010985,Hospital Chargemaster,Fluconazole/NS 400mg Piggyback,Outpatient,Outpatient Default Percent / Case Rate,636, $53.07 , $- , $21.23 , See APC Packaged Rates , $37.15 , $20.70 , $3.43 , $3.43 , $3.43 , See APC Packaged Rates , See APC Packaged Rates , $35.61 , $35.61 , See APC Packaged Rates , See APC Packaged Rates , $49.36 , $49.36 , $49.36 , $49.36 , See APC Packaged Rates , $18.57 , $3.14 , $- , $49.36 , $37.15
A9577,5710011055,Hospital Chargemaster,Gadobenate 5290 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , Not reimbursed , See APC Packaged Rates , $- , $- , $7.11 , $3.68 , $3.61 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.88 , $- , $7.11 , $-
A9577,5710011056,Hospital Chargemaster,Gadobenate 7935 mg/15 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , Not reimbursed , See APC Packaged Rates , $- , $- , $7.11 , $3.68 , $3.61 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.88 , $- , $7.11 , $-
A9577,5710011057,Hospital Chargemaster,Gadobenate 10580 mg/20 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , Not reimbursed , See APC Packaged Rates , $- , $- , $7.11 , $3.68 , $3.61 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.88 , $- , $7.11 , $-
A9585,5710011058,Hospital Chargemaster,Gadobutrol 10 MMOL/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.38 , $0.71 , $0.70 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.35 , $- , $1.38 , $-
A9585,5710011059,Hospital Chargemaster,Gadobutrol 2 MMOL/2 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.38 , $0.71 , $0.70 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.35 , $- , $1.38 , $-
A9585,5710011060,Hospital Chargemaster,Gadobutrol 7.5 MMOL/7.5mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.38 , $0.71 , $0.70 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.35 , $- , $1.38 , $-
A9576,5710011065,Hospital Chargemaster,Gadoteridol 2793 mg/10 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $148.31 , $- , $122.21 , See APC Packaged Rates , $103.82 , $57.84 , $5.31 , $2.75 , $2.70 , See APC Packaged Rates , See APC Packaged Rates , $99.52 , $99.52 , See APC Packaged Rates , See APC Packaged Rates , $137.93 , $137.93 , $137.93 , $137.93 , See APC Packaged Rates , $51.91 , $1.45 , $- , $137.93 , $103.82
A9576,5710011066,Hospital Chargemaster,Gadoteridol 4189.5 mg/15 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $217.03 , $- , $178.83 , See APC Packaged Rates , $151.92 , $84.64 , $5.31 , $2.75 , $2.70 , See APC Packaged Rates , See APC Packaged Rates , $145.63 , $145.63 , See APC Packaged Rates , See APC Packaged Rates , $201.84 , $201.84 , $201.84 , $201.84 , See APC Packaged Rates , $75.96 , $1.45 , $- , $201.84 , $151.92
A9576,5710011067,Hospital Chargemaster,Gadoteridol 5586 mg/20 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $268.03 , $- , $220.86 , See APC Packaged Rates , $187.62 , $104.53 , $5.31 , $2.75 , $2.70 , See APC Packaged Rates , See APC Packaged Rates , $179.85 , $179.85 , See APC Packaged Rates , See APC Packaged Rates , $249.27 , $249.27 , $249.27 , $249.27 , See APC Packaged Rates , $93.81 , $1.45 , $- , $249.27 , $187.62
A9576,5710011068,Hospital Chargemaster,Gadoteridol 1396.5 mg/5 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $75.61 , $- , $62.30 , See APC Packaged Rates , $52.93 , $29.49 , $5.31 , $2.75 , $2.70 , See APC Packaged Rates , See APC Packaged Rates , $50.73 , $50.73 , See APC Packaged Rates , See APC Packaged Rates , $70.32 , $70.32 , $70.32 , $70.32 , See APC Packaged Rates , $26.46 , $1.45 , $- , $70.32 , $52.93
A9581,5710011069,Hospital Chargemaster,Gadoxetate 2.5 MMOL/10 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $14.76 , $14.76 , $14.76 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $14.74 , $- , $14.76 , $-
J1570,5710011072,Hospital Chargemaster,Ganciclovir Sodium 500 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $12.84 , $12.84 , $12.84 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $47.37 , $- , $47.37 , $-
90723,5710011130,Hospital Chargemaster,Hep B/Dp(A)T-Pol/PF 0.5 mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $83.94 , $- , See APC Packaged Rates , $- , $- , $98.75 , $98.75 , $98.75 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $107.30 , $- , $107.30 , $-
90744,5710011146,Hospital Chargemaster,HepB Ped 10 mcg/0.5 mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $62.01 , $28.21 , $51.10 , See APC Packaged Rates , $43.41 , $24.18 , $28.21 , $28.21 , $28.21 , See APC Packaged Rates , See APC Packaged Rates , $41.61 , $41.61 , See APC Packaged Rates , See APC Packaged Rates , $28.21 , $28.21 , $28.94 , $28.94 , See APC Packaged Rates , $21.70 , $28.76 , $21.70 , $51.10 , $43.41
90744,5710011147,Hospital Chargemaster,HepB Ped 5 mcg/0.5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $28.21 , $- , See APC Packaged Rates , $- , $- , $28.21 , $28.21 , $28.21 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $28.21 , $28.21 , $28.94 , $28.94 , See APC Packaged Rates , $- , $28.76 , $- , $28.94 , $-
90747,5710011148,Hospital Chargemaster,HepB 40 mcg/mL 1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $140.75 , $- , See APC Packaged Rates , $- , $- , $140.76 , $140.76 , $140.76 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $140.76 , $- , $140.76 , $-
A9589,5710011150,Hospital Chargemaster,Hexaminolevulinate 100 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- ," $1,199.10 ", $- ," $1,199.10 ", $-
J7324,5710011160,Hospital Chargemaster,Hyaluronate 30 mg/2 mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $128.55 , $- , $174.11 , $- , $- , $128.41 , $128.41 , $128.41 , $174.11 , $174.11 , $- , $- , $182.82 , $177.60 , $- , $- , $- , $- , $174.11 , $- , $147.75 , $- , $182.82 , $-
J3473,5710011161,Hospital Chargemaster,Hyaluronidase 150 Unit/1 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $142.29 , $- , $56.92 , See APC Packaged Rates , $99.60 , $55.49 , $0.36 , $0.36 , $0.36 , See APC Packaged Rates , See APC Packaged Rates , $95.48 , $95.48 , See APC Packaged Rates , See APC Packaged Rates , $132.33 , $132.33 , $132.33 , $132.33 , See APC Packaged Rates , $49.80 , $0.36 , $- , $132.33 , $99.60
J3471,5710011162,Hospital Chargemaster,Hyaluronidase 200 Unit/1 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.46 , $0.46 , $0.46 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.47 , $- , $0.47 , $-
J1742,5710011224,Hospital Chargemaster,Ibutilide 1 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $273.16 , $- , $240.04 , $- , $- , $316.20 , $316.20 , $316.20 , $240.04 , $240.04 , $- , $- , $252.04 , $244.84 , $- , $- , $- , $- , $240.04 , $- , $316.20 , $- , $316.20 , $-
J3590,5710011226,Hospital Chargemaster,idaruCIZUmab 2.5gm/50mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
J1460,5710011248,Hospital Chargemaster,IgG/Glycine 2 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $43.30 , $- , $51.66 , $- , $- , $42.93 , $42.93 , $42.93 , $51.66 , $51.66 , $- , $- , $54.24 , $52.69 , $- , $- , $- , $- , $51.66 , $- , $45.42 , $- , $54.24 , $-
Q9966,5710011276,Hospital Chargemaster,Iohexol 240 mg/1 mL INFUS..Btl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , Not reimbursed , See APC Packaged Rates , $- , $- , $0.34 , $0.34 , $0.34 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.34 , $-
Q9966,5710011279,Hospital Chargemaster,Iohexol 240 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , Not reimbursed , See APC Packaged Rates , $- , $- , $0.34 , $0.34 , $0.34 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $0.34 , $-
Q9958,5710011285,Hospital Chargemaster,Iothalamate 172mg/mL 250mL,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.07 , $0.07 , $0.07 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.07 , $- , $0.07 , $-
J1840,5710011317,Hospital Chargemaster,Kanamycin 1000 mg/3 mL Powder,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $7.69 , $7.69 , $7.69 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $5.19 , $- , $7.69 , $-
J1885,5710011326,Hospital Chargemaster,Ketorolac 15 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $6.99 , $- , $2.80 , See APC Packaged Rates , $4.89 , $2.73 , $0.67 , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $4.69 , $4.69 , See APC Packaged Rates , See APC Packaged Rates , $6.50 , $6.50 , $6.50 , $6.50 , See APC Packaged Rates , $2.45 , $0.55 , $- , $6.50 , $4.89
J1885,5710011327,Hospital Chargemaster,Ketorolac 30 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $15.37 , $- , $6.15 , See APC Packaged Rates , $10.76 , $5.99 , $0.67 , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $10.31 , $10.31 , See APC Packaged Rates , See APC Packaged Rates , $14.29 , $14.29 , $14.29 , $14.29 , See APC Packaged Rates , $5.38 , $0.55 , $- , $14.29 , $10.76
J1885,5710011328,Hospital Chargemaster,Ketorolac 60 mg/2 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $15.89 , $- , $6.36 , See APC Packaged Rates , $11.12 , $6.20 , $0.67 , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $10.66 , $10.66 , See APC Packaged Rates , See APC Packaged Rates , $14.78 , $14.78 , $14.78 , $14.78 , See APC Packaged Rates , $5.56 , $0.55 , $- , $14.78 , $11.12
J1956,5710011388,Hospital Chargemaster,levoFLOXacin/D5W 250 mg/50 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $17.85 , $- , $7.14 , See APC Packaged Rates , $12.50 , $6.96 , $0.40 , $0.40 , $0.40 , See APC Packaged Rates , See APC Packaged Rates , $11.98 , $11.98 , See APC Packaged Rates , See APC Packaged Rates , $16.60 , $16.60 , $16.60 , $16.60 , See APC Packaged Rates , $6.25 , $- , $- , $16.60 , $12.50
J1956,5710011389,Hospital Chargemaster,levoFLOXacin/D5W 500 mg/100mL,Outpatient,Outpatient Default Percent / Case Rate,636, $27.36 , $- , $10.94 , See APC Packaged Rates , $19.15 , $10.67 , $0.40 , $0.40 , $0.40 , See APC Packaged Rates , See APC Packaged Rates , $18.36 , $18.36 , See APC Packaged Rates , See APC Packaged Rates , $25.44 , $25.44 , $25.44 , $25.44 , See APC Packaged Rates , $9.58 , $- , $- , $25.44 , $19.15
J1956,5710011390,Hospital Chargemaster,levoFLOXacin/D5W 750 mg/150mL,Outpatient,Outpatient Default Percent / Case Rate,636, $27.58 , $- , $11.03 , See APC Packaged Rates , $19.31 , $10.76 , $0.40 , $0.40 , $0.40 , See APC Packaged Rates , See APC Packaged Rates , $18.51 , $18.51 , See APC Packaged Rates , See APC Packaged Rates , $25.65 , $25.65 , $25.65 , $25.65 , See APC Packaged Rates , $9.65 , $- , $- , $25.65 , $19.31
J2150,5710011513,Hospital Chargemaster,Mannitol 12.5 gm/50 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $5.60 , $- , $2.24 , See APC Packaged Rates , $3.92 , $2.18 , $2.07 , $2.07 , $2.07 , See APC Packaged Rates , See APC Packaged Rates , $3.76 , $3.76 , See APC Packaged Rates , See APC Packaged Rates , $5.21 , $5.21 , $5.21 , $5.21 , See APC Packaged Rates , $1.96 , $4.63 , $- , $5.21 , $3.92
J9230,5710011517,Hospital Chargemaster,Mechlorethamine 10 mg/10 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $315.90 , $- , $13.74 , $- , $- , $353.07 , $353.07 , $353.07 , $13.74 , $13.74 , $- , $- , $14.43 , $14.02 , $- , $- , $- , $- , $13.74 , $- , $11.74 , $- , $353.07 , $-
J8600,5710011531,Hospital Chargemaster,Melphalan 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $12.00 , $- , See APC Packaged Rates , $- , $- , $10.44 , $10.44 , $10.44 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $12.90 , $- , $12.90 , $-
J1230,5710011571,Hospital Chargemaster,methADONE 10 mg/1 mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $17.55 , $17.55 , $17.55 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $17.55 , $-
J9250,5710011581,Hospital Chargemaster,metHOTREXate 50 mg/2 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.23 , $0.23 , $0.23 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.21 , $- , $0.23 , $-
J9250,5710011582,Hospital Chargemaster,metHOTREXate 250 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.23 , $0.23 , $0.23 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.21 , $- , $0.23 , $-
J9250,5710011583,Hospital Chargemaster,metHOTREXate/PF 100 mg/4 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.23 , $0.23 , $0.23 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.21 , $- , $0.23 , $-
Q9968,5710011587,Hospital Chargemaster,Methylene Blue 50 mg/10mL Amp,Outpatient,Outpatient Default Percent / Case Rate,636, $606.82 , $14.28 , $500.02 , $7.87 , $424.77 , $236.66 , $15.96 , $15.96 , $15.96 , $7.87 , $7.87 , $407.18 , $407.18 , $8.27 , $8.03 , $7.27 , $7.27 , $7.46 , $7.46 , $7.87 , $212.39 , $- , $- , $500.02 , $424.77
Q9968,5710011588,Hospital Chargemaster,Methylene Blue 100 mg/10 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $14.28 , $- , $7.87 , $- , $- , $15.96 , $15.96 , $15.96 , $7.87 , $7.87 , $- , $- , $8.27 , $8.03 , $7.27 , $7.27 , $7.46 , $7.46 , $7.87 , $- , $- , $- , $15.96 , $-
J2212,5710011591,Hospital Chargemaster,Methylnaltrexone 12mg/0.6mL,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.19 , $1.19 , $1.19 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.51 , $- , $1.51 , $-
J2920,5710011601,Hospital Chargemaster,methylPRED Na Succ/PF 40 mg Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $15.32 , $- , $6.13 , See APC Packaged Rates , $10.72 , $5.97 , $4.17 , $4.17 , $4.17 , See APC Packaged Rates , See APC Packaged Rates , $10.28 , $10.28 , See APC Packaged Rates , See APC Packaged Rates , $14.25 , $14.25 , $14.25 , $14.25 , See APC Packaged Rates , $5.36 , $- , $- , $14.25 , $10.72
J2765,5710011605,Hospital Chargemaster,Metoclopramide 10 mg/2 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $2.84 , $- , $1.14 , See APC Packaged Rates , $1.99 , $1.11 , $1.04 , $1.04 , $1.04 , See APC Packaged Rates , See APC Packaged Rates , $1.91 , $1.91 , See APC Packaged Rates , See APC Packaged Rates , $2.64 , $2.64 , $2.64 , $2.64 , See APC Packaged Rates , $0.99 , $1.07 , $- , $2.64 , $1.99
J7315,5710011666,Hospital Chargemaster,mitoMYcin 0.4 mg/1 mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $409.26 , $409.26 , $409.26 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $409.26 , $-
J2270,5710011675,Hospital Chargemaster,Morphine 10 mg/1 mL Cartridge,Outpatient,Outpatient Default Percent / Case Rate,636, $4.82 , $- , $1.93 , See APC Packaged Rates , $3.37 , $1.88 , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $3.23 , $3.23 , See APC Packaged Rates , See APC Packaged Rates , $4.48 , $4.48 , $4.48 , $4.48 , See APC Packaged Rates , $1.69 , $3.17 , $- , $4.48 , $3.37
J2270,5710011676,Hospital Chargemaster,Morphine 2 mg/1 mL Cartridge,Outpatient,Outpatient Default Percent / Case Rate,636, $5.25 , $- , $2.10 , See APC Packaged Rates , $3.68 , $2.05 , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $3.52 , $3.52 , See APC Packaged Rates , See APC Packaged Rates , $4.88 , $4.88 , $4.88 , $4.88 , See APC Packaged Rates , $1.84 , $3.17 , $- , $4.88 , $3.68
J2270,5710011677,Hospital Chargemaster,Morphine 4 mg/1 mL Cartridge,Outpatient,Outpatient Default Percent / Case Rate,636, $4.80 , $- , $1.92 , See APC Packaged Rates , $3.36 , $1.87 , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $3.22 , $3.22 , See APC Packaged Rates , See APC Packaged Rates , $4.46 , $4.46 , $4.46 , $4.46 , See APC Packaged Rates , $1.68 , $3.17 , $- , $4.46 , $3.36
J2270,5710011681,Hospital Chargemaster,Morphine 15 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.17 , $- , $3.17 , $-
J2270,5710011682,Hospital Chargemaster,Morphine 250 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.17 , $- , $3.17 , $-
J2270,5710011683,Hospital Chargemaster,Morphine 50 mg/mL mL,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.17 , $- , $3.17 , $-
J2270,5710011684,Hospital Chargemaster,Morphine 5 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.17 , $- , $3.17 , $-
J2270,5710011685,Hospital Chargemaster,Morphine 8 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.17 , $- , $3.17 , $-
J2270,5710011691,Hospital Chargemaster,Morphine/NS/PF 2 mg/2 mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.17 , $- , $3.17 , $-
J2270,5710011692,Hospital Chargemaster,Morphine/D5W 100 mg/100 mL Bag,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.17 , $- , $3.17 , $-
J2270,5710011693,Hospital Chargemaster,Morphine/PF 5 mg/10 mL Ampul,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.17 , $- , $3.17 , $-
J2270,5710011694,Hospital Chargemaster,Morphine/PF 10 mg/10 mL Ampul,Outpatient,Outpatient Default Percent / Case Rate,636, $73.85 , $- , $29.54 , See APC Packaged Rates , $51.70 , $28.80 , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $49.55 , $49.55 , See APC Packaged Rates , See APC Packaged Rates , $68.68 , $68.68 , $68.68 , $68.68 , See APC Packaged Rates , $25.85 , $3.17 , $- , $68.68 , $51.70
J2270,5710011695,Hospital Chargemaster,Morphine/PF 30 mg/30 mL PCA,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.17 , $- , $3.17 , $-
J2270,5710011696,Hospital Chargemaster,Morphine/PF 1 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.17 , $- , $3.17 , $-
J2280,5710011699,Hospital Chargemaster,Moxifloxacin 400 mg Piggyback,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $9.36 , $9.36 , $9.36 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $8.32 , $- , $9.36 , $-
90621,5710011712,Hospital Chargemaster,"N.meningB,LipFhbpRc 0.5 mL Syr",Outpatient,Outpatient Default Percent / Case Rate,636, $- , $152.76 , $- , See APC Packaged Rates , $- , $- , $179.72 , $179.72 , $179.72 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $179.72 , $-
J2300,5710011720,Hospital Chargemaster,Nalbuphine 10 mg/1 mL Ampul,Outpatient,Outpatient Default Percent / Case Rate,636, $9.26 , $- , $3.70 , See APC Packaged Rates , $6.48 , $3.61 , $3.07 , $3.07 , $3.07 , See APC Packaged Rates , See APC Packaged Rates , $6.21 , $6.21 , See APC Packaged Rates , See APC Packaged Rates , $8.61 , $8.61 , $8.61 , $8.61 , See APC Packaged Rates , $3.24 , $3.07 , $- , $8.61 , $6.48
J2300,5710011721,Hospital Chargemaster,Nalbuphine 100 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $3.07 , $3.07 , $3.07 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.07 , $- , $3.07 , $-
J2300,5710011722,Hospital Chargemaster,Nalbuphine 200 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $3.07 , $3.07 , $3.07 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.07 , $- , $3.07 , $-
J9301,5710011812,Hospital Chargemaster,Obinutuzumab 1000 mg/40mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $63.54 , $- , $75.54 , $- , $- , $63.74 , $63.74 , $63.74 , $75.54 , $75.54 , $- , $- , $79.32 , $77.06 , $- , $- , $- , $- , $75.54 , $- , $64.11 , $- , $79.32 , $-
J2358,5710011827,Hospital Chargemaster,OLANZapine Pamoate 210 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $3.41 , $- , $- , $2.92 , $2.92 , $2.92 , $3.41 , $3.41 , $- , $- , $3.58 , $3.48 , $- , $- , $- , $- , $3.41 , $- , $2.92 , $- , $3.58 , $-
J2358,5710011828,Hospital Chargemaster,OLANZapine Pamoate 300 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $3.41 , $- , $- , $2.92 , $2.92 , $2.92 , $3.41 , $3.41 , $- , $- , $3.58 , $3.48 , $- , $- , $- , $- , $3.41 , $- , $2.92 , $- , $3.58 , $-
J2358,5710011829,Hospital Chargemaster,OLANZapine Pamoate 405 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , $3.41 , $- , $- , $2.92 , $2.92 , $2.92 , $3.41 , $3.41 , $- , $- , $3.58 , $3.48 , $- , $- , $- , $- , $3.41 , $- , $2.92 , $- , $3.58 , $-
J2700,5710011856,Hospital Chargemaster,Oxacillin 1 gm Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $28.69 , $- , $11.48 , See APC Packaged Rates , $20.08 , $11.19 , $1.30 , $1.30 , $1.30 , See APC Packaged Rates , See APC Packaged Rates , $19.25 , $19.25 , See APC Packaged Rates , See APC Packaged Rates , $26.68 , $26.68 , $26.68 , $26.68 , See APC Packaged Rates , $10.04 , $1.28 , $- , $26.68 , $20.08
J2700,5710011857,Hospital Chargemaster,Oxacillin 2 gm Vial Port,Outpatient,Outpatient Default Percent / Case Rate,636, $6.15 , $- , $2.46 , See APC Packaged Rates , $4.31 , $2.40 , $1.30 , $1.30 , $1.30 , See APC Packaged Rates , See APC Packaged Rates , $4.13 , $4.13 , See APC Packaged Rates , See APC Packaged Rates , $5.72 , $5.72 , $5.72 , $5.72 , See APC Packaged Rates , $2.15 , $1.28 , $- , $5.72 , $4.31
J2590,5710011880,Hospital Chargemaster,Oxytocin 10 Unit/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $9.18 , $- , $3.67 , See APC Packaged Rates , $6.43 , $3.58 , $0.99 , $0.99 , $0.99 , See APC Packaged Rates , See APC Packaged Rates , $6.16 , $6.16 , See APC Packaged Rates , See APC Packaged Rates , $8.54 , $8.54 , $8.54 , $8.54 , See APC Packaged Rates , $3.21 , $1.77 , $- , $8.54 , $6.43
J2590,5710011881,Hospital Chargemaster,Oxytocin/NS 15 Unit/250 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.99 , $0.99 , $0.99 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.77 , $- , $1.77 , $-
J2590,5710011882,Hospital Chargemaster,Oxytocin/NS 30 Unit/500 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.99 , $0.99 , $0.99 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.77 , $- , $1.77 , $-
J2426,5710011889,Hospital Chargemaster,Paliperidone 117 mg/0.75mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $12.09 , $- , $14.82 , $- , $- , $12.10 , $12.10 , $12.10 , $14.82 , $14.82 , $- , $- , $15.56 , $15.12 , $- , $- , $- , $- , $14.82 , $- , $12.65 , $- , $15.56 , $-
J2426,5710011890,Hospital Chargemaster,Paliperidone 156 mg/1 mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $12.09 , $- , $14.82 , $- , $- , $12.10 , $12.10 , $12.10 , $14.82 , $14.82 , $- , $- , $15.56 , $15.12 , $- , $- , $- , $- , $14.82 , $- , $12.65 , $- , $15.56 , $-
J2426,5710011891,Hospital Chargemaster,Paliperidone 234 mg/1.5 mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $12.09 , $- , $14.82 , $- , $- , $12.10 , $12.10 , $12.10 , $14.82 , $14.82 , $- , $- , $15.56 , $15.12 , $- , $- , $- , $- , $14.82 , $- , $12.65 , $- , $15.56 , $-
J2426,5710011892,Hospital Chargemaster,Paliperidone 39 mg/0.25 mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $12.09 , $- , $14.82 , $- , $- , $12.10 , $12.10 , $12.10 , $14.82 , $14.82 , $- , $- , $15.56 , $15.12 , $- , $- , $- , $- , $14.82 , $- , $12.65 , $- , $15.56 , $-
J2426,5710011893,Hospital Chargemaster,Paliperidone 78 mg/0.5 mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $12.09 , $- , $14.82 , $- , $- , $12.10 , $12.10 , $12.10 , $14.82 , $14.82 , $- , $- , $15.56 , $15.12 , $- , $- , $- , $- , $14.82 , $- , $12.65 , $- , $15.56 , $-
J0561,5710011922,Hospital Chargemaster,Penicil G Benz 1200 MU/2mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $439.01 , $15.10 , $175.60 , $17.50 , $307.31 , $171.21 , $15.16 , $15.16 , $15.16 , $17.50 , $17.50 , $294.58 , $294.58 , $18.37 , $17.85 , $15.16 , $15.16 , $15.55 , $15.55 , $17.50 , $153.65 , $15.04 , $15.04 , $307.31 , $307.31
J0561,5710011923,Hospital Chargemaster,Penicil G Benz 2400 MU/4mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $15.10 , $- , $17.50 , $- , $- , $15.16 , $15.16 , $15.16 , $17.50 , $17.50 , $- , $- , $18.37 , $17.85 , $15.16 , $15.16 , $15.55 , $15.55 , $17.50 , $- , $15.04 , $- , $18.37 , $-
J0561,5710011924,Hospital Chargemaster,Penicil G Benz 600 MU/1 mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $15.10 , $- , $17.50 , $- , $- , $15.16 , $15.16 , $15.16 , $17.50 , $17.50 , $- , $- , $18.37 , $17.85 , $15.16 , $15.16 , $15.55 , $15.55 , $17.50 , $- , $15.04 , $- , $18.37 , $-
J2510,5710011928,Hospital Chargemaster,Penicill G Proc 600K Unit Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $30.53 , $30.53 , $30.53 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $30.99 , $- , $30.99 , $-
J2515,5710011934,Hospital Chargemaster,PENTobarbital 2500 mg/50 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $29.87 , $- , See APC Packaged Rates , $- , $- , $33.93 , $33.93 , $33.93 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $24.13 , $- , $33.93 , $-
J2370,5710011965,Hospital Chargemaster,Phenylephrine 50 mg/5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $4.18 , $4.18 , $4.18 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $4.29 , $- , $4.29 , $-
J2370,5710011966,Hospital Chargemaster,Phenylephrine 10 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $10.96 , $- , $4.38 , See APC Packaged Rates , $7.67 , $4.27 , $4.18 , $4.18 , $4.18 , See APC Packaged Rates , See APC Packaged Rates , $7.35 , $7.35 , See APC Packaged Rates , See APC Packaged Rates , $10.19 , $10.19 , $10.19 , $10.19 , See APC Packaged Rates , $3.84 , $4.29 , $- , $10.19 , $7.67
J2370,5710011967,Hospital Chargemaster,Phenylephrine 1000mcg/10mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $4.18 , $4.18 , $4.18 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $4.29 , $- , $4.29 , $-
J2543,5710011991,Hospital Chargemaster,Piperacillin/Tazo 2.25 gm Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $17.85 , $- , $7.14 , See APC Packaged Rates , $12.50 , $6.96 , $1.65 , $1.65 , $1.65 , See APC Packaged Rates , See APC Packaged Rates , $11.98 , $11.98 , See APC Packaged Rates , See APC Packaged Rates , $16.60 , $16.60 , $16.60 , $16.60 , See APC Packaged Rates , $6.25 , $1.42 , $- , $16.60 , $12.50
J2543,5710011992,Hospital Chargemaster,Piperacillin/Tazo 3.375gm Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $41.92 , $- , $16.77 , See APC Packaged Rates , $29.34 , $16.35 , $1.65 , $1.65 , $1.65 , See APC Packaged Rates , See APC Packaged Rates , $28.13 , $28.13 , See APC Packaged Rates , See APC Packaged Rates , $38.99 , $38.99 , $38.99 , $38.99 , See APC Packaged Rates , $14.67 , $1.42 , $- , $38.99 , $29.34
J2543,5710011993,Hospital Chargemaster,Piperacillin/Tazo 4.5 gm Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $36.43 , $- , $14.57 , See APC Packaged Rates , $25.50 , $14.21 , $1.65 , $1.65 , $1.65 , See APC Packaged Rates , See APC Packaged Rates , $24.44 , $24.44 , See APC Packaged Rates , See APC Packaged Rates , $33.88 , $33.88 , $33.88 , $33.88 , See APC Packaged Rates , $12.75 , $1.42 , $- , $33.88 , $25.50
90713,5710011999,Hospital Chargemaster,"Polio Vacc, Killed 0.5 mL Vial",Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $42.05 , $42.05 , $42.05 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $46.34 , $- , $46.34 , $-
J2730,5710012045,Hospital Chargemaster,Pralidoxime Chloride 1 gm Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $98.84 , $98.84 , $98.84 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $98.84 , $-
J2690,5710012078,Hospital Chargemaster,Procainamide 1000 mg/10 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $221.37 , $- , $88.55 , See APC Packaged Rates , $154.96 , $86.33 , $71.73 , $71.73 , $71.73 , See APC Packaged Rates , See APC Packaged Rates , $148.54 , $148.54 , See APC Packaged Rates , See APC Packaged Rates , $205.87 , $205.87 , $205.87 , $205.87 , See APC Packaged Rates , $77.48 , $106.27 , $- , $205.87 , $154.96
J2690,5710012079,Hospital Chargemaster,Procainamide 1000 mg/2 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $183.70 , $- , $73.48 , See APC Packaged Rates , $128.59 , $71.64 , $71.73 , $71.73 , $71.73 , See APC Packaged Rates , See APC Packaged Rates , $123.26 , $123.26 , See APC Packaged Rates , See APC Packaged Rates , $170.84 , $170.84 , $170.84 , $170.84 , See APC Packaged Rates , $64.30 , $106.27 , $- , $170.84 , $128.59
J2675,5710012084,Hospital Chargemaster,proGESTerone 500 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.43 , $1.43 , $1.43 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.15 , $- , $1.43 , $-
J2820,5710012217,Hospital Chargemaster,Sargramostim 250 mcg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $48.83 , $- , $60.34 , $- , $- , $48.12 , $48.12 , $48.12 , $60.34 , $60.34 , $- , $- , $63.36 , $61.55 , $- , $- , $- , $- , $60.34 , $- , $53.56 , $- , $63.36 , $-
J2860,5710012233,Hospital Chargemaster,Siltuximab 100 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $111.50 , $- , $145.26 , $- , $- , $111.94 , $111.94 , $111.94 , $145.26 , $145.26 , $- , $- , $152.52 , $148.17 , $- , $- , $- , $- , $145.26 , $- , $125.16 , $- , $152.52 , $-
J2860,5710012234,Hospital Chargemaster,Siltuximab 400 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $111.50 , $- , $145.26 , $- , $- , $111.94 , $111.94 , $111.94 , $145.26 , $145.26 , $- , $- , $152.52 , $148.17 , $- , $- , $- , $- , $145.26 , $- , $125.16 , $- , $152.52 , $-
J7131,5710012270,Hospital Chargemaster,Sodium Chloride 3 % 500 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $14.87 , $- , $5.95 , See APC Packaged Rates , $10.41 , $5.80 , $0.04 , $0.04 , $0.04 , See APC Packaged Rates , See APC Packaged Rates , $9.98 , $9.98 , See APC Packaged Rates , See APC Packaged Rates , $13.83 , $13.83 , $13.83 , $13.83 , See APC Packaged Rates , $5.20 , $- , $- , $13.83 , $10.41
J1447,5710012323,Hospital Chargemaster,Tbo-Filgrastim 300 mcg Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $0.46 , $- , $0.53 , $- , $- , $0.47 , $0.47 , $0.47 , $0.53 , $0.53 , $- , $- , $0.56 , $0.54 , $- , $- , $- , $- , $0.53 , $- , $0.45 , $- , $0.56 , $-
J1447,5710012324,Hospital Chargemaster,Tbo-Filgrastim 480mcg Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $0.46 , $- , $0.53 , $- , $- , $0.47 , $0.47 , $0.47 , $0.53 , $0.53 , $- , $- , $0.56 , $0.54 , $- , $- , $- , $- , $0.53 , $- , $0.45 , $- , $0.56 , $-
J3145,5710012340,Hospital Chargemaster,Testost Undecan 750 mg/3 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $1.53 , $- , $1.91 , $- , $- , $1.54 , $1.54 , $1.54 , $1.91 , $1.91 , $- , $- , $2.00 , $1.95 , $- , $- , $- , $- , $1.91 , $- , $1.61 , $- , $2.00 , $-
90714,5710012343,Hospital Chargemaster,Tetanus-Dip Tox Adul 0.5 mL VI,Outpatient,Outpatient Default Percent / Case Rate,636, $65.99 , $- , $54.38 , See APC Packaged Rates , $46.19 , $25.74 , $25.27 , $25.27 , $25.27 , See APC Packaged Rates , See APC Packaged Rates , $44.28 , $44.28 , See APC Packaged Rates , See APC Packaged Rates , $61.37 , $61.37 , $61.37 , $61.37 , See APC Packaged Rates , $23.10 , $27.70 , $- , $61.37 , $46.19
J3243,5710012372,Hospital Chargemaster,Tigecycline 50 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $1.19 , $- , See APC Packaged Rates , $- , $- , $1.38 , $1.38 , $1.38 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.06 , $- , $1.38 , $-
J9352,5710012402,Hospital Chargemaster,Trabectedin 1 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $318.92 , $- , $380.47 , $- , $- , $318.93 , $318.93 , $318.93 , $380.47 , $380.47 , $- , $- , $399.50 , $388.08 , $- , $- , $- , $- , $380.47 , $- , $325.03 , $- , $399.50 , $-
J3300,5710012420,Hospital Chargemaster,Triamcinolone 50 mg/5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $3.86 , $- , See APC Packaged Rates , $- , $- , $3.85 , $3.85 , $3.85 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.89 , $- , $3.89 , $-
J3300,5710012421,Hospital Chargemaster,Triamcinolone 40 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $23.87 , $3.86 , $9.55 , See APC Packaged Rates , $16.71 , $9.31 , $3.85 , $3.85 , $3.85 , See APC Packaged Rates , See APC Packaged Rates , $16.02 , $16.02 , See APC Packaged Rates , See APC Packaged Rates , $22.20 , $22.20 , $22.20 , $22.20 , See APC Packaged Rates , $8.35 , $3.89 , $3.85 , $22.20 , $16.71
J3300,5710012422,Hospital Chargemaster,Triamcinolone 200 mg/5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $121.15 , $3.86 , $48.46 , See APC Packaged Rates , $84.81 , $47.25 , $3.85 , $3.85 , $3.85 , See APC Packaged Rates , See APC Packaged Rates , $81.29 , $81.29 , See APC Packaged Rates , See APC Packaged Rates , $112.67 , $112.67 , $112.67 , $112.67 , See APC Packaged Rates , $42.40 , $3.89 , $3.85 , $112.67 , $84.81
90691,5710012447,Hospital Chargemaster,Typhoid VI Poly 25 mcg/0.5 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $75.16 , $75.16 , $75.16 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $98.35 , $- , $98.35 , $-
J3357,5710012453,Hospital Chargemaster,Ustekinumab 45mg/0.5mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $180.12 , $- , $206.78 , $- , $- , $184.36 , $184.36 , $184.36 , $206.78 , $206.78 , $- , $- , $217.12 , $210.92 , $- , $- , $- , $- , $206.78 , $- , $170.82 , $- , $217.12 , $-
J3357,5710012454,Hospital Chargemaster,Ustekinumab 90 mg/1 mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $180.12 , $- , $206.78 , $- , $- , $184.36 , $184.36 , $184.36 , $206.78 , $206.78 , $- , $- , $217.12 , $210.92 , $- , $- , $- , $- , $206.78 , $- , $170.82 , $- , $217.12 , $-
90396,5710012475,Hospital Chargemaster,Varicel-Zost IG 125Unit/1.2mL,Outpatient,Outpatient Default Percent / Case Rate,636, $- ," $1,840.22 ", $- ," $2,301.33 ", $- , $- ," $2,056.72 "," $2,056.72 "," $2,056.72 "," $2,301.33 "," $2,301.33 ", $- , $- ," $2,416.39 "," $2,347.35 ", $- , $- , $- , $- ," $2,301.33 ", $- ," $1,959.83 ", $- ," $2,416.39 ", $-
J3465,5710012513,Hospital Chargemaster,Voriconazole 200 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $382.35 , $- , $152.94 , See APC Packaged Rates , $267.65 , $149.12 , $1.18 , $1.18 , $1.18 , See APC Packaged Rates , See APC Packaged Rates , $256.56 , $256.56 , See APC Packaged Rates , See APC Packaged Rates , $355.59 , $355.59 , $355.59 , $355.59 , See APC Packaged Rates , $133.82 , $1.83 , $- , $355.59 , $267.65
J9400,5710012552,Hospital Chargemaster,Ziv-Aflibercept 100 mg/4 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $8.50 , $- , $9.86 , $- , $- , $8.07 , $8.07 , $8.07 , $9.86 , $9.86 , $- , $- , $10.35 , $10.05 , $- , $- , $- , $- , $9.86 , $- , $7.66 , $- , $10.35 , $-
J3370,5710012571,Hospital Chargemaster,"Vancomycin HCl 1,000 mg",Outpatient,Outpatient Default Percent / Case Rate,636, $8.04 , $- , $3.22 , See APC Packaged Rates , $5.63 , $3.14 , $2.77 , $2.77 , $2.77 , See APC Packaged Rates , See APC Packaged Rates , $5.39 , $5.39 , See APC Packaged Rates , See APC Packaged Rates , $7.48 , $7.48 , $7.48 , $7.48 , See APC Packaged Rates , $2.81 , $- , $- , $7.48 , $5.63
J3370,5710012572,Hospital Chargemaster,Vancomycin HCl 750 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $20.67 , $- , $8.27 , See APC Packaged Rates , $14.47 , $8.06 , $2.77 , $2.77 , $2.77 , See APC Packaged Rates , See APC Packaged Rates , $13.87 , $13.87 , See APC Packaged Rates , See APC Packaged Rates , $19.22 , $19.22 , $19.22 , $19.22 , See APC Packaged Rates , $7.23 , $- , $- , $19.22 , $14.47
90675,5710012621,Hospital Chargemaster,Rabies Vaccine,Outpatient,Outpatient Default Percent / Case Rate,636, $918.48 , $318.06 , $756.83 , $383.40 , $642.94 , $358.21 , $303.24 , $303.24 , $303.24 , $383.40 , $383.40 , $616.30 , $616.30 , $402.57 , $391.07 , $303.24 , $303.24 , $311.06 , $311.06 , $383.40 , $321.47 , $- , $- , $756.83 , $642.94
J3010,5710012626,Hospital Chargemaster,Fentanyl Citrate 0.1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $5.59 , $- , $2.24 , See APC Packaged Rates , $3.91 , $2.18 , $0.78 , $0.78 , $0.78 , See APC Packaged Rates , See APC Packaged Rates , $3.75 , $3.75 , See APC Packaged Rates , See APC Packaged Rates , $5.20 , $5.20 , $5.20 , $5.20 , See APC Packaged Rates , $1.96 , $- , $- , $5.20 , $3.91
J2370,5710012656,Hospital Chargemaster,Phenylephrine Inj per mL,Outpatient,Outpatient Default Percent / Case Rate,636, $7.71 , $- , $3.08 , See APC Packaged Rates , $5.40 , $3.01 , $4.18 , $4.18 , $4.18 , See APC Packaged Rates , See APC Packaged Rates , $5.17 , $5.17 , See APC Packaged Rates , See APC Packaged Rates , $7.17 , $7.17 , $7.17 , $7.17 , See APC Packaged Rates , $2.70 , $4.29 , $- , $7.17 , $5.40
J3370,5710012661,Hospital Chargemaster,"Vancomycin 1,250 mg/250 ml Inj",Outpatient,Outpatient Default Percent / Case Rate,636, $30.64 , $- , $12.26 , See APC Packaged Rates , $21.45 , $11.95 , $2.77 , $2.77 , $2.77 , See APC Packaged Rates , See APC Packaged Rates , $20.56 , $20.56 , See APC Packaged Rates , See APC Packaged Rates , $28.50 , $28.50 , $28.50 , $28.50 , See APC Packaged Rates , $10.72 , $- , $- , $28.50 , $21.45
J3370,5710012662,Hospital Chargemaster,"Vancomycin 1,500 mg/250 ml Inj",Outpatient,Outpatient Default Percent / Case Rate,636, $35.86 , $- , $14.34 , See APC Packaged Rates , $25.10 , $13.99 , $2.77 , $2.77 , $2.77 , See APC Packaged Rates , See APC Packaged Rates , $24.06 , $24.06 , See APC Packaged Rates , See APC Packaged Rates , $33.35 , $33.35 , $33.35 , $33.35 , See APC Packaged Rates , $12.55 , $- , $- , $33.35 , $25.10
J2250,5710012663,Hospital Chargemaster,Midazolam 100 mg/100 ml inj,Outpatient,Outpatient Default Percent / Case Rate,636, $38.08 , $- , $15.23 , See APC Packaged Rates , $26.66 , $14.85 , $0.13 , $0.13 , $0.13 , See APC Packaged Rates , See APC Packaged Rates , $25.55 , $25.55 , See APC Packaged Rates , See APC Packaged Rates , $35.41 , $35.41 , $35.41 , $35.41 , See APC Packaged Rates , $13.33 , $0.11 , $- , $35.41 , $26.66
J2796,5710012665,Hospital Chargemaster,romiPLOStim 125 mcg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $2,571.38 ", $79.11 ," $1,028.55 ", $97.70 ," $1,799.97 "," $1,002.84 ", $78.43 , $78.43 , $78.43 , $97.70 , $97.70 ," $1,725.40 "," $1,725.40 ", $102.59 , $99.66 ," $2,391.38 "," $2,391.38 "," $2,391.38 "," $2,391.38 ", $97.70 , $899.98 , $83.62 , $78.43 ," $2,391.38 "," $1,799.97 "
J3010,5710012680,Hospital Chargemaster,"fentaNYL/NS 1,250 mcg/250 mL",Outpatient,Outpatient Default Percent / Case Rate,636, $74.80 , $- , $29.92 , See APC Packaged Rates , $52.36 , $29.17 , $0.78 , $0.78 , $0.78 , See APC Packaged Rates , See APC Packaged Rates , $50.19 , $50.19 , See APC Packaged Rates , See APC Packaged Rates , $69.56 , $69.56 , $69.56 , $69.56 , See APC Packaged Rates , $26.18 , $- , $- , $69.56 , $52.36
J2270,5710012682,Hospital Chargemaster,Morphine/NS 30 mg/30 ml PCA,Outpatient,Outpatient Default Percent / Case Rate,636, $51.00 , $- , $20.40 , See APC Packaged Rates , $35.70 , $19.89 , $1.87 , $1.87 , $1.87 , See APC Packaged Rates , See APC Packaged Rates , $34.22 , $34.22 , See APC Packaged Rates , See APC Packaged Rates , $47.43 , $47.43 , $47.43 , $47.43 , See APC Packaged Rates , $17.85 , $3.17 , $- , $47.43 , $35.70
J2590,5710012710,Hospital Chargemaster,"Oxytocin 20 Unit/1,000 mL-NS",Outpatient,Outpatient Default Percent / Case Rate,636, $26.93 , $- , $10.77 , See APC Packaged Rates , $18.85 , $10.50 , $0.99 , $0.99 , $0.99 , See APC Packaged Rates , See APC Packaged Rates , $18.07 , $18.07 , See APC Packaged Rates , See APC Packaged Rates , $25.04 , $25.04 , $25.04 , $25.04 , See APC Packaged Rates , $9.43 , $1.77 , $- , $25.04 , $18.85
J3490,5710012718,Hospital Chargemaster,Remdesivir 100 mg/20 ml,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
J1170,5710012728,Hospital Chargemaster,HYDROmor/NaCl 30 mg/30 mL PCA,Outpatient,Outpatient Default Percent / Case Rate,636, $51.00 , $- , $20.40 , See APC Packaged Rates , $35.70 , $19.89 , $1.98 , $1.98 , $1.98 , See APC Packaged Rates , See APC Packaged Rates , $34.22 , $34.22 , See APC Packaged Rates , See APC Packaged Rates , $47.43 , $47.43 , $47.43 , $47.43 , See APC Packaged Rates , $17.85 , $2.75 , $- , $47.43 , $35.70
Q5117,5710012730,Hospital Chargemaster,Trastuzumab-anns 420 mg/20 ml,Outpatient,Outpatient Default Percent / Case Rate,636," $7,575.11 ", $72.50 ," $6,241.89 ", $62.25 ," $5,302.58 "," $2,954.29 ", $78.72 , $78.72 , $78.72 , $62.25 , $62.25 ," $5,082.90 "," $5,082.90 ", $65.37 , $63.50 , $78.72 , $78.72 , $80.75 , $80.75 , $62.25 ," $2,651.29 ", $47.41 , $47.41 ," $6,241.89 "," $5,302.58 "
J2405,5710012731,Hospital Chargemaster,Ondansetron HCL 2 mg/ml,Outpatient,Outpatient Default Percent / Case Rate,636, $1.28 , $- , $0.51 , See APC Packaged Rates , $0.90 , $0.50 , $0.09 , $0.09 , $0.09 , See APC Packaged Rates , See APC Packaged Rates , $0.86 , $0.86 , See APC Packaged Rates , See APC Packaged Rates , $1.19 , $1.19 , $1.19 , $1.19 , See APC Packaged Rates , $0.45 , $0.08 , $- , $1.19 , $0.90
Q5106,5710012740,Hospital Chargemaster,"Epoetin Alfa-epbx 40,000unit",Outpatient,Outpatient Default Percent / Case Rate,636, $900.05 , $8.55 , $741.64 , $10.13 , $630.04 , $351.02 , $8.61 , $8.61 , $8.61 , $10.13 , $10.13 , $603.93 , $603.93 , $10.64 , $10.33 , $8.61 , $8.61 , $8.83 , $8.83 , $10.13 , $315.02 , $- , $- , $741.64 , $630.04
J1790,5710012741,Hospital Chargemaster,Droperidol up to 5 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $25.50 , $- , $10.20 , See APC Packaged Rates , $17.85 , $9.95 , $8.51 , $8.51 , $8.51 , See APC Packaged Rates , See APC Packaged Rates , $17.11 , $17.11 , See APC Packaged Rates , See APC Packaged Rates , $23.72 , $23.72 , $23.72 , $23.72 , See APC Packaged Rates , $8.93 , $9.84 , $- , $23.72 , $17.85
Q5106,5710012749,Hospital Chargemaster,"Epoetin Alfa-Epbx 4,000 Unit",Outpatient,Outpatient Default Percent / Case Rate,636, $70.09 , $8.55 , $57.75 , $10.13 , $49.06 , $27.34 , $8.61 , $8.61 , $8.61 , $10.13 , $10.13 , $47.03 , $47.03 , $10.64 , $10.33 , $8.61 , $8.61 , $8.83 , $8.83 , $10.13 , $24.53 , $- , $- , $57.75 , $49.06
J0878,5710012750,Hospital Chargemaster,Daptomycin 350 Mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $847.62 , $0.13 , $339.05 , See APC Packaged Rates , $593.33 , $330.57 , $0.16 , $0.16 , $0.16 , See APC Packaged Rates , See APC Packaged Rates , $568.75 , $568.75 , See APC Packaged Rates , See APC Packaged Rates , $788.29 , $788.29 , $788.29 , $788.29 , See APC Packaged Rates , $296.67 , $0.05 , $0.05 , $788.29 , $593.33
J9317,5710012751,Hospital Chargemaster,Sacituzumab Govitec-Hziy180 Mg,Outpatient,Outpatient Default Percent / Case Rate,636," $5,293.89 "," $2,911.64 "," $2,117.56 ", $35.53 ," $3,705.72 "," $2,064.62 "," $5,108.07 "," $5,130.31 "," $2,726.46 ", $35.53 , $35.53 ," $3,552.20 "," $3,552.20 ", $37.31 , $36.24 ," $4,923.32 "," $4,923.32 "," $4,923.32 "," $4,923.32 ", $35.53 ," $1,852.86 ", $- , $- ," $5,130.31 "," $3,705.72 "
Q9967,5710012753,Hospital Chargemaster,Iohexol 350 Mg/1 Ml 75 Ml,Outpatient,Outpatient Default Percent / Case Rate,636, $216.11 , $- , $178.07 , See APC Packaged Rates , $151.28 , $84.28 , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $145.01 , $145.01 , See APC Packaged Rates , See APC Packaged Rates , $200.98 , $200.98 , $200.98 , $200.98 , See APC Packaged Rates , $75.64 , $- , $- , $200.98 , $151.28
Q9967,5710012754,Hospital Chargemaster,Iohexol 350 Mg/1 Ml 125 Ml,Outpatient,Outpatient Default Percent / Case Rate,636, $312.00 , $- , $257.09 , See APC Packaged Rates , $218.40 , $121.68 , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $209.35 , $209.35 , See APC Packaged Rates , See APC Packaged Rates , $290.16 , $290.16 , $290.16 , $290.16 , See APC Packaged Rates , $109.20 , $- , $- , $290.16 , $218.40
Q9967,5710012755,Hospital Chargemaster,Iohexol 300 Mg/1 Ml 10 Ml,Outpatient,Outpatient Default Percent / Case Rate,636, $147.85 , $- , $121.83 , See APC Packaged Rates , $103.50 , $57.66 , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $99.21 , $99.21 , See APC Packaged Rates , See APC Packaged Rates , $137.50 , $137.50 , $137.50 , $137.50 , See APC Packaged Rates , $51.75 , $- , $- , $137.50 , $103.50
J3475,5710012767,Hospital Chargemaster,Magnesium Sulf/D5W 6 gm/50 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $100.73 , $- , $40.29 , See APC Packaged Rates , $70.51 , $39.28 , $0.42 , $0.42 , $0.42 , See APC Packaged Rates , See APC Packaged Rates , $67.59 , $67.59 , See APC Packaged Rates , See APC Packaged Rates , $93.68 , $93.68 , $93.68 , $93.68 , See APC Packaged Rates , $35.26 , $- , $- , $93.68 , $70.51
J9145,5710012782,Hospital Chargemaster,Daratumum 1800mg-Hyaluron-fihj,Outpatient,Outpatient Default Percent / Case Rate,636," $15,875.10 ", $56.04 ," $6,350.04 ", $67.37 ," $11,112.57 "," $6,191.29 ", $56.29 , $56.29 , $56.29 , $67.37 , $67.37 ," $10,652.19 "," $10,652.19 ", $70.74 , $68.72 ," $14,763.84 "," $14,763.84 "," $14,763.84 "," $14,763.84 ", $67.37 ," $5,556.29 ", $57.22 , $56.04 ," $14,763.84 "," $11,112.57 "
J9070,5710012783,Hospital Chargemaster,Cyclophosphamide 1 gm/5 ml Vl,Outpatient,Outpatient Default Percent / Case Rate,636," $2,241.45 ", $31.16 , $896.58 , $34.13 ," $1,569.02 ", $874.17 , $29.67 , $29.67 , $29.67 , $34.13 , $34.13 ," $1,504.01 "," $1,504.01 ", $35.83 , $34.81 ," $2,084.55 "," $2,084.55 "," $2,084.55 "," $2,084.55 ", $34.13 , $784.51 , $27.47 , $27.47 ," $2,084.55 "," $1,569.02 "
J9070,5710012784,Hospital Chargemaster,Cyclophosphamide 500 mg/2.5ml,Outpatient,Outpatient Default Percent / Case Rate,636," $1,120.73 ", $31.16 , $448.29 , $34.13 , $784.51 , $437.08 , $29.67 , $29.67 , $29.67 , $34.13 , $34.13 , $752.01 , $752.01 , $35.83 , $34.81 ," $1,042.28 "," $1,042.28 "," $1,042.28 "," $1,042.28 ", $34.13 , $392.26 , $27.47 , $27.47 ," $1,042.28 ", $784.51
A9576,5710012787,Hospital Chargemaster,Gadoteridol 4748.1mg/17mL Syr,Outpatient,Outpatient Default Percent / Case Rate,636, $234.91 , $- , $193.57 , See APC Packaged Rates , $164.44 , $91.61 , $5.31 , $2.75 , $2.70 , See APC Packaged Rates , See APC Packaged Rates , $157.62 , $157.62 , See APC Packaged Rates , See APC Packaged Rates , $218.47 , $218.47 , $218.47 , $218.47 , See APC Packaged Rates , $82.22 , $1.45 , $- , $218.47 , $164.44
J3430,5710012797,Hospital Chargemaster,Phytonadione 1 mg/0.5 mL Amp,Outpatient,Outpatient Default Percent / Case Rate,636, $10.07 , $- , $4.03 , See APC Packaged Rates , $7.05 , $3.93 , $3.81 , $3.81 , $3.81 , See APC Packaged Rates , See APC Packaged Rates , $6.76 , $6.76 , See APC Packaged Rates , See APC Packaged Rates , $9.37 , $9.37 , $9.37 , $9.37 , See APC Packaged Rates , $3.52 , $3.42 , $- , $9.37 , $7.05
J1740,5710012805,Hospital Chargemaster,Ibandronate 1 mg inj 3 mg,Outpatient,Outpatient Default Percent / Case Rate,636," $1,288.26 ", $41.54 , $515.30 , See APC Packaged Rates , $901.78 , $502.42 , $51.00 , $51.00 , $51.00 , See APC Packaged Rates , See APC Packaged Rates , $864.42 , $864.42 , See APC Packaged Rates , See APC Packaged Rates ," $1,198.08 "," $1,198.08 "," $1,198.08 "," $1,198.08 ", See APC Packaged Rates , $450.89 , $29.27 , $29.27 ," $1,198.08 ", $901.78
J9047,5710012809,Hospital Chargemaster,carfilzomib 10 mg inj,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $39.35 , $- , $48.11 , $- , $- , $39.20 , $39.20 , $39.20 , $48.11 , $48.11 , $- , $- , $50.52 , $49.08 , $- , $- , $- , $- , $48.11 , $- , $41.11 , $- , $50.52 , $-
J3490,5710012811,Hospital Chargemaster,Remdesivir 100 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $1,220.37 ", $671.20 , $488.15 , See APC Packaged Rates , $854.26 , $475.94 ," $1,177.54 "," $1,182.66 ", $628.51 , See APC Packaged Rates , See APC Packaged Rates , $818.87 , $818.87 , See APC Packaged Rates , See APC Packaged Rates ," $1,134.94 "," $1,134.94 "," $1,134.94 "," $1,134.94 ", See APC Packaged Rates , $427.13 , $- , $- ," $1,182.66 ", $854.26
91300,5710012816,Hospital Chargemaster,Pfizer: COVID-19 Vaccine,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $- , $- , $0.01 , $0.01
91301,5710012817,Hospital Chargemaster,Moderna: Covid-19 Vaccine,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $- , $- , $0.01 , $0.01
J9223,5710012818,Hospital Chargemaster,Lurbinectedin 0.1 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636," $13,796.64 "," $7,588.15 "," $5,518.66 ", $203.72 ," $9,657.65 "," $5,380.69 "," $13,312.38 "," $13,370.32 "," $7,105.55 ", $203.72 , $203.72 ," $9,257.55 "," $9,257.55 ", $213.91 , $207.80 ," $12,830.88 "," $12,830.88 "," $12,830.88 "," $12,830.88 ", $203.72 ," $4,828.82 ", $180.23 , $180.23 ," $13,370.32 "," $9,657.65 "
J3370,5710012824,Hospital Chargemaster,Vancomycin 500 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $40.38 , $- , $16.15 , See APC Packaged Rates , $28.27 , $15.75 , $2.77 , $2.77 , $2.77 , See APC Packaged Rates , See APC Packaged Rates , $27.09 , $27.09 , See APC Packaged Rates , See APC Packaged Rates , $37.55 , $37.55 , $37.55 , $37.55 , See APC Packaged Rates , $14.13 , $- , $- , $37.55 , $28.27
90686,5710012826,Hospital Chargemaster,Influenza Vaccine Quadrvlt PF,Outpatient,Outpatient Default Percent / Case Rate,636, $44.34 , $19.58 , $36.54 , See APC Packaged Rates , $31.04 , $17.29 , $19.58 , $19.58 , $19.58 , See APC Packaged Rates , See APC Packaged Rates , $29.75 , $29.75 , See APC Packaged Rates , See APC Packaged Rates , $41.24 , $41.24 , $41.24 , $41.24 , See APC Packaged Rates , $15.52 , $20.53 , $15.52 , $41.24 , $31.04
J3370,5710012827,Hospital Chargemaster,Vancomycin 1250 mg vial,Outpatient,Outpatient Default Percent / Case Rate,636, $61.51 , $- , $24.60 , See APC Packaged Rates , $43.06 , $23.99 , $2.77 , $2.77 , $2.77 , See APC Packaged Rates , See APC Packaged Rates , $41.27 , $41.27 , See APC Packaged Rates , See APC Packaged Rates , $57.20 , $57.20 , $57.20 , $57.20 , See APC Packaged Rates , $21.53 , $- , $- , $57.20 , $43.06
J7307,5710012831,Hospital Chargemaster,EtonogestreL 68 mg Implant,Outpatient,Outpatient Default Percent / Case Rate,636," $2,812.00 "," $1,001.19 "," $1,124.80 ", See APC Packaged Rates ," $1,968.40 "," $1,096.68 "," $1,065.69 "," $1,065.69 "," $1,065.69 ", See APC Packaged Rates , See APC Packaged Rates ," $1,886.85 "," $1,886.85 ", See APC Packaged Rates , See APC Packaged Rates , $981.56 , $981.56 ," $1,006.88 "," $1,006.88 ", See APC Packaged Rates , $984.20 ," $1,236.77 ", $981.56 ," $1,968.40 "," $1,968.40 "
J0256,5710012832,Hospital Chargemaster,Alpha-1-Protein Inhib 1000mg i,Outpatient,Outpatient Default Percent / Case Rate,636, $832.31 , $4.52 , $332.92 , $5.31 , $582.62 , $324.60 , $4.36 , $4.36 , $4.36 , $5.31 , $5.31 , $558.48 , $558.48 , $5.58 , $5.42 , $4.36 , $4.36 , $4.47 , $4.47 , $5.31 , $291.31 , $- , $- , $582.62 , $582.62
90715,5710012833,Hospital Chargemaster,TDap age > or = 7 yrs,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $34.28 , $34.28 , $34.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $34.28 , $-
Q9967,5710012834,Hospital Chargemaster,Iohexol 350 mg/1 mL 150 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $33.62 , $- , $27.70 , See APC Packaged Rates , $23.53 , $13.11 , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $22.56 , $22.56 , See APC Packaged Rates , See APC Packaged Rates , $31.27 , $31.27 , $31.27 , $31.27 , See APC Packaged Rates , $11.77 , $- , $- , $31.27 , $23.53
J9227,5710012835,Hospital Chargemaster,Isatuximab-irfc 100 mg/5 ml,Outpatient,Outpatient Default Percent / Case Rate,636," $1,702.48 ", $66.37 , $680.99 , $79.13 ," $1,191.74 ", $663.97 , $66.67 , $66.67 , $66.67 , $79.13 , $79.13 ," $1,142.36 "," $1,142.36 ", $83.09 , $80.71 , $66.67 , $66.67 , $68.39 , $68.39 , $79.13 , $595.87 , $69.02 , $66.37 ," $1,191.74 "," $1,191.74 "
J9227,5710012836,Hospital Chargemaster,Isatuximab-irfc 500 mg/25 ml,Outpatient,Outpatient Default Percent / Case Rate,636," $8,512.39 ", $66.37 ," $3,404.96 ", $79.13 ," $5,958.67 "," $3,319.83 ", $66.67 , $66.67 , $66.67 , $79.13 , $79.13 ," $5,711.81 "," $5,711.81 ", $83.09 , $80.71 , $66.67 , $66.67 , $68.39 , $68.39 , $79.13 ," $2,979.34 ", $69.02 , $66.37 ," $5,958.67 "," $5,958.67 "
Q9967,5710012856,Hospital Chargemaster,Iohexol 350 mg/1 mL 50 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $12.58 , $- , $10.37 , See APC Packaged Rates , $8.81 , $4.91 , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $8.44 , $8.44 , See APC Packaged Rates , See APC Packaged Rates , $11.70 , $11.70 , $11.70 , $11.70 , See APC Packaged Rates , $4.40 , $- , $- , $11.70 , $8.81
J1930,5710012859,Hospital Chargemaster,Lanreotide 120 mg/0.5 ml syr,Outpatient,Outpatient Default Percent / Case Rate,636," $18,201.50 ", $68.46 ," $7,280.60 ", $79.18 ," $12,741.05 "," $7,098.59 ", $68.48 , $68.48 , $68.48 , $79.18 , $79.18 ," $12,213.21 "," $12,213.21 ", $83.13 , $80.76 ," $16,927.40 "," $16,927.40 "," $16,927.40 "," $16,927.40 ", $79.18 ," $6,370.53 ", $66.18 , $66.18 ," $16,927.40 "," $12,741.05 "
C9254,5710012862,Hospital Chargemaster,Lacosamide 200 mg/20 ml vial,Outpatient,Outpatient Default Percent / Case Rate,636, $198.62 , $- , $163.66 , See APC Packaged Rates , $139.03 , $77.46 , $0.45 , $0.45 , $0.45 , See APC Packaged Rates , See APC Packaged Rates , $133.27 , $133.27 , See APC Packaged Rates , See APC Packaged Rates , $184.72 , $184.72 , $184.72 , $184.72 , See APC Packaged Rates , $69.52 , $- , $- , $184.72 , $139.03
J9316,5710012864,Hospital Chargemaster,Pertuz/trastuz/hy-zzxf 600 mg,Outpatient,Outpatient Default Percent / Case Rate,636," $16,942.00 "," $9,318.10 "," $6,776.80 ", $84.46 ," $11,859.40 "," $6,607.38 "," $16,347.34 "," $16,418.49 "," $8,725.47 ", $84.46 , $84.46 ," $11,368.08 "," $11,368.08 ", $88.68 , $86.15 ," $15,756.06 "," $15,756.06 "," $15,756.06 "," $15,756.06 ", $84.46 ," $5,929.70 ", $71.65 , $71.65 ," $16,418.49 "," $11,859.40 "
J9356,5710012865,Hospital Chargemaster,Trastuzumab/Hyal-oysk 600 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $74.59 , $- , $84.11 , $- , $- , $75.08 , $75.08 , $75.08 , $84.11 , $84.11 , $- , $- , $88.32 , $85.79 , $- , $- , $- , $- , $84.11 , $- , $71.49 , $- , $88.32 , $-
90715,5710012871,Hospital Chargemaster,"Diph,Pertuss(Acell),Tet Vac",Outpatient,Outpatient Default Percent / Case Rate,636, $105.34 , $- , $86.80 , See APC Packaged Rates , $73.74 , $41.08 , $34.28 , $34.28 , $34.28 , See APC Packaged Rates , See APC Packaged Rates , $70.68 , $70.68 , See APC Packaged Rates , See APC Packaged Rates , $97.97 , $97.97 , $97.97 , $97.97 , See APC Packaged Rates , $36.87 , $- , $- , $97.97 , $73.74
Q5108,5710012876,Hospital Chargemaster,Pegfilgrastim-jmdb 6 mg/0.6mL,Outpatient,Outpatient Default Percent / Case Rate,636," $10,646.25 ", $248.18 ," $8,772.51 ", $247.21 ," $7,452.38 "," $4,152.04 ", $269.04 , $269.04 , $269.04 , $247.21 , $247.21 ," $7,143.63 "," $7,143.63 ", $259.57 , $252.15 , $269.04 , $269.04 , $275.98 , $275.98 , $247.21 ," $3,726.19 ", $- , $- ," $8,772.51 "," $7,452.38 "
Q5106,5710012880,Hospital Chargemaster,"Epoetin Alpha-epbx 10,000 unit",Outpatient,Outpatient Default Percent / Case Rate,636, $241.09 , $8.55 , $198.66 , $10.13 , $168.76 , $94.03 , $8.61 , $8.61 , $8.61 , $10.13 , $10.13 , $161.77 , $161.77 , $10.64 , $10.33 , $8.61 , $8.61 , $8.83 , $8.83 , $10.13 , $84.38 , $- , $- , $198.66 , $168.76
J9205,5710012881,Hospital Chargemaster,Irinotecan Liposomal 43mg via,Outpatient,Outpatient Default Percent / Case Rate,636," $6,303.60 ", $54.31 ," $2,521.44 ", $66.95 ," $4,412.52 "," $2,458.40 ", $54.33 , $54.33 , $54.33 , $66.95 , $66.95 ," $4,229.72 "," $4,229.72 ", $70.30 , $68.29 , $54.33 , $54.33 , $55.73 , $55.73 , $66.95 ," $2,206.26 ", $57.37 , $54.31 ," $4,412.52 "," $4,412.52 "
J0131,5710012887,Hospital Chargemaster,Acetaminophen 500 mg/50 mL,Outpatient,Outpatient Default Percent / Case Rate,636, $23.18 , $- , $9.27 , See APC Packaged Rates , $16.23 , $9.04 , $0.54 , $0.54 , $0.54 , See APC Packaged Rates , See APC Packaged Rates , $15.55 , $15.55 , See APC Packaged Rates , See APC Packaged Rates , $21.56 , $21.56 , $21.56 , $21.56 , See APC Packaged Rates , $8.11 , $- , $- , $21.56 , $16.23
J0690,5710012893,Hospital Chargemaster,Cefazolin 500 mg Inj/unit MD,Outpatient,Outpatient Default Percent / Case Rate,636, $1.69 , $- , $0.68 , See APC Packaged Rates , $1.18 , $0.66 , $0.97 , $0.97 , $0.97 , See APC Packaged Rates , See APC Packaged Rates , $1.13 , $1.13 , See APC Packaged Rates , See APC Packaged Rates , $1.57 , $1.57 , $1.57 , $1.57 , See APC Packaged Rates , $0.59 , $0.77 , $- , $1.57 , $1.18
J9316,5710012895,Hospital Chargemaster,Pertuz/trastuz/hy-zzxf 1200 mg,Outpatient,Outpatient Default Percent / Case Rate,636," $25,414.00 "," $13,977.70 "," $10,165.60 ", $84.46 ," $17,789.80 "," $9,911.46 "," $24,521.97 "," $24,628.71 "," $13,088.72 ", $84.46 , $84.46 ," $17,052.79 "," $17,052.79 ", $88.68 , $86.15 ," $23,635.02 "," $23,635.02 "," $23,635.02 "," $23,635.02 ", $84.46 ," $8,894.90 ", $71.65 , $71.65 ," $24,628.71 "," $17,789.80 "
J0714,5710012899,Hospital Chargemaster,cefTAZidime/Avibac 2.5 gm Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $914.97 , $92.28 , $365.99 , $108.15 , $640.48 , $356.84 , $92.00 , $92.00 , $92.00 , $108.15 , $108.15 , $613.94 , $613.94 , $113.56 , $110.32 , $- , $- , $- , $- , $108.15 , $320.24 , $92.37 , $- , $640.48 , $640.48
90682,5710013001,Hospital Chargemaster,RIV4 Vacc Recomninant DNA IM,Outpatient,Outpatient Default Percent / Case Rate,636, $57.00 , $60.98 , $46.97 , See APC Packaged Rates , $39.90 , $22.23 , $55.00 , $55.24 , $57.10 , See APC Packaged Rates , See APC Packaged Rates , $38.25 , $38.25 , See APC Packaged Rates , See APC Packaged Rates , $57.00 , $57.00 , $57.00 , $57.00 , See APC Packaged Rates , $19.95 , $65.26 , $19.95 , $65.26 , $39.90
J2930,5710013061,Hospital Chargemaster,methylPREDnisolone SS 125 mg,Outpatient,Outpatient Default Percent / Case Rate,636, $6.00 , $- , $2.40 , See APC Packaged Rates , $4.20 , $2.34 , $5.64 , $5.64 , $5.64 , See APC Packaged Rates , See APC Packaged Rates , $4.03 , $4.03 , See APC Packaged Rates , See APC Packaged Rates , $5.58 , $5.58 , $5.58 , $5.58 , See APC Packaged Rates , $2.10 , $5.89 , $- , $5.89 , $4.20
90686,5710013069,Hospital Chargemaster,Influenza Vaccine Quad PF,Outpatient,Outpatient Default Percent / Case Rate,636, $35.00 , $19.58 , $28.84 , See APC Packaged Rates , $24.50 , $13.65 , $19.58 , $19.58 , $19.58 , See APC Packaged Rates , See APC Packaged Rates , $23.49 , $23.49 , See APC Packaged Rates , See APC Packaged Rates , $32.55 , $32.55 , $32.55 , $32.55 , See APC Packaged Rates , $12.25 , $20.53 , $12.25 , $32.55 , $24.50
90746,5710013074,Hospital Chargemaster,Hepatitis B Vaccine,Outpatient,Outpatient Default Percent / Case Rate,636, $117.00 , $69.64 , $96.41 , See APC Packaged Rates , $81.90 , $45.63 , $69.65 , $69.65 , $69.65 , See APC Packaged Rates , See APC Packaged Rates , $78.51 , $78.51 , See APC Packaged Rates , See APC Packaged Rates , $108.81 , $108.81 , $108.81 , $108.81 , See APC Packaged Rates , $40.95 , $70.38 , $40.95 , $108.81 , $81.90
90732,5710013079,Hospital Chargemaster,Pneumococcal 23-Val 0.5mL Vac,Outpatient,Outpatient Default Percent / Case Rate,636, $156.00 , $125.92 , $128.54 , See APC Packaged Rates , $109.20 , $60.84 , $119.92 , $119.92 , $119.92 , See APC Packaged Rates , See APC Packaged Rates , $104.68 , $104.68 , See APC Packaged Rates , See APC Packaged Rates , $145.08 , $145.08 , $145.08 , $145.08 , See APC Packaged Rates , $54.60 , $133.47 , $54.60 , $145.08 , $109.20
J9030,5710013080,Hospital Chargemaster,BCG per instillation,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $2.85 , $- , See APC Packaged Rates , $- , $- , $2.79 , $2.79 , $2.79 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.83 , $- , $2.85 , $-
90670,5710013083,Hospital Chargemaster,Pneumococcal 13-Val 0.5 mL Vac,Outpatient,Outpatient Default Percent / Case Rate,636, $156.00 , $229.43 , $128.54 , See APC Packaged Rates , $109.20 , $60.84 , $230.14 , $230.14 , $230.14 , See APC Packaged Rates , See APC Packaged Rates , $104.68 , $104.68 , See APC Packaged Rates , See APC Packaged Rates , $145.08 , $145.08 , $145.08 , $145.08 , See APC Packaged Rates , $54.60 , $241.38 , $54.60 , $241.38 , $109.20
J0585,5710013088,Hospital Chargemaster,Onabotulinumtoxina 1 Unit Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $10.00 , $5.96 , $4.00 , $7.12 , $7.00 , $3.90 , $6.08 , $6.08 , $6.08 , $7.12 , $7.12 , $6.71 , $6.71 , $7.48 , $7.27 , $9.30 , $9.30 , $9.30 , $9.30 , $7.12 , $3.50 , $6.19 , $3.50 , $9.30 , $7.00
J3420,5710013101,Hospital Chargemaster,Vitamin B12 Injection,Outpatient,Outpatient Default Percent / Case Rate,636, $6.18 , $- , $2.47 , See APC Packaged Rates , $4.33 , $2.41 , $1.84 , $1.84 , $1.84 , See APC Packaged Rates , See APC Packaged Rates , $4.15 , $4.15 , See APC Packaged Rates , See APC Packaged Rates , $5.75 , $5.75 , $5.75 , $5.75 , See APC Packaged Rates , $2.16 , $1.80 , $- , $5.75 , $4.33
J0696,5710013102,Hospital Chargemaster,cefTRIAXone sod 500 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $33.00 , $- , $13.20 , See APC Packaged Rates , $23.10 , $12.87 , $0.63 , $0.63 , $0.63 , See APC Packaged Rates , See APC Packaged Rates , $22.14 , $22.14 , See APC Packaged Rates , See APC Packaged Rates , $30.69 , $30.69 , $30.69 , $30.69 , See APC Packaged Rates , $11.55 , $0.48 , $- , $30.69 , $23.10
J1885,5710013107,Hospital Chargemaster,Ketorolac tromethamin inj 30mg,Outpatient,Outpatient Default Percent / Case Rate,636, $2.00 , $- , $0.80 , See APC Packaged Rates , $1.40 , $0.78 , $0.67 , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $1.34 , $1.34 , See APC Packaged Rates , See APC Packaged Rates , $1.86 , $1.86 , $1.86 , $1.86 , See APC Packaged Rates , $0.70 , $0.55 , $- , $1.86 , $1.40
J1885,5710013108,Hospital Chargemaster,Ketorolac tromethamin inj 60mg,Outpatient,Outpatient Default Percent / Case Rate,636, $33.00 , $- , $13.20 , See APC Packaged Rates , $23.10 , $12.87 , $0.67 , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $22.14 , $22.14 , See APC Packaged Rates , See APC Packaged Rates , $30.69 , $30.69 , $30.69 , $30.69 , See APC Packaged Rates , $11.55 , $0.55 , $- , $30.69 , $23.10
J1726,5710013114,Hospital Chargemaster,Makena 10 MG 250 mg/mL IM oil,Outpatient,Outpatient Default Percent / Case Rate,636, $10.00 , $27.19 , $4.00 , $19.68 , $7.00 , $3.90 , $31.12 , $31.12 , $31.12 , $19.68 , $19.68 , $6.71 , $6.71 , $20.67 , $20.08 , $9.47 , $9.47 , $9.47 , $9.47 , $19.68 , $3.50 , $14.76 , $3.50 , $31.12 , $7.00
J3420,5710013129,Hospital Chargemaster,Vitamin B12 Injection,Outpatient,Outpatient Default Percent / Case Rate,636, $6.18 , $- , $2.47 , See APC Packaged Rates , $4.33 , $2.41 , $1.84 , $1.84 , $1.84 , See APC Packaged Rates , See APC Packaged Rates , $4.15 , $4.15 , See APC Packaged Rates , See APC Packaged Rates , $5.75 , $5.75 , $5.75 , $5.75 , See APC Packaged Rates , $2.16 , $1.80 , $- , $5.75 , $4.33
J1815,5710013135,Hospital Chargemaster,Insulin Injection 5 un 100 un,Outpatient,Outpatient Default Percent / Case Rate,636, $20.87 , $- , $8.35 , See APC Packaged Rates , $14.61 , $8.14 , $0.87 , $0.87 , $0.87 , See APC Packaged Rates , See APC Packaged Rates , $14.00 , $14.00 , See APC Packaged Rates , See APC Packaged Rates , $19.41 , $19.41 , $19.41 , $19.41 , See APC Packaged Rates , $7.30 , $0.90 , $- , $19.41 , $14.61
J7298,5710013138,Hospital Chargemaster,Levonorgestrel-rel IUD Mirena,Outpatient,Outpatient Default Percent / Case Rate,636," $2,568.00 ", $972.58 ," $1,027.20 ", See APC Packaged Rates ," $1,797.60 "," $1,001.52 "," $1,087.00 "," $1,087.00 "," $1,087.00 ", See APC Packaged Rates , See APC Packaged Rates ," $1,723.13 "," $1,723.13 ", See APC Packaged Rates , See APC Packaged Rates , $953.51 , $953.51 , $978.11 , $978.11 , See APC Packaged Rates , $898.80 ," $1,199.14 ", $898.80 ," $1,797.60 "," $1,797.60 "
J7296,5710013139,Hospital Chargemaster,Levonorgestrel-rel IUD Kyleena,Outpatient,Outpatient Default Percent / Case Rate,636," $2,000.00 ", $972.58 , $800.00 , See APC Packaged Rates ," $1,400.00 ", $780.00 ," $1,087.00 "," $1,087.00 "," $1,087.00 ", See APC Packaged Rates , See APC Packaged Rates ," $1,342.00 "," $1,342.00 ", See APC Packaged Rates , See APC Packaged Rates , $953.51 , $953.51 , $978.11 , $978.11 , See APC Packaged Rates , $700.00 ," $1,199.14 ", $700.00 ," $1,400.00 "," $1,400.00 "
J7307,5710013140,Hospital Chargemaster,Etonogestrel implant Nexplanon,Outpatient,Outpatient Default Percent / Case Rate,636," $2,812.00 "," $1,001.19 "," $1,124.80 ", See APC Packaged Rates ," $1,968.40 "," $1,096.68 "," $1,065.69 "," $1,065.69 "," $1,065.69 ", See APC Packaged Rates , See APC Packaged Rates ," $1,886.85 "," $1,886.85 ", See APC Packaged Rates , See APC Packaged Rates , $981.56 , $981.56 ," $1,006.88 "," $1,006.88 ", See APC Packaged Rates , $984.20 ," $1,236.77 ", $981.56 ," $1,968.40 "," $1,968.40 "
J7300,5710013141,Hospital Chargemaster,IUD copper contracept Paragard,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $902.19 , $- , See APC Packaged Rates , $- , $- ," $1,008.33 "," $1,008.33 "," $1,008.33 ", See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $884.50 , $884.50 , $906.00 , $906.00 , See APC Packaged Rates , $- ," $1,092.90 ", $- ," $1,092.90 ", $-
90715,5710013143,Hospital Chargemaster,Adacel Syringe age >/=7 yrs,Outpatient,Outpatient Default Percent / Case Rate,636, $51.83 , $- , $42.71 , See APC Packaged Rates , $36.28 , $20.21 , $34.28 , $34.28 , $34.28 , See APC Packaged Rates , See APC Packaged Rates , $34.78 , $34.78 , See APC Packaged Rates , See APC Packaged Rates , $48.20 , $48.20 , $48.20 , $48.20 , See APC Packaged Rates , $18.14 , $- , $- , $48.20 , $36.28
90715,5710013144,Hospital Chargemaster,Boostrix Syringe age >/=7 yrs,Outpatient,Outpatient Default Percent / Case Rate,636, $101.00 , $- , $83.22 , See APC Packaged Rates , $70.70 , $39.39 , $34.28 , $34.28 , $34.28 , See APC Packaged Rates , See APC Packaged Rates , $67.77 , $67.77 , See APC Packaged Rates , See APC Packaged Rates , $93.93 , $93.93 , $93.93 , $93.93 , See APC Packaged Rates , $35.35 , $- , $- , $93.93 , $70.70
90715,5710013148,Hospital Chargemaster,TDaP Boostrix Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $52.00 , $- , $42.85 , See APC Packaged Rates , $36.40 , $20.28 , $34.28 , $34.28 , $34.28 , See APC Packaged Rates , See APC Packaged Rates , $34.89 , $34.89 , See APC Packaged Rates , See APC Packaged Rates , $48.36 , $48.36 , $48.36 , $48.36 , See APC Packaged Rates , $18.20 , $- , $- , $48.36 , $36.40
90715,5710013149,Hospital Chargemaster,TDaP Adacel Vial,Outpatient,Outpatient Default Percent / Case Rate,636, $101.00 , $- , $83.22 , See APC Packaged Rates , $70.70 , $39.39 , $34.28 , $34.28 , $34.28 , See APC Packaged Rates , See APC Packaged Rates , $67.77 , $67.77 , See APC Packaged Rates , See APC Packaged Rates , $93.93 , $93.93 , $93.93 , $93.93 , See APC Packaged Rates , $35.35 , $- , $- , $93.93 , $70.70
J1040,5710030003,Hospital Chargemaster,Methylprednisolone 80 MG Inj,Outpatient,Outpatient Default Percent / Case Rate,636, $15.00 , $- , $6.00 , See APC Packaged Rates , $10.50 , $5.85 , $11.19 , $11.19 , $11.19 , See APC Packaged Rates , See APC Packaged Rates , $10.07 , $10.07 , See APC Packaged Rates , See APC Packaged Rates , $13.95 , $13.95 , $13.95 , $13.95 , See APC Packaged Rates , $5.25 , $11.82 , $- , $13.95 , $10.50
Q2038,5710030015,Hospital Chargemaster,"Fluzone Vacc, 3 Yrs & >, IM",Outpatient,Outpatient Default Percent / Case Rate,636, $- , $12.05 , $- , See APC Packaged Rates , $- , $- , $12.05 , $12.05 , $12.05 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $12.05 , $-
J3301,5710030023,Hospital Chargemaster,Triamcinolone acet inj nos,Outpatient,Outpatient Default Percent / Case Rate,636, $6.00 , $- , $2.40 , See APC Packaged Rates , $4.20 , $2.34 , $1.33 , $1.33 , $1.33 , See APC Packaged Rates , See APC Packaged Rates , $4.03 , $4.03 , See APC Packaged Rates , See APC Packaged Rates , $5.58 , $5.58 , $5.58 , $5.58 , See APC Packaged Rates , $2.10 , $1.11 , $- , $5.58 , $4.20
J3489,5710030024,Hospital Chargemaster,Zoledronic acid 1mg,Outpatient,Outpatient Default Percent / Case Rate,636, $48.00 , $- , $19.20 , See APC Packaged Rates , $33.60 , $18.72 , $9.71 , $9.71 , $9.71 , See APC Packaged Rates , See APC Packaged Rates , $32.21 , $32.21 , See APC Packaged Rates , See APC Packaged Rates , $44.64 , $44.64 , $44.64 , $44.64 , See APC Packaged Rates , $16.80 , $5.77 , $- , $44.64 , $33.60
90662,5710030026,Hospital Chargemaster,Flu Vaccine High Dose,Outpatient,Outpatient Default Percent / Case Rate,636, $65.00 , $60.98 , $53.56 , See APC Packaged Rates , $45.50 , $25.35 , $60.98 , $60.98 , $60.98 , See APC Packaged Rates , See APC Packaged Rates , $43.62 , $43.62 , See APC Packaged Rates , See APC Packaged Rates , $60.98 , $60.98 , $62.55 , $62.55 , See APC Packaged Rates , $22.75 , $65.26 , $22.75 , $65.26 , $45.50
J0171,5710030872,Hospital Chargemaster,Adren Epinephrine Inj 0.1 MG,Outpatient,Outpatient Default Percent / Case Rate,636, $176.00 , $- , $70.40 , See APC Packaged Rates , $123.20 , $68.64 , $0.88 , $0.88 , $0.88 , See APC Packaged Rates , See APC Packaged Rates , $118.10 , $118.10 , See APC Packaged Rates , See APC Packaged Rates , $163.68 , $163.68 , $163.68 , $163.68 , See APC Packaged Rates , $61.60 , $- , $- , $163.68 , $123.20
90716,5710032473,Hospital Chargemaster,Var Vaccine Live Subq,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $145.20 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $162.72 , $162.72 , $162.72 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $181.02 , $0.00 , $181.02 , $0.01
90621,5710032477,Hospital Chargemaster,Menb-fhb vcc 2/3 dose Im NChg,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $152.76 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $179.72 , $179.72 , $179.72 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $0.00 , $- , $- , $179.72 , $0.01
90621,5710032478,Hospital Chargemaster,Menb-fhbp vacc 2/3 dose im,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $152.76 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $179.72 , $179.72 , $179.72 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $0.00 , $- , $- , $179.72 , $0.01
90680,5710032486,Hospital Chargemaster,Rv5 vac 3 dose live oral NoChg,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $- , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $101.29 , $101.29 , $101.29 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $108.45 , $- , $108.45 , $0.01
90680,5710032487,Hospital Chargemaster,Rv5 vacc 3 dose live oral,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $- , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $101.29 , $101.29 , $101.29 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $108.45 , $- , $108.45 , $0.01
90713,5710032494,Hospital Chargemaster,Poliovirus ipv sc/im No Chg,Outpatient,Outpatient Default Percent / Case Rate,636, $0.01 , $- , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $42.05 , $42.05 , $42.05 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $46.34 , $- , $46.34 , $0.01
90713,5710032495,Hospital Chargemaster,Poliovirus ipv sc/im,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $42.05 , $42.05 , $42.05 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $46.34 , $- , $46.34 , $-
Q4101,61510322,Hospital Chargemaster,Apligraf,Outpatient,Outpatient Default Percent / Case Rate,636," $4,079.25 ", $- ," $3,361.30 ", See APC Packaged Rates ," $2,855.48 "," $1,590.91 ", $30.46 , $30.46 , $30.46 , See APC Packaged Rates , See APC Packaged Rates ," $2,737.18 "," $2,737.18 ", See APC Packaged Rates , See APC Packaged Rates ," $3,793.70 "," $3,793.70 "," $3,793.70 "," $3,793.70 ", See APC Packaged Rates ," $1,427.74 ", $- , $- ," $3,793.70 "," $2,855.48 "
Q4107,61511939,Hospital Chargemaster,"Graftjacket, Size 4X8",Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $96.07 , $96.07 , $96.07 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $96.07 , $-
Q4126,61513874,Hospital Chargemaster,Dermaspan 4 X 8 Cm,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $92.63 , $92.63 , $92.63 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $92.70 , $- , $92.70 , $-
Q4186,61514554,Hospital Chargemaster,Epifix 4Cm X 4.5Cm Mesh,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $196.63 , $98.63 , $89.04 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $154.31 , $- , $196.63 , $-
Q4160,61514768,Hospital Chargemaster,Nushfield 2Cm X 4Cm,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
Q4106,61534083,Hospital Chargemaster,"Dermagraft 2 X 3""",Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $32.01 , $32.01 , $32.01 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $32.01 , $-
Q4124,61535000,Hospital Chargemaster,Oasis Matrix Wnd Dress 3X7Cm,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $14.25 , $14.25 , $14.25 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $16.19 , $- , $16.19 , $-
Q4110,61535024,Hospital Chargemaster,Primatrix Dressing 4 X 4,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $46.41 , $46.41 , $46.41 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $46.41 , $-
Q4110,61535025,Hospital Chargemaster,Primatrix Dressing 6 X 6,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $46.41 , $46.41 , $46.41 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $46.41 , $-
Q4196,61535043,Hospital Chargemaster,Puraply Am 5X5,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $108.76 , $- , See APC Packaged Rates , $- , $- , $- , $- , $101.84 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $108.76 , $-
Q4196,61535044,Hospital Chargemaster,Puraply Am 2X2,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $108.76 , $- , See APC Packaged Rates , $- , $- , $- , $- , $101.84 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $108.76 , $-
Q4196,61535045,Hospital Chargemaster,Puraply Am 2X4,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $108.76 , $- , See APC Packaged Rates , $- , $- , $- , $- , $101.84 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $108.76 , $-
Q4151,61535048,Hospital Chargemaster,Amnioband 14M,Outpatient,Outpatient Default Percent / Case Rate,636, $826.88 , $- , $681.35 , See APC Packaged Rates , $578.82 , $322.48 , $797.86 , $801.33 , $- , See APC Packaged Rates , See APC Packaged Rates , $554.84 , $554.84 , See APC Packaged Rates , See APC Packaged Rates , $769.00 , $769.00 , $769.00 , $769.00 , See APC Packaged Rates , $289.41 , $- , $- , $801.33 , $578.82
Q4186,61535049,Hospital Chargemaster,Epifix 14M,Outpatient,Outpatient Default Percent / Case Rate,636, $941.85 , $- , $776.08 , See APC Packaged Rates , $659.30 , $367.32 , $196.63 , $98.63 , $89.04 , See APC Packaged Rates , See APC Packaged Rates , $631.98 , $631.98 , See APC Packaged Rates , See APC Packaged Rates , $875.92 , $875.92 , $875.92 , $875.92 , See APC Packaged Rates , $329.65 , $154.31 , $- , $875.92 , $659.30
Q4186,61535050,Hospital Chargemaster,Epifix 18M,Outpatient,Outpatient Default Percent / Case Rate,636," $1,417.50 ", $- ," $1,168.02 ", See APC Packaged Rates , $992.25 , $552.83 , $196.63 , $98.63 , $89.04 , See APC Packaged Rates , See APC Packaged Rates , $951.14 , $951.14 , See APC Packaged Rates , See APC Packaged Rates ," $1,318.28 "," $1,318.28 "," $1,318.28 "," $1,318.28 ", See APC Packaged Rates , $496.13 , $154.31 , $- ," $1,318.28 ", $992.25
Q4186,61535051,Hospital Chargemaster,Epifix 2 X 2 Cm,Outpatient,Outpatient Default Percent / Case Rate,636," $3,213.00 ", $- ," $2,647.51 ", See APC Packaged Rates ," $2,249.10 "," $1,253.07 ", $196.63 , $98.63 , $89.04 , See APC Packaged Rates , See APC Packaged Rates ," $2,155.92 "," $2,155.92 ", See APC Packaged Rates , See APC Packaged Rates ," $2,988.09 "," $2,988.09 "," $2,988.09 "," $2,988.09 ", See APC Packaged Rates ," $1,124.55 ", $154.31 , $- ," $2,988.09 "," $2,249.10 "
Q4186,61535052,Hospital Chargemaster,Epifix 2X3 Cm,Outpatient,Outpatient Default Percent / Case Rate,636," $3,603.60 ", $- ," $2,969.37 ", See APC Packaged Rates ," $2,522.52 "," $1,405.40 ", $196.63 , $98.63 , $89.04 , See APC Packaged Rates , See APC Packaged Rates ," $2,418.02 "," $2,418.02 ", See APC Packaged Rates , See APC Packaged Rates ," $3,351.35 "," $3,351.35 "," $3,351.35 "," $3,351.35 ", See APC Packaged Rates ," $1,261.26 ", $154.31 , $- ," $3,351.35 "," $2,522.52 "
Q4186,61535054,Hospital Chargemaster,Epifix 3.5 X 3.5 Cm,Outpatient,Outpatient Default Percent / Case Rate,636," $3,761.10 ", $- ," $3,099.15 ", See APC Packaged Rates ," $2,632.77 "," $1,466.83 ", $196.63 , $98.63 , $89.04 , See APC Packaged Rates , See APC Packaged Rates ," $2,523.70 "," $2,523.70 ", See APC Packaged Rates , See APC Packaged Rates ," $3,497.82 "," $3,497.82 "," $3,497.82 "," $3,497.82 ", See APC Packaged Rates ," $1,316.39 ", $154.31 , $- ," $3,497.82 "," $2,632.77 "
Q4196,61535060,Hospital Chargemaster,Purpaly 16M,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $108.76 , $- , See APC Packaged Rates , $- , $- , $- , $- , $101.84 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $108.76 , $-
Q4196,61535067,Hospital Chargemaster,Purply 8X16,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $108.76 , $- , See APC Packaged Rates , $- , $- , $- , $- , $101.84 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $108.76 , $-
Q4151,61535078,Hospital Chargemaster,Amnioband 14M,Outpatient,Outpatient Default Percent / Case Rate,636, $826.88 , $- , $681.35 , See APC Packaged Rates , $578.82 , $322.48 , $797.86 , $801.33 , $- , See APC Packaged Rates , See APC Packaged Rates , $554.84 , $554.84 , See APC Packaged Rates , See APC Packaged Rates , $769.00 , $769.00 , $769.00 , $769.00 , See APC Packaged Rates , $289.41 , $- , $- , $801.33 , $578.82
Q4151,61535079,Hospital Chargemaster,Amnioband 18M,Outpatient,Outpatient Default Percent / Case Rate,636," $1,653.75 ", $- ," $1,362.69 ", See APC Packaged Rates ," $1,157.63 ", $644.96 ," $1,595.70 "," $1,602.65 ", $- , See APC Packaged Rates , See APC Packaged Rates ," $1,109.67 "," $1,109.67 ", See APC Packaged Rates , See APC Packaged Rates ," $1,537.99 "," $1,537.99 "," $1,537.99 "," $1,537.99 ", See APC Packaged Rates , $578.81 , $- , $- ," $1,602.65 "," $1,157.63 "
Q4151,61535080,Hospital Chargemaster,Amnioband 2 X 2 Cm,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
Q4151,61535081,Hospital Chargemaster,Amnioband 2 X 3 Cm,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
Q4151,61535082,Hospital Chargemaster,Amnioband 2 X 4 Cm,Outpatient,Outpatient Default Percent / Case Rate,636, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
Q4196,61535085,Hospital Chargemaster,Puraply 1.6 Disc,Outpatient,Outpatient Default Percent / Case Rate,636," $1,417.50 ", $108.76 ," $1,168.02 ", See APC Packaged Rates , $992.25 , $552.83 ," $1,367.75 "," $1,373.70 ", $101.84 , See APC Packaged Rates , See APC Packaged Rates , $951.14 , $951.14 , See APC Packaged Rates , See APC Packaged Rates ," $1,318.28 "," $1,318.28 "," $1,318.28 "," $1,318.28 ", See APC Packaged Rates , $496.13 , $- , $- ," $1,373.70 ", $992.25
Q4128,61565083,Hospital Chargemaster,Allo Patch 2X2 Q4128,Outpatient,Outpatient Default Percent / Case Rate,636, $918.54 , $- , $756.88 , See APC Packaged Rates , $642.98 , $358.23 , $3.30 , $3.30 , $3.30 , See APC Packaged Rates , See APC Packaged Rates , $616.34 , $616.34 , See APC Packaged Rates , See APC Packaged Rates , $854.24 , $854.24 , $854.24 , $854.24 , See APC Packaged Rates , $321.49 , $- , $- , $854.24 , $642.98
90688,67401694,Hospital Chargemaster,Fluarix 0.5 ML Sryrin,Outpatient,Outpatient Default Percent / Case Rate,636, $53.42 , $19.17 , $44.02 , See APC Packaged Rates , $37.39 , $20.83 , $19.17 , $19.17 , $19.17 , See APC Packaged Rates , See APC Packaged Rates , $35.84 , $35.84 , See APC Packaged Rates , See APC Packaged Rates , $19.17 , $19.17 , $19.66 , $19.66 , See APC Packaged Rates , $18.70 , $19.91 , $18.70 , $44.02 , $37.39
Q9967,67709955,Hospital Chargemaster,Low Osmolar Contrast,Outpatient,Outpatient Default Percent / Case Rate,636, $1.00 , $- , $0.82 , See APC Packaged Rates , $0.70 , $0.39 , $0.10 , $0.10 , $0.10 , See APC Packaged Rates , See APC Packaged Rates , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $0.93 , $0.93 , $0.93 , $0.93 , See APC Packaged Rates , $0.35 , $- , $- , $0.93 , $0.70
A9579,67903001,Hospital Chargemaster,"Inj, Gadolinium MRI",Outpatient,Outpatient Default Percent / Case Rate,636, $6.00 , $- , $4.94 , See APC Packaged Rates , $4.20 , $2.34 , $6.19 , $3.21 , $3.15 , See APC Packaged Rates , See APC Packaged Rates , $4.03 , $4.03 , See APC Packaged Rates , See APC Packaged Rates , $5.58 , $5.58 , $5.58 , $5.58 , See APC Packaged Rates , $2.10 , $- , $- , $6.19 , $4.20
,4501110005,Hospital Chargemaster,W2 Extended Recovery,Outpatient,Outpatient Default Percent / Case Rate,710, $730.00 , $401.50 , $584.00 , See APC Packaged Rates , $511.00 , $284.70 , $704.38 , $707.44 , $375.96 , See APC Packaged Rates , See APC Packaged Rates , $489.83 , $489.83 , See APC Packaged Rates , See APC Packaged Rates , $678.90 , $678.90 , $678.90 , $678.90 , See APC Packaged Rates , $255.50 , $438.00 , $255.50 , $707.44 , $511.00
,4501510005,Hospital Chargemaster,W1 Extended Recovery,Outpatient,Outpatient Default Percent / Case Rate,710, $730.00 , $401.50 , $584.00 , See APC Packaged Rates , $511.00 , $284.70 , $704.38 , $707.44 , $375.96 , See APC Packaged Rates , See APC Packaged Rates , $489.83 , $489.83 , See APC Packaged Rates , See APC Packaged Rates , $678.90 , $678.90 , $678.90 , $678.90 , See APC Packaged Rates , $255.50 , $438.00 , $255.50 , $707.44 , $511.00
,4550110005,Hospital Chargemaster,OBS Extended Recovery,Outpatient,Outpatient Default Percent / Case Rate,710, $730.00 , $401.50 , $584.00 , See APC Packaged Rates , $511.00 , $284.70 , $704.38 , $707.44 , $375.96 , See APC Packaged Rates , See APC Packaged Rates , $489.83 , $489.83 , See APC Packaged Rates , See APC Packaged Rates , $678.90 , $678.90 , $678.90 , $678.90 , See APC Packaged Rates , $255.50 , $438.00 , $255.50 , $707.44 , $511.00
,5000011000,Hospital Chargemaster,Recovery 1st HR OBS,Outpatient,Outpatient Default Percent / Case Rate,710, $700.00 , $385.00 , $560.00 , See APC Packaged Rates , $490.00 , $273.00 , $675.43 , $678.37 , $360.51 , See APC Packaged Rates , See APC Packaged Rates , $469.70 , $469.70 , See APC Packaged Rates , See APC Packaged Rates , $651.00 , $651.00 , $651.00 , $651.00 , See APC Packaged Rates , $245.00 , $420.00 , $245.00 , $678.37 , $490.00
,5000012000,Hospital Chargemaster,Recovery 2 hrs OBS,Outpatient,Outpatient Default Percent / Case Rate,710," $1,200.00 ", $660.00 , $960.00 , See APC Packaged Rates , $840.00 , $468.00 ," $1,157.88 "," $1,162.92 ", $618.02 , See APC Packaged Rates , See APC Packaged Rates , $805.20 , $805.20 , See APC Packaged Rates , See APC Packaged Rates ," $1,116.00 "," $1,116.00 "," $1,116.00 "," $1,116.00 ", See APC Packaged Rates , $420.00 , $720.00 , $420.00 ," $1,162.92 ", $840.00
,5000013000,Hospital Chargemaster,Recovery 3 hrs OBS,Outpatient,Outpatient Default Percent / Case Rate,710," $1,700.00 ", $935.00 ," $1,360.00 ", See APC Packaged Rates ," $1,190.00 ", $663.00 ," $1,640.33 "," $1,647.47 ", $875.53 , See APC Packaged Rates , See APC Packaged Rates ," $1,140.70 "," $1,140.70 ", See APC Packaged Rates , See APC Packaged Rates ," $1,581.00 "," $1,581.00 "," $1,581.00 "," $1,581.00 ", See APC Packaged Rates , $595.00 ," $1,020.00 ", $595.00 ," $1,647.47 "," $1,190.00 "
,5000014000,Hospital Chargemaster,Recovery 4 Hrs OBS,Outpatient,Outpatient Default Percent / Case Rate,710," $2,200.00 "," $1,210.00 "," $1,760.00 ", See APC Packaged Rates ," $1,540.00 ", $858.00 ," $2,122.78 "," $2,132.02 "," $1,133.04 ", See APC Packaged Rates , See APC Packaged Rates ," $1,476.20 "," $1,476.20 ", See APC Packaged Rates , See APC Packaged Rates ," $2,046.00 "," $2,046.00 "," $2,046.00 "," $2,046.00 ", See APC Packaged Rates , $770.00 ," $1,320.00 ", $770.00 ," $2,132.02 "," $1,540.00 "
,5014010001,Hospital Chargemaster,Recovery 1st Hour,Outpatient,Outpatient Default Percent / Case Rate,710, $792.00 , $435.60 , $633.60 , See APC Packaged Rates , $554.40 , $308.88 , $764.20 , $767.53 , $407.90 , See APC Packaged Rates , See APC Packaged Rates , $531.43 , $531.43 , See APC Packaged Rates , See APC Packaged Rates , $736.56 , $736.56 , $736.56 , $736.56 , See APC Packaged Rates , $277.20 , $475.20 , $277.20 , $767.53 , $554.40
,5014010002,Hospital Chargemaster,Recovery ea addl 30 Min,Outpatient,Outpatient Default Percent / Case Rate,710, $250.00 , $137.50 , $200.00 , See APC Packaged Rates , $175.00 , $97.50 , $241.23 , $242.28 , $128.76 , See APC Packaged Rates , See APC Packaged Rates , $167.75 , $167.75 , See APC Packaged Rates , See APC Packaged Rates , $232.50 , $232.50 , $232.50 , $232.50 , See APC Packaged Rates , $87.50 , $150.00 , $87.50 , $242.28 , $175.00
,5000010000,Hospital Chargemaster,Delivery Room Charge,Outpatient,Outpatient Default Percent / Case Rate,720," $2,500.00 "," $1,375.00 "," $2,000.00 ", See APC Packaged Rates ," $1,750.00 ", $975.00 ," $2,412.25 "," $2,422.75 "," $1,287.55 ", See APC Packaged Rates , See APC Packaged Rates ," $1,677.50 "," $1,677.50 ", See APC Packaged Rates , See APC Packaged Rates ," $2,325.00 "," $2,325.00 "," $2,325.00 "," $2,325.00 ", See APC Packaged Rates , $875.00 ," $1,832.00 ", $875.00 ," $2,422.75 "," $1,750.00 "
59412,5000010012,Hospital Chargemaster,Antepartum manipulation,Outpatient,Outpatient Default Percent / Case Rate,722, $569.00 , $312.95 , $468.86 ," $3,136.64 ", $398.30 , $221.91 ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 ", $256.58 , $248.80 ," $3,293.47 "," $3,199.37 ", $569.00 , $569.00 , $569.00 , $569.00 ," $3,136.64 ", $199.15 , $- , $- ," $5,165.58 ", $398.30
59020,5000010007,Hospital Chargemaster,Fetal contract stress test,Outpatient,Outpatient Default Percent / Case Rate,722, $400.00 , $220.00 , $329.60 , $203.67 , $280.00 , $156.00 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $268.40 , $268.40 , $213.85 , $207.74 , $264.14 , $264.14 , $270.95 , $270.95 , $203.67 , $140.00 , $- , $- , $362.99 , $280.00
,5000010001,Hospital Chargemaster,Vaginal Birth,Outpatient,Outpatient Default Percent / Case Rate,722," $2,500.00 "," $1,375.00 "," $2,000.00 ", See APC Packaged Rates ," $1,750.00 ", $975.00 ," $2,412.25 "," $2,422.75 "," $1,287.55 ", See APC Packaged Rates , See APC Packaged Rates ," $1,677.50 "," $1,677.50 ", See APC Packaged Rates , See APC Packaged Rates ," $2,325.00 "," $2,325.00 "," $2,325.00 "," $2,325.00 ", See APC Packaged Rates , $875.00 ," $1,832.00 ", $875.00 ," $2,422.75 "," $1,750.00 "
,5000010003,Hospital Chargemaster,Vaginal Birth & Tubal Ligation,Outpatient,Outpatient Default Percent / Case Rate,722," $2,500.00 "," $1,375.00 "," $2,000.00 ", See APC Packaged Rates ," $1,750.00 ", $975.00 ," $2,412.25 "," $2,422.75 "," $1,287.55 ", See APC Packaged Rates , See APC Packaged Rates ," $1,677.50 "," $1,677.50 ", See APC Packaged Rates , See APC Packaged Rates ," $2,325.00 "," $2,325.00 "," $2,325.00 "," $2,325.00 ", See APC Packaged Rates , $875.00 ," $1,832.00 ", $875.00 ," $2,422.75 "," $1,750.00 "
54150,5000010004,Hospital Chargemaster,Circumcision,Outpatient,Outpatient Default Percent / Case Rate,723," $1,142.00 ", $628.10 ," $1,236.00 "," $2,140.58 ", $799.40 , $445.38 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $844.48 , $822.61 ," $2,247.61 "," $2,183.39 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $2,140.58 ", $399.70 , $- , $- ," $3,805.91 ", $799.40
59050,5000010018,Hospital Chargemaster,Fetal Monitor,Outpatient,Outpatient Default Percent / Case Rate,729, $547.00 , $300.85 , $450.73 , See APC Packaged Rates , $382.90 , $213.33 , $162.95 , $111.84 , $111.25 , See APC Packaged Rates , See APC Packaged Rates , $367.04 , $367.04 , See APC Packaged Rates , See APC Packaged Rates , $508.71 , $508.71 , $508.71 , $508.71 , See APC Packaged Rates , $191.45 , $- , $- , $508.71 , $382.90
93005,5510010018,Hospital Chargemaster,Electrocardiogram tracing,Outpatient,Outpatient Default Percent / Case Rate,730, $90.00 , $49.50 , $74.16 , $66.55 , $63.00 , $35.10 , $137.24 , $107.26 , $117.48 , $66.55 , $66.55 , $57.80 , $56.04 , $69.87 , $67.88 , $85.99 , $85.99 , $88.21 , $88.21 , $66.55 , $31.50 , $- , $- , $137.24 , $63.00
93041,5510010019,Hospital Chargemaster,Rhythm ecg tracing,Outpatient,Outpatient Default Percent / Case Rate,730, $100.00 , $55.00 , $82.40 , $66.55 , $70.00 , $39.00 , $137.24 , $107.26 , $117.48 , $66.55 , $66.55 , $- , $- , $69.87 , $67.88 , $85.51 , $85.51 , $87.71 , $87.71 , $66.55 , $35.00 , $- , $- , $137.24 , $70.00
93225,5510010020,Hospital Chargemaster,Ecg monit/reprt up to 48 hrs,Outpatient,Outpatient Default Percent / Case Rate,731, $325.00 , $178.75 , $267.80 , $134.80 , $227.50 , $126.75 , $261.44 , $204.33 , $223.81 , $134.80 , $134.80 , $155.14 , $150.43 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $113.75 , $- , $- , $267.80 , $227.50
93226,5510010021,Hospital Chargemaster,Ecg monit/reprt up to 48 hrs,Outpatient,Outpatient Default Percent / Case Rate,731, $500.00 , $275.00 , $412.00 , $134.80 , $350.00 , $195.00 , $261.44 , $204.33 , $223.81 , $134.80 , $134.80 , $276.82 , $268.42 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $175.00 , $- , $- , $412.00 , $350.00
93270,5510010022,Hospital Chargemaster,Remote 30 day ecg rev/report,Outpatient,Outpatient Default Percent / Case Rate,731, $697.00 , $383.35 , $574.33 , $44.52 , $487.90 , $271.83 , $91.23 , $71.30 , $78.10 , $44.52 , $44.52 , $155.14 , $150.43 , $46.74 , $45.41 , $57.47 , $57.47 , $58.95 , $58.95 , $44.52 , $243.95 , $- , $- , $574.33 , $487.90
93225,5510010087,Hospital Chargemaster,Ecg Monit/Reprt Up To 48 Hrs,Outpatient,Outpatient Default Percent / Case Rate,731, $325.00 , $178.75 , $267.80 , $134.80 , $227.50 , $126.75 , $261.44 , $204.33 , $223.81 , $134.80 , $134.80 , $155.14 , $150.43 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $113.75 , $- , $- , $267.80 , $227.50
95805,5320010001,Hospital Chargemaster,Multiple sleep latency test,Outpatient,Outpatient Default Percent / Case Rate,740," $2,042.00 "," $1,123.10 "," $1,682.61 ", $583.57 ," $1,429.40 ", $796.38 ," $1,117.79 ", $873.62 , $956.92 , $583.57 , $583.57 , $918.68 , $890.81 , $612.75 , $595.24 , $866.44 , $866.44 , $888.76 , $888.76 , $583.57 , $714.70 , $- , $- ," $1,682.61 "," $1,429.40 "
95805,5320010002,Hospital Chargemaster,Multiple sleep latency test<6h,Outpatient,Outpatient Default Percent / Case Rate,740," $2,042.00 "," $1,123.10 "," $1,682.61 ", $583.57 ," $1,429.40 ", $796.38 ," $1,117.79 ", $873.62 , $956.92 , $583.57 , $583.57 , $918.68 , $890.81 , $612.75 , $595.24 , $866.44 , $866.44 , $888.76 , $888.76 , $583.57 , $714.70 , $- , $- ," $1,682.61 "," $1,429.40 "
95805,5330010001,Hospital Chargemaster,Multiple sleep latency test,Outpatient,Outpatient Default Percent / Case Rate,740," $2,042.00 "," $1,123.10 "," $1,682.61 ", $583.57 ," $1,429.40 ", $796.38 ," $1,117.79 ", $873.62 , $956.92 , $583.57 , $583.57 , $918.68 , $890.81 , $612.75 , $595.24 , $866.44 , $866.44 , $888.76 , $888.76 , $583.57 , $714.70 , $- , $- ," $1,682.61 "," $1,429.40 "
95813,5330010002,Hospital Chargemaster,EEG over 1 hour,Outpatient,Outpatient Default Percent / Case Rate,740, $906.00 , $498.30 , $746.54 , $316.40 , $634.20 , $353.34 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $416.75 , $404.11 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $317.10 , $- , $- , $746.54 , $634.20
95816,5330010003,Hospital Chargemaster,EEG awake and drowsy,Outpatient,Outpatient Default Percent / Case Rate,740, $500.00 , $275.00 , $412.00 , $316.40 , $350.00 , $195.00 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $310.28 , $300.87 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $175.00 , $- , $- , $619.47 , $350.00
95819,5330010004,Hospital Chargemaster,EEG awake and asleep,Outpatient,Outpatient Default Percent / Case Rate,740," $1,037.00 ", $570.35 , $854.49 , $316.40 , $725.90 , $404.43 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $343.75 , $333.32 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $362.95 , $- , $- , $854.49 , $725.90
95806,5320010003,Hospital Chargemaster,Sleep study unatt&resp efft,Outpatient,Outpatient Default Percent / Case Rate,740, $625.00 , $343.75 , $515.00 , $166.91 , $437.50 , $243.75 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $- , $- , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $218.75 , $- , $- , $515.00 , $437.50
95822,5330010005,Hospital Chargemaster,EEG coma or sleep only,Outpatient,Outpatient Default Percent / Case Rate,740, $500.00 , $275.00 , $412.00 , $316.40 , $350.00 , $195.00 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $407.63 , $395.26 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $175.00 , $- , $- , $619.47 , $350.00
43235,5011010006,Hospital Chargemaster,EGD diagnostic brush wash,Outpatient,Outpatient Default Percent / Case Rate,750," $1,450.00 ", $797.50 ," $1,236.00 ", $967.36 ," $1,015.00 ", $565.50 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $967.36 , $507.50 , $- , $- ," $1,665.99 "," $1,015.00 "
43236,5011010007,Hospital Chargemaster,Upper GI scope w/submuc inj,Outpatient,Outpatient Default Percent / Case Rate,750, $550.00 , $302.50 ," $1,442.00 ", $967.36 , $385.00 , $214.50 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $550.00 , $550.00 , $550.00 , $550.00 , $967.36 , $192.50 , $- , $- ," $1,665.99 ", $385.00
43239,5011010008,Hospital Chargemaster,EGD biopsy single/multiple,Outpatient,Outpatient Default Percent / Case Rate,750," $1,200.00 ", $660.00 ," $1,442.00 ", $967.36 , $840.00 , $468.00 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 ," $1,133.44 "," $1,104.09 "," $1,015.72 ", $986.70 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $967.36 , $420.00 , $- , $- ," $1,665.99 ", $840.00
43244,5011010009,Hospital Chargemaster,EGD varices ligation,Outpatient,Outpatient Default Percent / Case Rate,750, $700.00 , $385.00 ," $1,442.00 "," $1,941.77 ", $490.00 , $273.00 ," $3,245.02 "," $2,227.24 "," $2,215.37 "," $1,941.77 "," $1,941.77 "," $1,133.44 "," $1,104.09 "," $2,038.86 "," $1,980.61 ", $700.00 , $700.00 , $700.00 , $700.00 ," $1,941.77 ", $245.00 , $- , $- ," $3,245.02 ", $490.00
43247,5011010012,Hospital Chargemaster,EGD remove foreign body,Outpatient,Outpatient Default Percent / Case Rate,750," $1,420.00 ", $781.00 ," $1,442.00 ", $967.36 , $994.00 , $553.80 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 ," $1,133.44 "," $1,104.09 "," $1,015.72 ", $986.70 , $619.00 , $619.00 , $619.00 , $619.00 , $967.36 , $497.00 , $- , $- ," $1,665.99 ", $994.00
43251,5011010015,Hospital Chargemaster,EGD remove lesion snare,Outpatient,Outpatient Default Percent / Case Rate,750, $700.00 , $385.00 ," $1,442.00 "," $1,941.77 ", $490.00 , $273.00 ," $3,245.02 "," $2,227.24 "," $2,215.37 "," $1,941.77 "," $1,941.77 "," $1,133.44 "," $1,104.09 "," $2,038.86 "," $1,980.61 ", $700.00 , $700.00 , $700.00 , $700.00 ," $1,941.77 ", $245.00 , $- , $- ," $3,245.02 ", $490.00
43255,5011010016,Hospital Chargemaster,EGD control bleeding any,Outpatient,Outpatient Default Percent / Case Rate,750," $1,100.00 ", $605.00 ," $1,442.00 "," $1,941.77 ", $770.00 , $429.00 ," $3,245.02 "," $2,227.24 "," $2,215.37 "," $1,941.77 "," $1,941.77 "," $1,133.44 "," $1,104.09 "," $2,038.86 "," $1,980.61 "," $1,100.00 "," $1,100.00 "," $1,100.00 "," $1,100.00 "," $1,941.77 ", $385.00 , $- , $- ," $3,245.02 ", $770.00
43262,5011010017,Hospital Chargemaster,Endo cholangiopancreatograph,Outpatient,Outpatient Default Percent / Case Rate,750," $5,800.00 "," $3,190.00 "," $1,442.00 "," $3,670.82 "," $4,060.00 "," $2,262.00 "," $6,179.35 "," $4,241.24 "," $4,218.63 "," $3,670.82 "," $3,670.82 "," $1,133.44 "," $1,104.09 "," $3,854.36 "," $3,744.24 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $3,670.82 "," $2,030.00 ", $- , $- ," $6,179.35 "," $4,060.00 "
44389,5011010025,Hospital Chargemaster,Colonoscopy with biopsy,Outpatient,Outpatient Default Percent / Case Rate,750, $900.00 , $495.00 ," $1,236.00 "," $1,239.71 ", $630.00 , $351.00 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 ", $844.48 , $822.61 ," $1,301.70 "," $1,264.51 ", $900.00 , $900.00 , $900.00 , $900.00 ," $1,239.71 ", $315.00 , $- , $- ," $2,143.42 ", $630.00
44392,5011010026,Hospital Chargemaster,Colonoscopy & polypectomy,Outpatient,Outpatient Default Percent / Case Rate,750, $900.00 , $495.00 ," $1,236.00 "," $1,239.71 ", $630.00 , $351.00 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 ", $844.48 , $822.61 ," $1,301.70 "," $1,264.51 ", $900.00 , $900.00 , $900.00 , $900.00 ," $1,239.71 ", $315.00 , $- , $- ," $2,143.42 ", $630.00
44394,5011010027,Hospital Chargemaster,Colonoscopy w/snare,Outpatient,Outpatient Default Percent / Case Rate,750, $900.00 , $495.00 ," $1,236.00 "," $1,239.71 ", $630.00 , $351.00 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 ", $844.48 , $822.61 ," $1,301.70 "," $1,264.51 ", $900.00 , $900.00 , $900.00 , $900.00 ," $1,239.71 ", $315.00 , $- , $- ," $2,143.42 ", $630.00
45330,5011010028,Hospital Chargemaster,Diagnostic sigmoidoscopy,Outpatient,Outpatient Default Percent / Case Rate,750," $1,142.00 ", $628.10 ," $1,236.00 ", $948.73 , $799.40 , $445.38 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $105.28 , $102.55 , $996.17 , $967.71 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $948.73 , $399.70 , $- , $- ," $1,629.53 ", $799.40
45331,5011010029,Hospital Chargemaster,Sigmoidoscopy and biopsy,Outpatient,Outpatient Default Percent / Case Rate,750," $1,450.00 ", $797.50 ," $1,236.00 ", $948.73 ," $1,015.00 ", $565.50 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $844.48 , $822.61 , $996.17 , $967.71 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $948.73 , $507.50 , $- , $- ," $1,629.53 "," $1,015.00 "
45338,5011010031,Hospital Chargemaster,Sigmoidoscopy w/tumr remove,Outpatient,Outpatient Default Percent / Case Rate,750," $1,142.00 ", $628.10 ," $1,236.00 "," $1,239.71 ", $799.40 , $445.38 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 ", $844.48 , $822.61 ," $1,301.70 "," $1,264.51 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,239.71 ", $399.70 , $- , $- ," $2,143.42 ", $799.40
45378,5011010033,Hospital Chargemaster,Diagnostic colonoscopy,Outpatient,Outpatient Default Percent / Case Rate,750, $900.00 , $495.00 ," $1,442.00 ", $948.73 , $630.00 , $351.00 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 ," $1,133.44 "," $1,104.09 ", $996.17 , $967.71 , $900.00 , $900.00 , $900.00 , $900.00 , $948.73 , $315.00 , $- , $- ," $1,629.53 ", $630.00
45380,5011010034,Hospital Chargemaster,Colonoscopy and biopsy,Outpatient,Outpatient Default Percent / Case Rate,750, $900.00 , $495.00 ," $1,442.00 "," $1,239.71 ", $630.00 , $351.00 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,133.44 "," $1,104.09 "," $1,301.70 "," $1,264.51 ", $900.00 , $900.00 , $900.00 , $900.00 ," $1,239.71 ", $315.00 , $- , $- ," $2,143.42 ", $630.00
45381,5011010035,Hospital Chargemaster,Colonoscopy submucous njx,Outpatient,Outpatient Default Percent / Case Rate,750, $900.00 , $495.00 ," $1,442.00 "," $1,239.71 ", $630.00 , $351.00 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 ", $844.48 , $822.61 ," $1,301.70 "," $1,264.51 ", $900.00 , $900.00 , $900.00 , $900.00 ," $1,239.71 ", $315.00 , $- , $- ," $2,143.42 ", $630.00
45382,5011010036,Hospital Chargemaster,Colonoscopy w/control bleed,Outpatient,Outpatient Default Percent / Case Rate,750, $900.00 , $495.00 ," $1,442.00 "," $1,239.71 ", $630.00 , $351.00 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,133.44 "," $1,104.09 "," $1,301.70 "," $1,264.51 ", $900.00 , $900.00 , $900.00 , $900.00 ," $1,239.71 ", $315.00 , $- , $- ," $2,143.42 ", $630.00
45384,5011010037,Hospital Chargemaster,Colonoscopy w/lesion removal,Outpatient,Outpatient Default Percent / Case Rate,750, $900.00 , $495.00 ," $1,442.00 "," $1,239.71 ", $630.00 , $351.00 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,133.44 "," $1,104.09 "," $1,301.70 "," $1,264.51 ", $900.00 , $900.00 , $900.00 , $900.00 ," $1,239.71 ", $315.00 , $- , $- ," $2,143.42 ", $630.00
45385,5011010038,Hospital Chargemaster,Colonoscopy w/lesion removal,Outpatient,Outpatient Default Percent / Case Rate,750, $900.00 , $495.00 ," $1,442.00 "," $1,239.71 ", $630.00 , $351.00 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,133.44 "," $1,104.09 "," $1,301.70 "," $1,264.51 ", $900.00 , $900.00 , $900.00 , $900.00 ," $1,239.71 ", $315.00 , $- , $- ," $2,143.42 ", $630.00
45386,5011010039,Hospital Chargemaster,Colonoscopy w/balloon dilat,Outpatient,Outpatient Default Percent / Case Rate,750, $900.00 , $495.00 ," $1,442.00 "," $1,239.71 ", $630.00 , $351.00 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 ", $844.48 , $822.61 ," $1,301.70 "," $1,264.51 ", $900.00 , $900.00 , $900.00 , $900.00 ," $1,239.71 ", $315.00 , $- , $- ," $2,143.42 ", $630.00
45388,5011010040,Hospital Chargemaster,Colonoscopy w/ablation,Outpatient,Outpatient Default Percent / Case Rate,750, $900.00 , $495.00 ," $1,442.00 "," $1,239.71 ", $630.00 , $351.00 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 ", $603.90 , $603.90 ," $1,301.70 "," $1,264.51 ", $900.00 , $900.00 , $900.00 , $900.00 ," $1,239.71 ", $315.00 , $- , $- ," $2,143.42 ", $630.00
45398,5011010041,Hospital Chargemaster,Colonoscopy w/band ligation,Outpatient,Outpatient Default Percent / Case Rate,750, $900.00 , $495.00 ," $1,442.00 "," $1,239.71 ", $630.00 , $351.00 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 ", $603.90 , $603.90 ," $1,301.70 "," $1,264.51 ", $900.00 , $900.00 , $900.00 , $900.00 ," $1,239.71 ", $315.00 , $- , $- ," $2,143.42 ", $630.00
91110,5011010047,Hospital Chargemaster,GI tract capsule endoscopy,Outpatient,Outpatient Default Percent / Case Rate,750," $2,931.00 "," $1,612.05 "," $2,415.14 ", $967.36 ," $2,051.70 "," $1,143.09 "," $1,869.78 "," $1,461.34 "," $1,600.68 ", $967.36 , $967.36 ," $1,966.70 "," $1,966.70 "," $1,015.72 ", $986.70 ," $1,255.47 "," $1,255.47 "," $1,287.82 "," $1,287.82 ", $967.36 ," $1,025.85 ", $- , $- ," $2,415.14 "," $2,051.70 "
91111,5011010048,Hospital Chargemaster,Esophageal capsule endoscopy,Outpatient,Outpatient Default Percent / Case Rate,750," $2,348.00 "," $1,291.40 "," $1,934.75 ", $967.36 ," $1,643.60 ", $915.72 ," $1,869.78 "," $1,461.34 "," $1,600.68 ", $967.36 , $967.36 ," $1,873.10 "," $1,816.27 "," $1,015.72 ", $986.70 ," $1,255.47 "," $1,255.47 "," $1,287.82 "," $1,287.82 ", $967.36 , $821.80 , $- , $- ," $1,934.75 "," $1,643.60 "
45385,5011010050,Hospital Chargemaster,EGD with colonoscopy,Outpatient,Outpatient Default Percent / Case Rate,750," $1,142.00 ", $628.10 ," $1,442.00 "," $1,239.71 ", $799.40 , $445.38 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,133.44 "," $1,104.09 "," $1,301.70 "," $1,264.51 ", $900.00 , $900.00 , $900.00 , $900.00 ," $1,239.71 ", $399.70 , $- , $- ," $2,143.42 ", $799.40
,5011010053,Hospital Chargemaster,ERCP ,Outpatient,Outpatient Default Percent / Case Rate,750," $5,800.00 "," $3,190.00 "," $4,640.00 ", See APC Packaged Rates ," $4,060.00 "," $2,262.00 "," $5,596.42 "," $5,620.78 "," $2,987.12 ", See APC Packaged Rates , See APC Packaged Rates ," $3,891.80 "," $3,891.80 ", See APC Packaged Rates , See APC Packaged Rates ," $5,394.00 "," $5,394.00 "," $5,394.00 "," $5,394.00 ", See APC Packaged Rates ," $2,030.00 "," $3,480.00 "," $2,030.00 "," $5,620.78 "," $4,060.00 "
46600,5011010068,Hospital Chargemaster,Anoscopy,Outpatient,Outpatient Default Percent / Case Rate,750, $446.00 , $245.30 ," $1,236.00 ", $134.80 , $312.20 , $173.94 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $116.00 , $116.00 , $116.00 , $116.00 , $134.80 , $156.10 , $- , $- ," $1,236.00 ", $312.20
91110,5011010070,Hospital Chargemaster,Capsule Endoscopy,Outpatient,Outpatient Default Percent / Case Rate,750," $2,931.00 "," $1,612.05 "," $2,415.14 ", $967.36 ," $2,051.70 "," $1,143.09 "," $1,869.78 "," $1,461.34 "," $1,600.68 ", $967.36 , $967.36 ," $1,966.70 "," $1,966.70 "," $1,015.72 ", $986.70 ," $1,255.47 "," $1,255.47 "," $1,287.82 "," $1,287.82 ", $967.36 ," $1,025.85 ", $- , $- ," $2,415.14 "," $2,051.70 "
,5011010071,Hospital Chargemaster,Colonoscopy with Polypectomy,Outpatient,Outpatient Default Percent / Case Rate,750, $900.00 , $495.00 , $720.00 , See APC Packaged Rates , $630.00 , $351.00 , $868.41 , $872.19 , $463.52 , See APC Packaged Rates , See APC Packaged Rates , $603.90 , $603.90 , See APC Packaged Rates , See APC Packaged Rates , $837.00 , $837.00 , $837.00 , $837.00 , See APC Packaged Rates , $315.00 , $540.00 , $315.00 , $872.19 , $630.00
43239,5011010074,Hospital Chargemaster,Gastro w/Biopsy Single/Multi,Outpatient,Outpatient Default Percent / Case Rate,750," $1,200.00 ", $660.00 ," $1,442.00 ", $967.36 , $840.00 , $468.00 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 ," $1,133.44 "," $1,104.09 "," $1,015.72 ", $986.70 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $967.36 , $420.00 , $- , $- ," $1,665.99 ", $840.00
,5011010075,Hospital Chargemaster,Gastro w/Ctrl Bleed Any Method,Outpatient,Outpatient Default Percent / Case Rate,750, $900.00 , $495.00 , $720.00 , See APC Packaged Rates , $630.00 , $351.00 , $868.41 , $872.19 , $463.52 , See APC Packaged Rates , See APC Packaged Rates , $603.90 , $603.90 , See APC Packaged Rates , See APC Packaged Rates , $837.00 , $837.00 , $837.00 , $837.00 , See APC Packaged Rates , $315.00 , $540.00 , $315.00 , $872.19 , $630.00
,5011010076,Hospital Chargemaster,Gastro Dil +/- Ballo/Bougi/Wir,Outpatient,Outpatient Default Percent / Case Rate,750," $1,450.00 ", $797.50 ," $1,160.00 ", See APC Packaged Rates ," $1,015.00 ", $565.50 ," $1,399.11 "," $1,405.20 ", $746.78 , See APC Packaged Rates , See APC Packaged Rates , $972.95 , $972.95 , See APC Packaged Rates , See APC Packaged Rates ," $1,348.50 "," $1,348.50 "," $1,348.50 "," $1,348.50 ", See APC Packaged Rates , $507.50 , $870.00 , $507.50 ," $1,405.20 "," $1,015.00 "
,5011010080,Hospital Chargemaster,Gastro w/Percut G-Tube Place,Outpatient,Outpatient Default Percent / Case Rate,750," $1,351.00 ", $743.05 ," $1,080.80 ", See APC Packaged Rates , $945.70 , $526.89 ," $1,303.58 "," $1,309.25 ", $695.79 , See APC Packaged Rates , See APC Packaged Rates , $906.52 , $906.52 , See APC Packaged Rates , See APC Packaged Rates ," $1,256.43 "," $1,256.43 "," $1,256.43 "," $1,256.43 ", See APC Packaged Rates , $472.85 , $810.60 , $472.85 ," $1,309.25 ", $945.70
,5011010085,Hospital Chargemaster,"Sigmoid, Flex /c Polypec",Outpatient,Outpatient Default Percent / Case Rate,750," $1,142.00 ", $628.10 , $913.60 , See APC Packaged Rates , $799.40 , $445.38 ," $1,101.92 "," $1,106.71 ", $588.15 , See APC Packaged Rates , See APC Packaged Rates , $766.28 , $766.28 , See APC Packaged Rates , See APC Packaged Rates ," $1,062.06 "," $1,062.06 "," $1,062.06 "," $1,062.06 ", See APC Packaged Rates , $399.70 , $685.20 , $399.70 ," $1,106.71 ", $799.40
,65101400,Hospital Chargemaster,Endo Room Chg,Outpatient,Outpatient Default Percent / Case Rate,750, $50.00 , $27.50 , $40.00 , See APC Packaged Rates , $35.00 , $19.50 , $48.25 , $48.46 , $25.75 , See APC Packaged Rates , See APC Packaged Rates , $33.55 , $33.55 , See APC Packaged Rates , See APC Packaged Rates , $46.50 , $46.50 , $46.50 , $46.50 , See APC Packaged Rates , $17.50 , $30.00 , $17.50 , $48.46 , $35.00
11721,501002469,Hospital Chargemaster,Debride nail 6 or more,Outpatient,Outpatient Default Percent / Case Rate,761, $239.00 , $131.45 ," $1,236.00 ", $66.55 , $167.30 , $93.21 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $185.14 , $185.14 , $185.14 , $185.14 , $66.55 , $83.65 , $- , $- ," $1,236.00 ", $167.30
11720,501002468,Hospital Chargemaster,Debride nail 1-5,Outpatient,Outpatient Default Percent / Case Rate,761, $47.00 , $25.85 ," $1,236.00 ", $66.55 , $32.90 , $18.33 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $47.00 , $47.00 , $47.00 , $47.00 , $66.55 , $16.45 , $- , $- ," $1,236.00 ", $32.90
11719,501002467,Hospital Chargemaster,Trim nail(s) any number,Outpatient,Outpatient Default Percent / Case Rate,761, $35.00 , $19.25 , $28.84 , $66.55 , $24.50 , $13.65 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $35.00 , $35.00 , $35.00 , $35.00 , $66.55 , $12.25 , $- , $- , $122.28 , $24.50
30300,501002576,Hospital Chargemaster,Remove nasal foreign body,Outpatient,Outpatient Default Percent / Case Rate,761, $384.00 , $211.20 , $316.42 , $134.80 , $268.80 , $149.76 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $343.81 , $343.81 , $343.81 , $343.81 , $134.80 , $134.40 , $- , $- , $343.81 , $268.80
11981,501002476,Hospital Chargemaster,Insert drug implant device,Outpatient,Outpatient Default Percent / Case Rate,761, $306.00 , $168.30 ," $1,236.00 ", $134.80 , $214.20 , $119.34 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $306.00 , $306.00 , $306.00 , $306.00 , $134.80 , $107.10 , $- , $- ," $1,236.00 ", $214.20
11981,6500010121,Hospital Chargemaster,Insert drug implant device,Outpatient,Outpatient Default Percent / Case Rate,761, $306.00 , $168.30 ," $1,236.00 ", $134.80 , $214.20 , $119.34 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $306.00 , $306.00 , $306.00 , $306.00 , $134.80 , $107.10 , $- , $- ," $1,236.00 ", $214.20
30901,501002577,Hospital Chargemaster,Control of nosebleed,Outpatient,Outpatient Default Percent / Case Rate,761, $184.00 , $101.20 ," $1,236.00 ", $134.80 , $128.80 , $71.76 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $64.40 , $- , $- ," $1,236.00 ", $128.80
30903,501002578,Hospital Chargemaster,Control of nosebleed,Outpatient,Outpatient Default Percent / Case Rate,761, $242.00 , $133.10 ," $1,236.00 ", $134.80 , $169.40 , $94.38 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $844.48 , $822.61 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $84.70 , $- , $- ," $1,236.00 ", $169.40
36591,5212010788,Hospital Chargemaster,Draw blood off venous device,Outpatient,Outpatient Default Percent / Case Rate,761, $124.00 , $68.20 , $102.18 , $134.80 , $86.80 , $48.36 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $83.20 , $83.20 , $141.54 , $137.50 , $124.00 , $124.00 , $124.00 , $124.00 , $134.80 , $43.40 , $- , $- , $232.95 , $86.80
29130,501002570,Hospital Chargemaster,Application of finger splint,Outpatient,Outpatient Default Percent / Case Rate,761, $150.00 , $82.50 , $123.60 , $134.80 , $105.00 , $58.50 , $122.28 , $83.93 , $83.48 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $110.05 , $110.05 , $112.89 , $112.89 , $134.80 , $52.50 , $- , $- , $147.89 , $105.00
29130,6500010215,Hospital Chargemaster,Application of finger splint,Outpatient,Outpatient Default Percent / Case Rate,761, $71.00 , $39.05 , $58.50 , $134.80 , $49.70 , $27.69 , $122.28 , $83.93 , $83.48 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $110.05 , $110.05 , $112.89 , $112.89 , $134.80 , $24.85 , $- , $- , $147.89 , $49.70
11740,501002472,Hospital Chargemaster,Drain blood from under nail,Outpatient,Outpatient Default Percent / Case Rate,761, $96.00 , $52.80 ," $1,236.00 ", $134.80 , $67.20 , $37.44 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $96.00 , $96.00 , $96.00 , $96.00 , $134.80 , $33.60 , $- , $- ," $1,236.00 ", $67.20
11740,6500010117,Hospital Chargemaster,Drain blood from under nail,Outpatient,Outpatient Default Percent / Case Rate,761, $115.00 , $63.25 ," $1,236.00 ", $134.80 , $80.50 , $44.85 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $96.00 , $96.00 , $96.00 , $96.00 , $134.80 , $40.25 , $- , $- ," $1,236.00 ", $80.50
29581,501002574,Hospital Chargemaster,Apply multlay comprs lwr leg,Outpatient,Outpatient Default Percent / Case Rate,761, $271.00 , $149.05 , $223.30 , $168.90 , $189.70 , $105.69 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $32.27 , $31.29 , $177.35 , $172.28 , $271.00 , $271.00 , $271.00 , $271.00 , $168.90 , $94.85 , $- , $- , $294.51 , $189.70
29580,501002573,Hospital Chargemaster,Application of paste boot,Outpatient,Outpatient Default Percent / Case Rate,761, $244.00 , $134.20 , $201.06 , $168.90 , $170.80 , $95.16 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $85.40 , $- , $- , $294.51 , $170.80
29580,6500010218,Hospital Chargemaster,Application of paste boot,Outpatient,Outpatient Default Percent / Case Rate,761, $149.00 , $81.95 , $122.78 , $168.90 , $104.30 , $58.11 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $52.15 , $- , $- , $294.51 , $104.30
29085,501002569,Hospital Chargemaster,Apply hand/wrist cast,Outpatient,Outpatient Default Percent / Case Rate,761, $197.00 , $108.35 , $162.33 , $168.90 , $137.90 , $76.83 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $266.32 , $258.23 , $177.35 , $172.28 , $197.00 , $197.00 , $197.00 , $197.00 , $168.90 , $68.95 , $- , $- , $294.51 , $137.90
29085,6500010214,Hospital Chargemaster,Apply hand/wrist cast,Outpatient,Outpatient Default Percent / Case Rate,761, $161.00 , $88.55 , $132.66 , $168.90 , $112.70 , $62.79 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $266.32 , $258.23 , $177.35 , $172.28 , $197.00 , $197.00 , $197.00 , $197.00 , $168.90 , $56.35 , $- , $- , $294.51 , $112.70
12014,501002482,Hospital Chargemaster,Rpr f/e/e/n/l/m 5.1-7.5 cm,Outpatient,Outpatient Default Percent / Case Rate,761, $431.00 , $237.05 ," $1,236.00 ", $214.68 , $301.70 , $168.09 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $431.00 , $431.00 , $431.00 , $431.00 , $214.68 , $150.85 , $- , $- ," $1,236.00 ", $301.70
12004,501002479,Hospital Chargemaster,Rpr s/n/ax/gen/trk7.6-12.5cm,Outpatient,Outpatient Default Percent / Case Rate,761, $398.00 , $218.90 ," $1,236.00 ", $214.68 , $278.60 , $155.22 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $398.00 , $398.00 , $398.00 , $398.00 , $214.68 , $139.30 , $- , $- ," $1,236.00 ", $278.60
12013,501002481,Hospital Chargemaster,Rpr f/e/e/n/l/m 2.6-5.0 cm,Outpatient,Outpatient Default Percent / Case Rate,761, $362.00 , $199.10 , $298.29 , $214.68 , $253.40 , $141.18 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $362.00 , $362.00 , $362.00 , $362.00 , $214.68 , $126.70 , $- , $- , $844.48 , $253.40
11102,501002435,Hospital Chargemaster,Tangntl bx skin single les,Outpatient,Outpatient Default Percent / Case Rate,761, $353.00 , $194.15 ," $1,236.00 ", $214.68 , $247.10 , $137.67 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $123.55 , $- , $- ," $1,236.00 ", $247.10
12015,501002483,Hospital Chargemaster,Rpr f/e/e/n/l/m 7.6-12.5 cm,Outpatient,Outpatient Default Percent / Case Rate,761, $536.00 , $294.80 ," $1,236.00 ", $214.68 , $375.20 , $209.04 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $187.60 , $- , $- ," $1,236.00 ", $375.20
17270,501002505,Hospital Chargemaster,Destruction of skin lesions,Outpatient,Outpatient Default Percent / Case Rate,761, $446.00 , $245.30 ," $1,236.00 ", $214.68 , $312.20 , $173.94 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $156.10 , $- , $- ," $1,236.00 ", $312.20
17280,501002506,Hospital Chargemaster,Destruction of skin lesions,Outpatient,Outpatient Default Percent / Case Rate,761, $446.00 , $245.30 ," $1,236.00 ", $214.68 , $312.20 , $173.94 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $156.10 , $- , $- ," $1,236.00 ", $312.20
11102,6500010080,Hospital Chargemaster,Tangntl bx skin single les,Outpatient,Outpatient Default Percent / Case Rate,761, $353.00 , $194.15 ," $1,236.00 ", $214.68 , $247.10 , $137.67 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $123.55 , $- , $- ," $1,236.00 ", $247.10
16025,501002498,Hospital Chargemaster,Dress/debrid p-thick burn m,Outpatient,Outpatient Default Percent / Case Rate,761, $344.00 , $189.20 ," $1,442.00 ", $214.68 , $240.80 , $134.16 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $120.40 , $- , $- ," $1,442.00 ", $240.80
12002,501002478,Hospital Chargemaster,Rpr s/n/ax/gen/trnk2.6-7.5cm,Outpatient,Outpatient Default Percent / Case Rate,761, $342.00 , $188.10 , $281.81 , $214.68 , $239.40 , $133.38 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $342.00 , $342.00 , $342.00 , $342.00 , $214.68 , $119.70 , $- , $- , $386.01 , $239.40
12002,6500010123,Hospital Chargemaster,Rpr s/n/ax/gen/trnk2.6-7.5cm,Outpatient,Outpatient Default Percent / Case Rate,761, $339.00 , $186.45 , $279.34 , $214.68 , $237.30 , $132.21 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $342.00 , $342.00 , $342.00 , $342.00 , $214.68 , $118.65 , $- , $- , $386.01 , $237.30
12001,501002477,Hospital Chargemaster,Rpr s/n/ax/gen/trnk 2.5cm/<,Outpatient,Outpatient Default Percent / Case Rate,761, $330.00 , $181.50 ," $1,236.00 ", $214.68 , $231.00 , $128.70 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $330.00 , $330.00 , $330.00 , $330.00 , $214.68 , $115.50 , $- , $- ," $1,236.00 ", $231.00
12001,6500010122,Hospital Chargemaster,Rpr s/n/ax/gen/trnk 2.5cm/<,Outpatient,Outpatient Default Percent / Case Rate,761, $332.00 , $182.60 ," $1,236.00 ", $214.68 , $232.40 , $129.48 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $330.00 , $330.00 , $330.00 , $330.00 , $214.68 , $116.20 , $- , $- ," $1,236.00 ", $232.40
12011,501002480,Hospital Chargemaster,Rpr f/e/e/n/l/m 2.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,761, $317.00 , $174.35 , $261.21 , $214.68 , $221.90 , $123.63 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $317.00 , $317.00 , $317.00 , $317.00 , $214.68 , $110.95 , $- , $- , $844.48 , $221.90
10060,6500010063,Hospital Chargemaster,Drainage of skin abscess,Outpatient,Outpatient Default Percent / Case Rate,761, $202.00 , $111.10 ," $1,236.00 ", $214.68 , $141.40 , $78.78 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $187.86 , $187.86 , $187.86 , $187.86 , $214.68 , $70.70 , $- , $- ," $1,236.00 ", $141.40
11057,501002434,Hospital Chargemaster,Trim skin lesions over 4,Outpatient,Outpatient Default Percent / Case Rate,761, $271.00 , $149.05 ," $1,236.00 ", $214.68 , $189.70 , $105.69 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $112.55 , $109.14 , $225.42 , $218.98 , $271.00 , $271.00 , $271.00 , $271.00 , $214.68 , $94.85 , $- , $- ," $1,236.00 ", $189.70
17111,6500010609,Hospital Chargemaster,Destruct Lesion 15 Or More,Outpatient,Outpatient Default Percent / Case Rate,761, $245.00 , $134.75 ," $1,236.00 ", $214.68 , $171.50 , $95.55 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $245.00 , $245.00 , $245.00 , $245.00 , $214.68 , $85.75 , $- , $- ," $1,236.00 ", $171.50
11055,501002432,Hospital Chargemaster,Trim skin lesion,Outpatient,Outpatient Default Percent / Case Rate,761, $239.00 , $131.45 ," $1,236.00 ", $214.68 , $167.30 , $93.21 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $61.61 , $59.74 , $225.42 , $218.98 , $239.00 , $239.00 , $239.00 , $239.00 , $214.68 , $83.65 , $- , $- ," $1,236.00 ", $167.30
11055,6500010077,Hospital Chargemaster,Trim skin lesion,Outpatient,Outpatient Default Percent / Case Rate,761, $186.00 , $102.30 ," $1,236.00 ", $214.68 , $130.20 , $72.54 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $61.61 , $59.74 , $225.42 , $218.98 , $239.00 , $239.00 , $239.00 , $239.00 , $214.68 , $65.10 , $- , $- ," $1,236.00 ", $130.20
11200,501002441,Hospital Chargemaster,Removal of skin tags ,Outpatient,Outpatient Default Percent / Case Rate,761, $446.00 , $245.30 ," $1,236.00 ", $312.35 , $312.20 , $173.94 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $89.51 , $86.79 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $156.10 , $- , $- ," $1,236.00 ", $312.20
20600,6500010184,Hospital Chargemaster,Drain/inj joint/bursa w/o us,Outpatient,Outpatient Default Percent / Case Rate,761, $264.00 , $145.20 ," $1,236.00 ", $312.35 , $184.80 , $102.96 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $96.34 , $93.41 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $92.40 , $- , $- ," $1,236.00 ", $184.80
20552,6500010182,Hospital Chargemaster,Inj trigger point 1/2 muscl,Outpatient,Outpatient Default Percent / Case Rate,761, $300.00 , $165.00 ," $1,236.00 ", $312.35 , $210.00 , $117.00 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $80.71 , $78.26 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $105.00 , $- , $- ," $1,236.00 ", $210.00
20611,6500010188,Hospital Chargemaster,Drain/inj joint/bursa w/us,Outpatient,Outpatient Default Percent / Case Rate,761, $375.00 , $206.25 ," $1,236.00 ", $312.35 , $262.50 , $146.25 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $348.75 , $348.75 , $348.75 , $348.75 , $312.35 , $131.25 , $- , $- ," $1,236.00 ", $262.50
11983,6500010559,Hospital Chargemaster,Remove/Insert Drug Implant,Outpatient,Outpatient Default Percent / Case Rate,761, $440.00 , $242.00 ," $1,236.00 ", $324.46 , $308.00 , $171.60 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $844.48 , $822.61 , $340.68 , $330.95 , $343.81 , $343.81 , $343.81 , $343.81 , $324.46 , $154.00 , $- , $- ," $1,236.00 ", $308.00
36593,501002640,Hospital Chargemaster,Declot vascular device,Outpatient,Outpatient Default Percent / Case Rate,761, $286.00 , $157.30 ," $1,236.00 ", $381.19 , $200.20 , $111.54 , $630.87 , $433.00 , $430.69 , $381.19 , $381.19 , $81.74 , $79.26 , $400.25 , $388.81 , $286.00 , $286.00 , $286.00 , $286.00 , $381.19 , $100.10 , $- , $- ," $1,236.00 ", $200.20
11750,501002473,Hospital Chargemaster,Removal of nail bed,Outpatient,Outpatient Default Percent / Case Rate,761, $526.00 , $289.30 ," $1,236.00 ", $413.21 , $368.20 , $205.14 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $526.00 , $526.00 , $526.00 , $526.00 , $413.21 , $184.10 , $- , $- ," $1,236.00 ", $368.20
11602,501002460,Hospital Chargemaster,Exc tr-ext mal+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,761, $444.00 , $244.20 ," $1,236.00 ", $413.21 , $310.80 , $173.16 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $444.00 , $444.00 , $444.00 , $444.00 , $413.21 , $155.40 , $- , $- ," $1,236.00 ", $310.80
11602,6500010105,Hospital Chargemaster,Exc tr-ext mal+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,761, $444.00 , $244.20 ," $1,236.00 ", $413.21 , $310.80 , $173.16 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $444.00 , $444.00 , $444.00 , $444.00 , $413.21 , $155.40 , $- , $- ," $1,236.00 ", $310.80
10061,6500010064,Hospital Chargemaster,Drainage of skin abscess,Outpatient,Outpatient Default Percent / Case Rate,761, $341.00 , $187.55 ," $1,236.00 ", $413.21 , $238.70 , $132.99 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $317.13 , $317.13 , $317.13 , $317.13 , $413.21 , $119.35 , $- , $- ," $1,236.00 ", $238.70
17004,501002502,Hospital Chargemaster,Destroy premal lesions 15/>,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 ," $1,236.00 ", $413.21 , $571.90 , $318.63 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $285.95 , $- , $- ," $1,236.00 ", $571.90
17106,501002503,Hospital Chargemaster,Destruction of skin lesions,Outpatient,Outpatient Default Percent / Case Rate,761, $975.00 , $536.25 ," $1,236.00 ", $413.21 , $682.50 , $380.25 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $341.25 , $- , $- ," $1,236.00 ", $682.50
16030,501002499,Hospital Chargemaster,Dress/debrid p-thick burn l,Outpatient,Outpatient Default Percent / Case Rate,761, $391.00 , $215.05 ," $1,442.00 ", $413.21 , $273.70 , $152.49 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $136.85 , $- , $- ," $1,442.00 ", $273.70
11104,501002437,Hospital Chargemaster,Punch bx skin single lesion,Outpatient,Outpatient Default Percent / Case Rate,761, $353.00 , $194.15 , $290.87 , $413.21 , $247.10 , $137.67 , $386.01 , $264.94 , $263.52 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $123.55 , $- , $- , $433.88 , $247.10
11104,6500010082,Hospital Chargemaster,Punch bx skin single lesion,Outpatient,Outpatient Default Percent / Case Rate,761, $353.00 , $194.15 , $290.87 , $413.21 , $247.10 , $137.67 , $386.01 , $264.94 , $263.52 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $123.55 , $- , $- , $433.88 , $247.10
11401,501002447,Hospital Chargemaster,Exc tr-ext b9+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,761, $341.00 , $187.55 ," $1,236.00 ", $413.21 , $238.70 , $132.99 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $341.00 , $341.00 , $341.00 , $341.00 , $413.21 , $119.35 , $- , $- ," $1,236.00 ", $238.70
11401,6500010092,Hospital Chargemaster,Exc tr-ext b9+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,761, $341.00 , $187.55 ," $1,236.00 ", $413.21 , $238.70 , $132.99 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $341.00 , $341.00 , $341.00 , $341.00 , $413.21 , $119.35 , $- , $- ," $1,236.00 ", $238.70
10160,501002423,Hospital Chargemaster,Puncture drainage of lesion,Outpatient,Outpatient Default Percent / Case Rate,761, $290.00 , $159.50 ," $1,236.00 ", $413.21 , $203.00 , $113.10 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $269.70 , $269.70 , $269.70 , $269.70 , $413.21 , $101.50 , $- , $- ," $1,236.00 ", $203.00
10160,6500010068,Hospital Chargemaster,Puncture drainage of lesion,Outpatient,Outpatient Default Percent / Case Rate,761, $341.00 , $187.55 ," $1,236.00 ", $413.21 , $238.70 , $132.99 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $317.13 , $317.13 , $317.13 , $317.13 , $413.21 , $119.35 , $- , $- ," $1,236.00 ", $238.70
10120,501002421,Hospital Chargemaster,Remove foreign body,Outpatient,Outpatient Default Percent / Case Rate,761, $278.00 , $152.90 ," $1,236.00 ", $413.21 , $194.60 , $108.42 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $258.54 , $258.54 , $258.54 , $258.54 , $413.21 , $97.30 , $- , $- ," $1,236.00 ", $194.60
10120,6500010066,Hospital Chargemaster,Remove foreign body,Outpatient,Outpatient Default Percent / Case Rate,761, $341.00 , $187.55 ," $1,236.00 ", $413.21 , $238.70 , $132.99 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $317.13 , $317.13 , $317.13 , $317.13 , $413.21 , $119.35 , $- , $- ," $1,236.00 ", $238.70
12041,501002484,Hospital Chargemaster,Intmd rpr n-hf/genit 2.5cm/<,Outpatient,Outpatient Default Percent / Case Rate,761, $216.00 , $118.80 ," $1,236.00 ", $413.21 , $151.20 , $84.24 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $216.00 , $216.00 , $216.00 , $216.00 , $413.21 , $75.60 , $- , $- ," $1,236.00 ", $151.20
11765,501002474,Hospital Chargemaster,Excision of nail fold toe,Outpatient,Outpatient Default Percent / Case Rate,761, $210.00 , $115.50 ," $1,236.00 ", $413.21 , $147.00 , $81.90 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $210.00 , $210.00 , $210.00 , $210.00 , $413.21 , $73.50 , $- , $- ," $1,236.00 ", $147.00
11300,501002443,Hospital Chargemaster,Shave skin lesion 0.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,761, $186.00 , $102.30 , $153.26 , $413.21 , $130.20 , $72.54 , $386.01 , $264.94 , $263.52 , $413.21 , $413.21 , $66.99 , $64.96 , $433.88 , $421.48 , $185.14 , $185.14 , $185.14 , $185.14 , $413.21 , $65.10 , $- , $- , $433.88 , $130.20
11300,6500010088,Hospital Chargemaster,Shave skin lesion 0.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,761, $186.00 , $102.30 , $153.26 , $413.21 , $130.20 , $72.54 , $386.01 , $264.94 , $263.52 , $413.21 , $413.21 , $66.99 , $64.96 , $433.88 , $421.48 , $185.14 , $185.14 , $185.14 , $185.14 , $413.21 , $65.10 , $- , $- , $433.88 , $130.20
11042,6500010071,Hospital Chargemaster,Deb subq tissue 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,761, $341.00 , $187.55 ," $1,442.00 ", $413.21 , $238.70 , $132.99 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $119.35 , $- , $- ," $1,442.00 ", $238.70
C5271,501002864,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,761, $830.00 , $456.50 ," $1,442.00 ", $626.13 , $581.00 , $323.70 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $556.93 , $556.93 , $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $290.50 , $- , $- ," $1,442.00 ", $581.00
C5275,501002868,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,761, $830.00 , $456.50 ," $1,442.00 ", $626.13 , $581.00 , $323.70 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $556.93 , $556.93 , $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $290.50 , $- , $- ," $1,442.00 ", $581.00
C5277,501002870,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,761, $960.00 , $528.00 ," $1,442.00 ", $626.13 , $672.00 , $374.40 , $926.30 , $930.34 , $494.42 , $626.13 , $626.13 , $644.16 , $644.16 , $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $336.00 , $- , $- ," $1,442.00 ", $672.00
11106,501002439,Hospital Chargemaster,Incal bx skn single les,Outpatient,Outpatient Default Percent / Case Rate,761, $628.00 , $345.40 ," $1,236.00 ", $626.13 , $439.60 , $244.92 , $687.09 , $471.59 , $469.08 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $219.80 , $- , $- ," $1,236.00 ", $439.60
11106,6500010084,Hospital Chargemaster,Incal bx skn single les,Outpatient,Outpatient Default Percent / Case Rate,761, $628.00 , $345.40 ," $1,236.00 ", $626.13 , $439.60 , $244.92 , $687.09 , $471.59 , $469.08 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $219.80 , $- , $- ," $1,236.00 ", $439.60
11043,501002427,Hospital Chargemaster,Deb musc/fascia 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,761, $724.00 , $398.20 ," $1,442.00 ", $626.13 , $506.80 , $282.36 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $253.40 , $- , $- ," $1,442.00 ", $506.80
11043,6500010072,Hospital Chargemaster,Deb musc/fascia 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,761, $537.00 , $295.35 ," $1,442.00 ", $626.13 , $375.90 , $209.43 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $187.95 , $- , $- ," $1,442.00 ", $375.90
15852,501002495,Hospital Chargemaster,Dressing change not for burn,Outpatient,Outpatient Default Percent / Case Rate,761, $300.00 , $165.00 ," $1,236.00 ", $626.13 , $210.00 , $117.00 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $185.14 , $185.14 , $185.14 , $185.14 , $626.13 , $105.00 , $- , $- ," $1,236.00 ", $210.00
11000,501002424,Hospital Chargemaster,Debride infected skin,Outpatient,Outpatient Default Percent / Case Rate,761, $90.00 , $49.50 ," $1,236.00 ", $626.13 , $63.00 , $35.10 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $83.70 , $83.70 , $83.70 , $83.70 , $626.13 , $31.50 , $- , $- ," $1,236.00 ", $63.00
32555,501002589,Hospital Chargemaster,Aspirate pleura w/ imaging,Outpatient,Outpatient Default Percent / Case Rate,761," $1,142.00 ", $628.10 ," $1,236.00 ", $646.21 , $799.40 , $445.38 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $105.28 , $102.55 , $678.52 , $659.13 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $646.21 , $399.70 , $- , $- ," $1,356.36 ", $799.40
36589,501002638,Hospital Chargemaster,Removal tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,236.00 ", $646.21 ," $1,015.00 ", $565.50 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $844.48 , $822.61 , $678.52 , $659.13 , $740.30 , $740.30 , $740.30 , $740.30 , $646.21 , $507.50 , $- , $- ," $1,356.36 "," $1,015.00 "
36575,501002629,Hospital Chargemaster,Repair tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,442.00 ", $646.21 ," $1,015.00 ", $565.50 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 ," $1,133.44 "," $1,104.09 ", $678.52 , $659.13 , $740.30 , $740.30 , $740.30 , $740.30 , $646.21 , $507.50 , $- , $- ," $1,442.00 "," $1,015.00 "
32552,501002587,Hospital Chargemaster,Remove lung catheter,Outpatient,Outpatient Default Percent / Case Rate,761, $575.00 , $316.25 ," $1,236.00 ", $646.21 , $402.50 , $224.25 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $385.83 , $385.83 , $678.52 , $659.13 , $575.00 , $575.00 , $575.00 , $575.00 , $646.21 , $201.25 , $- , $- ," $1,356.36 ", $402.50
32554,501002588,Hospital Chargemaster,Aspirate pleura w/o imaging,Outpatient,Outpatient Default Percent / Case Rate,761, $110.00 , $60.50 ," $1,236.00 ", $646.21 , $77.00 , $42.90 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $105.28 , $102.55 , $678.52 , $659.13 , $110.00 , $110.00 , $110.00 , $110.00 , $646.21 , $38.50 , $- , $- ," $1,356.36 ", $77.00
33286,501002595,Hospital Chargemaster,Rmvl subq car rhythm mntr,Outpatient,Outpatient Default Percent / Case Rate,761," $1,800.00 ", $990.00 ," $1,236.00 ", $743.95 ," $1,260.00 ", $702.00 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $743.95 , $630.00 , $- , $- ," $1,267.38 "," $1,260.00 "
11600,501002458,Hospital Chargemaster,Exc tr-ext mal+marg 0.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,761," $1,142.00 ", $628.10 ," $1,236.00 ", $743.95 , $799.40 , $445.38 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $743.95 , $399.70 , $- , $- ," $1,267.38 ", $799.40
10005,501002407,Hospital Chargemaster,Fna bx w/us gdn 1st les,Outpatient,Outpatient Default Percent / Case Rate,761, $850.00 , $467.50 ," $1,236.00 ", $743.95 , $595.00 , $331.50 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $790.50 , $790.50 , $790.50 , $790.50 , $743.95 , $297.50 , $- , $- ," $1,267.38 ", $595.00
10005,6500010052,Hospital Chargemaster,Fna bx w/us gdn 1st les,Outpatient,Outpatient Default Percent / Case Rate,761, $637.00 , $350.35 ," $1,236.00 ", $743.95 , $445.90 , $248.43 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $592.41 , $592.41 , $592.41 , $592.41 , $743.95 , $222.95 , $- , $- ," $1,267.38 ", $445.90
11621,501002462,Hospital Chargemaster,Exc s/n/h/f/g mal+mrg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 ," $1,236.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,267.38 ", $571.90
11440,501002455,Hospital Chargemaster,Exc face-mm b9+marg 0.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 ," $1,442.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,442.00 ", $571.90
11640,501002464,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 0.5cm<,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 ," $1,442.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,442.00 ", $571.90
11642,501002466,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 ," $1,442.00 ", $743.95 , $571.90 , $318.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $285.95 , $- , $- ," $1,442.00 ", $571.90
11640,6500010109,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 0.5cm<,Outpatient,Outpatient Default Percent / Case Rate,761, $510.00 , $280.50 ," $1,442.00 ", $743.95 , $357.00 , $198.90 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $178.50 , $- , $- ," $1,442.00 ", $357.00
11402,501002448,Hospital Chargemaster,Exc tr-ext b9+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11403,501002449,Hospital Chargemaster,Exc tr-ext b9+marg 2.1-3cm,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11442,501002457,Hospital Chargemaster,Exc face-mm b9+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11601,501002459,Hospital Chargemaster,Exc tr-ext mal+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11622,501002463,Hospital Chargemaster,Exc s/n/h/f/g mal+mrg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11402,6500010093,Hospital Chargemaster,Exc tr-ext b9+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11403,6500010094,Hospital Chargemaster,Exc tr-ext b9+marg 2.1-3cm,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11442,6500010102,Hospital Chargemaster,Exc face-mm b9+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11601,6500010104,Hospital Chargemaster,Exc tr-ext mal+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11622,6500010108,Hospital Chargemaster,Exc s/n/h/f/g mal+mrg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11603,6500010543,Hospital Chargemaster,Exc Tr-Ext Mal+Marg 2.1-3 Cm,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11976,6500010556,Hospital Chargemaster,Remove Contraceptive Capsule,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11421,501002452,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,442.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,442.00 ", $441.00
11441,501002456,Hospital Chargemaster,Exc face-mm b9+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,442.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,442.00 ", $441.00
11421,6500010097,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,442.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,442.00 ", $441.00
11441,6500010101,Hospital Chargemaster,Exc face-mm b9+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,442.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,442.00 ", $441.00
11604,6500010544,Hospital Chargemaster,Exc Tr-Ext Mal+Marg 3.1-4 Cm,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,442.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 ," $1,133.44 "," $1,104.09 ", $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $220.50 , $- , $- ," $1,442.00 ", $441.00
19000,501002507,Hospital Chargemaster,Drainage of breast lesion,Outpatient,Outpatient Default Percent / Case Rate,761, $590.00 , $324.50 ," $1,236.00 ", $743.95 , $413.00 , $230.10 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $590.00 , $590.00 , $590.00 , $590.00 , $743.95 , $206.50 , $- , $- ," $1,267.38 ", $413.00
11641,501002465,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,761, $558.00 , $306.90 ," $1,442.00 ", $743.95 , $390.60 , $217.62 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $558.00 , $558.00 , $558.00 , $558.00 , $743.95 , $195.30 , $- , $- ," $1,442.00 ", $390.60
10030,501002415,Hospital Chargemaster,Guide cathet fluid drainage,Outpatient,Outpatient Default Percent / Case Rate,761, $470.00 , $258.50 ," $1,442.00 ", $743.95 , $329.00 , $183.30 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $437.10 , $437.10 , $437.10 , $437.10 , $743.95 , $164.50 , $- , $- ," $1,442.00 ", $329.00
19281,501002517,Hospital Chargemaster,Perq device breast 1st imag,Outpatient,Outpatient Default Percent / Case Rate,761, $352.00 , $193.60 ," $1,442.00 ", $743.95 , $246.40 , $137.28 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $236.19 , $236.19 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $123.20 , $- , $- ," $1,442.00 ", $246.40
19283,501002519,Hospital Chargemaster,Perq dev breast 1st strtctc,Outpatient,Outpatient Default Percent / Case Rate,761, $352.00 , $193.60 ," $1,442.00 ", $743.95 , $246.40 , $137.28 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $236.19 , $236.19 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $123.20 , $- , $- ," $1,442.00 ", $246.40
19285,501002521,Hospital Chargemaster,Perq dev breast 1st us imag,Outpatient,Outpatient Default Percent / Case Rate,761, $352.00 , $193.60 ," $1,442.00 ", $743.95 , $246.40 , $137.28 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $236.19 , $236.19 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $123.20 , $- , $- ," $1,442.00 ", $246.40
10080,6500010065,Hospital Chargemaster,Drainage of pilonidal cyst,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $585.90 , $585.90 , $585.90 , $585.90 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
11400,501002446,Hospital Chargemaster,Exc tr-ext b9+marg 0.5 cm<,Outpatient,Outpatient Default Percent / Case Rate,761, $234.00 , $128.70 ," $1,236.00 ", $743.95 , $163.80 , $91.26 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $234.00 , $234.00 , $234.00 , $234.00 , $743.95 , $81.90 , $- , $- ," $1,267.38 ", $163.80
11400,6500010091,Hospital Chargemaster,Exc tr-ext b9+marg 0.5 cm<,Outpatient,Outpatient Default Percent / Case Rate,761, $630.00 , $346.50 ," $1,236.00 ", $743.95 , $441.00 , $245.70 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $234.00 , $234.00 , $234.00 , $234.00 , $743.95 , $220.50 , $- , $- ," $1,267.38 ", $441.00
G0260,501002872,Hospital Chargemaster,Inj for sacroiliac jt anesth,Outpatient,Outpatient Default Percent / Case Rate,761," $1,650.00 ", $907.50 ," $1,236.00 ", $759.14 ," $1,155.00 ", $643.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 ," $1,107.15 "," $1,107.15 ", $797.10 , $774.33 , $978.40 , $978.40 ," $1,003.60 "," $1,003.60 ", $759.14 , $577.50 , $- , $- ," $1,309.97 "," $1,155.00 "
20606,6500010186,Hospital Chargemaster,Drain/inj joint/bursa w/us,Outpatient,Outpatient Default Percent / Case Rate,761, $900.00 , $495.00 ," $1,236.00 ", $759.14 , $630.00 , $351.00 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $837.00 , $837.00 , $837.00 , $837.00 , $759.14 , $315.00 , $- , $- ," $1,309.97 ", $630.00
27238,6500010946,Hospital Chargemaster,Treat Thigh Fracture,Outpatient,Outpatient Default Percent / Case Rate,761," $1,485.00 ", $816.75 ," $1,236.00 "," $1,665.16 "," $1,039.50 ", $579.15 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $519.75 , $- , $- ," $2,873.10 "," $1,039.50 "
36580,501002632,Hospital Chargemaster,Replace cvad cath,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,236.00 "," $1,681.14 "," $1,015.00 ", $565.50 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,681.14 ", $507.50 , $- , $- ," $2,392.46 "," $1,015.00 "
36597,501002642,Hospital Chargemaster,Reposition venous catheter,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,236.00 "," $1,681.14 "," $1,015.00 ", $565.50 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $105.28 , $102.55 ," $1,765.20 "," $1,714.76 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,681.14 ", $507.50 , $- , $- ," $2,392.46 "," $1,015.00 "
36584,501002636,Hospital Chargemaster,Compl rplcmt picc rs&i,Outpatient,Outpatient Default Percent / Case Rate,761," $1,400.00 ", $770.00 ," $1,236.00 "," $1,681.14 ", $980.00 , $546.00 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,681.14 ", $490.00 , $- , $- ," $2,392.46 ", $980.00
36576,501002630,Hospital Chargemaster,Repair tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,442.00 "," $1,681.14 "," $1,015.00 ", $565.50 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 "," $1,133.44 "," $1,104.09 "," $1,765.20 "," $1,714.76 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,681.14 ", $507.50 , $- , $- ," $2,392.46 "," $1,015.00 "
36590,501002639,Hospital Chargemaster,Removal tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,761," $1,142.00 ", $628.10 ," $1,236.00 "," $1,681.14 ", $799.40 , $445.38 ," $1,356.36 ", $930.94 , $925.98 ," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,681.14 ", $399.70 , $- , $- ," $1,765.20 ", $799.40
32551,501002586,Hospital Chargemaster,Insertion of chest tube,Outpatient,Outpatient Default Percent / Case Rate,761, $528.00 , $290.40 ," $1,442.00 "," $1,681.14 ", $369.60 , $205.92 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 ", $528.00 , $528.00 , $528.00 , $528.00 ," $1,681.14 ", $184.80 , $- , $- ," $2,392.46 ", $369.60
11423,501002454,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 2.1-3,Outpatient,Outpatient Default Percent / Case Rate,761," $1,483.00 ", $815.65 ," $1,236.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
11423,6500010099,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 2.1-3,Outpatient,Outpatient Default Percent / Case Rate,761," $1,483.00 ", $815.65 ," $1,236.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
11406,501002450,Hospital Chargemaster,Exc tr-ext b9+marg >4.0 cm,Outpatient,Outpatient Default Percent / Case Rate,761," $1,483.00 ", $815.65 ," $1,442.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
11406,6500010095,Hospital Chargemaster,Exc tr-ext b9+marg >4.0 cm,Outpatient,Outpatient Default Percent / Case Rate,761," $1,483.00 ", $815.65 ," $1,442.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
11424,6500010533,Hospital Chargemaster,Exc H-F-Nk-Sp B9+Marg 3.1-4,Outpatient,Outpatient Default Percent / Case Rate,761," $1,483.00 ", $815.65 ," $1,442.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
23065,501002554,Hospital Chargemaster,Biopsy shoulder tissues,Outpatient,Outpatient Default Percent / Case Rate,761," $2,500.00 "," $1,375.00 "," $1,236.00 "," $1,682.11 "," $1,750.00 ", $975.00 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $875.00 , $- , $- ," $3,009.07 "," $1,750.00 "
11623,6500010546,Hospital Chargemaster,Exc S/N/H/F/G Mal+Mrg 2.1-3,Outpatient,Outpatient Default Percent / Case Rate,761," $1,483.00 ", $815.65 ," $1,236.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
19081,501002510,Hospital Chargemaster,Bx breast 1st lesion strtctc,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,442.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
11620,501002461,Hospital Chargemaster,Exc h-f-nk-sp mal+marg 0.5/<,Outpatient,Outpatient Default Percent / Case Rate,761," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
20206,501002527,Hospital Chargemaster,Needle biopsy muscle,Outpatient,Outpatient Default Percent / Case Rate,761," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
20220,501002528,Hospital Chargemaster,Bone biopsy trocar/needle,Outpatient,Outpatient Default Percent / Case Rate,761," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
11044,501002428,Hospital Chargemaster,Deb bone 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,761," $1,004.00 ", $552.20 ," $1,442.00 "," $1,682.11 ", $702.80 , $391.56 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,004.00 "," $1,004.00 "," $1,004.00 "," $1,004.00 "," $1,682.11 ", $351.40 , $- , $- ," $3,009.07 ", $702.80
19100,6500010612,Hospital Chargemaster,Bx Breast Percut W/O Image,Outpatient,Outpatient Default Percent / Case Rate,761," $1,770.00 ", $973.50 ," $1,236.00 "," $1,682.11 "," $1,239.00 ", $690.30 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 ", $740.30 , $740.30 , $740.30 , $740.30 ," $1,682.11 ", $619.50 , $- , $- ," $3,009.07 "," $1,239.00 "
20520,501002531,Hospital Chargemaster,Removal of foreign body,Outpatient,Outpatient Default Percent / Case Rate,761," $1,483.00 ", $815.65 ," $1,442.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $740.30 , $740.30 , $740.30 , $740.30 ," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
20520,6500010176,Hospital Chargemaster,Removal of foreign body,Outpatient,Outpatient Default Percent / Case Rate,761," $1,483.00 ", $815.65 ," $1,442.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $740.30 , $740.30 , $740.30 , $740.30 ," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
23931,501002556,Hospital Chargemaster,Drainage of arm bursa,Outpatient,Outpatient Default Percent / Case Rate,761, $505.00 , $277.75 ," $1,442.00 "," $1,682.11 ", $353.50 , $196.95 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $505.00 , $505.00 , $505.00 , $505.00 ," $1,682.11 ", $176.75 , $- , $- ," $3,009.07 ", $353.50
11422,501002453,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,761, $400.00 , $220.00 ," $1,236.00 "," $1,682.11 ", $280.00 , $156.00 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $400.00 , $400.00 , $400.00 , $400.00 ," $1,682.11 ", $140.00 , $- , $- ," $3,009.07 ", $280.00
11422,6500010098,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,761," $1,483.00 ", $815.65 ," $1,236.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $400.00 , $400.00 , $400.00 , $400.00 ," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
10140,501002422,Hospital Chargemaster,Drainage of hematoma/fluid,Outpatient,Outpatient Default Percent / Case Rate,761, $356.00 , $195.80 ," $1,236.00 "," $1,682.11 ", $249.20 , $138.84 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $331.08 , $331.08 , $331.08 , $331.08 ," $1,682.11 ", $124.60 , $- , $- ," $3,009.07 ", $249.20
10140,6500010067,Hospital Chargemaster,Drainage of hematoma/fluid,Outpatient,Outpatient Default Percent / Case Rate,761," $1,483.00 ", $815.65 ," $1,236.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,379.19 "," $1,379.19 "," $1,379.19 "," $1,379.19 "," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
11420,501002451,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 0.5/<,Outpatient,Outpatient Default Percent / Case Rate,761, $290.00 , $159.50 ," $1,442.00 "," $1,682.11 ", $203.00 , $113.10 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $290.00 , $290.00 , $290.00 , $290.00 ," $1,682.11 ", $101.50 , $- , $- ," $3,009.07 ", $203.00
11420,6500010096,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 0.5/<,Outpatient,Outpatient Default Percent / Case Rate,761," $1,483.00 ", $815.65 ," $1,442.00 "," $1,682.11 "," $1,038.10 ", $578.37 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $290.00 , $290.00 , $290.00 , $290.00 ," $1,682.11 ", $519.05 , $- , $- ," $3,009.07 "," $1,038.10 "
20225,501002529,Hospital Chargemaster,Bone biopsy trocar/needle,Outpatient,Outpatient Default Percent / Case Rate,761, $260.00 , $143.00 ," $1,442.00 "," $1,682.11 ", $182.00 , $101.40 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $260.00 , $260.00 , $260.00 , $260.00 ," $1,682.11 ", $91.00 , $- , $- ," $3,009.07 ", $182.00
58671,6500011792,Hospital Chargemaster,Laparoscopy Tubal Block,Outpatient,Outpatient Default Percent / Case Rate,761," $4,938.00 "," $2,715.90 "," $2,060.00 "," $6,049.19 "," $3,456.60 "," $1,925.82 "," $10,054.00 "," $6,900.63 "," $6,863.84 "," $6,049.19 "," $6,049.19 "," $1,599.36 "," $1,557.95 "," $6,351.65 "," $6,170.18 "," $4,315.01 "," $4,315.01 "," $4,315.01 "," $4,315.01 "," $6,049.19 "," $1,728.30 ", $- , $- ," $10,054.00 "," $3,456.60 "
58661,6500011790,Hospital Chargemaster,Laparoscopy Remove Adnexa,Outpatient,Outpatient Default Percent / Case Rate,761," $4,938.00 "," $2,715.90 "," $2,739.80 "," $6,049.19 "," $3,456.60 "," $1,925.82 "," $10,054.00 "," $6,900.63 "," $6,863.84 "," $6,049.19 "," $6,049.19 "," $1,823.36 "," $1,776.15 "," $6,351.65 "," $6,170.18 "," $4,315.01 "," $4,315.01 "," $4,315.01 "," $4,315.01 "," $6,049.19 "," $1,728.30 ", $- , $- ," $10,054.00 "," $3,456.60 "
31625,501002581,Hospital Chargemaster,Bronchoscopy w/biopsy(s),Outpatient,Outpatient Default Percent / Case Rate,761," $2,540.00 "," $1,397.00 "," $1,442.00 "," $1,788.65 "," $1,778.00 ", $990.60 ," $2,995.49 "," $2,055.97 "," $2,045.01 "," $1,788.65 "," $1,788.65 ", $844.48 , $822.61 ," $1,878.08 "," $1,824.42 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $1,788.65 ", $889.00 , $- , $- ," $2,995.49 "," $1,778.00 "
31622,501002580,Hospital Chargemaster,Dx bronchoscope/wash,Outpatient,Outpatient Default Percent / Case Rate,761," $2,305.00 "," $1,267.75 "," $1,442.00 "," $1,788.65 "," $1,613.50 ", $898.95 ," $2,995.49 "," $2,055.97 "," $2,045.01 "," $1,788.65 "," $1,788.65 ", $844.48 , $822.61 ," $1,878.08 "," $1,824.42 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,788.65 ", $806.75 , $- , $- ," $2,995.49 "," $1,613.50 "
C5273,501002866,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,761," $3,100.00 "," $1,705.00 "," $1,442.00 "," $2,047.65 "," $2,170.00 "," $1,209.00 "," $2,991.19 "," $3,004.21 "," $1,596.56 "," $2,047.65 "," $2,047.65 "," $2,080.10 "," $2,080.10 "," $2,150.03 "," $2,088.60 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,047.65 "," $1,085.00 ", $- , $- ," $3,004.21 "," $2,170.00 "
15271,501002486,Hospital Chargemaster,Skin sub graft trnk/arm/leg,Outpatient,Outpatient Default Percent / Case Rate,761," $2,265.00 "," $1,245.75 "," $1,442.00 "," $2,047.65 "," $1,585.50 ", $883.35 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $792.75 , $- , $- ," $3,388.54 "," $1,585.50 "
15275,501002490,Hospital Chargemaster,Skin sub graft face/nk/hf/g,Outpatient,Outpatient Default Percent / Case Rate,761," $2,265.00 "," $1,245.75 "," $1,442.00 "," $2,047.65 "," $1,585.50 ", $883.35 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $792.75 , $- , $- ," $3,388.54 "," $1,585.50 "
15277,501002492,Hospital Chargemaster,Skn sub grft f/n/hf/g child,Outpatient,Outpatient Default Percent / Case Rate,761," $2,265.00 "," $1,245.75 "," $1,442.00 "," $2,047.65 "," $1,585.50 ", $883.35 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 ", $740.30 , $740.30 , $740.30 , $740.30 ," $2,047.65 ", $792.75 , $- , $- ," $3,388.54 "," $1,585.50 "
64590,501002835,Hospital Chargemaster,Insrt/redo pn/gastr stimul,Outpatient,Outpatient Default Percent / Case Rate,761," $6,800.00 "," $3,740.00 "," $1,442.00 "," $24,479.81 "," $4,760.00 "," $2,652.00 "," $40,924.25 "," $28,088.63 "," $27,938.88 "," $24,479.81 "," $24,479.81 "," $1,133.44 "," $1,104.09 "," $25,703.80 "," $24,969.41 "," $6,800.00 "," $6,800.00 "," $6,800.00 "," $6,800.00 "," $24,479.81 "," $2,380.00 ", $- , $- ," $40,924.25 "," $4,760.00 "
21554,501002546,Hospital Chargemaster,Exc neck tum deep 5 cm/>,Outpatient,Outpatient Default Percent / Case Rate,761," $3,285.00 "," $1,806.75 "," $2,060.00 "," $2,834.62 "," $2,299.50 "," $1,281.15 "," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,294.72 "," $1,261.20 "," $2,976.35 "," $2,891.31 "," $3,285.00 "," $3,285.00 "," $3,285.00 "," $3,285.00 "," $2,834.62 "," $1,149.75 ", $- , $- ," $5,202.81 "," $2,299.50 "
21556,501002547,Hospital Chargemaster,Exc neck tum deep < 5 cm,Outpatient,Outpatient Default Percent / Case Rate,761," $3,285.00 "," $1,806.75 "," $1,442.00 "," $2,834.62 "," $2,299.50 "," $1,281.15 "," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,133.44 "," $1,104.09 "," $2,976.35 "," $2,891.31 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,834.62 "," $1,149.75 ", $- , $- ," $5,202.81 "," $2,299.50 "
11426,6500010534,Hospital Chargemaster,Exc H-F-Nk-Sp B9+Marg >4 Cm,Outpatient,Outpatient Default Percent / Case Rate,761," $2,557.00 "," $1,406.35 "," $1,442.00 "," $2,834.62 "," $1,789.90 ", $997.23 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,133.44 "," $1,104.09 "," $2,976.35 "," $2,891.31 "," $2,557.00 "," $2,557.00 "," $2,557.00 "," $2,557.00 "," $2,834.62 ", $894.95 , $- , $- ," $5,202.81 "," $1,789.90 "
20525,501002532,Hospital Chargemaster,Removal of foreign body,Outpatient,Outpatient Default Percent / Case Rate,761," $1,915.00 "," $1,053.25 "," $2,060.00 "," $2,834.62 "," $1,340.50 ", $746.85 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,294.72 "," $1,261.20 "," $2,976.35 "," $2,891.31 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $2,834.62 ", $670.25 , $- , $- ," $5,202.81 "," $1,340.50 "
36561,501002622,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,761," $3,208.00 "," $1,764.40 "," $2,060.00 "," $3,422.34 "," $2,245.60 "," $1,251.12 "," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $3,422.34 "," $1,122.80 ", $- , $- ," $5,778.66 "," $2,245.60 "
36578,501002631,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,761," $2,629.00 "," $1,445.95 "," $1,442.00 "," $3,422.34 "," $1,840.30 "," $1,025.31 "," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,133.44 "," $1,104.09 "," $3,593.46 "," $3,490.79 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $3,422.34 ", $920.15 , $- , $- ," $5,778.66 "," $1,840.30 "
36565,501002624,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,761," $2,629.00 "," $1,445.95 "," $2,060.00 "," $3,422.34 "," $1,840.30 "," $1,025.31 "," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $3,422.34 ", $920.15 , $- , $- ," $5,778.66 "," $1,840.30 "
36582,501002634,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,761," $2,540.00 "," $1,397.00 "," $2,060.00 "," $3,422.34 "," $1,778.00 ", $990.60 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $3,422.34 ", $889.00 , $- , $- ," $5,778.66 "," $1,778.00 "
36581,501002633,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,761," $1,400.00 ", $770.00 ," $1,442.00 "," $3,422.34 ", $980.00 , $546.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,133.44 "," $1,104.09 "," $3,593.46 "," $3,490.79 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $3,422.34 ", $490.00 , $- , $- ," $5,778.66 ", $980.00
36571,501002627,Hospital Chargemaster,Insert picvad cath,Outpatient,Outpatient Default Percent / Case Rate,761," $1,400.00 ", $770.00 ," $2,060.00 "," $3,422.34 ", $980.00 , $546.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $3,422.34 ", $490.00 , $- , $- ," $5,778.66 ", $980.00
36585,501002637,Hospital Chargemaster,Replace picvad cath,Outpatient,Outpatient Default Percent / Case Rate,761," $1,400.00 ", $770.00 ," $2,060.00 "," $3,422.34 ", $980.00 , $546.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $1,400.00 "," $3,422.34 ", $490.00 , $- , $- ," $5,778.66 ", $980.00
36558,501002621,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,761, $887.00 , $487.85 ," $1,442.00 "," $3,422.34 ", $620.90 , $345.93 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $887.00 , $887.00 , $887.00 , $887.00 ," $3,422.34 ", $310.45 , $- , $- ," $5,778.66 ", $620.90
36555,501002619,Hospital Chargemaster,Insert non-tunnel cv cath,Outpatient,Outpatient Default Percent / Case Rate,761, $378.00 , $207.90 ," $1,236.00 "," $3,422.34 ", $264.60 , $147.42 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $378.00 , $378.00 , $378.00 , $378.00 ," $3,422.34 ", $132.30 , $- , $- ," $3,593.46 ", $264.60
36556,501002620,Hospital Chargemaster,Insert non-tunnel cv cath,Outpatient,Outpatient Default Percent / Case Rate,761, $368.00 , $202.40 ," $1,236.00 "," $3,422.34 ", $257.60 , $143.52 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $368.00 , $368.00 , $368.00 , $368.00 ," $3,422.34 ", $128.80 , $- , $- ," $3,593.46 ", $257.60
31628,501002582,Hospital Chargemaster,Bronchoscopy/lung bx each,Outpatient,Outpatient Default Percent / Case Rate,761, $725.00 , $398.75 ," $1,442.00 "," $3,703.22 ", $507.50 , $282.75 ," $5,995.53 "," $4,115.07 "," $4,093.13 "," $3,703.22 "," $3,703.22 "," $1,133.44 "," $1,104.09 "," $3,888.38 "," $3,777.29 ", $725.00 , $725.00 , $725.00 , $725.00 ," $3,703.22 ", $253.75 , $- , $- ," $5,995.53 ", $507.50
19101,501002516,Hospital Chargemaster,Biopsy of breast open,Outpatient,Outpatient Default Percent / Case Rate,761," $1,162.00 ", $639.10 ," $1,442.00 "," $3,775.12 ", $813.40 , $453.18 ," $6,160.38 "," $4,228.21 "," $4,205.67 "," $3,775.12 "," $3,775.12 "," $1,133.44 "," $1,104.09 "," $3,963.88 "," $3,850.62 "," $1,162.00 "," $1,162.00 "," $1,162.00 "," $1,162.00 "," $3,775.12 ", $406.70 , $- , $- ," $6,160.38 ", $813.40
32550,501002585,Hospital Chargemaster,Insert pleural cath,Outpatient,Outpatient Default Percent / Case Rate,761," $3,500.00 "," $1,925.00 "," $1,442.00 "," $3,803.62 "," $2,450.00 "," $1,365.00 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 "," $2,495.36 "," $2,430.75 "," $3,993.81 "," $3,879.70 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $3,803.62 "," $1,225.00 ", $- , $- ," $6,447.63 "," $2,450.00 "
15273,501002488,Hospital Chargemaster,Skin sub grft t/arm/lg child,Outpatient,Outpatient Default Percent / Case Rate,761," $3,734.00 "," $2,053.70 "," $1,442.00 "," $4,209.66 "," $2,613.80 "," $1,456.26 "," $6,051.26 "," $4,153.32 "," $4,131.18 "," $4,209.66 "," $4,209.66 ", $844.48 , $822.61 ," $4,420.15 "," $4,293.86 ", $740.30 , $740.30 , $740.30 , $740.30 ," $4,209.66 "," $1,306.90 ", $- , $- ," $6,051.26 "," $2,613.80 "
36583,501002635,Hospital Chargemaster,Replace tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,761," $2,540.00 "," $1,397.00 "," $2,060.00 "," $5,701.02 "," $1,778.00 ", $990.60 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 "," $1,294.72 "," $1,261.20 "," $5,986.07 "," $5,815.04 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $5,701.02 ", $889.00 , $- , $- ," $9,574.18 "," $1,778.00 "
36566,501002625,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,761," $1,915.00 "," $1,053.25 "," $2,060.00 "," $5,701.02 "," $1,340.50 ", $746.85 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 "," $1,294.72 "," $1,261.20 "," $5,986.07 "," $5,815.04 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $5,701.02 ", $670.25 , $- , $- ," $9,574.18 "," $1,340.50 "
36563,501002623,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,761," $1,125.00 ", $618.75 ," $2,060.00 "," $5,701.02 ", $787.50 , $438.75 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 "," $1,294.72 "," $1,261.20 "," $5,986.07 "," $5,815.04 "," $1,125.00 "," $1,125.00 "," $1,125.00 "," $1,125.00 "," $5,701.02 ", $393.75 , $- , $- ," $9,574.18 ", $787.50
15830,501002494,Hospital Chargemaster,Exc skin abd,Outpatient,Outpatient Default Percent / Case Rate,761," $1,023.00 ", $562.65 ," $2,060.00 "," $6,616.24 ", $716.10 , $398.97 ," $10,752.63 "," $7,380.14 "," $7,340.79 "," $6,616.24 "," $6,616.24 "," $1,294.72 "," $1,261.20 "," $6,947.05 "," $6,748.56 "," $1,023.00 "," $1,023.00 "," $1,023.00 "," $1,023.00 "," $6,616.24 ", $358.05 , $- , $- ," $10,752.63 ", $716.10
33285,501002594,Hospital Chargemaster,Insj subq car rhythm mntr,Outpatient,Outpatient Default Percent / Case Rate,761," $1,800.00 ", $990.00 ," $1,236.00 "," $9,753.71 "," $1,260.00 ", $702.00 ," $16,197.41 "," $11,117.20 "," $11,057.93 "," $9,753.71 "," $9,753.71 ", $105.28 , $102.55 ," $10,241.39 "," $9,948.78 "," $1,800.00 "," $1,800.00 "," $1,800.00 "," $1,800.00 "," $9,753.71 ", $630.00 , $- , $- ," $16,197.41 "," $1,260.00 "
27759,6500011061,Hospital Chargemaster,Treatment Of Tibia Fracture,Outpatient,Outpatient Default Percent / Case Rate,761," $2,677.00 "," $1,472.35 "," $2,591.48 "," $14,741.45 "," $1,873.90 "," $1,044.03 "," $23,437.94 "," $16,086.78 "," $16,001.02 "," $14,741.45 "," $14,741.45 "," $1,599.36 "," $1,557.95 "," $15,478.53 "," $15,036.28 "," $2,677.00 "," $2,677.00 "," $2,677.00 "," $2,677.00 "," $14,741.45 ", $936.95 , $- , $- ," $23,437.94 "," $1,873.90 "
64402,501002804,Hospital Chargemaster,N block inj facial,Outpatient,Outpatient Default Percent / Case Rate,761, $219.00 , $120.45 ," $2,542.04 ", See APC Packaged Rates , $153.30 , $85.41 , $211.31 , $212.23 , $112.79 , See APC Packaged Rates , See APC Packaged Rates , $146.95 , $146.95 , See APC Packaged Rates , See APC Packaged Rates , $203.67 , $203.67 , $203.67 , $203.67 , See APC Packaged Rates , $76.65 , Not Applicable , $76.65 ," $2,542.04 ", $153.30
64413,501002806,Hospital Chargemaster,N block inj cervical plexus,Outpatient,Outpatient Default Percent / Case Rate,761, $900.00 , $495.00 ," $2,542.04 ", See APC Packaged Rates , $630.00 , $351.00 , $868.41 , $872.19 , $463.52 , See APC Packaged Rates , See APC Packaged Rates , $603.90 , $603.90 , See APC Packaged Rates , See APC Packaged Rates , $837.00 , $837.00 , $837.00 , $837.00 , See APC Packaged Rates , $315.00 , Not Applicable , $315.00 ," $2,542.04 ", $630.00
64517,501002828,Hospital Chargemaster,N block inj hypogas plxs,Outpatient,Outpatient Default Percent / Case Rate,761," $3,000.00 "," $1,650.00 "," $1,442.00 ", $984.14 ," $2,100.00 "," $1,170.00 "," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $290.53 , $281.72 ," $1,033.35 "," $1,003.82 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 ", $984.14 ," $1,050.00 ", $- , $- ," $2,806.32 "," $2,100.00 "
64680,501002853,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,761," $3,000.00 "," $1,650.00 "," $1,442.00 ", $984.14 ," $2,100.00 "," $1,170.00 "," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 ," $1,133.44 "," $1,104.09 "," $1,033.35 "," $1,003.82 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 ", $984.14 ," $1,050.00 ", $- , $- ," $2,806.32 "," $2,100.00 "
49405,501002723,Hospital Chargemaster,Image cath fluid colxn visc,Outpatient,Outpatient Default Percent / Case Rate,761," $3,617.00 "," $1,989.35 "," $1,442.00 "," $1,682.11 "," $2,531.90 "," $1,410.63 "," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,294.72 "," $1,261.20 "," $1,766.22 "," $1,715.75 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $1,682.11 "," $1,265.95 ", $- , $- ," $3,009.07 "," $2,531.90 "
49406,501002724,Hospital Chargemaster,Image cath fluid peri/retro,Outpatient,Outpatient Default Percent / Case Rate,761," $3,617.00 "," $1,989.35 "," $1,442.00 "," $1,682.11 "," $2,531.90 "," $1,410.63 "," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,294.72 "," $1,261.20 "," $1,766.22 "," $1,715.75 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $1,682.11 "," $1,265.95 ", $- , $- ," $3,009.07 "," $2,531.90 "
46250,6500011522,Hospital Chargemaster,Remove Ext Hem Groups 2+,Outpatient,Outpatient Default Percent / Case Rate,761," $2,547.00 "," $1,400.85 "," $2,060.00 "," $2,920.64 "," $1,782.90 ", $993.33 ," $5,107.19 "," $3,505.36 "," $3,486.67 "," $2,920.64 "," $2,920.64 "," $1,294.72 "," $1,261.20 "," $3,066.68 "," $2,979.06 "," $2,547.00 "," $2,547.00 "," $2,547.00 "," $2,547.00 "," $2,920.64 ", $891.45 , $- , $- ," $5,107.19 "," $1,782.90 "
62320,501002788,Hospital Chargemaster,Njx interlaminar crv/thrc,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $844.48 , $822.61 , $797.10 , $774.33 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
62322,501002790,Hospital Chargemaster,Njx interlaminar lmbr/sac,Outpatient,Outpatient Default Percent / Case Rate,761," $1,958.00 "," $1,076.90 "," $1,236.00 ", $759.14 ," $1,370.60 ", $763.62 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $844.48 , $822.61 , $797.10 , $774.33 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $759.14 , $685.30 , $- , $- ," $1,370.60 "," $1,370.60 "
64510,501002827,Hospital Chargemaster,N block stellate ganglion,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,236.00 ", $984.14 ," $1,015.00 ", $565.50 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $165.63 , $160.60 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $507.50 , $- , $- ," $1,673.19 "," $1,015.00 "
64600,501002836,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,761," $2,000.00 "," $1,100.00 "," $1,236.00 ", $984.14 ," $1,400.00 ", $780.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $844.48 , $822.61 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $700.00 , $- , $- ," $1,673.19 "," $1,400.00 "
64620,501002841,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,761," $2,000.00 "," $1,100.00 "," $1,236.00 ", $984.14 ," $1,400.00 ", $780.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $844.48 , $822.61 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $700.00 , $- , $- ," $1,673.19 "," $1,400.00 "
40819,501002697,Hospital Chargemaster,Excise lip or cheek fold,Outpatient,Outpatient Default Percent / Case Rate,761," $1,250.00 ", $687.50 ," $1,236.00 "," $1,617.20 ", $875.00 , $487.50 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 ", $844.48 , $822.61 ," $1,698.06 "," $1,649.55 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,617.20 ", $437.50 , $- , $- ," $2,798.18 ", $875.00
38505,501002695,Hospital Chargemaster,Needle biopsy lymph nodes,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,236.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
47000,501002705,Hospital Chargemaster,Needle biopsy of liver,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,236.00 "," $1,682.11 "," $1,015.00 ", $565.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $507.50 , $- , $- ," $3,009.07 "," $1,015.00 "
56501,501002763,Hospital Chargemaster,Destroy vulva lesions sim,Outpatient,Outpatient Default Percent / Case Rate,761," $1,725.00 ", $948.75 ," $1,236.00 "," $2,047.65 "," $1,207.50 ", $672.75 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $105.28 , $102.55 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $603.75 , $- , $- ," $3,388.54 "," $1,207.50 "
56501,6500010408,Hospital Chargemaster,Destroy vulva lesions sim,Outpatient,Outpatient Default Percent / Case Rate,761," $1,706.00 ", $938.30 ," $1,236.00 "," $2,047.65 "," $1,194.20 ", $665.34 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $105.28 , $102.55 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $597.10 , $- , $- ," $3,388.54 "," $1,194.20 "
64610,501002837,Hospital Chargemaster,Injection treatment of nerve,Outpatient,Outpatient Default Percent / Case Rate,761," $3,000.00 "," $1,650.00 "," $1,236.00 "," $2,099.21 "," $2,100.00 "," $1,170.00 "," $3,569.06 "," $2,449.65 "," $2,436.59 "," $2,099.21 "," $2,099.21 ", $844.48 , $822.61 ," $2,204.17 "," $2,141.20 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,099.21 "," $1,050.00 ", $- , $- ," $3,569.06 "," $2,100.00 "
50434,501002742,Hospital Chargemaster,Convert nephrostomy catheter,Outpatient,Outpatient Default Percent / Case Rate,761," $1,284.00 ", $706.20 ," $1,236.00 "," $2,140.58 ", $898.80 , $500.76 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $105.28 , $102.55 ," $2,247.61 "," $2,183.39 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,140.58 ", $449.40 , $- , $- ," $3,805.91 ", $898.80
58555,6500011786,Hospital Chargemaster,Hysteroscopy Dx Sep Proc,Outpatient,Outpatient Default Percent / Case Rate,761," $2,500.00 "," $1,375.00 "," $1,236.00 "," $3,136.64 "," $1,750.00 ", $975.00 ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 ", $844.48 , $822.61 ," $3,293.47 "," $3,199.37 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,136.64 ", $875.00 , $- , $- ," $5,165.58 "," $1,750.00 "
49422,501002727,Hospital Chargemaster,Remove tunneled ip cath,Outpatient,Outpatient Default Percent / Case Rate,761," $1,800.00 ", $990.00 ," $1,236.00 "," $3,422.34 "," $1,260.00 ", $702.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,422.34 ", $630.00 , $- , $- ," $5,778.66 "," $1,260.00 "
64585,501002834,Hospital Chargemaster,Revise/remove neuroelectrode,Outpatient,Outpatient Default Percent / Case Rate,761," $3,000.00 "," $1,650.00 "," $1,236.00 "," $3,916.44 "," $2,100.00 "," $1,170.00 "," $6,299.93 "," $4,324.00 "," $4,300.95 "," $3,916.44 "," $3,916.44 ", $844.48 , $822.61 ," $4,112.27 "," $3,994.77 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,916.44 "," $1,050.00 ", $- , $- ," $6,299.93 "," $2,100.00 "
64555,501002831,Hospital Chargemaster,Implant neuroelectrodes,Outpatient,Outpatient Default Percent / Case Rate,761," $6,800.00 "," $3,740.00 "," $1,236.00 "," $7,369.33 "," $4,760.00 "," $2,652.00 "," $13,080.96 "," $8,978.20 "," $8,930.34 "," $7,369.33 "," $7,369.33 "," $4,562.80 "," $4,562.80 "," $7,737.79 "," $7,516.71 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $7,369.33 "," $2,380.00 ", $- , $- ," $13,080.96 "," $4,760.00 "
64575,501002833,Hospital Chargemaster,Implant neuroelectrodes,Outpatient,Outpatient Default Percent / Case Rate,761," $6,800.00 "," $3,740.00 "," $1,236.00 "," $13,442.21 "," $4,760.00 "," $2,652.00 "," $40,924.25 "," $28,088.63 "," $27,938.88 "," $13,442.21 "," $13,442.21 ", $844.48 , $822.61 ," $14,114.33 "," $13,711.06 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $13,442.21 "," $2,380.00 ", $- , $- ," $40,924.25 "," $4,760.00 "
50432,501002740,Hospital Chargemaster,Plmt nephrostomy catheter,Outpatient,Outpatient Default Percent / Case Rate,761," $3,688.00 "," $2,028.40 "," $1,442.00 "," $2,140.58 "," $2,581.60 "," $1,438.32 "," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $105.28 , $102.55 ," $2,247.61 "," $2,183.39 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,140.58 "," $1,290.80 ", $- , $- ," $3,805.91 "," $2,581.60 "
50433,501002741,Hospital Chargemaster,Plmt nephroureteral catheter,Outpatient,Outpatient Default Percent / Case Rate,761," $3,688.00 "," $2,028.40 "," $1,442.00 "," $3,675.67 "," $2,581.60 "," $1,438.32 "," $3,805.91 "," $2,612.21 "," $2,598.29 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,290.80 ", $- , $- ," $3,859.45 "," $2,581.60 "
55700,501002761,Hospital Chargemaster,Biopsy of prostate,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,442.00 "," $2,140.58 "," $1,015.00 ", $565.50 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 "," $1,133.44 "," $1,104.09 "," $2,247.61 "," $2,183.39 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,140.58 ", $507.50 , $- , $- ," $3,805.91 "," $1,015.00 "
55250,6500011739,Hospital Chargemaster,Removal Of Sperm Duct(S),Outpatient,Outpatient Default Percent / Case Rate,761," $1,865.00 "," $1,025.75 "," $1,442.00 "," $2,140.58 "," $1,305.50 ", $727.35 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $105.28 , $102.55 ," $2,247.61 "," $2,183.39 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,140.58 ", $652.75 , $- , $- ," $3,805.91 "," $1,305.50 "
47533,501002711,Hospital Chargemaster,Plmt biliary drainage cath,Outpatient,Outpatient Default Percent / Case Rate,761," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $844.48 , $822.61 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
47534,501002712,Hospital Chargemaster,Plmt biliary drainage cath,Outpatient,Outpatient Default Percent / Case Rate,761," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $844.48 , $822.61 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
47535,501002713,Hospital Chargemaster,Conversion ext bil drg cath,Outpatient,Outpatient Default Percent / Case Rate,761," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $844.48 , $822.61 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
47536,501002714,Hospital Chargemaster,Exchange biliary drg cath,Outpatient,Outpatient Default Percent / Case Rate,761," $5,329.00 "," $2,930.95 "," $1,442.00 "," $3,803.62 "," $3,730.30 "," $2,078.31 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,865.15 ", $- , $- ," $6,447.63 "," $3,730.30 "
49418,501002726,Hospital Chargemaster,Insert tun ip cath perc,Outpatient,Outpatient Default Percent / Case Rate,761," $2,860.00 "," $1,573.00 "," $1,442.00 "," $3,803.62 "," $2,002.00 "," $1,115.40 "," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,803.62 "," $1,001.00 ", $- , $- ," $6,447.63 "," $2,002.00 "
49407,501002725,Hospital Chargemaster,Image cath fluid trns/vgnl,Outpatient,Outpatient Default Percent / Case Rate,761," $2,240.00 "," $1,232.00 "," $2,060.00 "," $1,682.11 "," $1,568.00 ", $873.60 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,294.72 "," $1,261.20 "," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $784.00 , $- , $- ," $3,009.07 "," $1,568.00 "
50693,501002746,Hospital Chargemaster,Plmt ureteral stent prq,Outpatient,Outpatient Default Percent / Case Rate,761," $5,492.00 "," $3,020.60 "," $2,060.00 "," $3,675.67 "," $3,844.40 "," $2,141.88 "," $3,805.91 "," $2,612.21 "," $2,598.29 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,922.20 ", $- , $- ," $3,859.45 "," $3,844.40 "
50694,501002747,Hospital Chargemaster,Plmt ureteral stent prq,Outpatient,Outpatient Default Percent / Case Rate,761," $5,492.00 "," $3,020.60 "," $2,060.00 "," $3,675.67 "," $3,844.40 "," $2,141.88 "," $6,402.87 "," $4,394.65 "," $4,371.22 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,922.20 ", $- , $- ," $6,402.87 "," $3,844.40 "
50695,501002748,Hospital Chargemaster,Plmt ureteral stent prq,Outpatient,Outpatient Default Percent / Case Rate,761," $5,492.00 "," $3,020.60 "," $2,060.00 "," $3,675.67 "," $3,844.40 "," $2,141.88 "," $6,402.87 "," $4,394.65 "," $4,371.22 "," $3,675.67 "," $3,675.67 ", $105.28 , $102.55 ," $3,859.45 "," $3,749.18 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,675.67 "," $1,922.20 ", $- , $- ," $6,402.87 "," $3,844.40 "
46040,501002702,Hospital Chargemaster,Incision of rectal abscess,Outpatient,Outpatient Default Percent / Case Rate,761," $1,185.00 ", $651.75 ," $2,060.00 "," $1,239.71 ", $829.50 , $462.15 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,294.72 "," $1,261.20 "," $1,301.70 "," $1,264.51 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,239.71 ", $414.75 , $- , $- ," $2,143.42 ", $829.50
46040,6500010347,Hospital Chargemaster,Incision of rectal abscess,Outpatient,Outpatient Default Percent / Case Rate,761," $1,017.00 ", $559.35 ," $2,060.00 "," $1,239.71 ", $711.90 , $396.63 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,294.72 "," $1,261.20 "," $1,301.70 "," $1,264.51 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,239.71 ", $355.95 , $- , $- ," $2,143.42 ", $711.90
50389,501002737,Hospital Chargemaster,Remove renal tube w/fluoro,Outpatient,Outpatient Default Percent / Case Rate,761," $1,150.00 ", $632.50 ," $1,236.00 ", $687.79 , $805.00 , $448.50 ," $1,229.98 ", $844.21 , $839.71 , $687.79 , $687.79 , $844.48 , $822.61 , $722.18 , $701.54 ," $1,150.00 "," $1,150.00 "," $1,150.00 "," $1,150.00 ", $687.79 , $402.50 , $- , $- ," $1,236.00 ", $805.00
62281,501002779,Hospital Chargemaster,Treat spinal cord lesion,Outpatient,Outpatient Default Percent / Case Rate,761," $1,142.00 ", $628.10 ," $1,236.00 ", $984.14 , $799.40 , $445.38 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $844.48 , $822.61 ," $1,033.35 "," $1,003.82 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $984.14 , $399.70 , $- , $- ," $1,673.19 ", $799.40
41115,501002698,Hospital Chargemaster,Excision of tongue fold,Outpatient,Outpatient Default Percent / Case Rate,761," $1,142.00 ", $628.10 ," $1,236.00 "," $1,617.20 ", $799.40 , $445.38 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 ", $844.48 , $822.61 ," $1,698.06 "," $1,649.55 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,617.20 ", $399.70 , $- , $- ," $2,798.18 ", $799.40
48102,501002717,Hospital Chargemaster,Needle biopsy pancreas,Outpatient,Outpatient Default Percent / Case Rate,761," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
49180,501002721,Hospital Chargemaster,Biopsy abdominal mass,Outpatient,Outpatient Default Percent / Case Rate,761," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
50200,501002735,Hospital Chargemaster,Renal biopsy perq,Outpatient,Outpatient Default Percent / Case Rate,761," $1,142.00 ", $628.10 ," $1,236.00 "," $1,682.11 ", $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $399.70 , $- , $- ," $3,009.07 ", $799.40
54150,501002759,Hospital Chargemaster,Circumcision w/regionl block,Outpatient,Outpatient Default Percent / Case Rate,761," $1,142.00 ", $628.10 ," $1,236.00 "," $2,140.58 ", $799.40 , $445.38 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $844.48 , $822.61 ," $2,247.61 "," $2,183.39 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $2,140.58 ", $399.70 , $- , $- ," $3,805.91 ", $799.40
32405,501002584,Hospital Chargemaster,Percut bx lung/mediastinum,Outpatient,Outpatient Default Percent / Case Rate,761," $1,142.00 ", $628.10 ," $2,542.04 ", See APC Packaged Rates , $799.40 , $445.38 ," $3,009.07 "," $2,065.30 "," $2,054.29 ", See APC Packaged Rates , See APC Packaged Rates , $766.28 , $766.28 , See APC Packaged Rates , See APC Packaged Rates ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", See APC Packaged Rates , $399.70 , Not Applicable , $399.70 ," $3,009.07 ", $799.40
37200,501002659,Hospital Chargemaster,Transcatheter biopsy,Outpatient,Outpatient Default Percent / Case Rate,761," $1,142.00 ", $628.10 ," $2,591.48 "," $5,701.02 ", $799.40 , $445.38 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 ", $844.48 , $822.61 ," $5,986.07 "," $5,815.04 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $5,701.02 ", $399.70 , $- , $- ," $9,574.18 ", $799.40
99291,6500010034,Hospital Chargemaster,Critical care first hour,Outpatient,Outpatient Default Percent / Case Rate,761, $659.00 , $362.45 , $543.02 , $890.51 , $461.30 , $257.01 ," $3,645.69 "," $2,255.28 "," $2,178.27 ", $890.51 , $890.51 , $836.55 , $811.17 , $935.03 , $908.32 ," $1,078.51 "," $1,078.51 "," $1,106.30 "," $1,106.30 ", $890.51 , $263.60 , $- , $- ," $3,645.69 ", $461.30
46220,6500011519,Hospital Chargemaster,Excise Anal Ext Tag/Papilla,Outpatient,Outpatient Default Percent / Case Rate,761," $1,030.00 ", $566.50 ," $1,236.00 "," $1,239.71 ", $721.00 , $401.70 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 ", $844.48 , $822.61 ," $1,301.70 "," $1,264.51 "," $1,030.00 "," $1,030.00 "," $1,030.00 "," $1,030.00 "," $1,239.71 ", $360.50 , $- , $- ," $2,143.42 ", $721.00
64415,501002807,Hospital Chargemaster,N block inj brachial plexus,Outpatient,Outpatient Default Percent / Case Rate,761, $900.00 , $495.00 ," $1,236.00 ", $984.14 , $630.00 , $351.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $174.52 , $169.22 ," $1,033.35 "," $1,003.82 ", $900.00 , $900.00 , $900.00 , $900.00 , $984.14 , $315.00 , $- , $- ," $1,673.19 ", $630.00
46221,6500011520,Hospital Chargemaster,Ligation Of Hemorrhoid(S),Outpatient,Outpatient Default Percent / Case Rate,761, $781.00 , $429.55 ," $1,236.00 ", $948.73 , $546.70 , $304.59 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $105.28 , $102.55 , $996.17 , $967.71 , $781.00 , $781.00 , $781.00 , $781.00 , $948.73 , $273.35 , $- , $- ," $1,629.53 ", $546.70
51728,6500011629,Hospital Chargemaster,Cystometrogram W/Vp,Outpatient,Outpatient Default Percent / Case Rate,761, $750.00 , $412.50 ," $1,236.00 ", $687.79 , $525.00 , $292.50 ," $1,229.98 ", $844.21 , $839.71 , $687.79 , $687.79 , $499.80 , $484.64 , $722.18 , $701.54 , $750.00 , $750.00 , $750.00 , $750.00 , $687.79 , $262.50 , $- , $- ," $1,236.00 ", $525.00
64616,501002840,Hospital Chargemaster,Chemodenerv musc neck dyston,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 ," $1,236.00 ", $312.35 , $571.90 , $318.63 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $740.30 , $740.30 , $740.30 , $740.30 , $312.35 , $285.95 , $- , $- ," $1,236.00 ", $571.90
64418,501002808,Hospital Chargemaster,N block inj suprascapular,Outpatient,Outpatient Default Percent / Case Rate,761," $1,032.00 ", $567.60 ," $1,236.00 ", $759.14 , $722.40 , $402.48 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $178.54 , $173.12 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $361.20 , $- , $- ," $1,309.97 ", $722.40
64425,501002811,Hospital Chargemaster,N block inj ilio-ing/hypogi,Outpatient,Outpatient Default Percent / Case Rate,761, $900.00 , $495.00 ," $1,236.00 ", $759.14 , $630.00 , $351.00 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $226.51 , $219.64 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $315.00 , $- , $- ," $1,309.97 ", $630.00
64642,501002847,Hospital Chargemaster,Chemodenerv 1 extremity 1-4,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
64644,501002849,Hospital Chargemaster,Chemodenerv 1 extrem 5/> mus,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
64646,501002851,Hospital Chargemaster,Chemodenerv trunk musc 1-5,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
64647,501002852,Hospital Chargemaster,Chemodenerv trunk musc 6/>,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
47537,501002715,Hospital Chargemaster,Removal biliary drg cath,Outpatient,Outpatient Default Percent / Case Rate,761," $1,182.00 ", $650.10 ," $1,236.00 ", $967.36 , $827.40 , $460.98 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $105.28 , $102.55 ," $1,015.72 ", $986.70 , $740.30 , $740.30 , $740.30 , $740.30 , $967.36 , $413.70 , $- , $- ," $1,665.99 ", $827.40
49450,501002731,Hospital Chargemaster,Replace g/c tube perc,Outpatient,Outpatient Default Percent / Case Rate,761," $2,102.00 "," $1,156.10 "," $1,236.00 ", $967.36 ," $1,471.40 ", $819.78 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $740.30 , $740.30 , $740.30 , $740.30 , $967.36 , $735.70 , $- , $- ," $1,665.99 "," $1,471.40 "
49450,6500010376,Hospital Chargemaster,Replace g/c tube perc,Outpatient,Outpatient Default Percent / Case Rate,761," $2,102.00 "," $1,156.10 "," $1,236.00 ", $967.36 ," $1,471.40 ", $819.78 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $740.30 , $740.30 , $740.30 , $740.30 , $967.36 , $735.70 , $- , $- ," $1,665.99 "," $1,471.40 "
47532,501002710,Hospital Chargemaster,Injection for cholangiogram,Outpatient,Outpatient Default Percent / Case Rate,761, $709.00 , $389.95 ," $1,442.00 "," $3,803.62 ", $496.30 , $276.51 ," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 ", $709.00 , $709.00 , $709.00 , $709.00 ," $3,803.62 ", $248.15 , $- , $- ," $6,447.63 ", $496.30
56605,501002764,Hospital Chargemaster,Biopsy of vulva/perineum,Outpatient,Outpatient Default Percent / Case Rate,761, $633.00 , $348.15 ," $1,236.00 ", $757.92 , $443.10 , $246.87 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $844.48 , $822.61 , $795.81 , $773.07 , $633.00 , $633.00 , $633.00 , $633.00 , $757.92 , $221.55 , $- , $- ," $1,236.00 ", $443.10
57100,501002765,Hospital Chargemaster,Biopsy of vagina,Outpatient,Outpatient Default Percent / Case Rate,761, $633.00 , $348.15 ," $1,236.00 ", $757.92 , $443.10 , $246.87 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $105.28 , $102.55 , $795.81 , $773.07 , $633.00 , $633.00 , $633.00 , $633.00 , $757.92 , $221.55 , $- , $- ," $1,236.00 ", $443.10
56605,6500010409,Hospital Chargemaster,Biopsy of vulva/perineum,Outpatient,Outpatient Default Percent / Case Rate,761, $633.00 , $348.15 ," $1,236.00 ", $757.92 , $443.10 , $246.87 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $844.48 , $822.61 , $795.81 , $773.07 , $633.00 , $633.00 , $633.00 , $633.00 , $757.92 , $221.55 , $- , $- ," $1,236.00 ", $443.10
57100,6500010410,Hospital Chargemaster,Biopsy of vagina,Outpatient,Outpatient Default Percent / Case Rate,761, $633.00 , $348.15 ," $1,236.00 ", $757.92 , $443.10 , $246.87 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $105.28 , $102.55 , $795.81 , $773.07 , $633.00 , $633.00 , $633.00 , $633.00 , $757.92 , $221.55 , $- , $- ," $1,236.00 ", $443.10
38792,501002696,Hospital Chargemaster,Ra tracer id of sentinl node,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 ," $1,236.00 ", $450.66 , $571.90 , $318.63 , $773.31 , $530.77 , $527.94 , $450.66 , $450.66 , $105.28 , $102.55 , $473.19 , $459.67 , $581.78 , $581.78 , $596.77 , $596.77 , $450.66 , $285.95 , $- , $- ," $1,236.00 ", $571.90
60100,501002773,Hospital Chargemaster,Biopsy of thyroid,Outpatient,Outpatient Default Percent / Case Rate,761, $590.00 , $324.50 ," $1,236.00 ", $743.95 , $413.00 , $230.10 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $590.00 , $590.00 , $590.00 , $590.00 , $743.95 , $206.50 , $- , $- ," $1,267.38 ", $413.00
38220,501002692,Hospital Chargemaster,Dx bone marrow aspirations,Outpatient,Outpatient Default Percent / Case Rate,761, $590.00 , $324.50 ," $1,236.00 "," $1,682.11 ", $413.00 , $230.10 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $158.51 , $153.70 ," $1,766.22 "," $1,715.75 ", $590.00 , $590.00 , $590.00 , $590.00 ," $1,682.11 ", $206.50 , $- , $- ," $3,009.07 ", $413.00
47531,501002709,Hospital Chargemaster,Injection for cholangiogram,Outpatient,Outpatient Default Percent / Case Rate,761, $563.00 , $309.65 ," $1,236.00 "," $3,803.62 ", $394.10 , $219.57 ," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $105.28 , $102.55 ," $3,993.81 "," $3,879.70 ", $563.00 , $563.00 , $563.00 , $563.00 ," $3,803.62 ", $197.05 , $- , $- ," $6,447.63 ", $394.10
60300,501002774,Hospital Chargemaster,Aspir/inj thyroid cyst,Outpatient,Outpatient Default Percent / Case Rate,761, $506.00 , $278.30 ," $1,236.00 ", $743.95 , $354.20 , $197.34 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $506.00 , $506.00 , $506.00 , $506.00 , $743.95 , $177.10 , $- , $- ," $1,267.38 ", $354.20
64612,501002838,Hospital Chargemaster,Destroy nerve face muscle,Outpatient,Outpatient Default Percent / Case Rate,761, $446.00 , $245.30 ," $1,236.00 ", $312.35 , $312.20 , $173.94 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $446.00 , $446.00 , $446.00 , $446.00 , $312.35 , $156.10 , $- , $- ," $1,236.00 ", $312.20
47556,501002716,Hospital Chargemaster,Biliary endoscopy thru skin,Outpatient,Outpatient Default Percent / Case Rate,761, $406.00 , $223.30 ," $2,060.00 "," $6,049.19 ", $284.20 , $158.34 ," $10,054.00 "," $6,900.63 "," $6,863.84 "," $6,049.19 "," $6,049.19 "," $4,032.00 "," $3,927.60 "," $6,351.65 "," $6,170.18 ", $406.00 , $406.00 , $406.00 , $406.00 ," $6,049.19 ", $142.10 , $- , $- ," $10,054.00 ", $284.20
37212,501002661,Hospital Chargemaster,Thrombolytic venous therapy,Outpatient,Outpatient Default Percent / Case Rate,761, $400.00 , $220.00 ," $1,236.00 "," $3,422.34 ", $280.00 , $156.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $400.00 , $400.00 , $400.00 , $400.00 ," $3,422.34 ", $140.00 , $- , $- ," $5,778.66 ", $280.00
54200,501002760,Hospital Chargemaster,Treatment of penis lesion,Outpatient,Outpatient Default Percent / Case Rate,761, $375.00 , $206.25 , $309.00 , $318.13 , $262.50 , $146.25 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $205.12 , $198.90 , $334.03 , $324.49 , $375.00 , $375.00 , $375.00 , $375.00 , $318.13 , $131.25 , $- , $- , $506.26 , $262.50
54200,6500010405,Hospital Chargemaster,Treatment of penis lesion,Outpatient,Outpatient Default Percent / Case Rate,761, $375.00 , $206.25 , $309.00 , $318.13 , $262.50 , $146.25 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $205.12 , $198.90 , $334.03 , $324.49 , $375.00 , $375.00 , $375.00 , $375.00 , $318.13 , $131.25 , $- , $- , $506.26 , $262.50
49465,501002734,Hospital Chargemaster,Fluoro exam of g/colon tube,Outpatient,Outpatient Default Percent / Case Rate,761," $1,300.00 ", $715.00 ," $1,236.00 ", $275.09 , $910.00 , $507.00 , $504.38 , $346.19 , $344.34 , $275.09 , $275.09 , $872.30 , $872.30 , $288.84 , $280.59 , $343.81 , $343.81 , $343.81 , $343.81 , $275.09 , $455.00 , $- , $- ," $1,236.00 ", $910.00
64505,501002826,Hospital Chargemaster,N block spenopalatine gangl,Outpatient,Outpatient Default Percent / Case Rate,761, $645.00 , $354.75 ," $1,236.00 ", $312.35 , $451.50 , $251.55 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $199.70 , $193.64 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $225.75 , $- , $- ," $1,236.00 ", $451.50
67500,501002857,Hospital Chargemaster,Inject/treat eye socket,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 , $673.21 , $312.73 , $571.90 , $318.63 , $620.23 , $425.70 , $423.43 , $312.73 , $312.73 , $105.28 , $102.55 , $328.37 , $318.99 , $343.81 , $343.81 , $343.81 , $343.81 , $312.73 , $285.95 , $- , $- , $673.21 , $571.90
43752,501002700,Hospital Chargemaster,Nasal/orogastric w/tube plmt,Outpatient,Outpatient Default Percent / Case Rate,761, $334.00 , $183.70 ," $1,442.00 ", $324.46 , $233.80 , $130.26 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $334.00 , $334.00 , $334.00 , $334.00 , $324.46 , $116.90 , $- , $- ," $1,442.00 ", $233.80
64566,6500011827,Hospital Chargemaster,Neuroeltrd Stim Post Tibial,Outpatient,Outpatient Default Percent / Case Rate,761, $333.00 , $183.15 ," $1,236.00 ", $312.35 , $233.10 , $129.87 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $223.44 , $223.44 , $327.96 , $318.59 , $333.00 , $333.00 , $333.00 , $333.00 , $312.35 , $116.55 , $- , $- ," $1,236.00 ", $233.10
56405,501002762,Hospital Chargemaster,I & d of vulva/perineum,Outpatient,Outpatient Default Percent / Case Rate,761, $331.00 , $182.05 ," $1,442.00 ", $337.17 , $231.70 , $129.09 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 ," $1,133.44 "," $1,104.09 ", $354.03 , $343.92 , $331.00 , $331.00 , $331.00 , $331.00 , $337.17 , $115.85 , $- , $- ," $1,442.00 ", $231.70
56405,6500010407,Hospital Chargemaster,I & d of vulva/perineum,Outpatient,Outpatient Default Percent / Case Rate,761, $275.00 , $151.25 ," $1,442.00 ", $337.17 , $192.50 , $107.25 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 ," $1,133.44 "," $1,104.09 ", $354.03 , $343.92 , $331.00 , $331.00 , $331.00 , $331.00 , $337.17 , $96.25 , $- , $- ," $1,442.00 ", $192.50
46083,501002704,Hospital Chargemaster,Incise external hemorrhoid,Outpatient,Outpatient Default Percent / Case Rate,761, $317.00 , $174.35 ," $1,236.00 ", $318.13 , $221.90 , $123.63 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $317.00 , $317.00 , $317.00 , $317.00 , $318.13 , $110.95 , $- , $- ," $1,236.00 ", $221.90
46083,6500010349,Hospital Chargemaster,Incise external hemorrhoid,Outpatient,Outpatient Default Percent / Case Rate,761, $333.00 , $183.15 ," $1,236.00 ", $318.13 , $233.10 , $129.87 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $317.00 , $317.00 , $317.00 , $317.00 , $318.13 , $116.55 , $- , $- ," $1,236.00 ", $233.10
96522,5810010015,Hospital Chargemaster,Refill/maint pump/resvr syst,Outpatient,Outpatient Default Percent / Case Rate,761, $418.00 , $229.90 , $344.43 , $244.57 , $292.60 , $163.02 , $409.48 , $281.05 , $279.55 , $244.57 , $244.57 , $283.00 , $274.41 , $256.80 , $249.46 , $300.73 , $300.73 , $308.47 , $308.47 , $244.57 , $146.30 , $- , $- , $409.48 , $292.60
96521,5810010014,Hospital Chargemaster,Refill/maint portable pump,Outpatient,Outpatient Default Percent / Case Rate,761, $540.00 , $297.00 , $444.96 , $244.57 , $378.00 , $210.60 , $459.57 , $359.18 , $393.42 , $244.57 , $244.57 , $392.79 , $380.87 , $256.80 , $249.46 , $300.73 , $300.73 , $308.47 , $308.47 , $244.57 , $189.00 , $- , $- , $459.57 , $378.00
46050,501002703,Hospital Chargemaster,Incision of anal abscess,Outpatient,Outpatient Default Percent / Case Rate,761, $279.00 , $153.45 ," $1,236.00 ", $948.73 , $195.30 , $108.81 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $844.48 , $822.61 , $996.17 , $967.71 , $279.00 , $279.00 , $279.00 , $279.00 , $948.73 , $97.65 , $- , $- ," $1,629.53 ", $195.30
46050,6500010348,Hospital Chargemaster,Incision of anal abscess,Outpatient,Outpatient Default Percent / Case Rate,761, $781.00 , $429.55 ," $1,236.00 ", $948.73 , $546.70 , $304.59 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $844.48 , $822.61 , $996.17 , $967.71 , $279.00 , $279.00 , $279.00 , $279.00 , $948.73 , $273.35 , $- , $- ," $1,629.53 ", $546.70
62270,501002775,Hospital Chargemaster,Spinal fluid tap diagnostic,Outpatient,Outpatient Default Percent / Case Rate,761, $237.00 , $130.35 ," $1,236.00 ", $759.14 , $165.90 , $92.43 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $177.96 , $172.56 , $797.10 , $774.33 , $237.00 , $237.00 , $237.00 , $237.00 , $759.14 , $82.95 , $- , $- ," $1,309.97 ", $165.90
38221,501002693,Hospital Chargemaster,Dx bone marrow biopsies,Outpatient,Outpatient Default Percent / Case Rate,761, $234.00 , $128.70 ," $1,236.00 "," $1,682.11 ", $163.80 , $91.26 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $200.58 , $194.50 ," $1,766.22 "," $1,715.75 ", $234.00 , $234.00 , $234.00 , $234.00 ," $1,682.11 ", $81.90 , $- , $- ," $3,009.07 ", $163.80
58100,501002767,Hospital Chargemaster,Biopsy of uterus lining,Outpatient,Outpatient Default Percent / Case Rate,761, $232.00 , $127.60 ," $1,236.00 ", $203.67 , $162.40 , $90.48 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $105.28 , $102.55 , $213.85 , $207.74 , $232.00 , $232.00 , $232.00 , $232.00 , $203.67 , $81.20 , $- , $- ," $1,236.00 ", $162.40
58100,6500010412,Hospital Chargemaster,Biopsy of uterus lining,Outpatient,Outpatient Default Percent / Case Rate,761, $232.00 , $127.60 ," $1,236.00 ", $203.67 , $162.40 , $90.48 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $105.28 , $102.55 , $213.85 , $207.74 , $232.00 , $232.00 , $232.00 , $232.00 , $203.67 , $81.20 , $- , $- ," $1,236.00 ", $162.40
64405,6500010450,Hospital Chargemaster,N block inj occipital,Outpatient,Outpatient Default Percent / Case Rate,761, $204.00 , $112.20 ," $1,236.00 ", $312.35 , $142.80 , $79.56 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $185.94 , $180.29 , $327.96 , $318.59 , $740.30 , $740.30 , $740.30 , $740.30 , $312.35 , $71.40 , $- , $- ," $1,236.00 ", $142.80
57500,501002766,Hospital Chargemaster,Biopsy of cervix,Outpatient,Outpatient Default Percent / Case Rate,761, $228.00 , $125.40 ," $1,236.00 ", $757.92 , $159.60 , $88.92 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $105.28 , $102.55 , $795.81 , $773.07 , $228.00 , $228.00 , $228.00 , $228.00 , $757.92 , $79.80 , $- , $- ," $1,236.00 ", $159.60
57500,6500010411,Hospital Chargemaster,Biopsy of cervix,Outpatient,Outpatient Default Percent / Case Rate,761, $633.00 , $348.15 ," $1,236.00 ", $757.92 , $443.10 , $246.87 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $105.28 , $102.55 , $795.81 , $773.07 , $228.00 , $228.00 , $228.00 , $228.00 , $757.92 , $221.55 , $- , $- ," $1,236.00 ", $443.10
51703,501002755,Hospital Chargemaster,Insert bladder cath complex,Outpatient,Outpatient Default Percent / Case Rate,761, $265.00 , $145.75 ," $1,236.00 ", $166.91 , $185.50 , $103.35 , $297.41 , $204.13 , $203.04 , $166.91 , $166.91 , $196.14 , $190.19 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $92.75 , $- , $- ," $1,236.00 ", $185.50
51703,6500010400,Hospital Chargemaster,Insert bladder cath complex,Outpatient,Outpatient Default Percent / Case Rate,761, $333.00 , $183.15 ," $1,236.00 ", $166.91 , $233.10 , $129.87 , $297.41 , $204.13 , $203.04 , $166.91 , $166.91 , $196.14 , $190.19 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $116.55 , $- , $- ," $1,236.00 ", $233.10
51741,6500011630,Hospital Chargemaster,Electro-Uroflowmetry First,Outpatient,Outpatient Default Percent / Case Rate,761, $243.00 , $133.65 , $200.23 , $166.91 , $170.10 , $94.77 , $297.41 , $204.13 , $203.04 , $166.91 , $166.91 , $163.05 , $163.05 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $85.05 , $- , $- , $297.41 , $170.10
51705,501002756,Hospital Chargemaster,Change of bladder tube,Outpatient,Outpatient Default Percent / Case Rate,761, $221.00 , $121.55 ," $1,236.00 ", $318.13 , $154.70 , $86.19 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $221.00 , $221.00 , $221.00 , $221.00 , $318.13 , $77.35 , $- , $- ," $1,236.00 ", $154.70
51705,6500010401,Hospital Chargemaster,Change of bladder tube,Outpatient,Outpatient Default Percent / Case Rate,761, $281.00 , $154.55 ," $1,236.00 ", $318.13 , $196.70 , $109.59 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $221.00 , $221.00 , $221.00 , $221.00 , $318.13 , $98.35 , $- , $- ," $1,236.00 ", $196.70
58300,501002768,Hospital Chargemaster,Insert intrauterine device,Outpatient,Outpatient Default Percent / Case Rate,761, $216.00 , $118.80 ," $1,236.00 ", See APC Packaged Rates , $151.20 , $84.24 , $172.06 , $118.09 , $117.46 , See APC Packaged Rates , See APC Packaged Rates , $131.39 , $127.40 , See APC Packaged Rates , See APC Packaged Rates , $216.00 , $216.00 , $216.00 , $216.00 , See APC Packaged Rates , $75.60 , $- , $- ," $1,236.00 ", $151.20
58300,6500010413,Hospital Chargemaster,Insert intrauterine device,Outpatient,Outpatient Default Percent / Case Rate,761, $216.00 , $118.80 ," $1,236.00 ", See APC Packaged Rates , $151.20 , $84.24 , $172.06 , $118.09 , $117.46 , See APC Packaged Rates , See APC Packaged Rates , $131.39 , $127.40 , See APC Packaged Rates , See APC Packaged Rates , $216.00 , $216.00 , $216.00 , $216.00 , See APC Packaged Rates , $75.60 , $- , $- ," $1,236.00 ", $151.20
64450,6500010459,Hospital Chargemaster,N block other peripheral,Outpatient,Outpatient Default Percent / Case Rate,761, $674.00 , $370.70 ," $1,236.00 ", $759.14 , $471.80 , $262.86 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $168.83 , $163.71 , $797.10 , $774.33 , $208.00 , $208.00 , $208.00 , $208.00 , $759.14 , $235.90 , $- , $- ," $1,309.97 ", $471.80
58301,501002769,Hospital Chargemaster,Remove intrauterine device,Outpatient,Outpatient Default Percent / Case Rate,761, $203.00 , $111.65 ," $1,236.00 ", $337.17 , $142.10 , $79.17 , $362.99 , $249.14 , $247.81 , $337.17 , $337.17 , $164.50 , $159.51 , $354.03 , $343.92 , $203.00 , $203.00 , $203.00 , $203.00 , $337.17 , $71.05 , $- , $- ," $1,236.00 ", $142.10
58301,6500010414,Hospital Chargemaster,Remove intrauterine device,Outpatient,Outpatient Default Percent / Case Rate,761, $213.00 , $117.15 ," $1,236.00 ", $337.17 , $149.10 , $83.07 , $362.99 , $249.14 , $247.81 , $337.17 , $337.17 , $164.50 , $159.51 , $354.03 , $343.92 , $203.00 , $203.00 , $203.00 , $203.00 , $337.17 , $74.55 , $- , $- ," $1,236.00 ", $149.10
64400,501002803,Hospital Chargemaster,N block inj trigeminal,Outpatient,Outpatient Default Percent / Case Rate,761, $194.00 , $106.70 ," $1,236.00 ", $312.35 , $135.80 , $75.66 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $157.25 , $152.48 , $327.96 , $318.59 , $194.00 , $194.00 , $194.00 , $194.00 , $312.35 , $67.90 , $- , $- ," $1,236.00 ", $135.80
57452,6500011769,Hospital Chargemaster,Exam Of Cervix W/Scope,Outpatient,Outpatient Default Percent / Case Rate,761, $194.00 , $106.70 ," $1,442.00 ", $203.67 , $135.80 , $75.66 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $105.28 , $102.55 , $213.85 , $207.74 , $194.00 , $194.00 , $194.00 , $194.00 , $203.67 , $67.90 , $- , $- ," $1,442.00 ", $135.80
37191,501002655,Hospital Chargemaster,Ins endovas vena cava filtr,Outpatient,Outpatient Default Percent / Case Rate,761, $189.00 , $103.95 ," $2,060.00 "," $5,701.02 ", $132.30 , $73.71 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 ", $105.28 , $102.55 ," $5,986.07 "," $5,815.04 ", $189.00 , $189.00 , $189.00 , $189.00 ," $5,701.02 ", $66.15 , $- , $- ," $9,574.18 ", $132.30
54056,501002758,Hospital Chargemaster,Cryosurgery penis lesion(s),Outpatient,Outpatient Default Percent / Case Rate,761, $247.00 , $135.85 , $203.53 , $214.68 , $172.90 , $96.33 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $185.14 , $185.14 , $185.14 , $185.14 , $214.68 , $86.45 , $- , $- , $386.01 , $172.90
43762,501002701,Hospital Chargemaster,Rplc gtube no revj trc,Outpatient,Outpatient Default Percent / Case Rate,761, $174.00 , $95.70 ," $1,236.00 ", $318.13 , $121.80 , $67.86 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 ," $1,133.44 "," $1,104.09 ", $334.03 , $324.49 , $174.00 , $174.00 , $174.00 , $174.00 , $318.13 , $60.90 , $- , $- ," $1,236.00 ", $121.80
43762,6500010346,Hospital Chargemaster,Rplc gtube no revj trc,Outpatient,Outpatient Default Percent / Case Rate,761, $897.00 , $493.35 ," $1,236.00 ", $318.13 , $627.90 , $349.83 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 ," $1,133.44 "," $1,104.09 ", $334.03 , $324.49 , $174.00 , $174.00 , $174.00 , $174.00 , $318.13 , $313.95 , $- , $- ," $1,236.00 ", $627.90
95971,501002862,Hospital Chargemaster,Alys smpl sp/pn npgt w/prgrm,Outpatient,Outpatient Default Percent / Case Rate,761, $645.00 , $354.75 , $531.48 , $120.02 , $451.50 , $251.55 , $288.58 , $225.54 , $247.05 , $120.02 , $120.02 , $- , $- , $126.02 , $122.42 , $161.99 , $161.99 , $166.16 , $166.16 , $120.02 , $225.75 , $- , $- , $531.48 , $451.50
38222,501002694,Hospital Chargemaster,Dx bone marrow bx & aspir,Outpatient,Outpatient Default Percent / Case Rate,761, $150.00 , $82.50 ," $1,236.00 "," $2,834.62 ", $105.00 , $58.50 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $2,834.62 "," $2,834.62 ", $105.28 , $102.55 ," $2,976.35 "," $2,891.31 ", $150.00 , $150.00 , $150.00 , $150.00 ," $2,834.62 ", $52.50 , $- , $- ," $3,009.07 ", $105.00
65205,501002855,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,761, $129.00 , $70.95 , $106.30 , $134.80 , $90.30 , $50.31 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $129.00 , $129.00 , $129.00 , $129.00 , $134.80 , $45.15 , $- , $- , $232.95 , $90.30
65220,501002856,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,761, $124.00 , $68.20 , $102.18 , $324.46 , $86.80 , $48.36 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $124.00 , $124.00 , $124.00 , $124.00 , $324.46 , $43.40 , $- , $- , $761.64 , $86.80
51702,501002754,Hospital Chargemaster,Insert temp bladder cath,Outpatient,Outpatient Default Percent / Case Rate,761, $98.00 , $53.90 ," $1,236.00 ", $134.80 , $68.60 , $38.22 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $73.01 , $70.79 , $141.54 , $137.50 , $98.00 , $98.00 , $98.00 , $98.00 , $134.80 , $34.30 , $- , $- ," $1,236.00 ", $68.60
51702,6500010399,Hospital Chargemaster,Insert temp bladder cath,Outpatient,Outpatient Default Percent / Case Rate,761, $208.00 , $114.40 ," $1,236.00 ", $134.80 , $145.60 , $81.12 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $73.01 , $70.79 , $141.54 , $137.50 , $98.00 , $98.00 , $98.00 , $98.00 , $134.80 , $72.80 , $- , $- ," $1,236.00 ", $145.60
69210,501002859,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,761, $97.00 , $53.35 ," $1,236.00 ", $66.55 , $67.90 , $37.83 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $65.09 , $65.09 , $69.87 , $67.88 , $97.00 , $97.00 , $97.00 , $97.00 , $66.55 , $33.95 , $- , $- ," $1,236.00 ", $67.90
69210,6500010504,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,761, $107.00 , $58.85 ," $1,236.00 ", $66.55 , $74.90 , $41.73 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $71.80 , $71.80 , $69.87 , $67.88 , $97.00 , $97.00 , $97.00 , $97.00 , $66.55 , $37.45 , $- , $- ," $1,236.00 ", $74.90
49082,501002718,Hospital Chargemaster,Abd paracentesis,Outpatient,Outpatient Default Percent / Case Rate,761, $93.00 , $51.15 ," $1,442.00 ", $967.36 , $65.10 , $36.27 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $93.00 , $93.00 , $93.00 , $93.00 , $967.36 , $32.55 , $- , $- ," $1,665.99 ", $65.10
49083,501002719,Hospital Chargemaster,Abd paracentesis w/imaging,Outpatient,Outpatient Default Percent / Case Rate,761, $93.00 , $51.15 ," $1,442.00 ", $967.36 , $65.10 , $36.27 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $93.00 , $93.00 , $93.00 , $93.00 , $967.36 , $32.55 , $- , $- ," $1,665.99 ", $65.10
51701,501002753,Hospital Chargemaster,Insert bladder catheter,Outpatient,Outpatient Default Percent / Case Rate,761, $88.00 , $48.40 ," $1,236.00 ", $134.80 , $61.60 , $34.32 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $66.83 , $64.80 , $141.54 , $137.50 , $88.00 , $88.00 , $88.00 , $88.00 , $134.80 , $30.80 , $- , $- ," $1,236.00 ", $61.60
51701,6500010398,Hospital Chargemaster,Insert bladder catheter,Outpatient,Outpatient Default Percent / Case Rate,761, $153.00 , $84.15 ," $1,236.00 ", $134.80 , $107.10 , $59.67 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $66.83 , $64.80 , $141.54 , $137.50 , $88.00 , $88.00 , $88.00 , $88.00 , $134.80 , $53.55 , $- , $- ," $1,236.00 ", $107.10
97597,501002863,Hospital Chargemaster,Rmvl devital tis 20 cm/<,Outpatient,Outpatient Default Percent / Case Rate,761, $78.00 , $42.90 ," $1,236.00 ", $214.68 , $54.60 , $30.42 , $875.52 , $556.51 , $546.42 , $214.68 , $214.68 , $126.90 , $123.05 , $225.42 , $218.98 , $78.00 , $78.00 , $78.00 , $78.00 , $214.68 , $27.30 , $- , $- ," $1,236.00 ", $54.60
99211,6500010029,Hospital Chargemaster,Office/outpatient visit est,Outpatient,Outpatient Default Percent / Case Rate,761, $124.00 , $68.20 , $102.18 , See APC Packaged Rates , $86.80 , $48.36 , $180.56 , $54.48 , $74.62 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $43.40 , $- , $- , $180.56 , $86.80
99212,6500010030,Hospital Chargemaster,Office/outpatient visit est,Outpatient,Outpatient Default Percent / Case Rate,761, $126.00 , $69.30 , $103.82 , See APC Packaged Rates , $88.20 , $49.14 , $500.70 , $151.07 , $206.91 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $44.10 , $- , $- , $500.70 , $88.20
99213,6500010031,Hospital Chargemaster,Office/outpatient visit est,Outpatient,Outpatient Default Percent / Case Rate,761, $158.00 , $86.90 , $130.19 , See APC Packaged Rates , $110.60 , $61.62 ," $1,001.28 ", $302.10 , $413.78 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $55.30 , $- , $- ," $1,001.28 ", $110.60
99214,6500010032,Hospital Chargemaster,Office/outpatient visit est,Outpatient,Outpatient Default Percent / Case Rate,761, $236.00 , $129.80 , $194.46 , See APC Packaged Rates , $165.20 , $92.04 ," $1,543.79 ", $465.78 , $637.97 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $82.60 , $- , $- ," $1,543.79 ", $165.20
99215,6500010033,Hospital Chargemaster,Office/outpatient visit est,Outpatient,Outpatient Default Percent / Case Rate,761, $273.00 , $150.15 , $224.95 , See APC Packaged Rates , $191.10 , $106.47 ," $2,176.35 ", $656.62 , $899.38 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $95.55 , $- , $- ," $2,176.35 ", $191.10
69209,501002858,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,761, $25.00 , $13.75 ," $1,236.00 ", $66.55 , $17.50 , $9.75 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $16.78 , $16.78 , $69.87 , $67.88 , $25.00 , $25.00 , $25.00 , $25.00 , $66.55 , $8.75 , $- , $- ," $1,236.00 ", $17.50
69209,6500010503,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,761, $62.00 , $34.10 ," $1,236.00 ", $66.55 , $43.40 , $24.18 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $41.60 , $41.60 , $69.87 , $67.88 , $25.00 , $25.00 , $25.00 , $25.00 , $66.55 , $21.70 , $- , $- ," $1,236.00 ", $43.40
82554,501002861,Hospital Chargemaster,Creatine isoforms,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 , $673.21 , See APC Packaged Rates , $571.90 , $318.63 , $65.04 , $43.64 , $41.79 , See APC Packaged Rates , See APC Packaged Rates , $25.86 , $25.07 , See APC Packaged Rates , See APC Packaged Rates , $20.20 , $20.20 , $20.72 , $20.72 , See APC Packaged Rates , $285.95 , $15.83 , $15.83 , $673.21 , $571.90
10006,501002408,Hospital Chargemaster,Fna bx w/us gdn ea addl,Outpatient,Outpatient Default Percent / Case Rate,761, $260.00 , $143.00 ," $1,236.00 ", See APC Packaged Rates , $182.00 , $101.40 , $159.18 , $109.25 , $108.67 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $241.80 , $241.80 , $241.80 , $241.80 , See APC Packaged Rates , $91.00 , $- , $- ," $1,236.00 ", $182.00
17003,501002501,Hospital Chargemaster,Destruct premalg les 2-14,Outpatient,Outpatient Default Percent / Case Rate,761, $239.00 , $131.45 ," $1,236.00 ", See APC Packaged Rates , $167.30 , $93.21 , $7.86 , $5.40 , $5.37 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $222.27 , $222.27 , $222.27 , $222.27 , See APC Packaged Rates , $83.65 , $- , $- ," $1,236.00 ", $167.30
17003,6500010146,Hospital Chargemaster,Destruct premalg les 2-14,Outpatient,Outpatient Default Percent / Case Rate,761, $37.00 , $20.35 ," $1,236.00 ", See APC Packaged Rates , $25.90 , $14.43 , $7.86 , $5.40 , $5.37 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $34.41 , $34.41 , $34.41 , $34.41 , See APC Packaged Rates , $12.95 , $- , $- ," $1,236.00 ", $25.90
C5272,501002865,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,761, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $34.41 , $23.62 , $23.49 , See APC Packaged Rates , See APC Packaged Rates , $416.02 , $416.02 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
11001,501002425,Hospital Chargemaster,Debride infected skin add-on,Outpatient,Outpatient Default Percent / Case Rate,761, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $45.41 , $31.17 , $31.00 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
15272,501002487,Hospital Chargemaster,Skin sub graft t/a/l add-on,Outpatient,Outpatient Default Percent / Case Rate,761, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $55.78 , $38.29 , $38.08 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
11732,501002471,Hospital Chargemaster,Remove nail plate add-on,Outpatient,Outpatient Default Percent / Case Rate,761, $150.00 , $82.50 ," $1,236.00 ", See APC Packaged Rates , $105.00 , $58.50 , $56.49 , $38.77 , $38.57 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $139.50 , $139.50 , $139.50 , $139.50 , See APC Packaged Rates , $52.50 , $- , $- ," $1,236.00 ", $105.00
19001,501002508,Hospital Chargemaster,Drain breast lesion add-on,Outpatient,Outpatient Default Percent / Case Rate,761, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $69.14 , $47.45 , $47.20 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
11103,501002436,Hospital Chargemaster,Tangntl bx skin ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,761, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $74.66 , $51.25 , $50.97 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
11103,6500010081,Hospital Chargemaster,Tangntl bx skin ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,761, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $74.66 , $51.25 , $50.97 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
15276,501002491,Hospital Chargemaster,Skin sub graft f/n/hf/g addl,Outpatient,Outpatient Default Percent / Case Rate,761, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $81.32 , $55.82 , $55.52 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
11105,501002438,Hospital Chargemaster,Punch bx skin ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,761, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $88.21 , $60.54 , $60.22 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
11105,6500010083,Hospital Chargemaster,Punch bx skin ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,761, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $88.21 , $60.54 , $60.22 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
11107,501002440,Hospital Chargemaster,Incal bx skn ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,761, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $105.14 , $72.16 , $71.78 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
11107,6500010085,Hospital Chargemaster,Incal bx skn ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,761, $271.00 , $149.05 ," $1,236.00 ", See APC Packaged Rates , $189.70 , $105.69 , $105.14 , $72.16 , $71.78 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- ," $1,236.00 ", $189.70
20501,501002530,Hospital Chargemaster,Inject sinus tract for x-ray,Outpatient,Outpatient Default Percent / Case Rate,761, $900.00 , $495.00 ," $1,236.00 ", See APC Packaged Rates , $630.00 , $351.00 , $121.46 , $83.36 , $82.92 , See APC Packaged Rates , See APC Packaged Rates , $100.01 , $96.98 , See APC Packaged Rates , See APC Packaged Rates , $837.00 , $837.00 , $837.00 , $837.00 , See APC Packaged Rates , $315.00 , $- , $- ," $1,236.00 ", $630.00
27369,501002564,Hospital Chargemaster,Njx cntrst kne arthg/ct/mri,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $130.87 , $89.82 , $89.34 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
19286,501002522,Hospital Chargemaster,Perq dev breast add us imag,Outpatient,Outpatient Default Percent / Case Rate,761, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $139.50 , $95.74 , $95.23 , See APC Packaged Rates , See APC Packaged Rates , $236.19 , $236.19 , See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
15274,501002489,Hospital Chargemaster,Skn sub grft t/a/l child add,Outpatient,Outpatient Default Percent / Case Rate,761, $830.00 , $456.50 ," $1,236.00 ", See APC Packaged Rates , $581.00 , $323.70 , $149.08 , $102.32 , $101.78 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $771.90 , $771.90 , $771.90 , $771.90 , See APC Packaged Rates , $290.50 , $- , $- ," $1,236.00 ", $581.00
19282,501002518,Hospital Chargemaster,Perq device breast ea imag,Outpatient,Outpatient Default Percent / Case Rate,761, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $162.99 , $111.87 , $111.27 , See APC Packaged Rates , See APC Packaged Rates , $236.19 , $236.19 , See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
23350,501002555,Hospital Chargemaster,Injection for shoulder x-ray,Outpatient,Outpatient Default Percent / Case Rate,761, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $164.23 , $112.72 , $112.12 , See APC Packaged Rates , See APC Packaged Rates , $119.20 , $115.58 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
11046,501002430,Hospital Chargemaster,Deb musc/fascia add-on,Outpatient,Outpatient Default Percent / Case Rate,761," $1,380.00 ", $759.00 ," $1,236.00 ", See APC Packaged Rates , $966.00 , $538.20 , $179.86 , $123.45 , $122.79 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates ," $1,283.40 "," $1,283.40 "," $1,283.40 "," $1,283.40 ", See APC Packaged Rates , $483.00 , $- , $- ," $1,283.40 ", $966.00
15278,501002493,Hospital Chargemaster,Skn sub grft f/n/hf/g ch add,Outpatient,Outpatient Default Percent / Case Rate,761, $830.00 , $456.50 ," $1,236.00 ", See APC Packaged Rates , $581.00 , $323.70 , $186.21 , $127.81 , $127.13 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $771.90 , $771.90 , $771.90 , $771.90 , See APC Packaged Rates , $290.50 , $- , $- ," $1,236.00 ", $581.00
58340,501002770,Hospital Chargemaster,Catheter for hysterography,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $186.80 , $128.21 , $127.53 , See APC Packaged Rates , See APC Packaged Rates , $145.67 , $141.25 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
24220,501002557,Hospital Chargemaster,Injection for elbow x-ray,Outpatient,Outpatient Default Percent / Case Rate,761, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $218.10 , $149.70 , $148.90 , See APC Packaged Rates , See APC Packaged Rates , $157.37 , $152.59 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
27093,501002561,Hospital Chargemaster,Injection for hip x-ray,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $225.37 , $154.68 , $153.86 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
50690,501002745,Hospital Chargemaster,Injection for ureter x-ray,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,236.00 ", See APC Packaged Rates ," $1,015.00 ", $565.50 , $229.10 , $157.24 , $156.41 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,348.50 "," $1,348.50 "," $1,348.50 "," $1,348.50 ", See APC Packaged Rates , $507.50 , $- , $- ," $1,348.50 "," $1,015.00 "
64643,501002848,Hospital Chargemaster,Chemodenerv 1 extrem 1-4 ea,Outpatient,Outpatient Default Percent / Case Rate,761, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $233.96 , $160.58 , $159.72 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
25246,501002559,Hospital Chargemaster,Injection for wrist x-ray,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $241.52 , $165.77 , $164.88 , See APC Packaged Rates , See APC Packaged Rates , $548.21 , $548.21 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
19084,501002513,Hospital Chargemaster,Bx breast add lesion us imag,Outpatient,Outpatient Default Percent / Case Rate,761, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $254.49 , $174.67 , $173.74 , See APC Packaged Rates , See APC Packaged Rates ," $1,133.44 "," $1,104.09 ", See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
64645,501002850,Hospital Chargemaster,Chemodenerv 1 extrem 5/> ea,Outpatient,Outpatient Default Percent / Case Rate,761, $446.00 , $245.30 ," $1,236.00 ", See APC Packaged Rates , $312.20 , $173.94 , $269.68 , $185.09 , $184.11 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $414.78 , $414.78 , $414.78 , $414.78 , See APC Packaged Rates , $156.10 , $- , $- ," $1,236.00 ", $312.20
27095,501002562,Hospital Chargemaster,Injection for hip x-ray,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $270.59 , $185.72 , $184.73 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
19082,501002511,Hospital Chargemaster,Bx breast add lesion strtctc,Outpatient,Outpatient Default Percent / Case Rate,761, $352.00 , $193.60 ," $1,236.00 ", See APC Packaged Rates , $246.40 , $137.28 , $272.37 , $186.94 , $185.95 , See APC Packaged Rates , See APC Packaged Rates ," $1,133.44 "," $1,104.09 ", See APC Packaged Rates , See APC Packaged Rates , $327.36 , $327.36 , $327.36 , $327.36 , See APC Packaged Rates , $123.20 , $- , $- ," $1,236.00 ", $246.40
62284,501002781,Hospital Chargemaster,Injection for myelogram,Outpatient,Outpatient Default Percent / Case Rate,761," $1,500.00 ", $825.00 ," $1,236.00 ", See APC Packaged Rates ," $1,050.00 ", $585.00 , $285.96 , $196.27 , $195.22 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,395.00 "," $1,395.00 "," $1,395.00 "," $1,395.00 ", See APC Packaged Rates , $525.00 , $- , $- ," $1,395.00 "," $1,050.00 "
11047,501002431,Hospital Chargemaster,Deb bone add-on,Outpatient,Outpatient Default Percent / Case Rate,761, $286.00 , $157.30 ," $1,236.00 ", See APC Packaged Rates , $200.20 , $111.54 , $318.48 , $218.59 , $217.42 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $265.98 , $265.98 , $265.98 , $265.98 , See APC Packaged Rates , $100.10 , $- , $- ," $1,236.00 ", $200.20
47001,501002706,Hospital Chargemaster,Needle biopsy liver add-on,Outpatient,Outpatient Default Percent / Case Rate,761, $590.00 , $324.50 ," $1,236.00 ", See APC Packaged Rates , $413.00 , $230.10 , $336.59 , $231.02 , $229.79 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $548.70 , $548.70 , $548.70 , $548.70 , See APC Packaged Rates , $206.50 , $- , $- ," $1,236.00 ", $413.00
36010,501002597,Hospital Chargemaster,Place catheter in vein,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 ," $1,236.00 ", See APC Packaged Rates , $571.90 , $318.63 , $354.08 , $243.02 , $241.73 , See APC Packaged Rates , See APC Packaged Rates , $299.66 , $290.57 , See APC Packaged Rates , See APC Packaged Rates , $759.81 , $759.81 , $759.81 , $759.81 , See APC Packaged Rates , $285.95 , $- , $- ," $1,236.00 ", $571.90
C5274,501002867,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,761, $860.00 , $473.00 ," $1,236.00 ", See APC Packaged Rates , $602.00 , $335.40 , $829.81 , $833.43 , $442.92 , See APC Packaged Rates , See APC Packaged Rates , $577.06 , $577.06 , See APC Packaged Rates , See APC Packaged Rates , $799.80 , $799.80 , $799.80 , $799.80 , See APC Packaged Rates , $301.00 , $- , $- ," $1,236.00 ", $602.00
C5276,501002869,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,761, $620.00 , $341.00 ," $1,236.00 ", See APC Packaged Rates , $434.00 , $241.80 , $598.24 , $600.84 , $319.31 , See APC Packaged Rates , See APC Packaged Rates , $416.02 , $416.02 , See APC Packaged Rates , See APC Packaged Rates , $576.60 , $576.60 , $576.60 , $576.60 , See APC Packaged Rates , $217.00 , $- , $- ," $1,236.00 ", $434.00
C5278,501002871,Hospital Chargemaster,Low cost skin substitute app,Outpatient,Outpatient Default Percent / Case Rate,761, $830.00 , $456.50 ," $1,236.00 ", See APC Packaged Rates , $581.00 , $323.70 , $800.87 , $804.35 , $427.47 , See APC Packaged Rates , See APC Packaged Rates , $556.93 , $556.93 , See APC Packaged Rates , See APC Packaged Rates , $771.90 , $771.90 , $771.90 , $771.90 , See APC Packaged Rates , $290.50 , $- , $- ," $1,236.00 ", $581.00
36416,501002618,Hospital Chargemaster,Capillary blood draw,Outpatient,Outpatient Default Percent / Case Rate,761, $11.00 , $6.05 , $9.06 , See APC Packaged Rates , $7.70 , $4.29 , $12.68 , $8.51 , $8.15 , See APC Packaged Rates , See APC Packaged Rates , $7.38 , $7.38 , See APC Packaged Rates , See APC Packaged Rates , $10.23 , $10.23 , $10.23 , $10.23 , See APC Packaged Rates , $3.85 , $3.46 , $3.46 , $12.68 , $7.70
36416,6500010263,Hospital Chargemaster,Capillary blood draw,Outpatient,Outpatient Default Percent / Case Rate,761, $11.00 , $6.05 , $9.06 , See APC Packaged Rates , $7.70 , $4.29 , $12.68 , $8.51 , $8.15 , See APC Packaged Rates , See APC Packaged Rates , $7.38 , $7.38 , See APC Packaged Rates , See APC Packaged Rates , $10.23 , $10.23 , $10.23 , $10.23 , See APC Packaged Rates , $3.85 , $3.46 , $3.46 , $12.68 , $7.70
36410,501002617,Hospital Chargemaster,Non-routine bl draw 3/> yrs,Outpatient,Outpatient Default Percent / Case Rate,761, $9.65 , $5.31 , $7.95 , See APC Packaged Rates , $6.76 , $3.76 , $30.17 , $20.71 , $20.60 , See APC Packaged Rates , See APC Packaged Rates , $21.29 , $20.65 , See APC Packaged Rates , See APC Packaged Rates , $8.97 , $8.97 , $8.97 , $8.97 , See APC Packaged Rates , $3.38 , $- , $- , $30.17 , $6.76
11201,501002442,Hospital Chargemaster,Remove skin tags add-on,Outpatient,Outpatient Default Percent / Case Rate,761, $271.00 , $149.05 , $223.30 , See APC Packaged Rates , $189.70 , $105.69 , $54.04 , $37.09 , $36.89 , See APC Packaged Rates , See APC Packaged Rates , $38.24 , $37.08 , See APC Packaged Rates , See APC Packaged Rates , $252.03 , $252.03 , $252.03 , $252.03 , See APC Packaged Rates , $94.85 , $- , $- , $252.03 , $189.70
51600,501002750,Hospital Chargemaster,Injection for bladder x-ray,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,194.80 ", See APC Packaged Rates ," $1,015.00 ", $565.50 , $143.93 , $98.79 , $98.26 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,348.50 "," $1,348.50 "," $1,348.50 "," $1,348.50 ", See APC Packaged Rates , $507.50 , $- , $- ," $1,348.50 "," $1,015.00 "
77002,501002860,Hospital Chargemaster,Needle localization by xray,Outpatient,Outpatient Default Percent / Case Rate,761, $282.00 , $155.10 , $232.37 , See APC Packaged Rates , $197.40 , $109.98 , $294.75 , $231.12 , $230.33 , See APC Packaged Rates , See APC Packaged Rates , $158.25 , $153.45 , See APC Packaged Rates , See APC Packaged Rates , $262.26 , $262.26 , $262.26 , $262.26 , See APC Packaged Rates , $98.70 , $- , $- , $294.75 , $197.40
99292,6500010035,Hospital Chargemaster,Critical care addl 30 min,Outpatient,Outpatient Default Percent / Case Rate,761, $329.00 , $180.95 , $271.10 , See APC Packaged Rates , $230.30 , $128.31 , $788.62 , $487.85 , $471.20 , See APC Packaged Rates , See APC Packaged Rates , $250.80 , $243.19 , See APC Packaged Rates , See APC Packaged Rates , $305.97 , $305.97 , $305.97 , $305.97 , See APC Packaged Rates , $131.60 , $- , $- , $788.62 , $230.30
59425,5000011017,Hospital Chargemaster,Antepartum Care Only,Outpatient,Outpatient Default Percent / Case Rate,761, $776.00 , $426.80 , $639.42 , See APC Packaged Rates , $543.20 , $302.64 ," $1,138.81 ", $781.63 , $777.46 , See APC Packaged Rates , See APC Packaged Rates , $520.70 , $520.70 , See APC Packaged Rates , See APC Packaged Rates , $721.68 , $721.68 , $721.68 , $721.68 , See APC Packaged Rates , $271.60 , $- , $- ," $1,138.81 ", $543.20
50430,501002738,Hospital Chargemaster,Njx px nfrosgrm &/urtrgrm,Outpatient,Outpatient Default Percent / Case Rate,761, $984.00 , $541.20 ," $1,236.00 ", $687.79 , $688.80 , $383.76 ," $1,229.98 ", $844.21 , $839.71 , $687.79 , $687.79 , $105.28 , $102.55 , $722.18 , $701.54 , $892.65 , $892.65 , $915.65 , $915.65 , $687.79 , $344.40 , $- , $- ," $1,236.00 ", $688.80
11044,6500010073,Hospital Chargemaster,Deb bone 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,761," $2,540.00 "," $1,397.00 "," $1,442.00 "," $1,682.11 "," $1,778.00 ", $990.60 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,004.00 "," $1,004.00 "," $1,004.00 "," $1,004.00 "," $1,682.11 ", $889.00 , $- , $- ," $3,009.07 "," $1,778.00 "
11045,6500010074,Hospital Chargemaster,Deb subq tissue add-on,Outpatient,Outpatient Default Percent / Case Rate,761," $1,270.00 ", $698.50 ," $1,236.00 ", See APC Packaged Rates , $889.00 , $495.30 , $84.75 , $58.17 , $57.86 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates ," $1,181.10 "," $1,181.10 "," $1,181.10 "," $1,181.10 ", See APC Packaged Rates , $444.50 , $- , $- ," $1,236.00 ", $889.00
11046,6500010075,Hospital Chargemaster,Deb musc/fascia add-on,Outpatient,Outpatient Default Percent / Case Rate,761," $1,380.00 ", $759.00 ," $1,236.00 ", See APC Packaged Rates , $966.00 , $538.20 , $179.86 , $123.45 , $122.79 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates ," $1,283.40 "," $1,283.40 "," $1,283.40 "," $1,283.40 ", See APC Packaged Rates , $483.00 , $- , $- ," $1,283.40 ", $966.00
11047,6500010076,Hospital Chargemaster,Deb bone add-on,Outpatient,Outpatient Default Percent / Case Rate,761," $1,422.00 ", $782.10 ," $1,236.00 ", See APC Packaged Rates , $995.40 , $554.58 , $318.48 , $218.59 , $217.42 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates ," $1,322.46 "," $1,322.46 "," $1,322.46 "," $1,322.46 ", See APC Packaged Rates , $497.70 , $- , $- ," $1,322.46 ", $995.40
11056,6500010078,Hospital Chargemaster,Trim skin lesions 2 to 4,Outpatient,Outpatient Default Percent / Case Rate,761, $239.00 , $131.45 ," $1,236.00 ", $214.68 , $167.30 , $93.21 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $86.18 , $83.57 , $225.42 , $218.98 , $185.14 , $185.14 , $185.14 , $185.14 , $214.68 , $83.65 , $- , $- ," $1,236.00 ", $167.30
11641,6500010110,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,761, $438.00 , $240.90 ," $1,442.00 ", $743.95 , $306.60 , $170.82 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $558.00 , $558.00 , $558.00 , $558.00 , $743.95 , $153.30 , $- , $- ," $1,442.00 ", $306.60
11750,6500010118,Hospital Chargemaster,Removal of nail bed,Outpatient,Outpatient Default Percent / Case Rate,761, $- , $- ," $1,236.00 ", $413.21 , $- , $- , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $526.00 , $526.00 , $526.00 , $526.00 , $413.21 , $- , $- , $- ," $1,236.00 ", $-
15271,6500010131,Hospital Chargemaster,Skin sub graft trnk/arm/leg,Outpatient,Outpatient Default Percent / Case Rate,761," $2,265.00 "," $1,245.75 "," $1,442.00 "," $2,047.65 "," $1,585.50 ", $883.35 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $792.75 , $- , $- ," $3,388.54 "," $1,585.50 "
15275,6500010135,Hospital Chargemaster,Skin sub graft face/nk/hf/g,Outpatient,Outpatient Default Percent / Case Rate,761," $2,265.00 "," $1,245.75 "," $1,442.00 "," $2,047.65 "," $1,585.50 ", $883.35 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $792.75 , $- , $- ," $3,388.54 "," $1,585.50 "
16020,6500010142,Hospital Chargemaster,Dress/debrid p-thick burn s,Outpatient,Outpatient Default Percent / Case Rate,761, $350.00 , $192.50 ," $1,236.00 ", $214.68 , $245.00 , $136.50 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $171.00 , $171.00 , $171.00 , $171.00 , $214.68 , $122.50 , $- , $- ," $1,236.00 ", $245.00
16025,6500010143,Hospital Chargemaster,Dress/debrid p-thick burn m,Outpatient,Outpatient Default Percent / Case Rate,761, $446.00 , $245.30 ," $1,442.00 ", $214.68 , $312.20 , $173.94 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $156.10 , $- , $- ," $1,442.00 ", $312.20
16030,6500010144,Hospital Chargemaster,Dress/debrid p-thick burn l,Outpatient,Outpatient Default Percent / Case Rate,761, $850.00 , $467.50 ," $1,442.00 ", $413.21 , $595.00 , $331.50 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $297.50 , $- , $- ," $1,442.00 ", $595.00
28810,6500010212,Hospital Chargemaster,Amputation toe & metatarsal,Outpatient,Outpatient Default Percent / Case Rate,761, $- , $- ," $1,442.00 "," $3,385.65 ", $- , $- ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,133.44 "," $1,104.09 "," $3,554.93 "," $3,453.36 ", $- , $- , $- , $- ," $3,385.65 ", $- , $- , $- ," $5,738.89 ", $-
29445,6500010217,Hospital Chargemaster,Apply rigid leg cast,Outpatient,Outpatient Default Percent / Case Rate,761, $446.00 , $245.30 , $367.50 , $288.41 , $312.20 , $173.94 , $515.36 , $353.72 , $351.84 , $288.41 , $288.41 , $263.51 , $255.51 , $302.83 , $294.18 , $327.00 , $327.00 , $327.00 , $327.00 , $288.41 , $156.10 , $- , $- , $515.36 , $312.20
29581,6500010219,Hospital Chargemaster,Apply multlay comprs lwr leg,Outpatient,Outpatient Default Percent / Case Rate,761, $271.00 , $149.05 , $223.30 , $168.90 , $189.70 , $105.69 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $32.27 , $31.29 , $177.35 , $172.28 , $271.00 , $271.00 , $271.00 , $271.00 , $168.90 , $94.85 , $- , $- , $294.51 , $189.70
33285,6500010239,Hospital Chargemaster,Insj subq car rhythm mntr,Outpatient,Outpatient Default Percent / Case Rate,761," $1,800.00 ", $990.00 ," $1,236.00 "," $9,753.71 "," $1,260.00 ", $702.00 ," $16,197.41 "," $11,117.20 "," $11,057.93 "," $9,753.71 "," $9,753.71 ", $105.28 , $102.55 ," $10,241.39 "," $9,948.78 "," $1,800.00 "," $1,800.00 "," $1,800.00 "," $1,800.00 "," $9,753.71 ", $630.00 , $- , $- ," $16,197.41 "," $1,260.00 "
33286,6500010240,Hospital Chargemaster,Rmvl subq car rhythm mntr,Outpatient,Outpatient Default Percent / Case Rate,761," $1,800.00 ", $990.00 ," $1,236.00 ", $743.95 ," $1,260.00 ", $702.00 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $743.95 , $630.00 , $- , $- ," $1,267.38 "," $1,260.00 "
38222,6500010339,Hospital Chargemaster,Dx bone marrow bx & aspir,Outpatient,Outpatient Default Percent / Case Rate,761," $1,066.00 ", $586.30 ," $1,236.00 "," $2,834.62 ", $746.20 , $415.74 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $2,834.62 "," $2,834.62 ", $105.28 , $102.55 ," $2,976.35 "," $2,891.31 ", $150.00 , $150.00 , $150.00 , $150.00 ," $2,834.62 ", $373.10 , $- , $- ," $3,009.07 ", $746.20
49084,6500010365,Hospital Chargemaster,Peritoneal lavage,Outpatient,Outpatient Default Percent / Case Rate,761, $- , $- ," $1,442.00 ", $967.36 , $- , $- ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $- , $- , $- , $- , $967.36 , $- , $- , $- ," $1,665.99 ", $-
51720,6500010402,Hospital Chargemaster,Treatment of bladder lesion,Outpatient,Outpatient Default Percent / Case Rate,761, $425.00 , $233.75 , $350.20 , $318.13 , $297.50 , $165.75 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $386.01 , $386.01 , $395.95 , $395.95 , $318.13 , $148.75 , $- , $- , $506.26 , $297.50
64400,6500010448,Hospital Chargemaster,N block inj trigeminal,Outpatient,Outpatient Default Percent / Case Rate,761, $817.00 , $449.35 ," $1,236.00 ", $312.35 , $571.90 , $318.63 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $157.25 , $152.48 , $327.96 , $318.59 , $194.00 , $194.00 , $194.00 , $194.00 , $312.35 , $285.95 , $- , $- ," $1,236.00 ", $571.90
64483,6500010462,Hospital Chargemaster,Inj foramen epidural l/s,Outpatient,Outpatient Default Percent / Case Rate,761," $1,200.00 ", $660.00 ," $1,236.00 ", $984.14 , $840.00 , $468.00 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $264.05 , $256.03 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $420.00 , $- , $- ," $1,673.19 ", $840.00
64612,6500010483,Hospital Chargemaster,Destroy nerve face muscle,Outpatient,Outpatient Default Percent / Case Rate,761, $278.00 , $152.90 ," $1,236.00 ", $312.35 , $194.60 , $108.42 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $446.00 , $446.00 , $446.00 , $446.00 , $312.35 , $97.30 , $- , $- ," $1,236.00 ", $194.60
64615,6500010484,Hospital Chargemaster,Chemodenerv musc migraine,Outpatient,Outpatient Default Percent / Case Rate,761, $415.00 , $228.25 ," $1,236.00 ", $312.35 , $290.50 , $161.85 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $278.47 , $278.47 , $327.96 , $318.59 , $415.00 , $415.00 , $415.00 , $415.00 , $312.35 , $145.25 , $- , $- ," $1,236.00 ", $290.50
64616,6500010485,Hospital Chargemaster,Chemodenerv musc neck dyston,Outpatient,Outpatient Default Percent / Case Rate,761, $445.00 , $244.75 ," $1,236.00 ", $312.35 , $311.50 , $173.55 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $740.30 , $740.30 , $740.30 , $740.30 , $312.35 , $155.75 , $- , $- ," $1,236.00 ", $311.50
64633,6500010487,Hospital Chargemaster,Destroy cerv/thor facet jnt,Outpatient,Outpatient Default Percent / Case Rate,761, $- , $- ," $1,236.00 "," $2,099.21 ", $- , $- ," $3,569.06 "," $2,449.65 "," $2,436.59 "," $2,099.21 "," $2,099.21 ", $844.48 , $822.61 ," $2,204.17 "," $2,141.20 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,099.21 ", $- , $- , $- ," $3,569.06 ", $-
64635,6500010489,Hospital Chargemaster,Destroy lumb/sac facet jnt,Outpatient,Outpatient Default Percent / Case Rate,761, $- , $- ," $1,236.00 "," $2,099.21 ", $- , $- ," $3,569.06 "," $2,449.65 "," $2,436.59 "," $2,099.21 "," $2,099.21 ", $105.28 , $102.55 ," $2,204.17 "," $2,141.20 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,099.21 ", $- , $- , $- ," $3,569.06 ", $-
64636,6500010490,Hospital Chargemaster,Destroy l/s facet jnt addl,Outpatient,Outpatient Default Percent / Case Rate,761, $- , $- ," $1,236.00 ", See APC Packaged Rates , $- , $- , $191.26 , $131.27 , $130.57 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- ," $1,236.00 ", $-
64642,6500010492,Hospital Chargemaster,Chemodenerv 1 extremity 1-4,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $507.50 , $- , $- ," $1,309.97 "," $1,015.00 "
64643,6500010493,Hospital Chargemaster,Chemodenerv 1 extrem 1-4 ea,Outpatient,Outpatient Default Percent / Case Rate,761, $872.00 , $479.60 ," $1,236.00 ", See APC Packaged Rates , $610.40 , $340.08 , $233.96 , $160.58 , $159.72 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $810.96 , $810.96 , $810.96 , $810.96 , See APC Packaged Rates , $305.20 , $- , $- ," $1,236.00 ", $610.40
64644,6500010494,Hospital Chargemaster,Chemodenerv 1 extrem 5/> mus,Outpatient,Outpatient Default Percent / Case Rate,761," $1,080.00 ", $594.00 ," $1,236.00 ", $759.14 , $756.00 , $421.20 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $378.00 , $- , $- ," $1,309.97 ", $756.00
10180,6500010521,Hospital Chargemaster,Complex Drainage Wound,Outpatient,Outpatient Default Percent / Case Rate,761, $218.00 , $119.90 ," $1,442.00 "," $2,834.62 ", $152.60 , $85.02 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,133.44 "," $1,104.09 "," $2,976.35 "," $2,891.31 ", $202.74 , $202.74 , $202.74 , $202.74 ," $2,834.62 ", $76.30 , $- , $- ," $5,202.81 ", $152.60
11760,6500010552,Hospital Chargemaster,Repair Of Nail Bed,Outpatient,Outpatient Default Percent / Case Rate,761, $407.00 , $223.85 ," $1,236.00 ", $626.13 , $284.90 , $158.73 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $142.45 , $- , $- ," $1,236.00 ", $284.90
11982,6500010558,Hospital Chargemaster,Remove Drug Implant Device,Outpatient,Outpatient Default Percent / Case Rate,761, $346.00 , $190.30 ," $1,236.00 ", $324.46 , $242.20 , $134.94 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $343.81 , $343.81 , $343.81 , $343.81 , $324.46 , $121.10 , $- , $- ," $1,236.00 ", $242.20
16035,6500010607,Hospital Chargemaster,Incision Of Burn Scab Initi,Outpatient,Outpatient Default Percent / Case Rate,761," $1,400.00 ", $770.00 ," $1,442.00 ", $413.21 , $980.00 , $546.00 ," $1,350.86 "," $1,356.74 ", $721.03 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $490.00 , $- , $- ," $1,442.00 ", $980.00
23600,6500010698,Hospital Chargemaster,Treat Humerus Fracture,Outpatient,Outpatient Default Percent / Case Rate,761, $450.00 , $247.50 ," $1,236.00 ", $246.41 , $315.00 , $175.50 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $246.41 , $157.50 , $- , $- ," $1,236.00 ", $315.00
24530,6500010742,Hospital Chargemaster,Treat Humerus Fracture,Outpatient,Outpatient Default Percent / Case Rate,761, $544.00 , $299.20 ," $1,236.00 ", $246.41 , $380.80 , $212.16 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $246.41 , $190.40 , $- , $- ," $1,236.00 ", $380.80
24650,6500010755,Hospital Chargemaster,Treat Radius Fracture,Outpatient,Outpatient Default Percent / Case Rate,761, $363.00 , $199.65 ," $1,236.00 ", $246.41 , $254.10 , $141.57 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $127.05 , $- , $- ," $1,236.00 ", $254.10
25530,6500010805,Hospital Chargemaster,Treat Fracture Of Ulna,Outpatient,Outpatient Default Percent / Case Rate,761, $363.00 , $199.65 ," $1,236.00 ", $246.41 , $254.10 , $141.57 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $127.05 , $- , $- ," $1,236.00 ", $254.10
25622,6500010817,Hospital Chargemaster,Treat Wrist Bone Fracture,Outpatient,Outpatient Default Percent / Case Rate,761, $421.00 , $231.55 , $346.90 , $246.41 , $294.70 , $164.19 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $147.35 , $- , $- , $492.41 , $294.70
26600,6500010882,Hospital Chargemaster,Treat Metacarpal Fracture,Outpatient,Outpatient Default Percent / Case Rate,761, $428.00 , $235.40 , $352.67 , $246.41 , $299.60 , $166.92 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $325.00 , $325.00 , $325.00 , $325.00 , $246.41 , $149.80 , $- , $- , $492.41 , $299.60
26720,6500010897,Hospital Chargemaster,Treat Finger Fracture Each,Outpatient,Outpatient Default Percent / Case Rate,761, $317.00 , $174.35 ," $1,236.00 ", $246.41 , $221.90 , $123.63 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $110.95 , $- , $- ," $1,236.00 ", $221.90
26750,6500010904,Hospital Chargemaster,Treat Finger Fracture Each,Outpatient,Outpatient Default Percent / Case Rate,761, $279.00 , $153.45 , $229.90 , $246.41 , $195.30 , $108.81 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $97.65 , $- , $- , $492.41 , $195.30
27530,6500011014,Hospital Chargemaster,Treat Knee Fracture,Outpatient,Outpatient Default Percent / Case Rate,761, $678.00 , $372.90 ," $1,236.00 ", $246.41 , $474.60 , $264.42 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $246.41 , $237.30 , $- , $- ," $1,236.00 ", $474.60
27786,6500011071,Hospital Chargemaster,Treatment Of Ankle Fracture,Outpatient,Outpatient Default Percent / Case Rate,761, $542.00 , $298.10 ," $1,236.00 ", $246.41 , $379.40 , $211.38 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $246.41 , $189.70 , $- , $- ," $1,236.00 ", $379.40
28002,6500011095,Hospital Chargemaster,Treatment Of Foot Infection,Outpatient,Outpatient Default Percent / Case Rate,761," $2,345.00 "," $1,289.75 "," $2,060.00 "," $1,665.16 "," $1,641.50 ", $914.55 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,294.72 "," $1,261.20 "," $1,748.42 "," $1,698.46 "," $2,345.00 "," $2,345.00 "," $2,345.00 "," $2,345.00 "," $1,665.16 ", $820.75 , $- , $- ," $2,873.10 "," $1,641.50 "
26600,6500011128,Hospital Chargemaster,Treat Metacarpal Fracture,Outpatient,Outpatient Default Percent / Case Rate,761, $364.00 , $200.20 , $299.94 , $246.41 , $254.80 , $141.96 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $325.00 , $325.00 , $325.00 , $325.00 , $246.41 , $127.40 , $- , $- , $492.41 , $254.80
25600,6500011131,Hospital Chargemaster,Treat Fracture Radius/Ulna,Outpatient,Outpatient Default Percent / Case Rate,761, $694.00 , $381.70 ," $1,236.00 ", $246.41 , $485.80 , $270.66 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $242.90 , $- , $- ," $1,236.00 ", $485.80
28470,6500011135,Hospital Chargemaster,Treat Metatarsal Fracture,Outpatient,Outpatient Default Percent / Case Rate,761, $303.00 , $166.65 ," $1,236.00 ", $246.41 , $212.10 , $118.17 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $106.05 , $- , $- ," $1,236.00 ", $212.10
28510,6500011139,Hospital Chargemaster,Treatment Of Toe Fracture,Outpatient,Outpatient Default Percent / Case Rate,761, $162.00 , $89.10 ," $1,236.00 ", $246.41 , $113.40 , $63.18 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $56.70 , $- , $- ," $1,236.00 ", $113.40
29065,6500011156,Hospital Chargemaster,Application Of Long Arm Cast,Outpatient,Outpatient Default Percent / Case Rate,761, $261.00 , $143.55 , $215.06 , $288.41 , $182.70 , $101.79 , $515.36 , $353.72 , $351.84 , $288.41 , $288.41 , $266.32 , $258.23 , $302.83 , $294.18 , $369.77 , $369.77 , $379.30 , $379.30 , $288.41 , $91.35 , $- , $- , $515.36 , $182.70
29125,6500011158,Hospital Chargemaster,Apply Forearm Splint,Outpatient,Outpatient Default Percent / Case Rate,761, $127.00 , $69.85 , $104.65 , $134.80 , $88.90 , $49.53 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $116.00 , $116.00 , $116.00 , $116.00 , $134.80 , $44.45 , $- , $- , $232.95 , $88.90
29260,6500011160,Hospital Chargemaster,Strapping Of Elbow or Wrist,Outpatient,Outpatient Default Percent / Case Rate,761, $110.00 , $60.50 , $90.64 , $66.55 , $77.00 , $42.90 , $70.26 , $48.23 , $47.97 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $62.64 , $62.64 , $64.26 , $64.26 , $66.55 , $38.50 , $- , $- , $147.89 , $77.00
29530,6500011167,Hospital Chargemaster,Strapping Of Knee,Outpatient,Outpatient Default Percent / Case Rate,761, $116.00 , $63.80 , $95.58 , $134.80 , $81.20 , $45.24 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $125.00 , $125.00 , $125.00 , $125.00 , $134.80 , $40.60 , $- , $- , $232.95 , $81.20
49421,6500011572,Hospital Chargemaster,Ins Tun Ip Cath For Dial Opn,Outpatient,Outpatient Default Percent / Case Rate,761, $- , $- ," $1,442.00 "," $3,803.62 ", $- , $- ," $6,447.63 "," $4,425.37 "," $4,401.78 "," $3,803.62 "," $3,803.62 ", $844.48 , $822.61 ," $3,993.81 "," $3,879.70 ", $- , $- , $- , $- ," $3,803.62 ", $- , $- , $- ," $6,447.63 ", $-
57160,6500011755,Hospital Chargemaster,Insert pessary/other device,Outpatient,Outpatient Default Percent / Case Rate,761, $177.00 , $97.35 , $145.85 , $203.67 , $123.90 , $69.03 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $105.28 , $102.55 , $213.85 , $207.74 , $177.00 , $177.00 , $177.00 , $177.00 , $203.67 , $61.95 , $- , $- , $362.99 , $123.90
57420,6500011767,Hospital Chargemaster,Exam Of Vagina W/Scope,Outpatient,Outpatient Default Percent / Case Rate,761, $295.00 , $162.25 ," $1,236.00 ", $337.17 , $206.50 , $115.05 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 , $105.28 , $102.55 , $354.03 , $343.92 , $295.00 , $295.00 , $295.00 , $295.00 , $337.17 , $103.25 , $- , $- ," $1,236.00 ", $206.50
57454,6500011770,Hospital Chargemaster,Bx/Curett Of Cervix w/Scope,Outpatient,Outpatient Default Percent / Case Rate,761, $307.00 , $168.85 ," $1,442.00 ", $337.17 , $214.90 , $119.73 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 , $105.28 , $102.55 , $354.03 , $343.92 , $307.00 , $307.00 , $307.00 , $307.00 , $337.17 , $107.45 , $- , $- ," $1,442.00 ", $214.90
57455,6500011771,Hospital Chargemaster,Biopsy Of Cervix W/Scope,Outpatient,Outpatient Default Percent / Case Rate,761, $295.00 , $162.25 ," $1,236.00 ", $337.17 , $206.50 , $115.05 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 , $105.28 , $102.55 , $354.03 , $343.92 , $295.00 , $295.00 , $295.00 , $295.00 , $337.17 , $103.25 , $- , $- ," $1,236.00 ", $206.50
57456,6500011772,Hospital Chargemaster,Endocerv Curettage W/Scope,Outpatient,Outpatient Default Percent / Case Rate,761, $295.00 , $162.25 ," $1,236.00 ", $337.17 , $206.50 , $115.05 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 , $105.28 , $102.55 , $354.03 , $343.92 , $295.00 , $295.00 , $295.00 , $295.00 , $337.17 , $103.25 , $- , $- ," $1,236.00 ", $206.50
57522,6500011774,Hospital Chargemaster,Conization Of Cervix,Outpatient,Outpatient Default Percent / Case Rate,761," $3,348.00 "," $1,841.40 "," $1,442.00 "," $3,136.64 "," $2,343.60 "," $1,305.72 "," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 "," $1,133.44 "," $1,104.09 "," $3,293.47 "," $3,199.37 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,136.64 "," $1,171.80 ", $- , $- ," $5,165.58 "," $2,343.60 "
17340,6500011852,Hospital Chargemaster,Cryotherapy Of Skin,Outpatient,Outpatient Default Percent / Case Rate,761, $66.00 , $36.30 , $54.38 , $40.47 , $46.20 , $25.74 , $70.26 , $48.23 , $47.97 , $40.47 , $40.47 , $105.28 , $102.55 , $42.49 , $41.28 , $66.00 , $66.00 , $66.00 , $66.00 , $40.47 , $23.10 , $- , $- , $105.28 , $46.20
56606,6500011854,Hospital Chargemaster,Biopsy Of Vulva/Perineum,Outpatient,Outpatient Default Percent / Case Rate,761, $72.00 , $39.60 ," $1,236.00 ", See APC Packaged Rates , $50.40 , $28.08 , $95.04 , $65.23 , $64.88 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $66.96 , $66.96 , $66.96 , $66.96 , See APC Packaged Rates , $25.20 , $- , $- ," $1,236.00 ", $50.40
56820,6500011856,Hospital Chargemaster,Exam Of Vulva W/Scope,Outpatient,Outpatient Default Percent / Case Rate,761, $203.00 , $111.65 ," $1,236.00 ", $203.67 , $142.10 , $79.17 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $105.28 , $102.55 , $213.85 , $207.74 , $203.00 , $203.00 , $203.00 , $203.00 , $203.67 , $71.05 , $- , $- ," $1,236.00 ", $142.10
57460,6500011858,Hospital Chargemaster,Bx Of Cervix W/Scope Leep,Outpatient,Outpatient Default Percent / Case Rate,761," $2,500.00 "," $1,375.00 "," $1,442.00 "," $3,136.64 "," $1,750.00 ", $975.00 ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 ", $105.28 , $102.55 ," $3,293.47 "," $3,199.37 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,136.64 ", $875.00 , $- , $- ," $5,165.58 "," $1,750.00 "
97598,6500011868,Hospital Chargemaster,Rmvl devital tis addl 20cm/<,Outpatient,Outpatient Default Percent / Case Rate,761, $450.00 , $247.50 ," $1,236.00 ", See APC Packaged Rates , $315.00 , $175.50 , $35.52 , $24.38 , $24.25 , See APC Packaged Rates , See APC Packaged Rates , $161.09 , $156.20 , See APC Packaged Rates , See APC Packaged Rates , $418.50 , $418.50 , $418.50 , $418.50 , See APC Packaged Rates , $157.50 , $- , $- ," $1,236.00 ", $315.00
97602,6500011869,Hospital Chargemaster,Wound(s) Care Non-Selective,Outpatient,Outpatient Default Percent / Case Rate,761, $216.00 , $118.80 , $177.98 , $214.68 , $151.20 , $84.24 , $875.52 , $556.51 , $546.42 , $214.68 , $214.68 , $144.94 , $144.94 , $225.42 , $218.98 , $80.00 , $80.00 , $80.00 , $80.00 , $214.68 , $75.60 , $- , $- , $875.52 , $151.20
51798,6500011895,Hospital Chargemaster,Us urine capacity measure,Outpatient,Outpatient Default Percent / Case Rate,761, $85.00 , $46.75 , $70.04 , $66.55 , $59.50 , $33.15 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $57.04 , $57.04 , $69.87 , $67.88 , $87.77 , $87.77 , $90.03 , $90.03 , $66.55 , $29.75 , $- , $- , $122.28 , $59.50
58558,6500011938,Hospital Chargemaster,Hysteroscopy Biospsy,Outpatient,Outpatient Default Percent / Case Rate,761," $2,500.00 "," $1,375.00 "," $2,060.00 "," $3,136.64 "," $1,750.00 ", $975.00 ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 ", $844.48 , $822.61 ," $3,293.47 "," $3,199.37 "," $2,500.00 "," $2,500.00 "," $2,500.00 "," $2,500.00 "," $3,136.64 ", $875.00 , $- , $- ," $5,165.58 "," $1,750.00 "
64454,6500011941,Hospital Chargemaster,Njx AA & Strd Gnclr Nrv Brnch,Outpatient,Outpatient Default Percent / Case Rate,761," $1,450.00 ", $797.50 ," $1,236.00 ", $759.14 ," $1,015.00 ", $565.50 ," $1,310.44 ", $899.43 , $894.64 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $978.40 , $978.40 ," $1,003.60 "," $1,003.60 ", $759.14 , $507.50 , $- , $- ," $1,310.44 "," $1,015.00 "
58562,6500011943,Hospital Chargemaster,Hysteroscopy Remove FB,Outpatient,Outpatient Default Percent / Case Rate,761," $2,500.00 "," $1,375.00 "," $2,060.00 "," $3,136.64 "," $1,750.00 ", $975.00 ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 ", $844.48 , $822.61 ," $3,293.47 "," $3,199.37 "," $2,500.00 "," $2,500.00 "," $2,500.00 "," $2,500.00 "," $3,136.64 ", $875.00 , $- , $- ," $5,165.58 "," $1,750.00 "
29280,6500012012,Hospital Chargemaster,Strapping of hand or finger,Outpatient,Outpatient Default Percent / Case Rate,761, $107.00 , $58.85 , $88.17 , $66.55 , $74.90 , $41.73 , $70.26 , $48.23 , $47.97 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $62.64 , $62.64 , $64.26 , $64.26 , $66.55 , $37.45 , $- , $- , $147.89 , $74.90
64611,6500012021,Hospital Chargemaster,Chemodenerv saliv gland,Outpatient,Outpatient Default Percent / Case Rate,761, $400.00 , $220.00 ," $1,236.00 ", $312.35 , $280.00 , $156.00 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $140.00 , $- , $- ," $1,236.00 ", $280.00
51797,6500012024,Hospital Chargemaster,Intraabdominal pressure test,Outpatient,Outpatient Default Percent / Case Rate,761, $- , $- ," $1,236.00 ", See APC Packaged Rates , $- , $- , $342.66 , $235.18 , $233.93 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- ," $1,236.00 ", $-
28400,6500012128,Hospital Chargemaster,Treatment Of Heel Fracture,Outpatient,Outpatient Default Percent / Case Rate,761, $364.00 , $200.20 ," $1,236.00 ", $246.41 , $254.80 , $141.96 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $246.41 , $127.40 , $- , $- ," $1,236.00 ", $254.80
29580,6500060001,Hospital Chargemaster,Application Of Paste Boot Bi,Outpatient,Outpatient Default Percent / Case Rate,761, $380.00 , $209.00 , $313.12 , $168.90 , $266.00 , $148.20 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $133.00 , $- , $- , $313.12 , $266.00
29581,6500060219,Hospital Chargemaster,Apply Multlay Cmprs Lwr leg Bi,Outpatient,Outpatient Default Percent / Case Rate,761, $426.00 , $234.30 , $351.02 , $168.90 , $298.20 , $166.14 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $32.27 , $31.29 , $177.35 , $172.28 , $271.00 , $271.00 , $271.00 , $271.00 , $168.90 , $149.10 , $- , $- , $351.02 , $298.20
99211,6827419001,Hospital Chargemaster,Nutrition Initial Consult,Outpatient,Outpatient Default Percent / Case Rate,761, $104.00 , $57.20 , $85.70 , See APC Packaged Rates , $72.80 , $40.56 , $180.56 , $54.48 , $74.62 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $36.40 , $- , $- , $180.56 , $72.80
99211,6827419002,Hospital Chargemaster,Nutrition Follow Up,Outpatient,Outpatient Default Percent / Case Rate,761, $104.00 , $57.20 , $85.70 , See APC Packaged Rates , $72.80 , $40.56 , $180.56 , $54.48 , $74.62 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $36.40 , $- , $- , $180.56 , $72.80
27750,8004011058,Hospital Chargemaster,Treatment Of Tibia Fracture,Outpatient,Outpatient Default Percent / Case Rate,761, $496.00 , $272.80 ," $1,236.00 ", $246.41 , $347.20 , $193.44 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $246.41 , $173.60 , $- , $- ," $1,236.00 ", $347.20
29240,8004019240,Hospital Chargemaster,Strapping of shoulder,Outpatient,Outpatient Default Percent / Case Rate,761, $133.00 , $73.15 , $109.59 , $134.80 , $93.10 , $51.87 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $125.00 , $125.00 , $125.00 , $125.00 , $134.80 , $46.55 , $- , $- , $232.95 , $93.10
29550,8004019550,Hospital Chargemaster,Stapping of Toes,Outpatient,Outpatient Default Percent / Case Rate,761, $90.00 , $49.50 , $74.16 , $66.55 , $63.00 , $35.10 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $85.99 , $85.99 , $88.21 , $88.21 , $66.55 , $31.50 , $- , $- , $147.89 , $63.00
64435,8014014435,Hospital Chargemaster,Njx aa&/strd paracrv nrv,Outpatient,Outpatient Default Percent / Case Rate,761, $598.00 , $328.90 ," $1,236.00 ", $759.14 , $418.60 , $233.22 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $204.40 , $198.20 , $797.10 , $774.33 , $598.00 , $598.00 , $598.00 , $598.00 , $759.14 , $209.30 , $- , $- ," $1,309.97 ", $418.60
64650,8037014650,Hospital Chargemaster,Chemodenerv eccrine glands,Outpatient,Outpatient Default Percent / Case Rate,761, $365.00 , $200.75 ," $1,236.00 ", $312.35 , $255.50 , $142.35 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $244.92 , $244.92 , $327.96 , $318.59 , $365.00 , $365.00 , $365.00 , $365.00 , $312.35 , $127.75 , $- , $- ," $1,236.00 ", $255.50
G0379,4501110003,Hospital Chargemaster,INo W2 Direct Admit,Outpatient,Outpatient Default Percent / Case Rate,762, $146.00 , $80.30 , $120.30 , $624.24 , $102.20 , $56.94 , $140.88 , $141.49 , $75.19 , $624.24 , $624.24 , $97.97 , $97.97 , $655.45 , $636.72 , $146.00 , $146.00 , $146.00 , $146.00 , $624.24 , $51.10 , $- , $- , $655.45 , $102.20
G0379,4501510003,Hospital Chargemaster,INo W1 Direct Admit,Outpatient,Outpatient Default Percent / Case Rate,762, $146.00 , $80.30 , $120.30 , $624.24 , $102.20 , $56.94 , $140.88 , $141.49 , $75.19 , $624.24 , $624.24 , $97.97 , $97.97 , $655.45 , $636.72 , $146.00 , $146.00 , $146.00 , $146.00 , $624.24 , $51.10 , $- , $- , $655.45 , $102.20
G0379,4550110003,Hospital Chargemaster,INo OBS Direct Admit,Outpatient,Outpatient Default Percent / Case Rate,762, $153.00 , $84.15 , $126.07 , $624.24 , $107.10 , $59.67 , $147.63 , $148.27 , $78.80 , $624.24 , $624.24 , $102.66 , $102.66 , $655.45 , $636.72 , $146.00 , $146.00 , $146.00 , $146.00 , $624.24 , $53.55 , $- , $- , $655.45 , $107.10
99218,4501110001,Hospital Chargemaster,INo W2 1st Hour,Outpatient,Outpatient Default Percent / Case Rate,762, $146.00 , $80.30 , $120.30 , See APC Packaged Rates , $102.20 , $56.94 , $140.88 , $141.49 , $75.19 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates , $51.10 , $- , $- , $146.00 , $102.20
99218,4501110002,Hospital Chargemaster,INo W2 Per Hour,Outpatient,Outpatient Default Percent / Case Rate,762, $40.00 , $22.00 , $32.96 , See APC Packaged Rates , $28.00 , $15.60 , $38.60 , $38.76 , $20.60 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates , $14.00 , $- , $- , $146.00 , $28.00
99218,4501510001,Hospital Chargemaster,INo W1 1st Hour,Outpatient,Outpatient Default Percent / Case Rate,762, $146.00 , $80.30 , $120.30 , See APC Packaged Rates , $102.20 , $56.94 , $140.88 , $141.49 , $75.19 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates , $51.10 , $- , $- , $146.00 , $102.20
99218,4501510002,Hospital Chargemaster,INo W1 Per Hour,Outpatient,Outpatient Default Percent / Case Rate,762, $40.00 , $22.00 , $32.96 , See APC Packaged Rates , $28.00 , $15.60 , $38.60 , $38.76 , $20.60 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates , $14.00 , $- , $- , $146.00 , $28.00
99218,4534110001,Hospital Chargemaster,INo GPU 1st Hour,Outpatient,Outpatient Default Percent / Case Rate,762, $258.00 , $141.90 , $212.59 , See APC Packaged Rates , $180.60 , $100.62 , $248.94 , $250.03 , $132.88 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates , $90.30 , $- , $- , $250.03 , $180.60
99218,4550110001,Hospital Chargemaster,INo OBS 1st Hour,Outpatient,Outpatient Default Percent / Case Rate,762, $153.00 , $84.15 , $126.07 , See APC Packaged Rates , $107.10 , $59.67 , $147.63 , $148.27 , $78.80 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates , $53.55 , $- , $- , $148.27 , $107.10
99218,4550110002,Hospital Chargemaster,INo OBS Per Hour,Outpatient,Outpatient Default Percent / Case Rate,762, $40.00 , $22.00 , $32.96 , See APC Packaged Rates , $28.00 , $15.60 , $38.60 , $38.76 , $20.60 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates , $14.00 , $- , $- , $146.00 , $28.00
99218,4501110004,Hospital Chargemaster,INo W2 Non Covered,Outpatient,Outpatient Default Percent / Case Rate,762, $40.00 , $22.00 , $32.96 , See APC Packaged Rates , $28.00 , $15.60 , $38.60 , $38.76 , $20.60 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates , $14.00 , $- , $- , $146.00 , $28.00
99218,4501510004,Hospital Chargemaster,INo W1 Non Covered,Outpatient,Outpatient Default Percent / Case Rate,762, $40.00 , $22.00 , $32.96 , See APC Packaged Rates , $28.00 , $15.60 , $38.60 , $38.76 , $20.60 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates , $14.00 , $- , $- , $146.00 , $28.00
99218,4534110002,Hospital Chargemaster,INo GPU Per Hour,Outpatient,Outpatient Default Percent / Case Rate,762, $71.00 , $39.05 , $58.50 , See APC Packaged Rates , $49.70 , $27.69 , $68.51 , $68.81 , $36.57 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates , $24.85 , $- , $- , $146.00 , $49.70
G0379,4534110003,Hospital Chargemaster,INo GPU Direct Admit,Outpatient,Outpatient Default Percent / Case Rate,762, $258.00 , $141.90 , $212.59 , $624.24 , $180.60 , $100.62 , $248.94 , $250.03 , $132.88 , $624.24 , $624.24 , $173.12 , $173.12 , $655.45 , $636.72 , $146.00 , $146.00 , $146.00 , $146.00 , $624.24 , $90.30 , $- , $- , $655.45 , $180.60
99218,4534110004,Hospital Chargemaster,INo GPU Non Covered,Outpatient,Outpatient Default Percent / Case Rate,762, $71.00 , $39.05 , $58.50 , See APC Packaged Rates , $49.70 , $27.69 , $68.51 , $68.81 , $36.57 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates , $24.85 , $- , $- , $146.00 , $49.70
99218,4540110001,Hospital Chargemaster,INo ICU 1st Hour,Outpatient,Outpatient Default Percent / Case Rate,762, $258.00 , $141.90 , $212.59 , See APC Packaged Rates , $180.60 , $100.62 , $248.94 , $250.03 , $132.88 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates , $90.30 , $- , $- , $250.03 , $180.60
99218,4540110002,Hospital Chargemaster,INo ICU Per Hour,Outpatient,Outpatient Default Percent / Case Rate,762, $71.00 , $39.05 , $58.50 , See APC Packaged Rates , $49.70 , $27.69 , $68.51 , $68.81 , $36.57 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates , $24.85 , $- , $- , $146.00 , $49.70
G0379,4540110003,Hospital Chargemaster,INo ICU Direct Admit,Outpatient,Outpatient Default Percent / Case Rate,762, $146.00 , $80.30 , $120.30 , $624.24 , $102.20 , $56.94 , $140.88 , $141.49 , $75.19 , $624.24 , $624.24 , $97.97 , $97.97 , $655.45 , $636.72 , $146.00 , $146.00 , $146.00 , $146.00 , $624.24 , $51.10 , $- , $- , $655.45 , $102.20
99218,4540110004,Hospital Chargemaster,INo ICU Non Covered,Outpatient,Outpatient Default Percent / Case Rate,762, $71.00 , $39.05 , $58.50 , See APC Packaged Rates , $49.70 , $27.69 , $68.51 , $68.81 , $36.57 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates , $24.85 , $- , $- , $146.00 , $49.70
99218,4550110004,Hospital Chargemaster,INo OBS Non Covered,Outpatient,Outpatient Default Percent / Case Rate,762, $40.00 , $22.00 , $32.96 , See APC Packaged Rates , $28.00 , $15.60 , $38.60 , $38.76 , $20.60 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates , $14.00 , $- , $- , $146.00 , $28.00
99218,6010019218,Hospital Chargemaster,ED Observation per HR,Outpatient,Outpatient Default Percent / Case Rate,762, $100.00 , $55.00 , $82.40 , See APC Packaged Rates , $70.00 , $39.00 , $96.49 , $96.91 , $51.50 , See APC Packaged Rates , See APC Packaged Rates ," $1,621.00 "," $1,621.00 ", See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $70.00
99381,6500010036,Hospital Chargemaster,Init pm e/m new pat infant,Outpatient,Outpatient Default Percent / Case Rate,770, $83.00 , $45.65 , $68.39 , See APC Packaged Rates , $58.10 , $32.37 , $80.09 , $80.44 , $42.75 , See APC Packaged Rates , See APC Packaged Rates , $264.42 , $256.40 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $29.05 , $- , $- , $264.42 , $58.10
99382,6500010037,Hospital Chargemaster,Init pm e/m new pat 1-4 yrs,Outpatient,Outpatient Default Percent / Case Rate,770, $80.00 , $44.00 , $65.92 , See APC Packaged Rates , $56.00 , $31.20 , $77.19 , $77.53 , $41.20 , See APC Packaged Rates , See APC Packaged Rates , $283.14 , $274.55 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $28.00 , $- , $- , $283.14 , $56.00
99383,6500010038,Hospital Chargemaster,Prev visit new age 5-11,Outpatient,Outpatient Default Percent / Case Rate,770, $103.00 , $56.65 , $84.87 , See APC Packaged Rates , $72.10 , $40.17 , $99.38 , $99.82 , $53.05 , See APC Packaged Rates , See APC Packaged Rates , $276.12 , $267.74 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $36.05 , $- , $- , $276.12 , $72.10
99384,6500010039,Hospital Chargemaster,Prev visit new age 12-17,Outpatient,Outpatient Default Percent / Case Rate,770, $99.00 , $54.45 , $81.58 , See APC Packaged Rates , $69.30 , $38.61 , $95.53 , $95.94 , $50.99 , See APC Packaged Rates , See APC Packaged Rates , $308.88 , $299.51 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $34.65 , $- , $- , $308.88 , $69.30
99385,6500010040,Hospital Chargemaster,Prev visit new age 18-39,Outpatient,Outpatient Default Percent / Case Rate,770, $119.00 , $65.45 , $98.06 , See APC Packaged Rates , $83.30 , $46.41 , $114.82 , $115.32 , $61.29 , See APC Packaged Rates , See APC Packaged Rates , $313.56 , $304.05 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $41.65 , $- , $- , $313.56 , $83.30
99386,6500010041,Hospital Chargemaster,Prev visit new age 40-64,Outpatient,Outpatient Default Percent / Case Rate,770, $135.00 , $74.25 , $111.24 , See APC Packaged Rates , $94.50 , $52.65 , $130.26 , $130.83 , $69.53 , See APC Packaged Rates , See APC Packaged Rates , $367.38 , $356.23 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $47.25 , $- , $- , $367.38 , $94.50
99387,6500010042,Hospital Chargemaster,Init pm e/m new pat 65+ yrs,Outpatient,Outpatient Default Percent / Case Rate,770, $130.00 , $71.50 , $107.12 , See APC Packaged Rates , $91.00 , $50.70 , $125.44 , $125.98 , $66.95 , See APC Packaged Rates , See APC Packaged Rates , $383.76 , $372.12 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $45.50 , $- , $- , $383.76 , $91.00
99391,6500010043,Hospital Chargemaster,Per pm reeval est pat infant,Outpatient,Outpatient Default Percent / Case Rate,770, $86.00 , $47.30 , $70.86 , See APC Packaged Rates , $60.20 , $33.54 , $82.98 , $83.34 , $44.29 , See APC Packaged Rates , See APC Packaged Rates , $205.92 , $199.67 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $30.10 , $- , $- , $205.92 , $60.20
99392,6500010044,Hospital Chargemaster,Prev visit est age 1-4,Outpatient,Outpatient Default Percent / Case Rate,770, $97.00 , $53.35 , $79.93 , See APC Packaged Rates , $67.90 , $37.83 , $93.60 , $94.00 , $49.96 , See APC Packaged Rates , See APC Packaged Rates , $229.32 , $222.36 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $33.95 , $- , $- , $229.32 , $67.90
99393,6500010045,Hospital Chargemaster,Prev visit est age 5-11,Outpatient,Outpatient Default Percent / Case Rate,770, $95.00 , $52.25 , $78.28 , See APC Packaged Rates , $66.50 , $37.05 , $91.67 , $92.06 , $48.93 , See APC Packaged Rates , See APC Packaged Rates , $224.64 , $217.82 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $33.25 , $- , $- , $224.64 , $66.50
99394,6500010046,Hospital Chargemaster,Prev visit est age 12-17,Outpatient,Outpatient Default Percent / Case Rate,770, $104.00 , $57.20 , $85.70 , See APC Packaged Rates , $72.80 , $40.56 , $100.35 , $100.79 , $53.56 , See APC Packaged Rates , See APC Packaged Rates , $250.38 , $242.78 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $36.40 , $- , $- , $250.38 , $72.80
99395,6500010047,Hospital Chargemaster,Prev visit est age 18-39,Outpatient,Outpatient Default Percent / Case Rate,770, $104.00 , $57.20 , $85.70 , See APC Packaged Rates , $72.80 , $40.56 , $100.35 , $100.79 , $53.56 , See APC Packaged Rates , See APC Packaged Rates , $264.42 , $256.40 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $36.40 , $- , $- , $264.42 , $72.80
99396,6500010048,Hospital Chargemaster,Prev visit est age 40-64,Outpatient,Outpatient Default Percent / Case Rate,770, $113.00 , $62.15 , $93.11 , See APC Packaged Rates , $79.10 , $44.07 , $109.03 , $109.51 , $58.20 , See APC Packaged Rates , See APC Packaged Rates , $292.50 , $283.63 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $39.55 , $- , $- , $292.50 , $79.10
99397,6500010049,Hospital Chargemaster,Per pm reeval est pat 65+ yr,Outpatient,Outpatient Default Percent / Case Rate,770, $122.00 , $67.10 , $100.53 , See APC Packaged Rates , $85.40 , $47.58 , $117.72 , $118.23 , $62.83 , See APC Packaged Rates , See APC Packaged Rates , $297.18 , $288.16 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $42.70 , $- , $- , $297.18 , $85.40
G0101,8014010101,Hospital Chargemaster,Ca Screen; Pelvic/Breast Exam,Outpatient,Outpatient Default Percent / Case Rate,770, $111.00 , $61.05 , $91.46 , $89.46 , $77.70 , $43.29 , $187.56 , $146.59 , $160.57 , $89.46 , $89.46 , $74.48 , $74.48 , $93.93 , $91.24 , $13.82 , $13.82 , $13.82 , $13.82 , $89.46 , $38.85 , $- , $- , $187.56 , $77.70
90471,5720010001,Hospital Chargemaster,Immunization admin,Outpatient,Outpatient Default Percent / Case Rate,771, $128.00 , $70.40 , $105.47 , $74.12 , $89.60 , $49.92 , $66.28 , $66.28 , $66.28 , $74.12 , $74.12 , $85.89 , $85.89 , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $44.80 , $- , $- , $105.47 , $89.60
90471,5720010003,Hospital Chargemaster,Admin influenza virus vac,Outpatient,Outpatient Default Percent / Case Rate,771, $80.00 , $44.00 , $65.92 , $74.12 , $56.00 , $31.20 , $66.28 , $66.28 , $66.28 , $74.12 , $74.12 , $53.68 , $53.68 , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $28.00 , $- , $- , $97.86 , $56.00
90471,5720010004,Hospital Chargemaster,Admin pneumococcal vaccine,Outpatient,Outpatient Default Percent / Case Rate,771, $128.00 , $70.40 , $105.47 , $74.12 , $89.60 , $49.92 , $66.28 , $66.28 , $66.28 , $74.12 , $74.12 , $85.89 , $85.89 , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $44.80 , $- , $- , $105.47 , $89.60
90471,5720010005,Hospital Chargemaster,Admin hepatitis b vaccine,Outpatient,Outpatient Default Percent / Case Rate,771, $128.00 , $70.40 , $105.47 , $74.12 , $89.60 , $49.92 , $66.28 , $66.28 , $66.28 , $74.12 , $74.12 , $85.89 , $85.89 , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $44.80 , $- , $- , $105.47 , $89.60
90461,5720030007,Hospital Chargemaster,Im Admin Each Addl Component,Outpatient,Outpatient Default Percent / Case Rate,771, $35.00 , $19.25 , $28.84 , See APC Packaged Rates , $24.50 , $13.65 , $46.93 , $36.68 , $40.18 , See APC Packaged Rates , See APC Packaged Rates , $23.49 , $23.49 , See APC Packaged Rates , See APC Packaged Rates , $20.49 , $20.49 , $21.01 , $21.01 , See APC Packaged Rates , $12.25 , $- , $- , $46.93 , $24.50
90460,5720030006,Hospital Chargemaster,Im Admin 1St/Only Component,Outpatient,Outpatient Default Percent / Case Rate,771, $76.00 , $41.80 , $62.62 , See APC Packaged Rates , $53.20 , $29.64 , $61.75 , $48.26 , $52.86 , See APC Packaged Rates , See APC Packaged Rates , $51.00 , $51.00 , See APC Packaged Rates , See APC Packaged Rates , $20.49 , $20.49 , $21.01 , $21.01 , See APC Packaged Rates , $26.60 , $- , $- , $62.62 , $53.20
90472,5720010002,Hospital Chargemaster,Immunization admin each add,Outpatient,Outpatient Default Percent / Case Rate,771, $128.00 , $70.40 , $105.47 , See APC Packaged Rates , $89.60 , $49.92 , $22.02 , $22.02 , $22.02 , See APC Packaged Rates , See APC Packaged Rates , $85.89 , $85.89 , See APC Packaged Rates , See APC Packaged Rates , $119.04 , $119.04 , $119.04 , $119.04 , See APC Packaged Rates , $44.80 , $- , $- , $119.04 , $89.60
0001A,5720010025,Hospital Chargemaster,Pfizer Covid Vacc Admin dose 1,Outpatient,Outpatient Default Percent / Case Rate,771, $50.00 , $27.50 , $41.20 , $46.82 , $35.00 , $19.50 , $48.25 , $48.46 , $25.75 , $46.82 , $46.82 , $33.55 , $33.55 , $49.16 , $47.76 , $46.50 , $46.50 , $46.50 , $46.50 , $46.82 , $17.50 , $- , $- , $49.16 , $35.00
0002A,5720010026,Hospital Chargemaster,Pfizer Covid Vacc Admin dose 2,Outpatient,Outpatient Default Percent / Case Rate,771, $80.00 , $44.00 , $65.92 , $46.82 , $56.00 , $31.20 , $77.19 , $77.53 , $41.20 , $46.82 , $46.82 , $53.68 , $53.68 , $49.16 , $47.76 , $74.40 , $74.40 , $74.40 , $74.40 , $46.82 , $28.00 , $- , $- , $77.53 , $56.00
0011A,5720010027,Hospital Chargemaster,Moderna Covid Vacc Admn dose 1,Outpatient,Outpatient Default Percent / Case Rate,771, $50.00 , $27.50 , $41.20 , $46.82 , $35.00 , $19.50 , $48.25 , $48.46 , $25.75 , $46.82 , $46.82 , $33.55 , $33.55 , $49.16 , $47.76 , $46.50 , $46.50 , $46.50 , $46.50 , $46.82 , $17.50 , $- , $- , $49.16 , $35.00
0012A,5720010028,Hospital Chargemaster,Moderna Covid Vacc Admn dose 2,Outpatient,Outpatient Default Percent / Case Rate,771, $80.00 , $44.00 , $65.92 , $46.82 , $56.00 , $31.20 , $77.19 , $77.53 , $41.20 , $46.82 , $46.82 , $53.68 , $53.68 , $49.16 , $47.76 , $74.40 , $74.40 , $74.40 , $74.40 , $46.82 , $28.00 , $- , $- , $77.53 , $56.00
0031A,5720010029,Hospital Chargemaster,J & J Covid Vaccine S Admin,Outpatient,Outpatient Default Percent / Case Rate,771, $50.00 , $27.50 , $41.20 , $46.82 , $35.00 , $19.50 , $48.25 , $48.46 , $25.75 , $46.82 , $46.82 , $33.55 , $33.55 , $49.16 , $47.76 , $46.50 , $46.50 , $46.50 , $46.50 , $46.82 , $17.50 , $- , $- , $49.16 , $35.00
0003A,5720010030,Hospital Chargemaster,Pfizer Covid Vacc Admin dose 3,Outpatient,Outpatient Default Percent / Case Rate,771, $80.00 , $44.00 , $65.92 , $46.82 , $56.00 , $31.20 , $77.19 , $77.53 , $41.20 , $46.82 , $46.82 , $53.68 , $53.68 , $49.16 , $47.76 , $74.40 , $74.40 , $74.40 , $74.40 , $46.82 , $28.00 , $- , $- , $77.53 , $56.00
0013A,5720010031,Hospital Chargemaster,Moderna Covid Vacc Admn dose 3,Outpatient,Outpatient Default Percent / Case Rate,771, $80.00 , $44.00 , $65.92 , $46.82 , $56.00 , $31.20 , $77.19 , $77.53 , $41.20 , $46.82 , $46.82 , $53.68 , $53.68 , See APC Packaged Rates , $47.76 , $74.40 , $74.40 , $74.40 , $74.40 , $46.82 , $28.00 , Not Applicable , $28.00 , $77.53 , $56.00
90473,5720030009,Hospital Chargemaster,Immune Admin Oral/Nasal,Outpatient,Outpatient Default Percent / Case Rate,771, $55.00 , $30.25 , $45.32 , $74.12 , $38.50 , $21.45 , $53.07 , $53.30 , $28.33 , $74.12 , $74.12 , $36.91 , $36.91 , $77.83 , $75.60 , $55.00 , $55.00 , $55.00 , $55.00 , $74.12 , $19.25 , $- , $- , $77.83 , $38.50
G0402,6500012003,Hospital Chargemaster,MCR Initial Preventive Exam,Outpatient,Outpatient Default Percent / Case Rate,771, $140.00 , $77.00 , $115.36 , $142.05 , $98.00 , $54.60 , $135.09 , $135.67 , $72.10 , $142.05 , $142.05 , $93.94 , $93.94 , $149.15 , $144.89 , $140.00 , $140.00 , $140.00 , $140.00 , $142.05 , $49.00 , $- , $- , $149.15 , $98.00
90867,6170010001,Hospital Chargemaster,Tcranial magn stim tx plan,Outpatient,Outpatient Default Percent / Case Rate,900, $- , $- , $- , $316.40 , $- , $- ," $3,427.45 "," $1,034.09 "," $1,416.39 ", $316.40 , $316.40 , $- , $- , $332.22 , $322.72 , $- , $- , $- , $- , $316.40 , $- , $- , $- ," $3,427.45 ", $-
90868,6170010002,Hospital Chargemaster,Tcranial magn stim tx deli,Outpatient,Outpatient Default Percent / Case Rate,900, $- , $- , $- , $316.40 , $- , $- ," $1,846.83 ", $557.20 , $763.20 , $316.40 , $316.40 , $- , $- , $332.22 , $322.72 , $- , $- , $- , $- , $316.40 , $- , $- , $- ," $1,846.83 ", $-
90869,6170010003,Hospital Chargemaster,Tcran magn stim redetemine,Outpatient,Outpatient Default Percent / Case Rate,900, $- , $- , $- , $316.40 , $- , $- ," $1,846.83 ", $557.20 , $763.20 , $316.40 , $316.40 , $- , $- , $332.22 , $322.72 , $- , $- , $- , $- , $316.40 , $- , $- , $- ," $1,846.83 ", $-
H0015,9000010015,Hospital Chargemaster,SOAP Program,Outpatient,Outpatient Default Percent / Case Rate,905, $250.00 , $137.50 , $206.00 , See APC Packaged Rates , $175.00 , $97.50 , $241.23 , $242.28 , $128.76 , See APC Packaged Rates , See APC Packaged Rates , $167.75 , $167.75 , See APC Packaged Rates , See APC Packaged Rates , $232.50 , $232.50 , $232.50 , $232.50 , See APC Packaged Rates , $87.50 , $- , $- , $242.28 , $175.00
S9480,9000019480,Hospital Chargemaster,IOP Program,Outpatient,Outpatient Default Percent / Case Rate,905, $250.00 , $137.50 , $206.00 , See APC Packaged Rates , $175.00 , $97.50 , $241.23 , $242.28 , $128.76 , See APC Packaged Rates , See APC Packaged Rates , $167.75 , $167.75 , See APC Packaged Rates , See APC Packaged Rates , $232.50 , $232.50 , $232.50 , $232.50 , See APC Packaged Rates , $87.50 , $- , $- , $242.28 , $175.00
H0035,6120010001,Hospital Chargemaster,Part Hosp 1/2 Day (4 Hrs),Outpatient,Outpatient Default Percent / Case Rate,912, $120.00 , $66.00 , $98.88 , See APC Packaged Rates , $84.00 , $46.80 , $115.79 , $116.29 , $61.80 , See APC Packaged Rates , See APC Packaged Rates , $80.52 , $80.52 , See APC Packaged Rates , See APC Packaged Rates , $111.60 , $111.60 , $111.60 , $111.60 , See APC Packaged Rates , $42.00 , $- , $- , $116.29 , $84.00
H0035,6120010002,Hospital Chargemaster,Part Hosp Full Day,Outpatient,Outpatient Default Percent / Case Rate,912, $240.00 , $132.00 , $197.76 , See APC Packaged Rates , $168.00 , $93.60 , $231.58 , $232.58 , $123.60 , See APC Packaged Rates , See APC Packaged Rates , $161.04 , $161.04 , See APC Packaged Rates , See APC Packaged Rates , $223.20 , $223.20 , $223.20 , $223.20 , See APC Packaged Rates , $84.00 , $- , $- , $232.58 , $168.00
90791,6130210002,Hospital Chargemaster,Psych diagnostic evaluation,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $379.31 , $367.80 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90792,6130210004,Hospital Chargemaster,Psych diag eval w/med srvcs,Outpatient,Outpatient Default Percent / Case Rate,914, $324.00 , $178.20 , $266.98 , $159.96 , $226.80 , $126.36 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $309.39 , $300.01 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $113.40 , $- , $- ," $1,732.67 ", $226.80
90834,6130210007,Hospital Chargemaster,Psytx w pt 45 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $201.08 , $194.98 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90837,6130210009,Hospital Chargemaster,Psytx w pt 60 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $293.95 , $285.03 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90832,6130210005,Hospital Chargemaster,Psytx w pt 30 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $497.00 , $273.35 , $409.53 , $159.96 , $347.90 , $193.83 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $157.08 , $152.32 , $167.96 , $163.16 , $24.44 , $24.44 , $24.44 , $24.44 , $159.96 , $173.95 , $- , $- ," $1,732.67 ", $347.90
90785,6130210001,Hospital Chargemaster,Psytx complex interactive,Outpatient,Outpatient Default Percent / Case Rate,914, $50.00 , $27.50 , $41.20 , See APC Packaged Rates , $35.00 , $19.50 , $265.50 , $80.10 , $109.72 , See APC Packaged Rates , See APC Packaged Rates , $11.72 , $11.37 , See APC Packaged Rates , See APC Packaged Rates , $46.50 , $46.50 , $46.50 , $46.50 , See APC Packaged Rates , $17.50 , $- , $- , $265.50 , $35.00
90833,6130210006,Hospital Chargemaster,Psytx w pt w e/m 30 min,Outpatient,Outpatient Default Percent / Case Rate,914, $115.00 , $63.25 , $94.76 , See APC Packaged Rates , $80.50 , $44.85 ," $1,256.20 ", $379.01 , $519.13 , See APC Packaged Rates , See APC Packaged Rates , $103.38 , $100.24 , See APC Packaged Rates , See APC Packaged Rates , $106.95 , $106.95 , $106.95 , $106.95 , See APC Packaged Rates , $40.25 , $- , $- ," $1,256.20 ", $80.50
90836,6130210008,Hospital Chargemaster,Psytx w pt w e/m 45 min,Outpatient,Outpatient Default Percent / Case Rate,914, $160.00 , $88.00 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 ," $1,591.43 ", $480.15 , $657.66 , See APC Packaged Rates , See APC Packaged Rates , $167.85 , $162.76 , See APC Packaged Rates , See APC Packaged Rates , $148.80 , $148.80 , $148.80 , $148.80 , See APC Packaged Rates , $56.00 , $- , $- ," $1,591.43 ", $112.00
90838,6130210010,Hospital Chargemaster,Psytx w pt w e/m 60 min,Outpatient,Outpatient Default Percent / Case Rate,914, $103.00 , $56.65 , $84.87 , See APC Packaged Rates , $72.10 , $40.17 ," $2,104.48 ", $634.94 , $869.68 , See APC Packaged Rates , See APC Packaged Rates , $271.32 , $263.09 , See APC Packaged Rates , See APC Packaged Rates , $95.79 , $95.79 , $95.79 , $95.79 , See APC Packaged Rates , $36.05 , $- , $- ," $2,104.48 ", $72.10
90785,6010010785,Hospital Chargemaster,Psytx complex interactive,Outpatient,Outpatient Default Percent / Case Rate,914, $50.00 , $27.50 , $41.20 , See APC Packaged Rates , $35.00 , $19.50 , $265.50 , $80.10 , $109.72 , See APC Packaged Rates , See APC Packaged Rates , $11.72 , $11.37 , See APC Packaged Rates , See APC Packaged Rates , $46.50 , $46.50 , $46.50 , $46.50 , See APC Packaged Rates , $17.50 , $- , $- , $265.50 , $35.00
90791,6010010791,Hospital Chargemaster,Psych diagnostic evaluation,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $379.31 , $367.80 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90792,6010010792,Hospital Chargemaster,Psych diag eval w/med srvcs,Outpatient,Outpatient Default Percent / Case Rate,914, $324.00 , $178.20 , $266.98 , $159.96 , $226.80 , $126.36 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $309.39 , $300.01 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $113.40 , $- , $- ," $1,732.67 ", $226.80
90832,6010010832,Hospital Chargemaster,Psytx w pt 30 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $497.00 , $273.35 , $409.53 , $159.96 , $347.90 , $193.83 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $157.08 , $152.32 , $167.96 , $163.16 , $24.44 , $24.44 , $24.44 , $24.44 , $159.96 , $173.95 , $- , $- ," $1,732.67 ", $347.90
90833,6010010833,Hospital Chargemaster,Psytx w pt w e/m 30 min,Outpatient,Outpatient Default Percent / Case Rate,914, $115.00 , $63.25 , $94.76 , See APC Packaged Rates , $80.50 , $44.85 ," $1,256.20 ", $379.01 , $519.13 , See APC Packaged Rates , See APC Packaged Rates , $103.38 , $100.24 , See APC Packaged Rates , See APC Packaged Rates , $106.95 , $106.95 , $106.95 , $106.95 , See APC Packaged Rates , $40.25 , $- , $- ," $1,256.20 ", $80.50
90834,6010010834,Hospital Chargemaster,Psytx w pt 45 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $201.08 , $194.98 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90836,6010010836,Hospital Chargemaster,Psytx w pt e/m 45 min,Outpatient,Outpatient Default Percent / Case Rate,914, $160.00 , $88.00 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 ," $1,591.43 ", $480.15 , $657.66 , See APC Packaged Rates , See APC Packaged Rates , $167.85 , $162.76 , See APC Packaged Rates , See APC Packaged Rates , $148.80 , $148.80 , $148.80 , $148.80 , See APC Packaged Rates , $56.00 , $- , $- ," $1,591.43 ", $112.00
90837,6010010837,Hospital Chargemaster,Psytx w pt 60 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $293.95 , $285.03 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90838,6010010838,Hospital Chargemaster,Psytx w pt e/m 60 min,Outpatient,Outpatient Default Percent / Case Rate,914, $150.00 , $82.50 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 ," $2,104.48 ", $634.94 , $869.68 , See APC Packaged Rates , See APC Packaged Rates , $271.32 , $263.09 , See APC Packaged Rates , See APC Packaged Rates , $139.50 , $139.50 , $139.50 , $139.50 , See APC Packaged Rates , $52.50 , $- , $- ," $2,104.48 ", $105.00
90839,6010010839,Hospital Chargemaster,Psytx Crisis Initial 60 min,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $454.27 , $454.27 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90840,6010010840,Hospital Chargemaster,Psytx Crisis ea addl 30 min,Outpatient,Outpatient Default Percent / Case Rate,914, $467.00 , $256.85 , $384.81 , See APC Packaged Rates , $326.90 , $182.13 ," $1,196.81 ", $361.09 , $494.58 , See APC Packaged Rates , See APC Packaged Rates , $313.36 , $313.36 , See APC Packaged Rates , See APC Packaged Rates , $434.31 , $434.31 , $434.31 , $434.31 , See APC Packaged Rates , $163.45 , $- , $- ," $1,196.81 ", $326.90
90785,6120010785,Hospital Chargemaster,Psytx complex interactive,Outpatient,Outpatient Default Percent / Case Rate,914, $50.00 , $27.50 , $41.20 , See APC Packaged Rates , $35.00 , $19.50 , $265.50 , $80.10 , $109.72 , See APC Packaged Rates , See APC Packaged Rates , $11.72 , $11.37 , See APC Packaged Rates , See APC Packaged Rates , $46.50 , $46.50 , $46.50 , $46.50 , See APC Packaged Rates , $17.50 , $- , $- , $265.50 , $35.00
90791,6120010791,Hospital Chargemaster,Psych diagnostic evaluation,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $379.31 , $367.80 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90792,6120010792,Hospital Chargemaster,Psych diag eval w/med srvcs,Outpatient,Outpatient Default Percent / Case Rate,914, $324.00 , $178.20 , $266.98 , $159.96 , $226.80 , $126.36 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $309.39 , $300.01 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $113.40 , $- , $- ," $1,732.67 ", $226.80
90832,6120010832,Hospital Chargemaster,Psytx w pt 30 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $497.00 , $273.35 , $409.53 , $159.96 , $347.90 , $193.83 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $157.08 , $152.32 , $167.96 , $163.16 , $24.44 , $24.44 , $24.44 , $24.44 , $159.96 , $173.95 , $- , $- ," $1,732.67 ", $347.90
90833,6120010833,Hospital Chargemaster,Psytx w pt w e/m 30 min,Outpatient,Outpatient Default Percent / Case Rate,914, $115.00 , $63.25 , $94.76 , See APC Packaged Rates , $80.50 , $44.85 ," $1,256.20 ", $379.01 , $519.13 , See APC Packaged Rates , See APC Packaged Rates , $103.38 , $100.24 , See APC Packaged Rates , See APC Packaged Rates , $106.95 , $106.95 , $106.95 , $106.95 , See APC Packaged Rates , $40.25 , $- , $- ," $1,256.20 ", $80.50
90834,6120010834,Hospital Chargemaster,Psytx w pt 45 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $201.08 , $194.98 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90836,6120010836,Hospital Chargemaster,Psytx w pt e/m 45 min,Outpatient,Outpatient Default Percent / Case Rate,914, $160.00 , $88.00 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 ," $1,591.43 ", $480.15 , $657.66 , See APC Packaged Rates , See APC Packaged Rates , $167.85 , $162.76 , See APC Packaged Rates , See APC Packaged Rates , $148.80 , $148.80 , $148.80 , $148.80 , See APC Packaged Rates , $56.00 , $- , $- ," $1,591.43 ", $112.00
90837,6120010837,Hospital Chargemaster,Psytx w pt 60 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $293.95 , $285.03 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90838,6120010838,Hospital Chargemaster,Psytx w pt e/m 60 min,Outpatient,Outpatient Default Percent / Case Rate,914, $150.00 , $82.50 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 ," $2,104.48 ", $634.94 , $869.68 , See APC Packaged Rates , See APC Packaged Rates , $271.32 , $263.09 , See APC Packaged Rates , See APC Packaged Rates , $139.50 , $139.50 , $139.50 , $139.50 , See APC Packaged Rates , $52.50 , $- , $- ," $2,104.48 ", $105.00
90785,6160010785,Hospital Chargemaster,Psytx complex interactive,Outpatient,Outpatient Default Percent / Case Rate,914, $50.00 , $27.50 , $41.20 , See APC Packaged Rates , $35.00 , $19.50 , $265.50 , $80.10 , $109.72 , See APC Packaged Rates , See APC Packaged Rates , $11.72 , $11.37 , See APC Packaged Rates , See APC Packaged Rates , $46.50 , $46.50 , $46.50 , $46.50 , See APC Packaged Rates , $17.50 , $- , $- , $265.50 , $35.00
90791,6160010791,Hospital Chargemaster,Psych diagnostic evaluation,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $379.31 , $367.80 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90792,6160010792,Hospital Chargemaster,Psych diag eval w/med srvcs,Outpatient,Outpatient Default Percent / Case Rate,914, $324.00 , $178.20 , $266.98 , $159.96 , $226.80 , $126.36 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $309.39 , $300.01 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $113.40 , $- , $- ," $1,732.67 ", $226.80
90832,6160010832,Hospital Chargemaster,Psytx w pt 30 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $497.00 , $273.35 , $409.53 , $159.96 , $347.90 , $193.83 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $157.08 , $152.32 , $167.96 , $163.16 , $24.44 , $24.44 , $24.44 , $24.44 , $159.96 , $173.95 , $- , $- ," $1,732.67 ", $347.90
90833,6160010833,Hospital Chargemaster,Psytx w pt w e/m 30 min,Outpatient,Outpatient Default Percent / Case Rate,914, $115.00 , $63.25 , $94.76 , See APC Packaged Rates , $80.50 , $44.85 ," $1,256.20 ", $379.01 , $519.13 , See APC Packaged Rates , See APC Packaged Rates , $103.38 , $100.24 , See APC Packaged Rates , See APC Packaged Rates , $106.95 , $106.95 , $106.95 , $106.95 , See APC Packaged Rates , $40.25 , $- , $- ," $1,256.20 ", $80.50
90834,6160010834,Hospital Chargemaster,Psytx w pt 45 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $201.08 , $194.98 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90836,6160010836,Hospital Chargemaster,Psytx w pt e/m 45 min,Outpatient,Outpatient Default Percent / Case Rate,914, $160.00 , $88.00 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 ," $1,591.43 ", $480.15 , $657.66 , See APC Packaged Rates , See APC Packaged Rates , $167.85 , $162.76 , See APC Packaged Rates , See APC Packaged Rates , $148.80 , $148.80 , $148.80 , $148.80 , See APC Packaged Rates , $56.00 , $- , $- ," $1,591.43 ", $112.00
90837,6160010837,Hospital Chargemaster,Psytx w pt 60 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $293.95 , $285.03 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90838,6160010838,Hospital Chargemaster,Psytx w pt e/m 60 min,Outpatient,Outpatient Default Percent / Case Rate,914, $150.00 , $82.50 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 ," $2,104.48 ", $634.94 , $869.68 , See APC Packaged Rates , See APC Packaged Rates , $271.32 , $263.09 , See APC Packaged Rates , See APC Packaged Rates , $139.50 , $139.50 , $139.50 , $139.50 , See APC Packaged Rates , $52.50 , $- , $- ," $2,104.48 ", $105.00
90785,6160210785,Hospital Chargemaster,Psytx complex interactive,Outpatient,Outpatient Default Percent / Case Rate,914, $50.00 , $27.50 , $41.20 , See APC Packaged Rates , $35.00 , $19.50 , $265.50 , $80.10 , $109.72 , See APC Packaged Rates , See APC Packaged Rates , $11.72 , $11.37 , See APC Packaged Rates , See APC Packaged Rates , $46.50 , $46.50 , $46.50 , $46.50 , See APC Packaged Rates , $17.50 , $- , $- , $265.50 , $35.00
90791,6160210791,Hospital Chargemaster,Psych diagnostic evaluation,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $379.31 , $367.80 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90792,6160210792,Hospital Chargemaster,Psych diag eval w/med srvcs,Outpatient,Outpatient Default Percent / Case Rate,914, $324.00 , $178.20 , $266.98 , $159.96 , $226.80 , $126.36 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $309.39 , $300.01 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $113.40 , $- , $- ," $1,732.67 ", $226.80
90832,6160210832,Hospital Chargemaster,Psytx w pt 30 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $497.00 , $273.35 , $409.53 , $159.96 , $347.90 , $193.83 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $157.08 , $152.32 , $167.96 , $163.16 , $24.44 , $24.44 , $24.44 , $24.44 , $159.96 , $173.95 , $- , $- ," $1,732.67 ", $347.90
90833,6160210833,Hospital Chargemaster,Psytx w pt w e/m 30 min,Outpatient,Outpatient Default Percent / Case Rate,914, $115.00 , $63.25 , $94.76 , See APC Packaged Rates , $80.50 , $44.85 ," $1,256.20 ", $379.01 , $519.13 , See APC Packaged Rates , See APC Packaged Rates , $103.38 , $100.24 , See APC Packaged Rates , See APC Packaged Rates , $106.95 , $106.95 , $106.95 , $106.95 , See APC Packaged Rates , $40.25 , $- , $- ," $1,256.20 ", $80.50
90834,6160210834,Hospital Chargemaster,Psytx w pt 45 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $201.08 , $194.98 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90836,6160210836,Hospital Chargemaster,Psytx w pt e/m 45 min,Outpatient,Outpatient Default Percent / Case Rate,914, $160.00 , $88.00 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 ," $1,591.43 ", $480.15 , $657.66 , See APC Packaged Rates , See APC Packaged Rates , $167.85 , $162.76 , See APC Packaged Rates , See APC Packaged Rates , $148.80 , $148.80 , $148.80 , $148.80 , See APC Packaged Rates , $56.00 , $- , $- ," $1,591.43 ", $112.00
90837,6160210837,Hospital Chargemaster,Psytx w pt 60 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $140.00 , $77.00 , $115.36 , $159.96 , $98.00 , $54.60 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $293.95 , $285.03 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $49.00 , $- , $- ," $1,732.67 ", $98.00
90838,6160210838,Hospital Chargemaster,Psytx w pt e/m 60 min,Outpatient,Outpatient Default Percent / Case Rate,914, $150.00 , $82.50 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 ," $2,104.48 ", $634.94 , $869.68 , See APC Packaged Rates , See APC Packaged Rates , $271.32 , $263.09 , See APC Packaged Rates , See APC Packaged Rates , $139.50 , $139.50 , $139.50 , $139.50 , See APC Packaged Rates , $52.50 , $- , $- ," $2,104.48 ", $105.00
90785,9000010785,Hospital Chargemaster,Psytx complex interactive,Outpatient,Outpatient Default Percent / Case Rate,914, $50.00 , $27.50 , $41.20 , See APC Packaged Rates , $35.00 , $19.50 , $265.50 , $80.10 , $109.72 , See APC Packaged Rates , See APC Packaged Rates , $11.72 , $11.37 , See APC Packaged Rates , See APC Packaged Rates , $46.50 , $46.50 , $46.50 , $46.50 , See APC Packaged Rates , $17.50 , $- , $- , $265.50 , $35.00
90791,9000010791,Hospital Chargemaster,Psych diagnostic evaluation,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $379.31 , $367.80 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90792,9000010792,Hospital Chargemaster,Psych diag eval w/med srvcs,Outpatient,Outpatient Default Percent / Case Rate,914, $324.00 , $178.20 , $266.98 , $159.96 , $226.80 , $126.36 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $309.39 , $300.01 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $113.40 , $- , $- ," $1,732.67 ", $226.80
90832,9000010832,Hospital Chargemaster,Psytx w pt 30 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $497.00 , $273.35 , $409.53 , $159.96 , $347.90 , $193.83 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $157.08 , $152.32 , $167.96 , $163.16 , $24.44 , $24.44 , $24.44 , $24.44 , $159.96 , $173.95 , $- , $- ," $1,732.67 ", $347.90
90833,9000010833,Hospital Chargemaster,Psytx w pt w e/m 30 min,Outpatient,Outpatient Default Percent / Case Rate,914, $115.00 , $63.25 , $94.76 , See APC Packaged Rates , $80.50 , $44.85 ," $1,256.20 ", $379.01 , $519.13 , See APC Packaged Rates , See APC Packaged Rates , $103.38 , $100.24 , See APC Packaged Rates , See APC Packaged Rates , $106.95 , $106.95 , $106.95 , $106.95 , See APC Packaged Rates , $40.25 , $- , $- ," $1,256.20 ", $80.50
90834,9000010834,Hospital Chargemaster,Psytx w pt 45 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $201.08 , $194.98 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90836,9000010836,Hospital Chargemaster,Psytx w pt e/m 45 min,Outpatient,Outpatient Default Percent / Case Rate,914, $160.00 , $88.00 , $131.84 , See APC Packaged Rates , $112.00 , $62.40 ," $1,591.43 ", $480.15 , $657.66 , See APC Packaged Rates , See APC Packaged Rates , $167.85 , $162.76 , See APC Packaged Rates , See APC Packaged Rates , $148.80 , $148.80 , $148.80 , $148.80 , See APC Packaged Rates , $56.00 , $- , $- ," $1,591.43 ", $112.00
90837,9000010837,Hospital Chargemaster,Psytx w pt 60 minutes,Outpatient,Outpatient Default Percent / Case Rate,914, $677.00 , $372.35 , $557.85 , $159.96 , $473.90 , $264.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $293.95 , $285.03 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $236.95 , $- , $- ," $1,732.67 ", $473.90
90838,9000010838,Hospital Chargemaster,Psytx w pt e/m 60 min,Outpatient,Outpatient Default Percent / Case Rate,914, $150.00 , $82.50 , $123.60 , See APC Packaged Rates , $105.00 , $58.50 ," $2,104.48 ", $634.94 , $869.68 , See APC Packaged Rates , See APC Packaged Rates , $271.32 , $263.09 , See APC Packaged Rates , See APC Packaged Rates , $139.50 , $139.50 , $139.50 , $139.50 , See APC Packaged Rates , $52.50 , $- , $- ," $2,104.48 ", $105.00
90853,6130210022,Hospital Chargemaster,Group psychotherapy,Outpatient,Outpatient Default Percent / Case Rate,915, $99.00 , $54.45 , $81.58 , $89.46 , $69.30 , $38.61 ," $1,037.75 ", $313.10 , $428.85 , $89.46 , $89.46 , $66.43 , $66.43 , $93.93 , $91.24 , $17.39 , $17.39 , $17.39 , $17.39 , $89.46 , $34.65 , $- , $- ," $1,037.75 ", $69.30
90853,6010010853,Hospital Chargemaster,Group psychotherapy,Outpatient,Outpatient Default Percent / Case Rate,915, $99.00 , $54.45 , $81.58 , $89.46 , $69.30 , $38.61 ," $1,037.75 ", $313.10 , $428.85 , $89.46 , $89.46 , $66.43 , $66.43 , $93.93 , $91.24 , $17.39 , $17.39 , $17.39 , $17.39 , $89.46 , $34.65 , $- , $- ," $1,037.75 ", $69.30
90853,6120010853,Hospital Chargemaster,Group psychotherapy,Outpatient,Outpatient Default Percent / Case Rate,915, $99.00 , $54.45 , $81.58 , $89.46 , $69.30 , $38.61 ," $1,037.75 ", $313.10 , $428.85 , $89.46 , $89.46 , $66.43 , $66.43 , $93.93 , $91.24 , $17.39 , $17.39 , $17.39 , $17.39 , $89.46 , $34.65 , $- , $- ," $1,037.75 ", $69.30
90853,6160010853,Hospital Chargemaster,Group psychotherapy,Outpatient,Outpatient Default Percent / Case Rate,915, $99.00 , $54.45 , $81.58 , $89.46 , $69.30 , $38.61 ," $1,037.75 ", $313.10 , $428.85 , $89.46 , $89.46 , $66.43 , $66.43 , $93.93 , $91.24 , $17.39 , $17.39 , $17.39 , $17.39 , $89.46 , $34.65 , $- , $- ," $1,037.75 ", $69.30
90853,6160210853,Hospital Chargemaster,Group psychotherapy,Outpatient,Outpatient Default Percent / Case Rate,915, $253.00 , $139.15 , $208.47 , $89.46 , $177.10 , $98.67 ," $1,037.75 ", $313.10 , $428.85 , $89.46 , $89.46 , $169.76 , $169.76 , $93.93 , $91.24 , $17.39 , $17.39 , $17.39 , $17.39 , $89.46 , $88.55 , $- , $- ," $1,037.75 ", $177.10
90853,9000010853,Hospital Chargemaster,Group psychotherapy,Outpatient,Outpatient Default Percent / Case Rate,915, $99.00 , $54.45 , $81.58 , $89.46 , $69.30 , $38.61 ," $1,037.75 ", $313.10 , $428.85 , $89.46 , $89.46 , $66.43 , $66.43 , $93.93 , $91.24 , $17.39 , $17.39 , $17.39 , $17.39 , $89.46 , $34.65 , $- , $- ," $1,037.75 ", $69.30
90846,6130210011,Hospital Chargemaster,Family psytx w/o pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,916, $130.00 , $71.50 , $107.12 , $159.96 , $91.00 , $50.70 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $87.23 , $87.23 , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $45.50 , $- , $- ," $1,732.67 ", $91.00
90847,6130210012,Hospital Chargemaster,Family psytx w/pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,916, $762.00 , $419.10 , $627.89 , $159.96 , $533.40 , $297.18 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $511.30 , $511.30 , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $266.70 , $- , $- ," $1,732.67 ", $533.40
90846,6010010846,Hospital Chargemaster,Family psytx w/o pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,916, $130.00 , $71.50 , $107.12 , $159.96 , $91.00 , $50.70 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $87.23 , $87.23 , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $45.50 , $- , $- ," $1,732.67 ", $91.00
90847,6010010847,Hospital Chargemaster,Family psytx w/pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,916, $762.00 , $419.10 , $627.89 , $159.96 , $533.40 , $297.18 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $511.30 , $511.30 , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $266.70 , $- , $- ," $1,732.67 ", $533.40
90846,6120010846,Hospital Chargemaster,Family psytx w/o pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,916, $130.00 , $71.50 , $107.12 , $159.96 , $91.00 , $50.70 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $87.23 , $87.23 , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $45.50 , $- , $- ," $1,732.67 ", $91.00
90847,6120010847,Hospital Chargemaster,Family psytx w/pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,916, $762.00 , $419.10 , $627.89 , $159.96 , $533.40 , $297.18 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $511.30 , $511.30 , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $266.70 , $- , $- ," $1,732.67 ", $533.40
90846,6160010846,Hospital Chargemaster,Family psytx w/o pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,916, $130.00 , $71.50 , $107.12 , $159.96 , $91.00 , $50.70 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $87.23 , $87.23 , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $45.50 , $- , $- ," $1,732.67 ", $91.00
90847,6160010847,Hospital Chargemaster,Family psytx w/pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,916, $762.00 , $419.10 , $627.89 , $159.96 , $533.40 , $297.18 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $511.30 , $511.30 , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $266.70 , $- , $- ," $1,732.67 ", $533.40
90846,6160210846,Hospital Chargemaster,Family psytx w/o pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,916, $130.00 , $71.50 , $107.12 , $159.96 , $91.00 , $50.70 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $87.23 , $87.23 , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $45.50 , $- , $- ," $1,732.67 ", $91.00
90847,6160210847,Hospital Chargemaster,Family psytx w/pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,916, $762.00 , $419.10 , $627.89 , $159.96 , $533.40 , $297.18 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $511.30 , $511.30 , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $266.70 , $- , $- ," $1,732.67 ", $533.40
90846,9000010846,Hospital Chargemaster,Family psytx w/o pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,916, $130.00 , $71.50 , $107.12 , $159.96 , $91.00 , $50.70 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $87.23 , $87.23 , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $45.50 , $- , $- ," $1,732.67 ", $91.00
90847,9000010847,Hospital Chargemaster,Family psytx w/pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,916, $762.00 , $419.10 , $627.89 , $159.96 , $533.40 , $297.18 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $511.30 , $511.30 , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $266.70 , $- , $- ," $1,732.67 ", $533.40
96127,6500011882,Hospital Chargemaster,Brief Emotional/Behav Assmt,Outpatient,Outpatient Default Percent / Case Rate,918, $46.00 , $25.30 , $37.90 , $40.47 , $32.20 , $17.94 , $78.86 , $61.63 , $67.51 , $40.47 , $40.47 , $30.87 , $30.87 , $42.49 , $41.28 , $46.00 , $46.00 , $46.00 , $46.00 , $40.47 , $16.10 , $- , $- , $78.86 , $32.20
59025,5000010008,Hospital Chargemaster,Fetal non-stress test,Outpatient,Outpatient Default Percent / Case Rate,920, $300.00 , $165.00 , $247.20 , $203.67 , $210.00 , $117.00 , $407.39 , $318.40 , $348.76 , $203.67 , $203.67 , $201.30 , $201.30 , $213.85 , $207.74 , $264.14 , $264.14 , $270.95 , $270.95 , $203.67 , $105.00 , $- , $- , $407.39 , $210.00
94780,5000010014,Hospital Chargemaster,Cars/bd tst inft-12mo 60 min,Outpatient,Outpatient Default Percent / Case Rate,920, $107.00 , $58.85 , $88.17 , $40.47 , $74.90 , $41.73 , $78.86 , $61.63 , $67.51 , $40.47 , $40.47 , $71.80 , $71.80 , $42.49 , $41.28 , $52.40 , $52.40 , $53.75 , $53.75 , $40.47 , $37.45 , $- , $- , $88.17 , $74.90
59025,5000010028,Hospital Chargemaster,Fetal non-stress test -Twin,Outpatient,Outpatient Default Percent / Case Rate,920, $300.00 , $165.00 , $247.20 , $203.67 , $210.00 , $117.00 , $407.39 , $318.40 , $348.76 , $203.67 , $203.67 , $201.30 , $201.30 , $213.85 , $207.74 , $264.14 , $264.14 , $270.95 , $270.95 , $203.67 , $105.00 , $- , $- , $407.39 , $210.00
94781,5000010032,Hospital Chargemaster,Cars/bd tst inft-12mo addl 30,Outpatient,Outpatient Default Percent / Case Rate,920, $54.00 , $29.70 , $44.50 , See APC Packaged Rates , $37.80 , $21.06 , $30.04 , $23.48 , $25.71 , See APC Packaged Rates , See APC Packaged Rates , $36.23 , $36.23 , See APC Packaged Rates , See APC Packaged Rates , $50.22 , $50.22 , $50.22 , $50.22 , See APC Packaged Rates , $18.90 , $- , $- , $50.22 , $37.80
93976,5145010081,Hospital Chargemaster,Vascular Study,Outpatient,Outpatient Default Percent / Case Rate,920, $560.00 , $308.00 , $461.44 , $130.16 , $392.00 , $218.40 , $276.23 , $215.89 , $236.48 , $130.16 , $130.16 , $407.63 , $395.26 , $136.66 , $132.76 , $190.87 , $190.87 , $195.79 , $195.79 , $130.16 , $196.00 , $- , $- , $461.44 , $392.00
92611,5420010013,Hospital Chargemaster,Motion Fluoroscopy/Swallow,Outpatient,Outpatient Default Percent / Case Rate,920, $300.00 , $165.00 , $247.20 , See APC Packaged Rates , $210.00 , $117.00 , $327.50 , $255.96 , $280.37 , See APC Packaged Rates , See APC Packaged Rates , $119.41 , $115.79 , See APC Packaged Rates , See APC Packaged Rates , $259.82 , $259.82 , $266.51 , $266.51 , See APC Packaged Rates , $105.00 , $- , $- , $327.50 , $210.00
93925,5145010071,Hospital Chargemaster,Lower Extremity Study Bilat,Outpatient,Outpatient Default Percent / Case Rate,921, $700.00 , $385.00 , $576.80 , $275.09 , $490.00 , $273.00 , $566.08 , $442.42 , $484.61 , $275.09 , $275.09 , $486.72 , $471.95 , $288.84 , $280.59 , $343.61 , $343.61 , $352.46 , $352.46 , $275.09 , $245.00 , $- , $- , $576.80 , $490.00
93975,5145010077,Hospital Chargemaster,Vascular Study,Outpatient,Outpatient Default Percent / Case Rate,921, $836.00 , $459.80 , $688.86 , $275.09 , $585.20 , $326.04 , $566.08 , $442.42 , $484.61 , $275.09 , $275.09 , $608.40 , $589.94 , $288.84 , $280.59 , $343.61 , $343.61 , $352.46 , $352.46 , $275.09 , $292.60 , $- , $- , $688.86 , $585.20
93880,5145010070,Hospital Chargemaster,Extracranial Bilat Study,Outpatient,Outpatient Default Percent / Case Rate,921, $933.00 , $513.15 , $768.79 , $275.09 , $653.10 , $363.87 , $566.08 , $442.42 , $484.61 , $275.09 , $275.09 , $596.23 , $578.14 , $288.84 , $280.59 , $343.61 , $343.61 , $352.46 , $352.46 , $275.09 , $326.55 , $- , $- , $768.79 , $653.10
93930,5145010073,Hospital Chargemaster,Upper Extremity Study,Outpatient,Outpatient Default Percent / Case Rate,921, $710.00 , $390.50 , $585.04 , $275.09 , $497.00 , $276.90 , $566.08 , $442.42 , $484.61 , $275.09 , $275.09 , $517.14 , $501.45 , $288.84 , $280.59 , $343.61 , $343.61 , $352.46 , $352.46 , $275.09 , $248.50 , $- , $- , $585.04 , $497.00
93970,5145010075,Hospital Chargemaster,Extremity Study,Outpatient,Outpatient Default Percent / Case Rate,921, $740.00 , $407.00 , $609.76 , $275.09 , $518.00 , $288.60 , $566.08 , $442.42 , $484.61 , $275.09 , $275.09 , $538.43 , $522.10 , $288.84 , $280.59 , $343.61 , $343.61 , $352.46 , $352.46 , $275.09 , $259.00 , $- , $- , $609.76 , $518.00
93930,5145060073,Hospital Chargemaster,Upper Extremity Study Bilat,Outpatient,Outpatient Default Percent / Case Rate,921, $710.00 , $390.50 , $585.04 , $275.09 , $497.00 , $276.90 , $566.08 , $442.42 , $484.61 , $275.09 , $275.09 , $517.14 , $501.45 , $288.84 , $280.59 , $343.61 , $343.61 , $352.46 , $352.46 , $275.09 , $248.50 , $- , $- , $585.04 , $497.00
93880,5330010010,Hospital Chargemaster,Extracranial bilat study,Outpatient,Outpatient Default Percent / Case Rate,921, $933.00 , $513.15 , $768.79 , $275.09 , $653.10 , $363.87 , $566.08 , $442.42 , $484.61 , $275.09 , $275.09 , $596.23 , $578.14 , $288.84 , $280.59 , $343.61 , $343.61 , $352.46 , $352.46 , $275.09 , $326.55 , $- , $- , $768.79 , $653.10
93923,5330010012,Hospital Chargemaster,Upr/lxtr art stdy 3+ lvls,Outpatient,Outpatient Default Percent / Case Rate,921, $315.00 , $173.25 , $259.56 , $166.91 , $220.50 , $122.85 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $285.95 , $277.27 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $110.25 , $- , $- , $333.79 , $220.50
93882,5330010011,Hospital Chargemaster,Extracranial uni/ltd study,Outpatient,Outpatient Default Percent / Case Rate,921, $439.00 , $241.45 , $361.74 , $130.16 , $307.30 , $171.21 , $276.23 , $215.89 , $236.48 , $130.16 , $130.16 , $319.41 , $309.72 , $136.66 , $132.76 , $172.20 , $172.20 , $176.63 , $176.63 , $130.16 , $153.65 , $- , $- , $361.74 , $307.30
93926,5145010072,Hospital Chargemaster,Lower Extremity Study Unilat,Outpatient,Outpatient Default Percent / Case Rate,921, $447.00 , $245.85 , $368.33 , $130.16 , $312.90 , $174.33 , $276.23 , $215.89 , $236.48 , $130.16 , $130.16 , $325.49 , $315.62 , $136.66 , $132.76 , $169.55 , $169.55 , $173.92 , $173.92 , $130.16 , $156.45 , $- , $- , $368.33 , $312.90
93931,5145010074,Hospital Chargemaster,Upper Extremity Study Unilat,Outpatient,Outpatient Default Percent / Case Rate,921, $472.00 , $259.60 , $388.93 , $130.16 , $330.40 , $184.08 , $276.23 , $215.89 , $236.48 , $130.16 , $130.16 , $343.75 , $333.32 , $136.66 , $132.76 , $169.55 , $169.55 , $173.92 , $173.92 , $130.16 , $165.20 , $- , $- , $388.93 , $330.40
93971,5145010076,Hospital Chargemaster,Extremity Study Unilateral,Outpatient,Outpatient Default Percent / Case Rate,921, $493.00 , $271.15 , $406.23 , $130.16 , $345.10 , $192.27 , $276.23 , $215.89 , $236.48 , $130.16 , $130.16 , $358.96 , $348.06 , $136.66 , $132.76 , $169.55 , $169.55 , $173.92 , $173.92 , $130.16 , $172.55 , $- , $- , $406.23 , $345.10
93926,5145040072,Hospital Chargemaster,Lower Extremity Study Unilat L,Outpatient,Outpatient Default Percent / Case Rate,921, $447.00 , $245.85 , $368.33 , $130.16 , $312.90 , $174.33 , $276.23 , $215.89 , $236.48 , $130.16 , $130.16 , $325.49 , $315.62 , $136.66 , $132.76 , $169.55 , $169.55 , $173.92 , $173.92 , $130.16 , $156.45 , $- , $- , $368.33 , $312.90
93971,5145040076,Hospital Chargemaster,Extremity Study Unilateral LT,Outpatient,Outpatient Default Percent / Case Rate,921, $493.00 , $271.15 , $406.23 , $130.16 , $345.10 , $192.27 , $276.23 , $215.89 , $236.48 , $130.16 , $130.16 , $358.96 , $348.06 , $136.66 , $132.76 , $169.55 , $169.55 , $173.92 , $173.92 , $130.16 , $172.55 , $- , $- , $406.23 , $345.10
93926,5145050072,Hospital Chargemaster,Lower Extremity Study Unilat R,Outpatient,Outpatient Default Percent / Case Rate,921, $447.00 , $245.85 , $368.33 , $130.16 , $312.90 , $174.33 , $276.23 , $215.89 , $236.48 , $130.16 , $130.16 , $325.49 , $315.62 , $136.66 , $132.76 , $169.55 , $169.55 , $173.92 , $173.92 , $130.16 , $156.45 , $- , $- , $368.33 , $312.90
93931,5145050074,Hospital Chargemaster,Upper Extremity Study Unilat R,Outpatient,Outpatient Default Percent / Case Rate,921, $472.00 , $259.60 , $388.93 , $130.16 , $330.40 , $184.08 , $276.23 , $215.89 , $236.48 , $130.16 , $130.16 , $343.75 , $333.32 , $136.66 , $132.76 , $169.55 , $169.55 , $173.92 , $173.92 , $130.16 , $165.20 , $- , $- , $388.93 , $330.40
93971,5145050076,Hospital Chargemaster,Extremity Study Unilateral RT,Outpatient,Outpatient Default Percent / Case Rate,921, $493.00 , $271.15 , $406.23 , $130.16 , $345.10 , $192.27 , $276.23 , $215.89 , $236.48 , $130.16 , $130.16 , $358.96 , $348.06 , $136.66 , $132.76 , $169.55 , $169.55 , $173.92 , $173.92 , $130.16 , $172.55 , $- , $- , $406.23 , $345.10
93990,5145010080,Hospital Chargemaster,Doppler Flow Testing,Outpatient,Outpatient Default Percent / Case Rate,921, $300.00 , $165.00 , $247.20 , $130.16 , $210.00 , $117.00 , $276.23 , $215.89 , $236.48 , $130.16 , $130.16 , $251.22 , $243.60 , $136.66 , $132.76 , $169.55 , $169.55 , $173.92 , $173.92 , $130.16 , $105.00 , $- , $- , $276.23 , $210.00
93922,5910013922,Hospital Chargemaster,Upr/L Xtremity Art 2 Levels,Outpatient,Outpatient Default Percent / Case Rate,921, $304.00 , $167.20 , $250.50 , $134.80 , $212.80 , $118.56 , $261.44 , $204.33 , $223.81 , $134.80 , $134.80 , $152.10 , $147.49 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $106.40 , $- , $- , $261.44 , $212.80
95913,5330010034,Hospital Chargemaster,Nrv cndj test 13/> studies,Outpatient,Outpatient Default Percent / Case Rate,922, $840.00 , $462.00 , $692.16 , $583.57 , $588.00 , $327.60 ," $1,117.79 ", $873.62 , $956.92 , $583.57 , $583.57 , $305.53 , $296.26 , $612.75 , $595.24 , $754.46 , $754.46 , $773.90 , $773.90 , $583.57 , $294.00 , $- , $- ," $1,117.79 ", $588.00
95912,5330010033,Hospital Chargemaster,Nrv cndj test 11-12 studies,Outpatient,Outpatient Default Percent / Case Rate,922, $720.00 , $396.00 , $593.28 , $583.57 , $504.00 , $280.80 ," $1,117.79 ", $873.62 , $956.92 , $583.57 , $583.57 , $273.15 , $264.86 , $612.75 , $595.24 , $720.00 , $720.00 , $720.00 , $720.00 , $583.57 , $252.00 , $- , $- ," $1,117.79 ", $504.00
95911,5330010032,Hospital Chargemaster,Nrv cndj test 9-10 studies,Outpatient,Outpatient Default Percent / Case Rate,922, $666.00 , $366.30 , $548.78 , $583.57 , $466.20 , $259.74 ," $1,117.79 ", $873.62 , $956.92 , $583.57 , $583.57 , $241.42 , $234.09 , $612.75 , $595.24 , $666.00 , $666.00 , $666.00 , $666.00 , $583.57 , $233.10 , $- , $- ," $1,117.79 ", $466.20
95908,5330010029,Hospital Chargemaster,Nrv cndj tst 3-4 studies,Outpatient,Outpatient Default Percent / Case Rate,922, $501.00 , $275.55 , $412.82 , $316.40 , $350.70 , $195.39 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $134.25 , $130.17 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $175.35 , $- , $- , $619.47 , $350.70
95909,5330010030,Hospital Chargemaster,Nrv cndj tst 5-6 studies,Outpatient,Outpatient Default Percent / Case Rate,922, $666.00 , $366.30 , $548.78 , $316.40 , $466.20 , $259.74 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $161.32 , $156.42 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $233.10 , $- , $- , $619.47 , $466.20
95910,5330010031,Hospital Chargemaster,Nrv cndj test 7-8 studies,Outpatient,Outpatient Default Percent / Case Rate,922, $666.00 , $366.30 , $548.78 , $316.40 , $466.20 , $259.74 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $208.14 , $201.83 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $233.10 , $- , $- , $619.47 , $466.20
95868,5330010019,Hospital Chargemaster,Muscle test cran nerve bilat,Outpatient,Outpatient Default Percent / Case Rate,922, $510.00 , $280.50 , $420.24 , $316.40 , $357.00 , $198.90 , $333.79 , $260.88 , $285.75 , $316.40 , $316.40 , $371.12 , $359.86 , $332.22 , $322.72 , $270.89 , $270.89 , $277.87 , $277.87 , $316.40 , $178.50 , $- , $- , $420.24 , $357.00
95863,5330010016,Hospital Chargemaster,Muscle test 3 limbs,Outpatient,Outpatient Default Percent / Case Rate,922, $673.00 , $370.15 , $554.55 , $166.91 , $471.10 , $262.47 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $489.76 , $474.90 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $235.55 , $- , $- , $554.55 , $471.10
95864,5330010017,Hospital Chargemaster,Muscle test 4 limbs,Outpatient,Outpatient Default Percent / Case Rate,922, $790.00 , $434.50 , $650.96 , $166.91 , $553.00 , $308.10 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $574.94 , $557.49 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $276.50 , $- , $- , $650.96 , $553.00
95907,5330010028,Hospital Chargemaster,Nvr cndj tst 1-2 studies,Outpatient,Outpatient Default Percent / Case Rate,922, $386.00 , $212.30 , $318.06 , $166.91 , $270.20 , $150.54 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $111.17 , $107.80 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $135.10 , $- , $- , $333.79 , $270.20
95937,5330010036,Hospital Chargemaster,Neuromuscular junction test,Outpatient,Outpatient Default Percent / Case Rate,922, $230.00 , $126.50 , $189.52 , $166.91 , $161.00 , $89.70 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $167.31 , $162.23 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $80.50 , $- , $- , $333.79 , $161.00
95861,5330010015,Hospital Chargemaster,Muscle test 2 limbs,Outpatient,Outpatient Default Percent / Case Rate,922, $568.00 , $312.40 , $468.03 , $134.80 , $397.60 , $221.52 , $261.44 , $204.33 , $223.81 , $134.80 , $134.80 , $413.71 , $401.16 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $198.80 , $- , $- , $468.03 , $397.60
95860,5330010014,Hospital Chargemaster,Muscle test one limb,Outpatient,Outpatient Default Percent / Case Rate,922, $330.00 , $181.50 , $271.92 , $134.80 , $231.00 , $128.70 , $261.44 , $204.33 , $223.81 , $134.80 , $134.80 , $240.32 , $233.03 , $141.54 , $137.50 , $166.49 , $166.49 , $170.78 , $170.78 , $134.80 , $115.50 , $- , $- , $271.92 , $231.00
95870,5330010021,Hospital Chargemaster,Muscle test nonparaspinal,Outpatient,Outpatient Default Percent / Case Rate,922, $145.00 , $79.75 , $119.48 , $134.80 , $101.50 , $56.55 , $137.24 , $107.26 , $117.48 , $134.80 , $134.80 , $21.48 , $20.83 , $141.54 , $137.50 , $116.33 , $116.33 , $119.33 , $119.33 , $134.80 , $50.75 , $- , $- , $141.54 , $101.50
95885,5330010024,Hospital Chargemaster,Musc tst done w/nerv tst lim,Outpatient,Outpatient Default Percent / Case Rate,922, $276.00 , $151.80 , $227.42 , See APC Packaged Rates , $193.20 , $107.64 , $164.03 , $128.20 , $140.42 , See APC Packaged Rates , See APC Packaged Rates , $99.24 , $96.23 , See APC Packaged Rates , See APC Packaged Rates , $256.68 , $256.68 , $256.68 , $256.68 , See APC Packaged Rates , $96.60 , $- , $- , $256.68 , $193.20
95887,5330010026,Hospital Chargemaster,Musc tst done w/n tst nonext,Outpatient,Outpatient Default Percent / Case Rate,922, $145.00 , $79.75 , $119.48 , See APC Packaged Rates , $101.50 , $56.55 , $172.30 , $134.66 , $147.50 , See APC Packaged Rates , See APC Packaged Rates , $106.33 , $103.10 , See APC Packaged Rates , See APC Packaged Rates , $134.85 , $134.85 , $134.85 , $134.85 , See APC Packaged Rates , $50.75 , $- , $- , $172.30 , $101.50
95886,5330010025,Hospital Chargemaster,Musc test done w/n test comp,Outpatient,Outpatient Default Percent / Case Rate,922, $276.00 , $151.80 , $227.42 , See APC Packaged Rates , $193.20 , $107.64 , $187.45 , $146.51 , $160.48 , See APC Packaged Rates , See APC Packaged Rates , $104.57 , $101.40 , See APC Packaged Rates , See APC Packaged Rates , $256.68 , $256.68 , $256.68 , $256.68 , See APC Packaged Rates , $96.60 , $- , $- , $256.68 , $193.20
95873,5330010022,Hospital Chargemaster,Guide nerv destr elec stim,Outpatient,Outpatient Default Percent / Case Rate,922, $118.00 , $64.90 , $97.23 , See APC Packaged Rates , $82.60 , $46.02 , $215.02 , $168.05 , $184.08 , See APC Packaged Rates , See APC Packaged Rates , $21.08 , $20.44 , See APC Packaged Rates , See APC Packaged Rates , $109.74 , $109.74 , $109.74 , $109.74 , See APC Packaged Rates , $41.30 , $- , $- , $215.02 , $82.60
95874,5330010023,Hospital Chargemaster,Guide nerv destr needle emg,Outpatient,Outpatient Default Percent / Case Rate,922, $114.00 , $62.70 , $93.94 , See APC Packaged Rates , $79.80 , $44.46 , $221.91 , $173.44 , $189.98 , See APC Packaged Rates , See APC Packaged Rates , $21.08 , $20.44 , See APC Packaged Rates , See APC Packaged Rates , $106.02 , $106.02 , $106.02 , $106.02 , See APC Packaged Rates , $39.90 , $- , $- , $221.91 , $79.80
95869,5330010020,Hospital Chargemaster,Muscle test thor paraspinal,Outpatient,Outpatient Default Percent / Case Rate,922, $240.00 , $132.00 , $197.76 , $166.91 , $168.00 , $93.60 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $106.47 , $103.24 , $175.26 , $170.25 , $209.96 , $209.96 , $215.37 , $215.37 , $166.91 , $84.00 , $- , $- , $333.79 , $168.00
95874,8037015874,Hospital Chargemaster,Guide nerv destr needle emg,Outpatient,Outpatient Default Percent / Case Rate,922, $114.00 , $62.70 , $93.94 , See APC Packaged Rates , $79.80 , $44.46 , $221.91 , $173.44 , $189.98 , See APC Packaged Rates , See APC Packaged Rates , $21.08 , $20.44 , See APC Packaged Rates , See APC Packaged Rates , $106.02 , $106.02 , $106.02 , $106.02 , See APC Packaged Rates , $39.90 , $- , $- , $221.91 , $79.80
96522,5720010020,Hospital Chargemaster,Refill/maint pump/resvr syst,Outpatient,Outpatient Default Percent / Case Rate,940, $418.00 , $229.90 , $344.43 , $244.57 , $292.60 , $163.02 , $409.48 , $281.05 , $279.55 , $244.57 , $244.57 , $283.00 , $274.41 , $256.80 , $249.46 , $300.73 , $300.73 , $308.47 , $308.47 , $244.57 , $146.30 , $- , $- , $409.48 , $292.60
96521,5720010019,Hospital Chargemaster,Refill/maint portable pump,Outpatient,Outpatient Default Percent / Case Rate,940, $540.00 , $297.00 , $444.96 , $244.57 , $378.00 , $210.60 , $459.57 , $359.18 , $393.42 , $244.57 , $244.57 , $392.79 , $380.87 , $256.80 , $249.46 , $300.73 , $300.73 , $308.47 , $308.47 , $244.57 , $189.00 , $- , $- , $459.57 , $378.00
99195,5212010795,Hospital Chargemaster,Phlebotomy,Outpatient,Outpatient Default Percent / Case Rate,940, $175.00 , $96.25 , $144.20 , $134.80 , $122.50 , $68.25 , $261.44 , $204.33 , $223.81 , $134.80 , $134.80 , $102.33 , $99.22 , $141.54 , $137.50 , $171.32 , $171.32 , $175.00 , $175.00 , $134.80 , $61.25 , $- , $- , $261.44 , $122.50
96372,5720010014,Hospital Chargemaster,Ther/proph/diag inj sc/im,Outpatient,Outpatient Default Percent / Case Rate,940, $118.00 , $64.90 , $97.23 , $74.12 , $82.60 , $46.02 , $146.70 , $114.66 , $125.59 , $74.12 , $74.12 , $55.06 , $53.39 , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $41.30 , $- , $- , $146.70 , $82.60
96523,5720010021,Hospital Chargemaster,Irrig drug delivery device,Outpatient,Outpatient Default Percent / Case Rate,940, $148.00 , $81.40 , $121.95 , $66.55 , $103.60 , $57.72 , $137.24 , $107.26 , $117.48 , $66.55 , $66.55 , $71.96 , $69.77 , $69.87 , $67.88 , $85.99 , $85.99 , $88.21 , $88.21 , $66.55 , $51.80 , $- , $- , $137.24 , $103.60
96523,5810010016,Hospital Chargemaster,Irrig drug delivery device,Outpatient,Outpatient Default Percent / Case Rate,940, $148.00 , $81.40 , $121.95 , $66.55 , $103.60 , $57.72 , $137.24 , $107.26 , $117.48 , $66.55 , $66.55 , $71.96 , $69.77 , $69.87 , $67.88 , $85.99 , $85.99 , $88.21 , $88.21 , $66.55 , $51.80 , $- , $- , $137.24 , $103.60
96379,5720010018,Hospital Chargemaster,Ther/prop/diag inj/inf proc,Outpatient,Outpatient Default Percent / Case Rate,940, $80.00 , $44.00 , $65.92 , $47.84 , $56.00 , $31.20 , $77.19 , $77.53 , $41.20 , $47.84 , $47.84 , $53.68 , $53.68 , $50.23 , $48.80 , $61.50 , $61.50 , $63.08 , $63.08 , $47.84 , $28.00 , $- , $- , $77.53 , $56.00
96379,5810010002,Hospital Chargemaster,Ther/prop/diag inj/inf proc,Outpatient,Outpatient Default Percent / Case Rate,940, $80.00 , $44.00 , $65.92 , $47.84 , $56.00 , $31.20 , $77.19 , $77.53 , $41.20 , $47.84 , $47.84 , $53.68 , $53.68 , $50.23 , $48.80 , $61.50 , $61.50 , $63.08 , $63.08 , $47.84 , $28.00 , $- , $- , $77.53 , $56.00
95117,5720010007,Hospital Chargemaster,Immunotherapy injections,Outpatient,Outpatient Default Percent / Case Rate,940, $38.00 , $20.90 , $31.31 , $47.84 , $26.60 , $14.82 , $93.01 , $72.69 , $79.62 , $47.84 , $47.84 , $25.50 , $25.50 , $50.23 , $48.80 , $38.00 , $38.00 , $38.00 , $38.00 , $47.84 , $13.30 , $- , $- , $93.01 , $26.60
95115,5720010006,Hospital Chargemaster,Immunotherapy one injection,Outpatient,Outpatient Default Percent / Case Rate,940, $31.00 , $17.05 , $25.54 , $47.84 , $21.70 , $12.09 , $93.01 , $72.69 , $79.62 , $47.84 , $47.84 , $20.80 , $20.80 , $50.23 , $48.80 , $31.00 , $31.00 , $31.00 , $31.00 , $47.84 , $10.85 , $- , $- , $93.01 , $21.70
96377,5810010001,Hospital Chargemaster,Applicaton on-body injector,Outpatient,Outpatient Default Percent / Case Rate,940, $118.00 , $64.90 ," $1,236.00 ", $47.84 , $82.60 , $46.02 , $82.87 , $56.88 , $56.58 , $47.84 , $47.84 , $79.18 , $79.18 , $50.23 , $48.80 , $61.50 , $61.50 , $63.08 , $63.08 , $47.84 , $41.30 , $- , $- ," $1,236.00 ", $82.60
99407,6500011956,Hospital Chargemaster,Behav Chng Smoking > 10 min,Outpatient,Outpatient Default Percent / Case Rate,940, $83.00 , $45.65 , $68.39 , $31.42 , $58.10 , $32.37 , $453.42 , $136.80 , $187.38 , $31.42 , $31.42 , $55.69 , $55.69 , $32.99 , $32.05 , $42.55 , $42.55 , $43.64 , $43.64 , $31.42 , $29.05 , $- , $- , $453.42 , $58.10
99406,6500019268,Hospital Chargemaster,Behav Chng Smoking 3-10 Min,Outpatient,Outpatient Default Percent / Case Rate,940, $23.00 , $12.65 , $18.95 , $31.42 , $16.10 , $8.97 , $453.42 , $136.80 , $187.38 , $31.42 , $31.42 , $15.43 , $15.43 , $32.99 , $32.05 , $23.00 , $23.00 , $23.00 , $23.00 , $31.42 , $8.05 , $- , $- , $453.42 , $16.10
G0270,6827410006,Hospital Chargemaster,Mnt subs tx for change dx,Outpatient,Outpatient Default Percent / Case Rate,942, $97.00 , $53.35 , $79.93 , See APC Packaged Rates , $67.90 , $37.83 , $93.60 , $94.00 , $49.96 , See APC Packaged Rates , See APC Packaged Rates , $65.09 , $65.09 , See APC Packaged Rates , See APC Packaged Rates , $90.21 , $90.21 , $90.21 , $90.21 , See APC Packaged Rates , $33.95 , $- , $- , $94.00 , $67.90
G0108,6827410004,Hospital Chargemaster,Diab manage trn per indiv,Outpatient,Outpatient Default Percent / Case Rate,942, $180.00 , $99.00 , $148.32 , See APC Packaged Rates , $126.00 , $70.20 , $199.11 , $155.62 , $170.46 , See APC Packaged Rates , See APC Packaged Rates , $120.78 , $120.78 , See APC Packaged Rates , See APC Packaged Rates , $62.42 , $62.42 , $64.03 , $64.03 , See APC Packaged Rates , $63.00 , $- , $- , $199.11 , $126.00
97802,6827410001,Hospital Chargemaster,Medical nutrition ind in,Outpatient,Outpatient Default Percent / Case Rate,942, $80.00 , $44.00 , $65.92 , See APC Packaged Rates , $56.00 , $31.20 , $123.00 , $96.13 , $105.30 , See APC Packaged Rates , See APC Packaged Rates , $77.36 , $75.01 , See APC Packaged Rates , See APC Packaged Rates , $49.17 , $49.17 , $50.44 , $50.44 , See APC Packaged Rates , $28.00 , $- , $- , $123.00 , $56.00
97803,6827410002,Hospital Chargemaster,Med nutrition indiv subseq,Outpatient,Outpatient Default Percent / Case Rate,942, $80.00 , $44.00 , $65.92 , See APC Packaged Rates , $56.00 , $31.20 , $105.07 , $82.12 , $89.95 , See APC Packaged Rates , See APC Packaged Rates , $70.79 , $68.64 , See APC Packaged Rates , See APC Packaged Rates , $41.43 , $41.43 , $42.50 , $42.50 , See APC Packaged Rates , $28.00 , $- , $- , $105.07 , $56.00
G0109,6827410005,Hospital Chargemaster,Diab manage trn ind/group,Outpatient,Outpatient Default Percent / Case Rate,942, $79.00 , $43.45 , $65.10 , See APC Packaged Rates , $55.30 , $30.81 , $54.86 , $42.87 , $46.96 , See APC Packaged Rates , See APC Packaged Rates , $53.01 , $53.01 , See APC Packaged Rates , See APC Packaged Rates , $36.31 , $36.31 , $37.25 , $37.25 , See APC Packaged Rates , $27.65 , $- , $- , $65.10 , $55.30
97804,6827410003,Hospital Chargemaster,Medical nutrition group,Outpatient,Outpatient Default Percent / Case Rate,942, $51.00 , $28.05 , $42.02 , See APC Packaged Rates , $35.70 , $19.89 , $57.63 , $45.04 , $49.33 , See APC Packaged Rates , See APC Packaged Rates , $36.81 , $35.69 , See APC Packaged Rates , See APC Packaged Rates , $23.04 , $23.04 , $23.63 , $23.63 , See APC Packaged Rates , $17.85 , $- , $- , $57.63 , $35.70
71551,5171020019,Hospital Chargemaster,MRI chest w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $335.00 , $184.25 , $276.04 , $855.31 , $234.50 , $130.65 ," $2,799.56 "," $1,449.22 "," $1,422.33 ", $855.31 , $855.31 ," $1,102.58 "," $1,069.13 ", $898.07 , $872.41 ," $1,235.84 "," $1,235.84 "," $1,267.65 "," $1,267.65 ", $855.31 , $117.25 ," $1,037.63 ", $117.25 ," $2,799.56 ", $234.50
72157,5171020029,Hospital Chargemaster,MRI chest spine w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $499.00 , $274.45 , $411.18 , $440.24 , $349.30 , $194.61 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $174.65 , $578.82 , $174.65 ," $1,633.34 ", $349.30
72158,5171020030,Hospital Chargemaster,MRI lumbar spine w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $459.00 , $252.45 , $378.22 , $440.24 , $321.30 , $179.01 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $160.65 , $578.82 , $160.65 ," $1,633.34 ", $321.30
72156,5171020028,Hospital Chargemaster,MRI neck spine w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $499.00 , $274.45 , $411.18 , $440.24 , $349.30 , $194.61 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $174.65 , $578.82 , $174.65 ," $1,633.34 ", $349.30
70543,5171020003,Hospital Chargemaster,MRI orbt/fac/nck w/o &w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $416.00 , $228.80 , $342.78 , $440.24 , $291.20 , $162.24 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,422.63 "," $2,349.12 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $145.60 , $578.82 , $145.60 ," $2,422.63 ", $291.20
70553,5171020012,Hospital Chargemaster,MRI brain stem w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $458.00 , $251.90 , $377.39 , $440.24 , $320.60 , $178.62 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $160.30 , $578.82 , $160.30 ," $1,633.34 ", $320.60
71552,5171020020,Hospital Chargemaster,MRI chest w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $440.00 , $242.00 , $362.56 , $440.24 , $308.00 , $171.60 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,321.75 "," $1,281.64 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $154.00 , $578.82 , $154.00 ," $1,561.69 ", $308.00
72197,5171020034,Hospital Chargemaster,MRI pelvis w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $439.00 , $241.45 , $361.74 , $440.24 , $307.30 , $171.21 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,426.81 "," $2,353.18 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $153.65 , $578.82 , $153.65 ," $2,426.81 ", $307.30
74183,5171020052,Hospital Chargemaster,MRI abdomen w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $439.00 , $241.45 , $361.74 , $440.24 , $307.30 , $171.21 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,426.81 "," $2,353.18 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $153.65 , $578.82 , $153.65 ," $2,426.81 ", $307.30
72147,5171020025,Hospital Chargemaster,MRI chest spine w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $374.00 , $205.70 , $308.18 , $440.24 , $261.80 , $145.86 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $130.90 , $578.82 , $130.90 ," $1,633.34 ", $261.80
70542,5171020002,Hospital Chargemaster,MRI orbit/face/neck w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $313.00 , $172.15 , $257.91 , $440.24 , $219.10 , $122.07 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,308.50 "," $1,268.80 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $109.55 , $578.82 , $109.55 ," $1,561.69 ", $219.10
70545,5171020005,Hospital Chargemaster,MRA angiography head w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $233.00 , $128.15 , $191.99 , $440.24 , $163.10 , $90.87 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,102.58 "," $1,069.13 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $81.55 , $578.82 , $81.55 ," $1,561.69 ", $163.10
72149,5171020027,Hospital Chargemaster,MRI lumbar spine w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $347.00 , $190.85 , $285.93 , $440.24 , $242.90 , $135.33 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $121.45 , $578.82 , $121.45 ," $1,633.34 ", $242.90
72196,5171020033,Hospital Chargemaster,MRI pelvis w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $336.00 , $184.80 , $276.86 , $440.24 , $235.20 , $131.04 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,361.27 "," $1,319.97 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $117.60 , $578.82 , $117.60 ," $1,561.69 ", $235.20
70548,5171020008,Hospital Chargemaster,MRA angiography neck w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $233.00 , $128.15 , $191.99 , $440.24 , $163.10 , $90.87 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,102.58 "," $1,069.13 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $81.55 , $578.82 , $81.55 ," $1,561.69 ", $163.10
70552,5171020011,Hospital Chargemaster,MRI brain stem w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $346.00 , $190.30 , $285.10 , $440.24 , $242.20 , $134.94 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $121.10 , $578.82 , $121.10 ," $1,633.34 ", $242.20
72142,5171020023,Hospital Chargemaster,MRI neck spine w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $374.00 , $205.70 , $308.18 , $440.24 , $261.80 , $145.86 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,633.34 "," $1,583.78 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $130.90 , $578.82 , $130.90 ," $1,633.34 ", $261.80
74182,5171020051,Hospital Chargemaster,MRI abdomen w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $336.00 , $184.80 , $276.86 , $440.24 , $235.20 , $131.04 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,311.27 "," $1,271.48 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $117.60 , $578.82 , $117.60 ," $1,561.69 ", $235.20
70546,5171020006,Hospital Chargemaster,MRA angiograph head w/o&w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $349.00 , $191.95 , $287.58 , $440.24 , $244.30 , $136.11 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,172.01 "," $2,106.11 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $122.15 , $578.82 , $122.15 ," $2,172.01 ", $244.30
70549,5171020009,Hospital Chargemaster,MRA angiograph neck w/o&w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $349.00 , $191.95 , $287.58 , $440.24 , $244.30 , $136.11 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,172.01 "," $2,106.11 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $122.15 , $578.82 , $122.15 ," $2,172.01 ", $244.30
70336,5171020000,Hospital Chargemaster,MRI jaw joint,Outpatient,Outpatient Default Percent / Case Rate,960, $288.00 , $158.40 , $237.31 , $275.09 , $201.60 , $112.32 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $100.80 , $345.84 , $100.80 ," $1,361.27 ", $201.60
70540,5171020001,Hospital Chargemaster,MRI orbit/face/neck w/o dye,Outpatient,Outpatient Default Percent / Case Rate,960, $261.00 , $143.55 , $215.06 , $275.09 , $182.70 , $101.79 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $91.35 , $345.84 , $91.35 ," $1,361.27 ", $182.70
70544,5171020004,Hospital Chargemaster,MRA angiography head w/o dye,Outpatient,Outpatient Default Percent / Case Rate,960, $233.00 , $128.15 , $191.99 , $275.09 , $163.10 , $90.87 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,102.58 "," $1,069.13 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $81.55 , $345.84 , $81.55 ," $1,102.58 ", $163.10
70547,5171020007,Hospital Chargemaster,MRA angiography neck w/o dye,Outpatient,Outpatient Default Percent / Case Rate,960, $233.00 , $128.15 , $191.99 , $275.09 , $163.10 , $90.87 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,102.58 "," $1,069.13 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $81.55 , $345.84 , $81.55 ," $1,102.58 ", $163.10
70551,5171020010,Hospital Chargemaster,MRI brain stem w/o dye,Outpatient,Outpatient Default Percent / Case Rate,960, $287.00 , $157.85 , $236.49 , $275.09 , $200.90 , $111.93 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $100.45 , $345.84 , $100.45 ," $1,361.27 ", $200.90
71550,5171020018,Hospital Chargemaster,MRI chest w/o dye,Outpatient,Outpatient Default Percent / Case Rate,960, $283.00 , $155.65 , $233.19 , $275.09 , $198.10 , $110.37 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $99.05 , $345.84 , $99.05 ," $1,361.27 ", $198.10
72141,5171020022,Hospital Chargemaster,MRI neck spine w/o dye,Outpatient,Outpatient Default Percent / Case Rate,960, $311.00 , $171.05 , $256.26 , $275.09 , $217.70 , $121.29 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $108.85 , $345.84 , $108.85 ," $1,361.27 ", $217.70
72146,5171020024,Hospital Chargemaster,MRI chest spine w/o dye,Outpatient,Outpatient Default Percent / Case Rate,960, $313.00 , $172.15 , $257.91 , $275.09 , $219.10 , $122.07 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,511.27 "," $1,465.41 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $109.55 , $345.84 , $109.55 ," $1,511.27 ", $219.10
72148,5171020026,Hospital Chargemaster,MRI lumbar spine w/o dye,Outpatient,Outpatient Default Percent / Case Rate,960, $288.00 , $158.40 , $237.31 , $275.09 , $201.60 , $112.32 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,511.27 "," $1,465.41 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $100.80 , $345.84 , $100.80 ," $1,511.27 ", $201.60
72195,5171020032,Hospital Chargemaster,MRI pelvis w/o dye,Outpatient,Outpatient Default Percent / Case Rate,960, $283.00 , $155.65 , $233.19 , $275.09 , $198.10 , $110.37 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,094.23 "," $1,061.03 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $99.05 , $345.84 , $99.05 ," $1,094.23 ", $198.10
74181,5171020050,Hospital Chargemaster,MRI abdomen w/o dye,Outpatient,Outpatient Default Percent / Case Rate,960, $282.00 , $155.10 , $232.37 , $275.09 , $197.40 , $109.98 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $98.70 , $345.84 , $98.70 ," $1,361.27 ", $197.40
94060,5311020010,Hospital Chargemaster,Evaluation Of Wheezing,Outpatient,Outpatient Default Percent / Case Rate,960, $45.00 , $24.75 , $37.08 , $316.40 , $31.50 , $17.55 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $197.73 , $191.73 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $15.75 , $- , $- , $619.47 , $31.50
94070,5311020011,Hospital Chargemaster,Evaluation Of Wheezing,Outpatient,Outpatient Default Percent / Case Rate,960, $88.00 , $48.40 , $72.51 , $316.40 , $61.60 , $34.32 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $292.03 , $283.17 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $30.80 , $- , $- , $619.47 , $61.60
73723,5171040048,Hospital Chargemaster,MRI joint lwr extr wo&w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,960, $418.00 , $229.90 , $344.43 , $440.24 , $292.60 , $163.02 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,422.63 "," $2,349.12 ", $462.26 , $449.05 , $418.00 , $418.00 , $418.00 , $418.00 , $440.24 , $146.30 , $578.82 , $146.30 ," $2,422.63 ", $292.60
73723,5171050048,Hospital Chargemaster,MRI joint lwr extr wo&w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,960, $418.00 , $229.90 , $344.43 , $440.24 , $292.60 , $163.02 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,422.63 "," $2,349.12 ", $462.26 , $449.05 , $418.00 , $418.00 , $418.00 , $418.00 , $440.24 , $146.30 , $578.82 , $146.30 ," $2,422.63 ", $292.60
73220,5171040038,Hospital Chargemaster,MRI uppr extr wo&w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,960, $418.00 , $229.90 , $344.43 , $440.24 , $292.60 , $163.02 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,361.27 "," $1,319.97 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $146.30 , $578.82 , $146.30 ," $1,561.69 ", $292.60
73720,5171040045,Hospital Chargemaster,MRI lwr extr wo&w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,960, $418.00 , $229.90 , $344.43 , $440.24 , $292.60 , $163.02 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,361.27 "," $1,319.97 ", $462.26 , $449.05 , $418.00 , $418.00 , $418.00 , $418.00 , $440.24 , $146.30 , $578.82 , $146.30 ," $1,561.69 ", $292.60
73220,5171050038,Hospital Chargemaster,MRI uppr extr wo&w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,960, $418.00 , $229.90 , $344.43 , $440.24 , $292.60 , $163.02 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,361.27 "," $1,319.97 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $146.30 , $578.82 , $146.30 ," $1,561.69 ", $292.60
73720,5171050045,Hospital Chargemaster,MRI lwr extr wo&w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,960, $418.00 , $229.90 , $344.43 , $440.24 , $292.60 , $163.02 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,361.27 "," $1,319.97 ", $462.26 , $449.05 , $418.00 , $418.00 , $418.00 , $418.00 , $440.24 , $146.30 , $578.82 , $146.30 ," $1,561.69 ", $292.60
73223,5171040041,Hospital Chargemaster,MRI joint upr extr wo&w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,960, $416.00 , $228.80 , $342.78 , $440.24 , $291.20 , $162.24 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,422.63 "," $2,349.12 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $145.60 , $578.82 , $145.60 ," $2,422.63 ", $291.20
73223,5171050041,Hospital Chargemaster,MRI joint upr extr wo&w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,960, $416.00 , $228.80 , $342.78 , $440.24 , $291.20 , $162.24 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $2,422.63 "," $2,349.12 ", $462.26 , $449.05 , $723.23 , $723.23 , $741.85 , $741.85 , $440.24 , $145.60 , $578.82 , $145.60 ," $2,422.63 ", $291.20
94726,5311020037,Hospital Chargemaster,Pulm Funct Tst Plethysmograp,Outpatient,Outpatient Default Percent / Case Rate,960, $25.00 , $13.75 , $20.60 , $316.40 , $17.50 , $9.75 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $107.92 , $104.65 , $332.22 , $322.72 , $349.00 , $349.00 , $349.00 , $349.00 , $316.40 , $8.75 , $- , $- , $619.47 , $17.50
73225,5171030042,Hospital Chargemaster,MRA angio upr extr wo&w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,960, $333.00 , $183.15 , $274.39 , See APC Packaged Rates , $233.10 , $129.87 ," $1,939.90 "," $1,004.21 ", $985.57 , See APC Packaged Rates , See APC Packaged Rates ," $1,018.06 ", $987.17 , See APC Packaged Rates , See APC Packaged Rates , $588.93 , $588.93 , $604.09 , $604.09 , See APC Packaged Rates , $116.55 , $461.66 , $116.55 ," $1,939.90 ", $233.10
73225,5171040042,Hospital Chargemaster,MRA angio upr extr wo&w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,960, $333.00 , $183.15 , $274.39 , See APC Packaged Rates , $233.10 , $129.87 ," $1,939.90 "," $1,004.21 ", $985.57 , See APC Packaged Rates , See APC Packaged Rates ," $1,018.06 ", $987.17 , See APC Packaged Rates , See APC Packaged Rates , $588.93 , $588.93 , $604.09 , $604.09 , See APC Packaged Rates , $116.55 , $461.66 , $116.55 ," $1,939.90 ", $233.10
73722,5171040047,Hospital Chargemaster,MRI joint of lwr extr w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,960, $318.00 , $174.90 , $262.03 , $855.31 , $222.60 , $124.02 ," $2,799.56 "," $1,449.22 "," $1,422.33 ", $855.31 , $855.31 ," $1,308.50 "," $1,268.80 ", $898.07 , $872.41 , $318.00 , $318.00 , $318.00 , $318.00 , $855.31 , $111.30 ," $1,037.63 ", $111.30 ," $2,799.56 ", $222.60
73722,5171050047,Hospital Chargemaster,MRI joint of lwr extr w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,960, $318.00 , $174.90 , $262.03 , $855.31 , $222.60 , $124.02 ," $2,799.56 "," $1,449.22 "," $1,422.33 ", $855.31 , $855.31 ," $1,308.50 "," $1,268.80 ", $898.07 , $872.41 , $318.00 , $318.00 , $318.00 , $318.00 , $855.31 , $111.30 ," $1,037.63 ", $111.30 ," $2,799.56 ", $222.60
73219,5171040037,Hospital Chargemaster,MRI upper extr w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,960, $315.00 , $173.25 , $259.56 , $440.24 , $220.50 , $122.85 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,308.50 "," $1,268.80 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $110.25 , $578.82 , $110.25 ," $1,561.69 ", $220.50
73219,5171050037,Hospital Chargemaster,MRI upper extr w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,960, $315.00 , $173.25 , $259.56 , $440.24 , $220.50 , $122.85 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,308.50 "," $1,268.80 ", $462.26 , $449.05 , $703.07 , $703.07 , $721.17 , $721.17 , $440.24 , $110.25 , $578.82 , $110.25 ," $1,561.69 ", $220.50
73222,5171040040,Hospital Chargemaster,MRI joint upr extrem w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,960, $315.00 , $173.25 , $259.56 , $855.31 , $220.50 , $122.85 ," $2,799.56 "," $1,449.22 "," $1,422.33 ", $855.31 , $855.31 ," $1,308.50 "," $1,268.80 ", $898.07 , $872.41 ," $1,235.84 "," $1,235.84 "," $1,267.65 "," $1,267.65 ", $855.31 , $110.25 ," $1,037.63 ", $110.25 ," $2,799.56 ", $220.50
73222,5171050040,Hospital Chargemaster,MRI joint upr extrem w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,960, $315.00 , $173.25 , $259.56 , $855.31 , $220.50 , $122.85 ," $2,799.56 "," $1,449.22 "," $1,422.33 ", $855.31 , $855.31 ," $1,308.50 "," $1,268.80 ", $898.07 , $872.41 ," $1,235.84 "," $1,235.84 "," $1,267.65 "," $1,267.65 ", $855.31 , $110.25 ," $1,037.63 ", $110.25 ," $2,799.56 ", $220.50
73719,5171040044,Hospital Chargemaster,MRI lower extr w/dye LT,Outpatient,Outpatient Default Percent / Case Rate,960, $313.00 , $172.15 , $257.91 , $440.24 , $219.10 , $122.07 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,308.50 "," $1,268.80 ", $462.26 , $449.05 , $313.00 , $313.00 , $313.00 , $313.00 , $440.24 , $109.55 , $578.82 , $109.55 ," $1,561.69 ", $219.10
73719,5171050044,Hospital Chargemaster,MRI lower extr w/dye RT,Outpatient,Outpatient Default Percent / Case Rate,960, $313.00 , $172.15 , $257.91 , $440.24 , $219.10 , $122.07 ," $1,561.69 ", $808.42 , $793.42 , $440.24 , $440.24 ," $1,308.50 "," $1,268.80 ", $462.26 , $449.05 , $313.00 , $313.00 , $313.00 , $313.00 , $440.24 , $109.55 , $578.82 , $109.55 ," $1,561.69 ", $219.10
73221,5171040039,Hospital Chargemaster,MRI joint upr extrem wo dye LT,Outpatient,Outpatient Default Percent / Case Rate,960, $262.00 , $144.10 , $215.89 , $275.09 , $183.40 , $102.18 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $91.70 , $345.84 , $91.70 ," $1,361.27 ", $183.40
73718,5171040043,Hospital Chargemaster,MRI lower extr wo dye LT,Outpatient,Outpatient Default Percent / Case Rate,960, $262.00 , $144.10 , $215.89 , $275.09 , $183.40 , $102.18 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,090.74 "," $1,057.65 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $91.70 , $345.84 , $91.70 ," $1,090.74 ", $183.40
73721,5171040046,Hospital Chargemaster,MRI jnt of lwr extre wo dye LT,Outpatient,Outpatient Default Percent / Case Rate,960, $262.00 , $144.10 , $215.89 , $275.09 , $183.40 , $102.18 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $262.00 , $262.00 , $262.00 , $262.00 , $275.09 , $91.70 , $345.84 , $91.70 ," $1,361.27 ", $183.40
73221,5171050039,Hospital Chargemaster,MRI joint upr extrem wo dye RT,Outpatient,Outpatient Default Percent / Case Rate,960, $262.00 , $144.10 , $215.89 , $275.09 , $183.40 , $102.18 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $91.70 , $345.84 , $91.70 ," $1,361.27 ", $183.40
73718,5171050043,Hospital Chargemaster,MRI lower extr wo dye RT,Outpatient,Outpatient Default Percent / Case Rate,960, $262.00 , $144.10 , $215.89 , $275.09 , $183.40 , $102.18 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,090.74 "," $1,057.65 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $91.70 , $345.84 , $91.70 ," $1,090.74 ", $183.40
73721,5171050046,Hospital Chargemaster,MRI jnt of lwr extre wo dye RT,Outpatient,Outpatient Default Percent / Case Rate,960, $262.00 , $144.10 , $215.89 , $275.09 , $183.40 , $102.18 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,361.27 "," $1,319.97 ", $288.84 , $280.59 , $262.00 , $262.00 , $262.00 , $262.00 , $275.09 , $91.70 , $345.84 , $91.70 ," $1,361.27 ", $183.40
73218,5171040036,Hospital Chargemaster,MRI upper extr wo dye LT,Outpatient,Outpatient Default Percent / Case Rate,960, $260.00 , $143.00 , $214.24 , $275.09 , $182.00 , $101.40 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,090.74 "," $1,057.65 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $91.00 , $345.84 , $91.00 ," $1,090.74 ", $182.00
73218,5171050036,Hospital Chargemaster,MRI upper extr wo dye RT,Outpatient,Outpatient Default Percent / Case Rate,960, $260.00 , $143.00 , $214.24 , $275.09 , $182.00 , $101.40 , $933.09 , $483.03 , $474.06 , $275.09 , $275.09 ," $1,090.74 "," $1,057.65 ", $288.84 , $280.59 , $440.29 , $440.29 , $451.63 , $451.63 , $275.09 , $91.00 , $345.84 , $91.00 ," $1,090.74 ", $182.00
94010,5311020003,Hospital Chargemaster,Breathing Capacity Test,Outpatient,Outpatient Default Percent / Case Rate,960, $25.00 , $13.75 , $20.60 , $166.91 , $17.50 , $9.75 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $106.47 , $103.24 , $175.26 , $170.25 , $214.00 , $214.00 , $214.00 , $214.00 , $166.91 , $8.75 , $- , $- , $333.79 , $17.50
94727,5311020038,Hospital Chargemaster,Pulm Function Test By Gas,Outpatient,Outpatient Default Percent / Case Rate,960, $38.00 , $20.90 , $31.31 , $166.91 , $26.60 , $14.82 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $77.95 , $75.58 , $175.26 , $170.25 , $205.00 , $205.00 , $205.00 , $205.00 , $166.91 , $13.30 , $- , $- , $333.79 , $26.60
94729,5311020040,Hospital Chargemaster,Co/Membane Diffuse Capacity,Outpatient,Outpatient Default Percent / Case Rate,960, $38.00 , $20.90 , $31.31 , See APC Packaged Rates , $26.60 , $14.82 , $179.06 , $139.95 , $153.29 , See APC Packaged Rates , See APC Packaged Rates , $117.89 , $114.31 , See APC Packaged Rates , See APC Packaged Rates , $35.34 , $35.34 , $35.34 , $35.34 , See APC Packaged Rates , $13.30 , $- , $- , $179.06 , $26.60
75571,5161020002,Hospital Chargemaster,CT Heart Calcium Scoring PC,Outpatient,Outpatient Default Percent / Case Rate,960, $33.00 , $18.15 , $27.19 , $96.70 , $23.10 , $12.87 , $252.12 , $130.51 , $128.09 , $96.70 , $96.70 , $122.27 , $118.56 , $101.54 , $98.64 , $66.00 , $66.00 , $66.00 , $66.00 , $96.70 , $11.55 , $93.45 , $11.55 , $252.12 , $23.10
71555,5171020021,Hospital Chargemaster,MRI angio chest w or w/o dye,Outpatient,Outpatient Default Percent / Case Rate,960, $354.00 , $194.70 , $291.70 , See APC Packaged Rates , $247.80 , $138.06 ," $1,928.54 ", $998.33 , $979.80 , See APC Packaged Rates , See APC Packaged Rates ," $1,431.17 "," $1,387.74 ", See APC Packaged Rates , See APC Packaged Rates , $562.38 , $562.38 , $576.86 , $576.86 , See APC Packaged Rates , $123.90 , $458.96 , $123.90 ," $1,928.54 ", $247.80
72198,5171020035,Hospital Chargemaster,MRA angio pelvis w/o & w/dye,Outpatient,Outpatient Default Percent / Case Rate,960, $350.00 , $192.50 , $288.40 , See APC Packaged Rates , $245.00 , $136.50 ," $1,944.43 "," $1,006.56 ", $987.88 , See APC Packaged Rates , See APC Packaged Rates ," $1,028.36 ", $997.16 , See APC Packaged Rates , See APC Packaged Rates , $567.15 , $567.15 , $581.75 , $581.75 , See APC Packaged Rates , $122.50 , $462.74 , $122.50 ," $1,944.43 ", $245.00
74185,5171020053,Hospital Chargemaster,MRI angio abdom w orw/o dye,Outpatient,Outpatient Default Percent / Case Rate,960, $350.00 , $192.50 , $288.40 , See APC Packaged Rates , $245.00 , $136.50 ," $1,951.26 "," $1,010.09 ", $991.35 , See APC Packaged Rates , See APC Packaged Rates ," $1,028.36 ", $997.16 , See APC Packaged Rates , See APC Packaged Rates , $569.87 , $569.87 , $584.54 , $584.54 , See APC Packaged Rates , $122.50 , $464.37 , $122.50 ," $1,951.26 ", $245.00
76390,5171020056,Hospital Chargemaster,MRI spectroscopy,Outpatient,Outpatient Default Percent / Case Rate,960, $110.00 , $60.50 , $90.64 , $96.70 , $77.00 , $42.90 ," $2,346.82 "," $1,214.85 "," $1,192.31 ", $96.70 , $96.70 ," $1,431.17 "," $1,387.74 ", $101.54 , $98.64 , $679.02 , $679.02 , $696.50 , $696.50 , $96.70 , $38.50 , $558.42 , $38.50 ," $2,346.82 ", $77.00
73725,5171040049,Hospital Chargemaster,MRA ang lwr ext w or wo dye LT,Outpatient,Outpatient Default Percent / Case Rate,960, $355.00 , $195.25 , $292.52 , See APC Packaged Rates , $248.50 , $138.45 ," $1,942.17 "," $1,005.38 ", $986.72 , See APC Packaged Rates , See APC Packaged Rates ," $1,361.27 "," $1,319.97 ", See APC Packaged Rates , See APC Packaged Rates , $858.82 , $858.82 , $880.93 , $880.93 , See APC Packaged Rates , $124.25 , $462.20 , $124.25 ," $1,942.17 ", $248.50
73725,5171050049,Hospital Chargemaster,MRA ang lwr ext w or wo dye RT,Outpatient,Outpatient Default Percent / Case Rate,960, $355.00 , $195.25 , $292.52 , See APC Packaged Rates , $248.50 , $138.45 ," $1,942.17 "," $1,005.38 ", $986.72 , See APC Packaged Rates , See APC Packaged Rates ," $1,361.27 "," $1,319.97 ", See APC Packaged Rates , See APC Packaged Rates , $858.82 , $858.82 , $880.93 , $880.93 , See APC Packaged Rates , $124.25 , $462.20 , $124.25 ," $1,942.17 ", $248.50
99204,6500011914,Hospital Chargemaster,Tele Office Visit New Level 4,Outpatient,Outpatient Default Percent / Case Rate,960, $345.00 , $189.75 , $284.28 , See APC Packaged Rates , $241.50 , $134.55 ," $2,530.46 ", $763.46 ," $1,045.72 ", See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $120.75 , $- , $- ," $2,530.46 ", $241.50
99455,6500020024,Hospital Chargemaster,Work related disability exam,Outpatient,Outpatient Default Percent / Case Rate,960, $66.00 , $36.30 , $54.38 , See APC Packaged Rates , $46.20 , $25.74 , $63.68 , $63.96 , $33.99 , See APC Packaged Rates , See APC Packaged Rates , $44.29 , $44.29 , See APC Packaged Rates , See APC Packaged Rates , $61.38 , $61.38 , $61.38 , $61.38 , See APC Packaged Rates , $23.10 , $- , $- , $63.96 , $46.20
99204,6500021914,Hospital Chargemaster,Tele Office Visit New Level 4,Outpatient,Outpatient Default Percent / Case Rate,960, $155.00 , $85.25 , $127.72 , See APC Packaged Rates , $108.50 , $60.45 ," $2,530.46 ", $763.46 ," $1,045.72 ", See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $54.25 , $- , $- ," $2,530.46 ", $108.50
99212,6500021917,Hospital Chargemaster,Tele Office Visit Estab Lvl 2,Outpatient,Outpatient Default Percent / Case Rate,960, $41.00 , $22.55 , $33.78 , See APC Packaged Rates , $28.70 , $15.99 , $500.70 , $151.07 , $206.91 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $14.35 , $- , $- , $500.70 , $28.70
99213,6500021918,Hospital Chargemaster,Tele Office Visit Estab Lvl 3,Outpatient,Outpatient Default Percent / Case Rate,960, $77.00 , $42.35 , $63.45 , See APC Packaged Rates , $53.90 , $30.03 ," $1,001.28 ", $302.10 , $413.78 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $26.95 , $- , $- ," $1,001.28 ", $53.90
99214,6500021919,Hospital Chargemaster,Tele Office Visit Estab Lvl 4,Outpatient,Outpatient Default Percent / Case Rate,960, $114.00 , $62.70 , $93.94 , See APC Packaged Rates , $79.80 , $44.46 ," $1,543.79 ", $465.78 , $637.97 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $39.90 , $- , $- ," $1,543.79 ", $79.80
99215,6500021920,Hospital Chargemaster,Tele Office Visit Estab Lvl 5,Outpatient,Outpatient Default Percent / Case Rate,960, $127.00 , $69.85 , $104.65 , See APC Packaged Rates , $88.90 , $49.53 ," $2,176.35 ", $656.62 , $899.38 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $44.45 , $- , $- ," $2,176.35 ", $88.90
G0402,6500022003,Hospital Chargemaster,MCR Initial Preventive Exam,Outpatient,Outpatient Default Percent / Case Rate,960, $195.00 , $107.25 , $160.68 , $142.05 , $136.50 , $76.05 , $188.16 , $188.97 , $100.43 , $142.05 , $142.05 , $130.85 , $130.85 , $149.15 , $144.89 , $140.00 , $140.00 , $140.00 , $140.00 , $142.05 , $68.25 , $- , $- , $188.97 , $136.50
H0015,6130230032,Hospital Chargemaster,SOAP Program 1/2 Day,Outpatient,Outpatient Default Percent / Case Rate,961, $250.00 , $137.50 , $206.00 , See APC Packaged Rates , $175.00 , $97.50 , $241.23 , $242.28 , $128.76 , See APC Packaged Rates , See APC Packaged Rates , $167.75 , $167.75 , See APC Packaged Rates , See APC Packaged Rates , $232.50 , $232.50 , $232.50 , $232.50 , See APC Packaged Rates , $87.50 , $- , $- , $242.28 , $175.00
90846,6130220011,Hospital Chargemaster,Family psytx w/o pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,961, $130.00 , $71.50 , $107.12 , $159.96 , $91.00 , $50.70 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $87.23 , $87.23 , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $45.50 , $- , $- ," $1,732.67 ", $91.00
90847,6130220012,Hospital Chargemaster,Family psytx w/pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,961, $209.00 , $114.95 , $172.22 , $159.96 , $146.30 , $81.51 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $140.24 , $140.24 , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $73.15 , $- , $- ," $1,732.67 ", $146.30
90846,6130230011,Hospital Chargemaster,Family psytx w/o pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,961, $130.00 , $71.50 , $107.12 , $159.96 , $91.00 , $50.70 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $87.23 , $87.23 , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $45.50 , $- , $- ," $1,732.67 ", $91.00
90791,6130220002,Hospital Chargemaster,Psych diagnostic evaluation,Outpatient,Outpatient Default Percent / Case Rate,961, $209.00 , $114.95 , $172.22 , $159.96 , $146.30 , $81.51 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $379.31 , $367.80 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $73.15 , $- , $- ," $1,732.67 ", $146.30
90792,6130220004,Hospital Chargemaster,Psych diag eval w/med srvcs,Outpatient,Outpatient Default Percent / Case Rate,961, $209.00 , $114.95 , $172.22 , $159.96 , $146.30 , $81.51 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $309.39 , $300.01 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $73.15 , $- , $- ," $1,732.67 ", $146.30
90834,6130220007,Hospital Chargemaster,Psytx w pt 45 minutes,Outpatient,Outpatient Default Percent / Case Rate,961, $135.00 , $74.25 , $111.24 , $159.96 , $94.50 , $52.65 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $201.08 , $194.98 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $47.25 , $- , $- ," $1,732.67 ", $94.50
90837,6130220009,Hospital Chargemaster,Psytx w pt 60 minutes,Outpatient,Outpatient Default Percent / Case Rate,961, $168.00 , $92.40 , $138.43 , $159.96 , $117.60 , $65.52 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $293.95 , $285.03 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $58.80 , $- , $- ," $1,732.67 ", $117.60
90791,6130230002,Hospital Chargemaster,Psych diagnostic evaluation,Outpatient,Outpatient Default Percent / Case Rate,961, $- , $- , $- , $159.96 , $- , $- ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $379.31 , $367.80 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $- , $- , $- ," $1,732.67 ", $-
90834,6130230007,Hospital Chargemaster,Psytx w pt 45 minutes,Outpatient,Outpatient Default Percent / Case Rate,961, $- , $- , $- , $159.96 , $- , $- ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $201.08 , $194.98 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $- , $- , $- ," $1,732.67 ", $-
90832,6130220005,Hospital Chargemaster,Psytx w pt 30 minutes,Outpatient,Outpatient Default Percent / Case Rate,961, $77.00 , $42.35 , $63.45 , $159.96 , $53.90 , $30.03 ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $157.08 , $152.32 , $167.96 , $163.16 , $24.44 , $24.44 , $24.44 , $24.44 , $159.96 , $26.95 , $- , $- ," $1,732.67 ", $53.90
90853,6130230022,Hospital Chargemaster,Group psychotherapy,Outpatient,Outpatient Default Percent / Case Rate,961, $- , $- , $- , $89.46 , $- , $- ," $1,037.75 ", $313.10 , $428.85 , $89.46 , $89.46 , $- , $- , $93.93 , $91.24 , $17.39 , $17.39 , $17.39 , $17.39 , $89.46 , $- , $- , $- ," $1,037.75 ", $-
90785,6130220001,Hospital Chargemaster,Psytx complex interactive,Outpatient,Outpatient Default Percent / Case Rate,961, $50.00 , $27.50 , $41.20 , See APC Packaged Rates , $35.00 , $19.50 , $265.50 , $80.10 , $109.72 , See APC Packaged Rates , See APC Packaged Rates , $11.72 , $11.37 , See APC Packaged Rates , See APC Packaged Rates , $46.50 , $46.50 , $46.50 , $46.50 , See APC Packaged Rates , $17.50 , $- , $- , $265.50 , $35.00
90833,6130220006,Hospital Chargemaster,Psytx w pt w e/m 30 min,Outpatient,Outpatient Default Percent / Case Rate,961, $163.00 , $89.65 , $134.31 , See APC Packaged Rates , $114.10 , $63.57 ," $1,256.20 ", $379.01 , $519.13 , See APC Packaged Rates , See APC Packaged Rates , $103.38 , $100.24 , See APC Packaged Rates , See APC Packaged Rates , $151.59 , $151.59 , $151.59 , $151.59 , See APC Packaged Rates , $57.05 , $- , $- ," $1,256.20 ", $114.10
90836,6130220008,Hospital Chargemaster,Psytx w pt w e/m 45 min,Outpatient,Outpatient Default Percent / Case Rate,961, $145.00 , $79.75 , $119.48 , See APC Packaged Rates , $101.50 , $56.55 ," $1,591.43 ", $480.15 , $657.66 , See APC Packaged Rates , See APC Packaged Rates , $167.85 , $162.76 , See APC Packaged Rates , See APC Packaged Rates , $134.85 , $134.85 , $134.85 , $134.85 , See APC Packaged Rates , $50.75 , $- , $- ," $1,591.43 ", $101.50
90838,6130220010,Hospital Chargemaster,Psytx w pt w e/m 60 min,Outpatient,Outpatient Default Percent / Case Rate,961, $179.00 , $98.45 , $147.50 , See APC Packaged Rates , $125.30 , $69.81 ," $2,104.48 ", $634.94 , $869.68 , See APC Packaged Rates , See APC Packaged Rates , $271.32 , $263.09 , See APC Packaged Rates , See APC Packaged Rates , $166.47 , $166.47 , $166.47 , $166.47 , See APC Packaged Rates , $62.65 , $- , $- ," $2,104.48 ", $125.30
90837,6130230009,Hospital Chargemaster,Psytx w pt 60 minutes,Outpatient,Outpatient Default Percent / Case Rate,961, $- , $- , $- , $159.96 , $- , $- ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $293.95 , $285.03 , $167.96 , $163.16 , $30.97 , $30.97 , $30.97 , $30.97 , $159.96 , $- , $- , $- ," $1,732.67 ", $-
90847,6130230012,Hospital Chargemaster,Family psytx w/pt 50 min,Outpatient,Outpatient Default Percent / Case Rate,961, $- , $- , $- , $159.96 , $- , $- ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $- , $- , $167.96 , $163.16 , $34.38 , $34.38 , $34.38 , $34.38 , $159.96 , $- , $- , $- ," $1,732.67 ", $-
90849,6130230031,Hospital Chargemaster,Multiple family group psytx,Outpatient,Outpatient Default Percent / Case Rate,961, $- , $- , $- , $159.96 , $- , $- ," $1,732.67 ", $522.76 , $716.03 , $159.96 , $159.96 , $- , $- , $167.96 , $163.16 , $- , $- , $- , $- , $159.96 , $- , $- , $- ," $1,732.67 ", $-
H0046,6130230033,Hospital Chargemaster,Collateral Contact,Outpatient,Outpatient Default Percent / Case Rate,961, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
93880,5511020007,Hospital Chargemaster,Extracranial bilat study,Outpatient,Outpatient Default Percent / Case Rate,969, $933.00 , $513.15 , $768.79 , $275.09 , $653.10 , $363.87 , $566.08 , $442.42 , $484.61 , $275.09 , $275.09 , $596.23 , $578.14 , $288.84 , $280.59 , $343.61 , $343.61 , $352.46 , $352.46 , $275.09 , $326.55 , $- , $- , $768.79 , $653.10
93923,5511020009,Hospital Chargemaster,Upr/lxtr art stdy 3+ lvls,Outpatient,Outpatient Default Percent / Case Rate,969, $315.00 , $173.25 , $259.56 , $166.91 , $220.50 , $122.85 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $285.95 , $277.27 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $110.25 , $- , $- , $333.79 , $220.50
93882,5511020008,Hospital Chargemaster,Extracranial uni/ltd study,Outpatient,Outpatient Default Percent / Case Rate,969, $439.00 , $241.45 , $361.74 , $130.16 , $307.30 , $171.21 , $276.23 , $215.89 , $236.48 , $130.16 , $130.16 , $319.41 , $309.72 , $136.66 , $132.76 , $172.20 , $172.20 , $176.63 , $176.63 , $130.16 , $153.65 , $- , $- , $361.74 , $307.30
29131,6010220270,Hospital Chargemaster,Application of finger splint,Outpatient,Outpatient Default Percent / Case Rate,981, $99.00 , $54.45 , $81.58 , $66.55 , $69.30 , $38.61 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $85.99 , $85.99 , $88.21 , $88.21 , $66.55 , $34.65 , $- , $- , $147.89 , $69.30
29550,6010220284,Hospital Chargemaster,Strapping of toes,Outpatient,Outpatient Default Percent / Case Rate,981, $92.00 , $50.60 , $75.81 , $66.55 , $64.40 , $35.88 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $85.99 , $85.99 , $88.21 , $88.21 , $66.55 , $32.20 , $- , $- , $147.89 , $64.40
29260,6010220273,Hospital Chargemaster,Strapping of elbow or wrist,Outpatient,Outpatient Default Percent / Case Rate,981, $112.00 , $61.60 , $92.29 , $66.55 , $78.40 , $43.68 , $70.26 , $48.23 , $47.97 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $62.64 , $62.64 , $64.26 , $64.26 , $66.55 , $39.20 , $- , $- , $147.89 , $78.40
29280,6010220274,Hospital Chargemaster,Strapping of hand or finger,Outpatient,Outpatient Default Percent / Case Rate,981, $107.00 , $58.85 , $88.17 , $66.55 , $74.90 , $41.73 , $70.26 , $48.23 , $47.97 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $62.64 , $62.64 , $64.26 , $64.26 , $66.55 , $37.45 , $- , $- , $147.89 , $74.90
11720,6010220036,Hospital Chargemaster,Debride nail 1-5,Outpatient,Outpatient Default Percent / Case Rate,981, $47.00 , $25.85 ," $1,236.00 ", $66.55 , $32.90 , $18.33 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $47.00 , $47.00 , $47.00 , $47.00 , $66.55 , $16.45 , $- , $- ," $1,236.00 ", $32.90
11719,6010220035,Hospital Chargemaster,Trim nail(s) any number,Outpatient,Outpatient Default Percent / Case Rate,981, $35.00 , $19.25 , $28.84 , $66.55 , $24.50 , $13.65 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $105.28 , $102.55 , $69.87 , $67.88 , $35.00 , $35.00 , $35.00 , $35.00 , $66.55 , $12.25 , $- , $- , $122.28 , $24.50
30905,6010220296,Hospital Chargemaster,Control of nosebleed,Outpatient,Outpatient Default Percent / Case Rate,981, $308.00 , $169.40 ," $1,236.00 ", $134.80 , $215.60 , $120.12 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $844.48 , $822.61 , $141.54 , $137.50 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $134.80 , $107.80 , $- , $- ," $1,236.00 ", $215.60
30300,6010220292,Hospital Chargemaster,Remove nasal foreign body,Outpatient,Outpatient Default Percent / Case Rate,981, $384.00 , $211.20 , $316.42 , $134.80 , $268.80 , $149.76 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $343.81 , $343.81 , $343.81 , $343.81 , $134.80 , $134.40 , $- , $- , $343.81 , $268.80
30901,6010220294,Hospital Chargemaster,Control of nosebleed,Outpatient,Outpatient Default Percent / Case Rate,981, $184.00 , $101.20 ," $1,236.00 ", $134.80 , $128.80 , $71.76 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $64.40 , $- , $- ," $1,236.00 ", $128.80
30903,6010220295,Hospital Chargemaster,Control of nosebleed,Outpatient,Outpatient Default Percent / Case Rate,981, $242.00 , $133.10 ," $1,236.00 ", $134.80 , $169.40 , $94.38 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $844.48 , $822.61 , $141.54 , $137.50 , $171.36 , $171.36 , $175.78 , $175.78 , $134.80 , $84.70 , $- , $- ," $1,236.00 ", $169.40
36600,6010220334,Hospital Chargemaster,Withdrawal of arterial blood,Outpatient,Outpatient Default Percent / Case Rate,981, $46.00 , $25.30 ," $2,542.04 ", $134.80 , $32.20 , $17.94 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $38.14 , $36.98 , $141.54 , $137.50 , $157.34 , $157.34 , $161.39 , $161.39 , $134.80 , $16.10 , $- , $- ," $2,542.04 ", $32.20
29240,6010220272,Hospital Chargemaster,Strapping of shoulder,Outpatient,Outpatient Default Percent / Case Rate,981, $131.00 , $72.05 , $107.94 , $134.80 , $91.70 , $51.09 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $125.00 , $125.00 , $125.00 , $125.00 , $134.80 , $45.85 , $- , $- , $232.95 , $91.70
29530,6010220282,Hospital Chargemaster,Strapping of knee,Outpatient,Outpatient Default Percent / Case Rate,981, $113.00 , $62.15 , $93.11 , $134.80 , $79.10 , $44.07 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $125.00 , $125.00 , $125.00 , $125.00 , $134.80 , $39.55 , $- , $- , $232.95 , $79.10
36591,6010220332,Hospital Chargemaster,Draw blood off venous device,Outpatient,Outpatient Default Percent / Case Rate,981, $100.00 , $55.00 , $82.40 , $134.80 , $70.00 , $39.00 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $67.10 , $67.10 , $141.54 , $137.50 , $124.00 , $124.00 , $124.00 , $124.00 , $134.80 , $35.00 , $- , $- , $232.95 , $70.00
29125,6010220268,Hospital Chargemaster,Apply forearm splint,Outpatient,Outpatient Default Percent / Case Rate,981, $127.00 , $69.85 , $104.65 , $134.80 , $88.90 , $49.53 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $116.00 , $116.00 , $116.00 , $116.00 , $134.80 , $44.45 , $- , $- , $232.95 , $88.90
36420,6010220324,Hospital Chargemaster,Vein access cutdown < 1 yr,Outpatient,Outpatient Default Percent / Case Rate,981, $153.00 , $84.15 ," $1,236.00 ", $134.80 , $107.10 , $59.67 , $122.28 , $83.93 , $83.48 , $134.80 , $134.80 , $38.52 , $37.35 , $141.54 , $137.50 , $110.05 , $110.05 , $112.89 , $112.89 , $134.80 , $53.55 , $- , $- ," $1,236.00 ", $107.10
29130,6010220269,Hospital Chargemaster,Application of finger splint,Outpatient,Outpatient Default Percent / Case Rate,981, $150.00 , $82.50 , $123.60 , $134.80 , $105.00 , $58.50 , $122.28 , $83.93 , $83.48 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $110.05 , $110.05 , $112.89 , $112.89 , $134.80 , $52.50 , $- , $- , $147.89 , $105.00
11740,6010220039,Hospital Chargemaster,Drain blood from under nail,Outpatient,Outpatient Default Percent / Case Rate,981, $96.00 , $52.80 ," $1,236.00 ", $134.80 , $67.20 , $37.44 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $96.00 , $96.00 , $96.00 , $96.00 , $134.80 , $33.60 , $- , $- ," $1,236.00 ", $67.20
29505,6010220280,Hospital Chargemaster,Application long leg splint,Outpatient,Outpatient Default Percent / Case Rate,981, $145.00 , $79.75 , $119.48 , $168.90 , $101.50 , $56.55 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $50.75 , $- , $- , $294.51 , $101.50
29515,6010220281,Hospital Chargemaster,Application lower leg splint,Outpatient,Outpatient Default Percent / Case Rate,981, $148.00 , $81.40 , $121.95 , $168.90 , $103.60 , $57.72 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $51.80 , $- , $- , $294.51 , $103.60
29580,6010220285,Hospital Chargemaster,Application of paste boot,Outpatient,Outpatient Default Percent / Case Rate,981, $244.00 , $134.20 , $201.06 , $168.90 , $170.80 , $95.16 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $85.40 , $- , $- , $294.51 , $170.80
29730,6010220288,Hospital Chargemaster,Windowing of cast,Outpatient,Outpatient Default Percent / Case Rate,981, $135.00 , $74.25 , $111.24 , $168.90 , $94.50 , $52.65 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $90.32 , $87.58 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $47.25 , $- , $- , $294.51 , $94.50
29540,6010220283,Hospital Chargemaster,Strapping of ankle and/or ft,Outpatient,Outpatient Default Percent / Case Rate,981, $97.00 , $53.35 , $79.93 , $168.90 , $67.90 , $37.83 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $210.35 , $210.35 , $215.76 , $215.76 , $168.90 , $33.95 , $- , $- , $294.51 , $67.90
29085,6010220266,Hospital Chargemaster,Apply hand/wrist cast,Outpatient,Outpatient Default Percent / Case Rate,981, $197.00 , $108.35 , $162.33 , $168.90 , $137.90 , $76.83 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $266.32 , $258.23 , $177.35 , $172.28 , $197.00 , $197.00 , $197.00 , $197.00 , $168.90 , $68.95 , $- , $- , $294.51 , $137.90
29105,6010220267,Hospital Chargemaster,Apply long arm splint,Outpatient,Outpatient Default Percent / Case Rate,981, $176.00 , $96.80 , $145.02 , $168.90 , $123.20 , $68.64 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $116.00 , $116.00 , $116.00 , $116.00 , $168.90 , $61.60 , $- , $- , $294.51 , $123.20
31575,6010220305,Hospital Chargemaster,Diagnostic laryngoscopy,Outpatient,Outpatient Default Percent / Case Rate,981, $237.00 , $130.35 ," $1,442.00 ", $196.80 , $165.90 , $92.43 , $358.71 , $246.20 , $244.89 , $196.80 , $196.80 , $105.28 , $102.55 , $206.64 , $200.73 , $271.00 , $271.00 , $271.00 , $271.00 , $196.80 , $82.95 , $- , $- ," $1,442.00 ", $165.90
12007,6010220051,Hospital Chargemaster,Rpr s/n/ax/gen/trnk >30.0 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $702.00 , $386.10 ," $1,442.00 ", $214.68 , $491.40 , $273.78 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 ," $1,133.44 "," $1,104.09 ", $225.42 , $218.98 , $817.00 , $817.00 , $817.00 , $817.00 , $214.68 , $245.70 , $- , $- ," $1,442.00 ", $491.40
12018,6010220058,Hospital Chargemaster,Rpr f/e/e/n/l/m >30.0 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $924.00 , $508.20 ," $1,442.00 ", $214.68 , $646.80 , $360.36 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 ," $1,133.44 "," $1,104.09 ", $225.42 , $218.98 , $640.00 , $640.00 , $640.00 , $640.00 , $214.68 , $323.40 , $- , $- ," $1,442.00 ", $646.80
12014,6010220054,Hospital Chargemaster,Rpr f/e/e/n/l/m 5.1-7.5 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $431.00 , $237.05 ," $1,236.00 ", $214.68 , $301.70 , $168.09 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $431.00 , $431.00 , $431.00 , $431.00 , $214.68 , $150.85 , $- , $- ," $1,236.00 ", $301.70
12004,6010220048,Hospital Chargemaster,Rpr s/n/ax/gen/trk7.6-12.5cm,Outpatient,Outpatient Default Percent / Case Rate,981, $398.00 , $218.90 ," $1,236.00 ", $214.68 , $278.60 , $155.22 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $398.00 , $398.00 , $398.00 , $398.00 , $214.68 , $139.30 , $- , $- ," $1,236.00 ", $278.60
12013,6010220053,Hospital Chargemaster,Rpr f/e/e/n/l/m 2.6-5.0 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $362.00 , $199.10 , $298.29 , $214.68 , $253.40 , $141.18 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $362.00 , $362.00 , $362.00 , $362.00 , $214.68 , $126.70 , $- , $- , $844.48 , $253.40
12015,6010220055,Hospital Chargemaster,Rpr f/e/e/n/l/m 7.6-12.5 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $536.00 , $294.80 ," $1,236.00 ", $214.68 , $375.20 , $209.04 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $187.60 , $- , $- ," $1,236.00 ", $375.20
16025,6010220096,Hospital Chargemaster,Dress/debrid p-thick burn m,Outpatient,Outpatient Default Percent / Case Rate,981, $344.00 , $189.20 ," $1,442.00 ", $214.68 , $240.80 , $134.16 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $120.40 , $- , $- ," $1,442.00 ", $240.80
26010,6010220181,Hospital Chargemaster,Drainage of finger abscess,Outpatient,Outpatient Default Percent / Case Rate,981," $1,104.00 ", $607.20 , $909.70 , $214.68 , $772.80 , $430.56 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $386.40 , $- , $- , $909.70 , $772.80
12002,6010220047,Hospital Chargemaster,Rpr s/n/ax/gen/trnk2.6-7.5cm,Outpatient,Outpatient Default Percent / Case Rate,981, $342.00 , $188.10 , $281.81 , $214.68 , $239.40 , $133.38 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $342.00 , $342.00 , $342.00 , $342.00 , $214.68 , $119.70 , $- , $- , $386.01 , $239.40
12001,6010220046,Hospital Chargemaster,Rpr s/n/ax/gen/trnk 2.5cm/<,Outpatient,Outpatient Default Percent / Case Rate,981, $330.00 , $181.50 ," $1,236.00 ", $214.68 , $231.00 , $128.70 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $330.00 , $330.00 , $330.00 , $330.00 , $214.68 , $115.50 , $- , $- ," $1,236.00 ", $231.00
12011,6010220052,Hospital Chargemaster,Rpr f/e/e/n/l/m 2.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,981, $317.00 , $174.35 , $261.21 , $214.68 , $221.90 , $123.63 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $844.48 , $822.61 , $225.42 , $218.98 , $317.00 , $317.00 , $317.00 , $317.00 , $214.68 , $110.95 , $- , $- , $844.48 , $221.90
10060,6010220010,Hospital Chargemaster,Drainage of skin abscess,Outpatient,Outpatient Default Percent / Case Rate,981, $282.00 , $155.10 ," $1,236.00 ", $214.68 , $197.40 , $109.98 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $262.26 , $262.26 , $262.26 , $262.26 , $214.68 , $98.70 , $- , $- ," $1,236.00 ", $197.40
11200,6010220029,Hospital Chargemaster,Removal of skin tags ,Outpatient,Outpatient Default Percent / Case Rate,981, $122.00 , $67.10 ," $1,236.00 ", $312.35 , $85.40 , $47.58 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $89.51 , $86.79 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $42.70 , $- , $- ," $1,236.00 ", $85.40
20600,6010220111,Hospital Chargemaster,Drain/inj joint/bursa w/o us,Outpatient,Outpatient Default Percent / Case Rate,981, $117.00 , $64.35 ," $1,236.00 ", $312.35 , $81.90 , $45.63 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $96.34 , $93.41 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $40.95 , $- , $- ," $1,236.00 ", $81.90
20552,6010220109,Hospital Chargemaster,Inj trigger point 1/2 muscl,Outpatient,Outpatient Default Percent / Case Rate,981, $109.00 , $59.95 ," $1,236.00 ", $312.35 , $76.30 , $42.51 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $80.71 , $78.26 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $38.15 , $- , $- ," $1,236.00 ", $76.30
54420,6010220409,Hospital Chargemaster,Revision of penis,Outpatient,Outpatient Default Percent / Case Rate,981, $875.00 , $481.25 ," $2,591.48 "," $3,675.67 ", $612.50 , $341.25 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $3,675.67 "," $3,675.67 "," $1,599.36 "," $1,557.95 "," $3,859.45 "," $3,749.18 "," $4,315.01 "," $4,315.01 "," $4,315.01 "," $4,315.01 "," $3,675.67 ", $306.25 , $- , $- ," $4,315.01 ", $612.50
36680,6010220336,Hospital Chargemaster,Insert needle bone cavity,Outpatient,Outpatient Default Percent / Case Rate,981, $181.00 , $99.55 ," $1,236.00 ", $324.46 , $126.70 , $70.59 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $334.00 , $334.00 , $334.00 , $334.00 , $324.46 , $63.35 , $- , $- ," $1,236.00 ", $126.70
36425,6010220325,Hospital Chargemaster,Vein access cutdown > 1 yr,Outpatient,Outpatient Default Percent / Case Rate,981, $120.00 , $66.00 ," $1,236.00 ", $324.46 , $84.00 , $46.80 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $38.52 , $37.35 , $340.68 , $330.95 , $239.00 , $239.00 , $239.00 , $239.00 , $324.46 , $42.00 , $- , $- ," $1,236.00 ", $84.00
12005,6010220049,Hospital Chargemaster,Rpr s/n/a/gen/trk12.6-20.0cm,Outpatient,Outpatient Default Percent / Case Rate,981, $491.00 , $270.05 ," $1,442.00 ", $413.21 , $343.70 , $191.49 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $413.21 , $171.85 , $- , $- ," $1,442.00 ", $343.70
12042,6010220068,Hospital Chargemaster,Intmd rpr n-hf/genit2.6-7.5,Outpatient,Outpatient Default Percent / Case Rate,981, $599.00 , $329.45 ," $1,236.00 ", $413.21 , $419.30 , $233.61 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $740.30 , $740.30 , $740.30 , $740.30 , $413.21 , $209.65 , $- , $- ," $1,236.00 ", $419.30
12052,6010220074,Hospital Chargemaster,Intmd rpr face/mm 2.6-5.0 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $655.00 , $360.25 ," $1,236.00 ", $413.21 , $458.50 , $255.45 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $740.30 , $740.30 , $740.30 , $740.30 , $413.21 , $229.25 , $- , $- ," $1,236.00 ", $458.50
12053,6010220075,Hospital Chargemaster,Intmd rpr face/mm 5.1-7.5 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $647.00 , $355.85 ," $1,236.00 ", $413.21 , $452.90 , $252.33 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $740.30 , $740.30 , $740.30 , $740.30 , $413.21 , $226.45 , $- , $- ," $1,236.00 ", $452.90
12034,6010220063,Hospital Chargemaster,Intmd rpr s/tr/ext 7.6-12.5,Outpatient,Outpatient Default Percent / Case Rate,981, $609.00 , $334.95 ," $1,442.00 ", $413.21 , $426.30 , $237.51 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $740.30 , $740.30 , $740.30 , $740.30 , $413.21 , $213.15 , $- , $- ," $1,442.00 ", $426.30
12035,6010220064,Hospital Chargemaster,Intmd rpr s/a/t/ext 12.6-20,Outpatient,Outpatient Default Percent / Case Rate,981, $705.00 , $387.75 ," $1,442.00 ", $413.21 , $493.50 , $274.95 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $740.30 , $740.30 , $740.30 , $740.30 , $413.21 , $246.75 , $- , $- ," $1,442.00 ", $493.50
12055,6010220077,Hospital Chargemaster,Intmd rpr face/mm 12.6-20 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $817.00 , $449.35 ," $1,442.00 ", $413.21 , $571.90 , $318.63 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $740.30 , $740.30 , $740.30 , $740.30 , $413.21 , $285.95 , $- , $- ," $1,442.00 ", $571.90
13131,6010220084,Hospital Chargemaster,Cmplx rpr f/c/c/m/n/ax/g/h/f,Outpatient,Outpatient Default Percent / Case Rate,981, $837.00 , $460.35 ," $1,442.00 ", $413.21 , $585.90 , $326.43 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $740.30 , $740.30 , $740.30 , $740.30 , $413.21 , $292.95 , $- , $- ," $1,442.00 ", $585.90
12006,6010220050,Hospital Chargemaster,Rpr s/n/a/gen/trk20.1-30.0cm,Outpatient,Outpatient Default Percent / Case Rate,981, $619.00 , $340.45 ," $1,442.00 ", $413.21 , $433.30 , $241.41 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $600.00 , $600.00 , $600.00 , $600.00 , $413.21 , $216.65 , $- , $- ," $1,442.00 ", $433.30
12017,6010220057,Hospital Chargemaster,Rpr fe/e/en/l/m 20.1-30.0 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $760.00 , $418.00 ," $1,442.00 ", $413.21 , $532.00 , $296.40 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $600.00 , $600.00 , $600.00 , $600.00 , $413.21 , $266.00 , $- , $- ," $1,442.00 ", $532.00
12031,6010220061,Hospital Chargemaster,Intmd rpr s/a/t/ext 2.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,981, $481.00 , $264.55 ," $1,236.00 ", $413.21 , $336.70 , $187.59 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $590.00 , $590.00 , $590.00 , $590.00 , $413.21 , $168.35 , $- , $- ," $1,236.00 ", $336.70
12032,6010220062,Hospital Chargemaster,Intmd rpr s/a/t/ext 2.6-7.5,Outpatient,Outpatient Default Percent / Case Rate,981, $593.00 , $326.15 ," $1,236.00 ", $413.21 , $415.10 , $231.27 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $590.00 , $590.00 , $590.00 , $590.00 , $413.21 , $207.55 , $- , $- ," $1,236.00 ", $415.10
12051,6010220073,Hospital Chargemaster,Intmd rpr face/mm 2.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,981, $547.00 , $300.85 ," $1,236.00 ", $413.21 , $382.90 , $213.33 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $590.00 , $590.00 , $590.00 , $590.00 , $413.21 , $191.45 , $- , $- ," $1,236.00 ", $382.90
12016,6010220056,Hospital Chargemaster,Rpr fe/e/en/l/m 12.6-20.0 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $650.00 , $357.50 ," $1,442.00 ", $413.21 , $455.00 , $253.50 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $530.00 , $530.00 , $530.00 , $530.00 , $413.21 , $227.50 , $- , $- ," $1,442.00 ", $455.00
11750,6010220040,Hospital Chargemaster,Removal of nail bed,Outpatient,Outpatient Default Percent / Case Rate,981, $526.00 , $289.30 ," $1,236.00 ", $413.21 , $368.20 , $205.14 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $526.00 , $526.00 , $526.00 , $526.00 , $413.21 , $184.10 , $- , $- ," $1,236.00 ", $368.20
10021,6010220008,Hospital Chargemaster,Fna bx w/o img gdn 1st les,Outpatient,Outpatient Default Percent / Case Rate,981, $132.00 , $72.60 ," $1,236.00 ", $413.21 , $92.40 , $51.48 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $122.76 , $122.76 , $122.76 , $122.76 , $413.21 , $46.20 , $- , $- ," $1,236.00 ", $92.40
10061,6010220011,Hospital Chargemaster,Drainage of skin abscess,Outpatient,Outpatient Default Percent / Case Rate,981, $484.00 , $266.20 ," $1,236.00 ", $413.21 , $338.80 , $188.76 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $450.12 , $450.12 , $450.12 , $450.12 , $413.21 , $169.40 , $- , $- ," $1,236.00 ", $338.80
16030,6010220097,Hospital Chargemaster,Dress/debrid p-thick burn l,Outpatient,Outpatient Default Percent / Case Rate,981, $391.00 , $215.05 ," $1,442.00 ", $413.21 , $273.70 , $152.49 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $136.85 , $- , $- ," $1,442.00 ", $273.70
10160,6010220017,Hospital Chargemaster,Puncture drainage of lesion,Outpatient,Outpatient Default Percent / Case Rate,981, $290.00 , $159.50 ," $1,236.00 ", $413.21 , $203.00 , $113.10 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $269.70 , $269.70 , $269.70 , $269.70 , $413.21 , $101.50 , $- , $- ," $1,236.00 ", $203.00
10120,6010220014,Hospital Chargemaster,Remove foreign body,Outpatient,Outpatient Default Percent / Case Rate,981, $278.00 , $152.90 ," $1,236.00 ", $413.21 , $194.60 , $108.42 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $258.54 , $258.54 , $258.54 , $258.54 , $413.21 , $97.30 , $- , $- ," $1,236.00 ", $194.60
12054,6010220076,Hospital Chargemaster,Intmd rpr face/mm 7.6-12.5cm,Outpatient,Outpatient Default Percent / Case Rate,981, $679.00 , $373.45 ," $1,442.00 ", $413.21 , $475.30 , $264.81 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $271.00 , $271.00 , $271.00 , $271.00 , $413.21 , $237.65 , $- , $- ," $1,442.00 ", $475.30
12041,6010220067,Hospital Chargemaster,Intmd rpr n-hf/genit 2.5cm/<,Outpatient,Outpatient Default Percent / Case Rate,981, $216.00 , $118.80 ," $1,236.00 ", $413.21 , $151.20 , $84.24 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $844.48 , $822.61 , $433.88 , $421.48 , $216.00 , $216.00 , $216.00 , $216.00 , $413.21 , $75.60 , $- , $- ," $1,236.00 ", $151.20
11765,6010220043,Hospital Chargemaster,Excision of nail fold toe,Outpatient,Outpatient Default Percent / Case Rate,981, $210.00 , $115.50 ," $1,236.00 ", $413.21 , $147.00 , $81.90 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $210.00 , $210.00 , $210.00 , $210.00 , $413.21 , $73.50 , $- , $- ," $1,236.00 ", $147.00
11042,6010220022,Hospital Chargemaster,Deb subq tissue 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,981, $131.00 , $72.05 ," $1,442.00 ", $413.21 , $91.70 , $51.09 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $45.85 , $- , $- ," $1,442.00 ", $91.70
36430,6010220326,Hospital Chargemaster,Blood transfusion service,Outpatient,Outpatient Default Percent / Case Rate,981, $121.00 , $66.55 ," $1,236.00 ", $474.52 , $84.70 , $47.19 , $837.65 , $574.92 , $571.86 , $474.52 , $474.52 , $504.15 , $488.86 , $498.24 , $484.01 , $611.48 , $611.48 , $627.23 , $627.23 , $474.52 , $42.35 , $- , $- ," $1,236.00 ", $84.70
20100,6010220103,Hospital Chargemaster,Explore wound neck,Outpatient,Outpatient Default Percent / Case Rate,981," $1,743.00 ", $958.65 ," $1,436.23 ", $540.69 ," $1,220.10 ", $679.77 ," $1,065.66 ", $731.42 , $727.52 , $540.69 , $540.69 , $105.28 , $102.55 , $567.73 , $551.50 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $540.69 , $610.05 , $- , $- ," $1,436.23 "," $1,220.10 "
30020,6010220291,Hospital Chargemaster,Drainage of nose lesion,Outpatient,Outpatient Default Percent / Case Rate,981, $250.00 , $137.50 ," $1,236.00 ", $540.69 , $175.00 , $97.50 ," $1,065.66 ", $731.42 , $727.52 , $540.69 , $540.69 , $105.28 , $102.55 , $567.73 , $551.50 , $740.30 , $740.30 , $740.30 , $740.30 , $540.69 , $87.50 , $- , $- ," $1,236.00 ", $175.00
12020,6010220059,Hospital Chargemaster,Closure of split wound,Outpatient,Outpatient Default Percent / Case Rate,981, $558.00 , $306.90 ," $1,236.00 ", $626.13 , $390.60 , $217.62 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $844.48 , $822.61 , $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $195.30 , $- , $- ," $1,236.00 ", $390.60
12036,6010220065,Hospital Chargemaster,Intmd rpr s/a/t/ext 20.1-30,Outpatient,Outpatient Default Percent / Case Rate,981, $803.00 , $441.65 ," $1,442.00 ", $626.13 , $562.10 , $313.17 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $281.05 , $- , $- ," $1,442.00 ", $562.10
12044,6010220069,Hospital Chargemaster,Intmd rpr n-hf/genit7.6-12.5,Outpatient,Outpatient Default Percent / Case Rate,981, $634.00 , $348.70 ," $1,442.00 ", $626.13 , $443.80 , $247.26 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $221.90 , $- , $- ," $1,442.00 ", $443.80
13120,6010220081,Hospital Chargemaster,Cmplx rpr s/a/l 1.1-2.5 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $742.00 , $408.10 ," $1,442.00 ", $626.13 , $519.40 , $289.38 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $259.70 , $- , $- ," $1,442.00 ", $519.40
13132,6010220085,Hospital Chargemaster,Cmplx rpr f/c/c/m/n/ax/g/h/f,Outpatient,Outpatient Default Percent / Case Rate,981," $1,426.00 ", $784.30 ," $2,060.00 ", $626.13 , $998.20 , $556.14 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,294.72 "," $1,261.20 ", $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $499.10 , $- , $- ," $2,060.00 ", $998.20
13152,6010220088,Hospital Chargemaster,Cmplx rpr e/n/e/l 2.6-7.5 cm,Outpatient,Outpatient Default Percent / Case Rate,981," $1,291.00 ", $710.05 ," $2,060.00 ", $626.13 , $903.70 , $503.49 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,294.72 "," $1,261.20 ", $657.44 , $638.65 , $740.30 , $740.30 , $740.30 , $740.30 , $626.13 , $451.85 , $- , $- ," $2,060.00 ", $903.70
12046,6010220071,Hospital Chargemaster,Intmd rpr n-hf/genit20.1-30,Outpatient,Outpatient Default Percent / Case Rate,981, $877.00 , $482.35 ," $1,442.00 ", $626.13 , $613.90 , $342.03 , $687.09 , $471.59 , $469.08 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $590.00 , $590.00 , $590.00 , $590.00 , $626.13 , $306.95 , $- , $- ," $1,442.00 ", $613.90
12045,6010220070,Hospital Chargemaster,Intmd rpr n-hf/genit12.6-20,Outpatient,Outpatient Default Percent / Case Rate,981, $726.00 , $399.30 ," $1,442.00 ", $626.13 , $508.20 , $283.14 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $590.00 , $590.00 , $590.00 , $590.00 , $626.13 , $254.10 , $- , $- ," $1,442.00 ", $508.20
13100,6010220078,Hospital Chargemaster,Cmplx rpr trunk 1.1-2.5 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $710.00 , $390.50 ," $1,442.00 ", $626.13 , $497.00 , $276.90 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $590.00 , $590.00 , $590.00 , $590.00 , $626.13 , $248.50 , $- , $- ," $1,442.00 ", $497.00
13101,6010220079,Hospital Chargemaster,Cmplx rpr trunk 2.6-7.5 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $865.00 , $475.75 ," $2,060.00 ", $626.13 , $605.50 , $337.35 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,294.72 "," $1,261.20 ", $657.44 , $638.65 , $590.00 , $590.00 , $590.00 , $590.00 , $626.13 , $302.75 , $- , $- ," $2,060.00 ", $605.50
13121,6010220082,Hospital Chargemaster,Cmplx rpr s/a/l 2.6-7.5 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $992.00 , $545.60 ," $2,060.00 ", $626.13 , $694.40 , $386.88 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,294.72 "," $1,261.20 ", $657.44 , $638.65 , $590.00 , $590.00 , $590.00 , $590.00 , $626.13 , $347.20 , $- , $- ," $2,060.00 ", $694.40
13151,6010220087,Hospital Chargemaster,Cmplx rpr e/n/e/l 1.1-2.5 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $967.00 , $531.85 ," $2,060.00 ", $626.13 , $676.90 , $377.13 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,294.72 "," $1,261.20 ", $657.44 , $638.65 , $590.00 , $590.00 , $590.00 , $590.00 , $626.13 , $338.45 , $- , $- ," $2,060.00 ", $676.90
11760,6010220041,Hospital Chargemaster,Repair of nail bed,Outpatient,Outpatient Default Percent / Case Rate,981, $397.00 , $218.35 ," $1,236.00 ", $626.13 , $277.90 , $154.83 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $138.95 , $- , $- ," $1,236.00 ", $277.90
11043,6010220023,Hospital Chargemaster,Deb musc/fascia 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,981, $724.00 , $398.20 ," $1,442.00 ", $626.13 , $506.80 , $282.36 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $253.40 , $- , $- ," $1,442.00 ", $506.80
11000,6010220019,Hospital Chargemaster,Debride infected skin,Outpatient,Outpatient Default Percent / Case Rate,981, $90.00 , $49.50 ," $1,236.00 ", $626.13 , $63.00 , $35.10 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $83.70 , $83.70 , $83.70 , $83.70 , $626.13 , $31.50 , $- , $- ," $1,236.00 ", $63.00
32554,6010220310,Hospital Chargemaster,Aspirate pleura w/o imaging,Outpatient,Outpatient Default Percent / Case Rate,981, $110.00 , $60.50 ," $1,236.00 ", $646.21 , $77.00 , $42.90 ," $1,356.36 ", $930.94 , $925.98 , $646.21 , $646.21 , $105.28 , $102.55 , $678.52 , $659.13 , $110.00 , $110.00 , $110.00 , $110.00 , $646.21 , $38.50 , $- , $- ," $1,356.36 ", $77.00
10081,6010220013,Hospital Chargemaster,Drainage of pilonidal cyst,Outpatient,Outpatient Default Percent / Case Rate,981, $260.00 , $143.00 ," $1,236.00 ", $743.95 , $182.00 , $101.40 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $241.80 , $241.80 , $241.80 , $241.80 , $743.95 , $91.00 , $- , $- ," $1,267.38 ", $182.00
20103,6010220105,Hospital Chargemaster,Explore wound extremity,Outpatient,Outpatient Default Percent / Case Rate,981," $1,041.00 ", $572.55 ," $1,236.00 ", $743.95 , $728.70 , $405.99 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $844.48 , $822.61 , $781.15 , $758.83 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $743.95 , $364.35 , $- , $- ," $1,267.38 ", $728.70
28190,6010220245,Hospital Chargemaster,Removal of foot foreign body,Outpatient,Outpatient Default Percent / Case Rate,981, $410.00 , $225.50 ," $1,442.00 ", $743.95 , $287.00 , $159.90 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $743.95 , $143.50 , $- , $- ," $1,442.00 ", $287.00
11010,6010220020,Hospital Chargemaster,Debride skin at fx site,Outpatient,Outpatient Default Percent / Case Rate,981, $835.00 , $459.25 ," $1,442.00 ", $743.95 , $584.50 , $325.65 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $292.25 , $- , $- ," $1,442.00 ", $584.50
10080,6010220012,Hospital Chargemaster,Drainage of pilonidal cyst,Outpatient,Outpatient Default Percent / Case Rate,981, $295.00 , $162.25 ," $1,236.00 ", $743.95 , $206.50 , $115.05 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $274.35 , $274.35 , $274.35 , $274.35 , $743.95 , $103.25 , $- , $- ," $1,267.38 ", $206.50
11400,6010220030,Hospital Chargemaster,Exc tr-ext b9+marg 0.5 cm<,Outpatient,Outpatient Default Percent / Case Rate,981, $234.00 , $128.70 ," $1,236.00 ", $743.95 , $163.80 , $91.26 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $234.00 , $234.00 , $234.00 , $234.00 , $743.95 , $81.90 , $- , $- ," $1,267.38 ", $163.80
21315,6010220120,Hospital Chargemaster,Closed tx nose fx w/o stablj,Outpatient,Outpatient Default Percent / Case Rate,981, $191.00 , $105.05 ," $1,442.00 "," $1,617.20 ", $133.70 , $74.49 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 "," $1,133.44 "," $1,104.09 "," $1,698.06 "," $1,649.55 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,617.20 ", $66.85 , $- , $- ," $2,798.18 ", $133.70
31603,6010220306,Hospital Chargemaster,Incision of windpipe,Outpatient,Outpatient Default Percent / Case Rate,981, $673.00 , $370.15 ," $1,236.00 "," $1,617.20 ", $471.10 , $262.47 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 ", $844.48 , $822.61 ," $1,698.06 "," $1,649.55 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,617.20 ", $235.55 , $- , $- ," $2,798.18 ", $471.10
30320,6010220293,Hospital Chargemaster,Remove nasal foreign body,Outpatient,Outpatient Default Percent / Case Rate,981," $1,395.00 ", $767.25 ," $1,442.00 "," $1,617.20 ", $976.50 , $544.05 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 "," $1,133.44 "," $1,104.09 "," $1,698.06 "," $1,649.55 ", $593.00 , $593.00 , $593.00 , $593.00 ," $1,617.20 ", $488.25 , $- , $- ," $2,798.18 ", $976.50
23665,6010220139,Hospital Chargemaster,Treat dislocation/fracture,Outpatient,Outpatient Default Percent / Case Rate,981, $612.00 , $336.60 ," $1,442.00 "," $1,665.16 ", $428.40 , $238.68 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $1,665.16 ", $214.20 , $- , $- ," $2,873.10 ", $428.40
27502,6010220218,Hospital Chargemaster,Treatment of thigh fracture,Outpatient,Outpatient Default Percent / Case Rate,981," $1,198.00 ", $658.90 ," $1,442.00 "," $1,665.16 ", $838.60 , $467.22 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $2,806.32 "," $1,665.16 ", $419.30 , $- , $- ," $2,873.10 ", $838.60
23605,6010220135,Hospital Chargemaster,Treat humerus fracture,Outpatient,Outpatient Default Percent / Case Rate,981," $1,053.00 ", $579.15 ," $1,442.00 "," $1,665.16 ", $737.10 , $410.67 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 "," $2,704.00 "," $2,704.00 "," $2,704.00 "," $2,704.00 "," $1,665.16 ", $368.55 , $- , $- ," $2,873.10 ", $737.10
26410,6010220186,Hospital Chargemaster,Repair hand tendon,Outpatient,Outpatient Default Percent / Case Rate,981," $1,730.00 ", $951.50 ," $2,060.00 "," $1,665.16 "," $1,211.00 ", $674.70 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,294.72 "," $1,261.20 "," $1,748.42 "," $1,698.46 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,665.16 ", $605.50 , $- , $- ," $2,873.10 "," $1,211.00 "
26418,6010220187,Hospital Chargemaster,Repair finger tendon,Outpatient,Outpatient Default Percent / Case Rate,981," $1,758.00 ", $966.90 ," $2,591.48 "," $1,665.16 "," $1,230.60 ", $685.62 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,599.36 "," $1,557.95 "," $1,748.42 "," $1,698.46 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,665.16 ", $615.30 , $- , $- ," $2,873.10 "," $1,230.60 "
23675,6010220140,Hospital Chargemaster,Treat dislocation/fracture,Outpatient,Outpatient Default Percent / Case Rate,981, $805.00 , $442.75 ," $1,442.00 "," $1,665.16 ", $563.50 , $313.95 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 "," $1,870.00 "," $1,870.00 "," $1,870.00 "," $1,870.00 "," $1,665.16 ", $281.75 , $- , $- ," $2,873.10 ", $563.50
27257,6010220210,Hospital Chargemaster,Treat hip dislocation,Outpatient,Outpatient Default Percent / Case Rate,981, $432.00 , $237.60 ," $2,060.00 "," $1,665.16 ", $302.40 , $168.48 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 "," $1,870.00 "," $1,870.00 "," $1,870.00 "," $1,870.00 "," $1,665.16 ", $151.20 , $- , $- ," $2,873.10 ", $302.40
23505,6010220127,Hospital Chargemaster,Treat clavicle fracture,Outpatient,Outpatient Default Percent / Case Rate,981, $430.00 , $236.50 ," $1,236.00 "," $1,665.16 ", $301.00 , $167.70 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $150.50 , $- , $- ," $2,873.10 ", $301.00
23655,6010220138,Hospital Chargemaster,Treat shoulder dislocation,Outpatient,Outpatient Default Percent / Case Rate,981," $1,145.00 ", $629.75 ," $1,236.00 "," $1,665.16 ", $801.50 , $446.55 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $400.75 , $- , $- ," $2,873.10 ", $801.50
24505,6010220146,Hospital Chargemaster,Treat humerus fracture,Outpatient,Outpatient Default Percent / Case Rate,981," $1,331.00 ", $732.05 ," $1,236.00 "," $1,665.16 ", $931.70 , $519.09 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $465.85 , $- , $- ," $2,873.10 ", $931.70
27752,6010220228,Hospital Chargemaster,Treatment of tibia fracture,Outpatient,Outpatient Default Percent / Case Rate,981," $1,471.00 ", $809.05 ," $1,236.00 "," $1,665.16 "," $1,029.70 ", $573.69 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $514.85 , $- , $- ," $2,873.10 "," $1,029.70 "
27266,6010220212,Hospital Chargemaster,Treat hip dislocation,Outpatient,Outpatient Default Percent / Case Rate,981," $1,719.00 ", $945.45 ," $1,442.00 "," $1,665.16 "," $1,203.30 ", $670.41 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $601.65 , $- , $- ," $2,873.10 "," $1,203.30 "
25605,6010220171,Hospital Chargemaster,Treat fracture radius/ulna,Outpatient,Outpatient Default Percent / Case Rate,981," $1,716.00 ", $943.80 ," $2,060.00 "," $1,665.16 "," $1,201.20 ", $669.24 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,294.72 "," $1,261.20 "," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $600.60 , $- , $- ," $2,873.10 "," $1,201.20 "
23575,6010220133,Hospital Chargemaster,Treat shoulder blade fx,Outpatient,Outpatient Default Percent / Case Rate,981," $1,078.00 ", $592.90 ," $1,236.00 "," $1,665.16 ", $754.60 , $420.42 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $377.30 , $- , $- ," $2,873.10 ", $754.60
24675,6010220160,Hospital Chargemaster,Treat ulnar fracture,Outpatient,Outpatient Default Percent / Case Rate,981," $1,225.00 ", $673.75 ," $1,236.00 "," $1,665.16 ", $857.50 , $477.75 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $428.75 , $- , $- ," $2,873.10 ", $857.50
25505,6010220165,Hospital Chargemaster,Treat fracture of radius,Outpatient,Outpatient Default Percent / Case Rate,981," $1,352.00 ", $743.60 ," $1,236.00 "," $1,665.16 ", $946.40 , $527.28 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $473.20 , $- , $- ," $2,873.10 ", $946.40
26645,6010220192,Hospital Chargemaster,Treat thumb fracture,Outpatient,Outpatient Default Percent / Case Rate,981," $1,118.00 ", $614.90 ," $1,236.00 "," $1,665.16 ", $782.60 , $436.02 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $391.30 , $- , $- ," $2,873.10 ", $782.60
27762,6010220230,Hospital Chargemaster,Cltx med ankle fx w/mnpj,Outpatient,Outpatient Default Percent / Case Rate,981," $1,308.00 ", $719.40 ," $1,236.00 "," $1,665.16 ", $915.60 , $510.12 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $457.80 , $- , $- ," $2,873.10 ", $915.60
27810,6010220237,Hospital Chargemaster,Treatment of ankle fracture,Outpatient,Outpatient Default Percent / Case Rate,981," $1,276.00 ", $701.80 ," $1,236.00 "," $1,665.16 ", $893.20 , $497.64 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $446.60 , $- , $- ," $2,873.10 ", $893.20
27818,6010220239,Hospital Chargemaster,Treatment of ankle fracture,Outpatient,Outpatient Default Percent / Case Rate,981," $1,296.00 ", $712.80 ," $1,236.00 "," $1,665.16 ", $907.20 , $505.44 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $453.60 , $- , $- ," $2,873.10 ", $907.20
28455,6010220253,Hospital Chargemaster,Treat midfoot fracture each,Outpatient,Outpatient Default Percent / Case Rate,981, $805.00 , $442.75 ," $1,236.00 "," $1,665.16 ", $563.50 , $313.95 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,665.16 ", $281.75 , $- , $- ," $2,873.10 ", $563.50
25624,6010220174,Hospital Chargemaster,Treat wrist bone fracture,Outpatient,Outpatient Default Percent / Case Rate,981," $1,237.00 ", $680.35 ," $1,442.00 "," $1,665.16 ", $865.90 , $482.43 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 ", $817.00 , $817.00 , $817.00 , $817.00 ," $1,665.16 ", $432.95 , $- , $- ," $2,873.10 ", $865.90
25248,6010220162,Hospital Chargemaster,Remove forearm foreign body,Outpatient,Outpatient Default Percent / Case Rate,981," $1,310.00 ", $720.50 ," $1,442.00 "," $1,665.16 ", $917.00 , $510.90 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 ", $812.00 , $812.00 , $812.00 , $812.00 ," $1,665.16 ", $458.50 , $- , $- ," $2,873.10 ", $917.00
24535,6010220148,Hospital Chargemaster,Treat humerus fracture,Outpatient,Outpatient Default Percent / Case Rate,981, $700.00 , $385.00 ," $1,236.00 "," $1,665.16 ", $490.00 , $273.00 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 ", $770.00 , $770.00 , $770.00 , $770.00 ," $1,665.16 ", $245.00 , $- , $- ," $2,873.10 ", $490.00
24620,6010220155,Hospital Chargemaster,Treat elbow fracture,Outpatient,Outpatient Default Percent / Case Rate,981," $1,630.00 ", $896.50 ," $1,442.00 "," $1,665.16 "," $1,141.00 ", $635.70 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 ", $761.00 , $761.00 , $761.00 , $761.00 ," $1,665.16 ", $570.50 , $- , $- ," $2,873.10 "," $1,141.00 "
26070,6010220183,Hospital Chargemaster,Explore/treat hand joint,Outpatient,Outpatient Default Percent / Case Rate,981," $1,153.00 ", $634.15 ," $1,442.00 "," $1,665.16 ", $807.10 , $449.67 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 ", $719.00 , $719.00 , $719.00 , $719.00 ," $1,665.16 ", $403.55 , $- , $- ," $2,873.10 ", $807.10
24655,6010220158,Hospital Chargemaster,Treat radius fracture,Outpatient,Outpatient Default Percent / Case Rate,981, $615.00 , $338.25 ," $1,236.00 "," $1,665.16 ", $430.50 , $239.85 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 ", $513.00 , $513.00 , $513.00 , $513.00 ," $1,665.16 ", $215.25 , $- , $- ," $2,873.10 ", $430.50
25565,6010220169,Hospital Chargemaster,Treat fracture radius & ulna,Outpatient,Outpatient Default Percent / Case Rate,981," $1,394.00 ", $766.70 ," $1,442.00 "," $1,665.16 ", $975.80 , $543.66 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 ", $197.00 , $197.00 , $197.00 , $197.00 ," $1,665.16 ", $487.90 , $- , $- ," $2,873.10 ", $975.80
26742,6010220198,Hospital Chargemaster,Treat finger fracture each,Outpatient,Outpatient Default Percent / Case Rate,981, $977.00 , $537.35 ," $1,442.00 "," $1,665.16 ", $683.90 , $381.03 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 ", $197.00 , $197.00 , $197.00 , $197.00 ," $1,665.16 ", $341.95 , $- , $- ," $2,873.10 ", $683.90
25635,6010220175,Hospital Chargemaster,Treat wrist bone fracture,Outpatient,Outpatient Default Percent / Case Rate,981," $1,158.00 ", $636.90 ," $1,236.00 "," $1,665.16 ", $810.60 , $451.62 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 ", $135.00 , $135.00 , $135.00 , $135.00 ," $1,665.16 ", $405.30 , $- , $- ," $2,873.10 ", $810.60
32551,6010220309,Hospital Chargemaster,Insertion of chest tube,Outpatient,Outpatient Default Percent / Case Rate,981, $528.00 , $290.40 ," $1,442.00 "," $1,681.14 ", $369.60 , $205.92 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 ", $528.00 , $528.00 , $528.00 , $528.00 ," $1,681.14 ", $184.80 , $- , $- ," $2,392.46 ", $369.60
36569,6010220331,Hospital Chargemaster,Insj picc 5 yr+ w/o imaging,Outpatient,Outpatient Default Percent / Case Rate,981, $293.00 , $161.15 ," $1,236.00 "," $1,681.14 ", $205.10 , $114.27 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $1,681.14 ", $102.55 , $- , $- ," $2,540.00 ", $205.10
10121,6010220015,Hospital Chargemaster,Remove foreign body,Outpatient,Outpatient Default Percent / Case Rate,981, $547.00 , $300.85 ," $1,442.00 "," $1,682.11 ", $382.90 , $213.33 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $508.71 , $508.71 , $508.71 , $508.71 ," $1,682.11 ", $191.45 , $- , $- ," $3,009.07 ", $382.90
24200,6010220143,Hospital Chargemaster,Removal of arm foreign body,Outpatient,Outpatient Default Percent / Case Rate,981, $409.00 , $224.95 , $337.02 ," $1,682.11 ", $286.30 , $159.51 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $143.15 , $- , $- ," $3,009.07 ", $286.30
11044,6010220024,Hospital Chargemaster,Deb bone 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,981," $1,004.00 ", $552.20 ," $1,442.00 "," $1,682.11 ", $702.80 , $391.56 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,004.00 "," $1,004.00 "," $1,004.00 "," $1,004.00 "," $1,682.11 ", $351.40 , $- , $- ," $3,009.07 ", $702.80
28193,6010220247,Hospital Chargemaster,Removal of foot foreign body,Outpatient,Outpatient Default Percent / Case Rate,981," $1,153.00 ", $634.15 ," $2,591.48 "," $1,682.11 ", $807.10 , $449.67 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,599.36 "," $1,557.95 "," $1,766.22 "," $1,715.75 ", $835.00 , $835.00 , $835.00 , $835.00 ," $1,682.11 ", $403.55 , $- , $- ," $3,009.07 ", $807.10
27327,6010220216,Hospital Chargemaster,Exc thigh/knee les sc < 3 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $969.00 , $532.95 ," $1,442.00 "," $1,682.11 ", $678.30 , $377.91 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $604.00 , $604.00 , $604.00 , $604.00 ," $1,682.11 ", $339.15 , $- , $- ," $3,009.07 ", $678.30
21930,6010220125,Hospital Chargemaster,Exc back les sc < 3 cm,Outpatient,Outpatient Default Percent / Case Rate,981," $1,096.00 ", $602.80 ," $1,442.00 "," $1,682.11 ", $767.20 , $427.44 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $512.00 , $512.00 , $512.00 , $512.00 ," $1,682.11 ", $383.60 , $- , $- ," $3,009.07 ", $767.20
23931,6010220142,Hospital Chargemaster,Drainage of arm bursa,Outpatient,Outpatient Default Percent / Case Rate,981, $505.00 , $277.75 ," $1,442.00 "," $1,682.11 ", $353.50 , $196.95 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $505.00 , $505.00 , $505.00 , $505.00 ," $1,682.11 ", $176.75 , $- , $- ," $3,009.07 ", $353.50
19020,6010220101,Hospital Chargemaster,Incision of breast lesion,Outpatient,Outpatient Default Percent / Case Rate,981, $871.00 , $479.05 ," $1,442.00 "," $1,682.11 ", $609.70 , $339.69 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 ", $431.00 , $431.00 , $431.00 , $431.00 ," $1,682.11 ", $304.85 , $- , $- ," $3,009.07 ", $609.70
11422,6010220034,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,981, $400.00 , $220.00 ," $1,236.00 "," $1,682.11 ", $280.00 , $156.00 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $400.00 , $400.00 , $400.00 , $400.00 ," $1,682.11 ", $140.00 , $- , $- ," $3,009.07 ", $280.00
10140,6010220016,Hospital Chargemaster,Drainage of hematoma/fluid,Outpatient,Outpatient Default Percent / Case Rate,981, $356.00 , $195.80 ," $1,236.00 "," $1,682.11 ", $249.20 , $138.84 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $331.08 , $331.08 , $331.08 , $331.08 ," $1,682.11 ", $124.60 , $- , $- ," $3,009.07 ", $249.20
11420,6010220033,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 0.5/<,Outpatient,Outpatient Default Percent / Case Rate,981, $290.00 , $159.50 ," $1,442.00 "," $1,682.11 ", $203.00 , $113.10 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $290.00 , $290.00 , $290.00 , $290.00 ," $1,682.11 ", $101.50 , $- , $- ," $3,009.07 ", $203.00
31238,6010220299,Hospital Chargemaster,Nasal/sinus endoscopy surg,Outpatient,Outpatient Default Percent / Case Rate,981, $605.00 , $332.75 ," $1,442.00 "," $1,788.65 ", $423.50 , $235.95 ," $2,995.49 "," $2,055.97 "," $2,045.01 "," $1,788.65 "," $1,788.65 ", $844.48 , $822.61 ," $1,878.08 "," $1,824.42 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,788.65 ", $211.75 , $- , $- ," $2,995.49 ", $423.50
31525,6010220303,Hospital Chargemaster,Dx laryngoscopy excl nb,Outpatient,Outpatient Default Percent / Case Rate,981, $425.00 , $233.75 ," $1,442.00 "," $1,788.65 ", $297.50 , $165.75 ," $2,995.49 "," $2,055.97 "," $2,045.01 "," $1,788.65 "," $1,788.65 ", $844.48 , $822.61 ," $1,878.08 "," $1,824.42 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,788.65 ", $148.75 , $- , $- ," $2,995.49 ", $297.50
13160,6010220090,Hospital Chargemaster,Late closure of wound,Outpatient,Outpatient Default Percent / Case Rate,981," $2,402.00 "," $1,321.10 "," $1,442.00 "," $2,047.65 "," $1,681.40 ", $936.78 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 "," $1,133.44 "," $1,104.09 "," $2,150.03 "," $2,088.60 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,047.65 ", $840.70 , $- , $- ," $3,388.54 "," $1,681.40 "
20102,6010220104,Hospital Chargemaster,Explore wound abdomen,Outpatient,Outpatient Default Percent / Case Rate,981, $738.00 , $405.90 , $608.11 ," $2,047.65 ", $516.60 , $287.82 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $844.48 , $822.61 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $258.30 , $- , $- ," $3,388.54 ", $516.60
12037,6010220066,Hospital Chargemaster,Intmd rpr s/tr/ext >30.0 cm,Outpatient,Outpatient Default Percent / Case Rate,981, $933.00 , $513.15 ," $1,442.00 "," $2,047.65 ", $653.10 , $363.87 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 "," $1,133.44 "," $1,104.09 "," $2,150.03 "," $2,088.60 ", $740.30 , $740.30 , $740.30 , $740.30 ," $2,047.65 ", $326.55 , $- , $- ," $3,388.54 ", $653.10
12047,6010220072,Hospital Chargemaster,Intmd rpr n-hf/genit >30.0cm,Outpatient,Outpatient Default Percent / Case Rate,981, $965.00 , $530.75 ," $1,442.00 "," $2,047.65 ", $675.50 , $376.35 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 "," $1,133.44 "," $1,104.09 "," $2,150.03 "," $2,088.60 ", $740.30 , $740.30 , $740.30 , $740.30 ," $2,047.65 ", $337.75 , $- , $- ," $3,388.54 ", $675.50
27372,6010220217,Hospital Chargemaster,Removal of foreign body,Outpatient,Outpatient Default Percent / Case Rate,981," $1,204.00 ", $662.20 ," $2,976.70 "," $2,834.62 ", $842.80 , $469.56 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $2,528.96 "," $2,463.48 "," $2,976.35 "," $2,891.31 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $1,915.00 "," $2,834.62 ", $421.40 , $- , $- ," $5,202.81 ", $842.80
23930,6010220141,Hospital Chargemaster,Drainage of arm lesion,Outpatient,Outpatient Default Percent / Case Rate,981, $345.00 , $189.75 ," $1,236.00 "," $2,834.62 ", $241.50 , $134.55 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $2,834.62 "," $2,834.62 ", $844.48 , $822.61 ," $2,976.35 "," $2,891.31 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,834.62 ", $120.75 , $- , $- ," $3,009.07 ", $241.50
11012,6010220021,Hospital Chargemaster,Deb skin bone at fx site,Outpatient,Outpatient Default Percent / Case Rate,981," $1,278.00 ", $702.90 ," $1,442.00 "," $2,834.62 ", $894.60 , $498.42 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 ", $105.28 , $102.55 ," $2,976.35 "," $2,891.31 ", $740.30 , $740.30 , $740.30 , $740.30 ," $2,834.62 ", $447.30 , $- , $- ," $5,202.81 ", $894.60
24201,6010220144,Hospital Chargemaster,Removal of arm foreign body,Outpatient,Outpatient Default Percent / Case Rate,981," $1,085.00 ", $596.75 ," $1,442.00 "," $2,834.62 ", $759.50 , $423.15 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,133.44 "," $1,104.09 "," $2,976.35 "," $2,891.31 ", $645.00 , $645.00 , $645.00 , $645.00 ," $2,834.62 ", $379.75 , $- , $- ," $5,202.81 ", $759.50
11770,6010220044,Hospital Chargemaster,Remove pilonidal cyst simple,Outpatient,Outpatient Default Percent / Case Rate,981, $529.00 , $290.95 ," $2,060.00 "," $2,834.62 ", $370.30 , $206.31 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,294.72 "," $1,261.20 "," $2,976.35 "," $2,891.31 ", $258.00 , $258.00 , $258.00 , $258.00 ," $2,834.62 ", $185.15 , $- , $- ," $5,202.81 ", $370.30
10180,6010220018,Hospital Chargemaster,Complex drainage wound,Outpatient,Outpatient Default Percent / Case Rate,981, $527.00 , $289.85 ," $1,442.00 "," $2,834.62 ", $368.90 , $205.53 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,133.44 "," $1,104.09 "," $2,976.35 "," $2,891.31 ", $490.11 , $490.11 , $490.11 , $490.11 ," $2,834.62 ", $184.45 , $- , $- ," $5,202.81 ", $368.90
25606,6010220172,Hospital Chargemaster,Treat fx distal radial,Outpatient,Outpatient Default Percent / Case Rate,981," $1,983.00 "," $1,090.65 "," $2,060.00 "," $3,385.65 "," $1,388.10 ", $773.37 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,294.72 "," $1,261.20 "," $3,554.93 "," $3,453.36 "," $2,545.00 "," $2,545.00 "," $2,545.00 "," $2,545.00 "," $3,385.65 ", $694.05 , $- , $- ," $5,738.89 "," $1,388.10 "
26951,6010220206,Hospital Chargemaster,Amputation of finger/thumb,Outpatient,Outpatient Default Percent / Case Rate,981," $1,919.00 "," $1,055.45 "," $1,442.00 "," $3,385.65 "," $1,343.30 ", $748.41 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,133.44 "," $1,104.09 "," $3,554.93 "," $3,453.36 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $3,385.65 ", $671.65 , $- , $- ," $5,738.89 "," $1,343.30 "
27310,6010220215,Hospital Chargemaster,Exploration of knee joint,Outpatient,Outpatient Default Percent / Case Rate,981," $2,164.00 "," $1,190.20 "," $2,591.48 "," $3,385.65 "," $1,514.80 ", $843.96 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,599.36 "," $1,557.95 "," $3,554.93 "," $3,453.36 "," $1,989.00 "," $1,989.00 "," $1,989.00 "," $1,989.00 "," $3,385.65 ", $757.40 , $- , $- ," $5,738.89 "," $1,514.80 "
26370,6010220185,Hospital Chargemaster,Repair finger/hand tendon,Outpatient,Outpatient Default Percent / Case Rate,981," $2,328.00 "," $1,280.40 "," $2,591.48 "," $3,385.65 "," $1,629.60 ", $907.92 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,599.36 "," $1,557.95 "," $3,554.93 "," $3,453.36 "," $1,712.00 "," $1,712.00 "," $1,712.00 "," $1,712.00 "," $3,385.65 ", $814.80 , $- , $- ," $5,738.89 "," $1,629.60 "
26952,6010220207,Hospital Chargemaster,Amputation of finger/thumb,Outpatient,Outpatient Default Percent / Case Rate,981," $1,955.00 "," $1,075.25 "," $2,591.48 "," $3,385.65 "," $1,368.50 ", $762.45 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,599.36 "," $1,557.95 "," $3,554.93 "," $3,453.36 "," $1,409.00 "," $1,409.00 "," $1,409.00 "," $1,409.00 "," $3,385.65 ", $684.25 , $- , $- ," $5,738.89 "," $1,368.50 "
27610,6010220225,Hospital Chargemaster,Explore/treat ankle joint,Outpatient,Outpatient Default Percent / Case Rate,981," $1,954.00 "," $1,074.70 "," $1,442.00 "," $3,385.65 "," $1,367.80 ", $762.06 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,133.44 "," $1,104.09 "," $3,554.93 "," $3,453.36 "," $1,357.00 "," $1,357.00 "," $1,357.00 "," $1,357.00 "," $3,385.65 ", $683.90 , $- , $- ," $5,738.89 "," $1,367.80 "
28020,6010220244,Hospital Chargemaster,Exploration of foot joint,Outpatient,Outpatient Default Percent / Case Rate,981," $1,089.00 ", $598.95 ," $1,442.00 "," $3,385.65 ", $762.30 , $424.71 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,133.44 "," $1,104.09 "," $3,554.93 "," $3,453.36 ", $813.00 , $813.00 , $813.00 , $813.00 ," $3,385.65 ", $381.15 , $- , $- ," $5,738.89 ", $762.30
26765,6010220201,Hospital Chargemaster,Treat finger fracture each,Outpatient,Outpatient Default Percent / Case Rate,981," $1,428.00 ", $785.40 ," $2,591.48 "," $3,385.65 ", $999.60 , $556.92 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,599.36 "," $1,557.95 "," $3,554.93 "," $3,453.36 ", $683.00 , $683.00 , $683.00 , $683.00 ," $3,385.65 ", $499.80 , $- , $- ," $5,738.89 ", $999.60
28240,6010220248,Hospital Chargemaster,Release of big toe,Outpatient,Outpatient Default Percent / Case Rate,981, $917.00 , $504.35 ," $1,442.00 "," $3,385.65 ", $641.90 , $357.63 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $3,385.65 "," $3,385.65 "," $1,133.44 "," $1,104.09 "," $3,554.93 "," $3,453.36 ", $666.00 , $666.00 , $666.00 , $666.00 ," $3,385.65 ", $320.95 , $- , $- ," $5,738.89 ", $641.90
36558,6010220329,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,981, $887.00 , $487.85 ," $1,442.00 "," $3,422.34 ", $620.90 , $345.93 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $887.00 , $887.00 , $887.00 , $887.00 ," $3,422.34 ", $310.45 , $- , $- ," $5,778.66 ", $620.90
36555,6010220327,Hospital Chargemaster,Insert non-tunnel cv cath,Outpatient,Outpatient Default Percent / Case Rate,981, $378.00 , $207.90 ," $1,236.00 "," $3,422.34 ", $264.60 , $147.42 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $378.00 , $378.00 , $378.00 , $378.00 ," $3,422.34 ", $132.30 , $- , $- ," $3,593.46 ", $264.60
36556,6010220328,Hospital Chargemaster,Insert non-tunnel cv cath,Outpatient,Outpatient Default Percent / Case Rate,981, $368.00 , $202.40 ," $1,236.00 "," $3,422.34 ", $257.60 , $143.52 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $368.00 , $368.00 , $368.00 , $368.00 ," $3,422.34 ", $128.80 , $- , $- ," $3,593.46 ", $257.60
36563,6010220330,Hospital Chargemaster,Insert tunneled cv cath,Outpatient,Outpatient Default Percent / Case Rate,981," $1,125.00 ", $618.75 ," $2,060.00 "," $5,701.02 ", $787.50 , $438.75 ," $9,574.18 "," $6,571.30 "," $6,536.27 "," $5,701.02 "," $5,701.02 "," $1,294.72 "," $1,261.20 "," $5,986.07 "," $5,815.04 "," $1,125.00 "," $1,125.00 "," $1,125.00 "," $1,125.00 "," $5,701.02 ", $393.75 , $- , $- ," $9,574.18 ", $787.50
27822,6010220240,Hospital Chargemaster,Treatment of ankle fracture,Outpatient,Outpatient Default Percent / Case Rate,981," $2,544.00 "," $1,399.20 "," $2,060.00 "," $7,488.26 "," $1,780.80 ", $992.16 ," $12,468.57 "," $8,557.88 "," $8,512.26 "," $7,488.26 "," $7,488.26 "," $1,294.72 "," $1,261.20 "," $7,862.67 "," $7,638.02 "," $3,548.00 "," $3,548.00 "," $3,548.00 "," $3,548.00 "," $7,488.26 ", $890.40 , $- , $- ," $12,468.57 "," $1,780.80 "
23532,6010220129,Hospital Chargemaster,Treat clavicle dislocation,Outpatient,Outpatient Default Percent / Case Rate,981," $1,844.00 "," $1,014.20 "," $2,591.48 "," $7,488.26 "," $1,290.80 ", $719.16 ," $12,468.57 "," $8,557.88 "," $8,512.26 "," $7,488.26 "," $7,488.26 "," $1,599.36 "," $1,557.95 "," $7,862.67 "," $7,638.02 "," $2,544.00 "," $2,544.00 "," $2,544.00 "," $2,544.00 "," $7,488.26 ", $645.40 , $- , $- ," $12,468.57 "," $1,290.80 "
27650,6010220226,Hospital Chargemaster,Repair achilles tendon,Outpatient,Outpatient Default Percent / Case Rate,981," $2,013.00 "," $1,107.15 "," $2,060.00 "," $7,488.26 "," $1,409.10 ", $785.07 ," $5,738.89 "," $3,938.92 "," $3,917.92 "," $7,488.26 "," $7,488.26 "," $1,294.72 "," $1,261.20 "," $7,862.67 "," $7,638.02 "," $2,382.00 "," $2,382.00 "," $2,382.00 "," $2,382.00 "," $7,488.26 ", $704.55 , $- , $- ," $7,862.67 "," $1,409.10 "
20690,6010220117,Hospital Chargemaster,Apply bone fixation device,Outpatient,Outpatient Default Percent / Case Rate,981," $1,675.00 ", $921.25 ," $1,442.00 "," $7,488.26 "," $1,172.50 ", $653.25 ," $12,468.57 "," $8,557.88 "," $8,512.26 "," $7,488.26 "," $7,488.26 "," $1,133.44 "," $1,104.09 "," $7,862.67 "," $7,638.02 ", $335.00 , $335.00 , $335.00 , $335.00 ," $7,488.26 ", $586.25 , $- , $- ," $12,468.57 "," $1,172.50 "
33210,6010220314,Hospital Chargemaster,Insert electrd/pm cath sngl,Outpatient,Outpatient Default Percent / Case Rate,981, $585.00 , $321.75 ," $2,591.48 "," $9,753.71 ", $409.50 , $228.15 ," $16,197.41 "," $11,117.20 "," $11,057.93 "," $9,753.71 "," $9,753.71 ", $844.48 , $822.61 ," $10,241.39 "," $9,948.78 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $9,753.71 ", $204.75 , $- , $- ," $16,197.41 ", $409.50
23615,6010220136,Hospital Chargemaster,Treat humerus fracture,Outpatient,Outpatient Default Percent / Case Rate,981," $2,619.00 "," $1,440.45 "," $2,591.48 "," $14,741.45 "," $1,833.30 "," $1,021.41 "," $23,437.94 "," $16,086.78 "," $16,001.02 "," $14,741.45 "," $14,741.45 "," $1,599.36 "," $1,557.95 "," $15,478.53 "," $15,036.28 "," $2,006.00 "," $2,006.00 "," $2,006.00 "," $2,006.00 "," $14,741.45 ", $916.65 , $- , $- ," $23,437.94 "," $1,833.30 "
64402,6010220431,Hospital Chargemaster,N block inj facial,Outpatient,Outpatient Default Percent / Case Rate,981, $219.00 , $120.45 ," $2,542.04 ", See APC Packaged Rates , $153.30 , $85.41 , $211.31 , $212.23 , $112.79 , See APC Packaged Rates , See APC Packaged Rates , $146.95 , $146.95 , See APC Packaged Rates , See APC Packaged Rates , $203.67 , $203.67 , $203.67 , $203.67 , See APC Packaged Rates , $76.65 , Not Applicable , $76.65 ," $2,542.04 ", $153.30
54700,6010220411,Hospital Chargemaster,Drainage of scrotum,Outpatient,Outpatient Default Percent / Case Rate,981, $693.00 , $381.15 ," $1,442.00 "," $2,140.58 ", $485.10 , $270.27 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 "," $1,133.44 "," $1,104.09 "," $2,247.61 "," $2,183.39 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,140.58 ", $242.55 , $- , $- ," $3,805.91 ", $485.10
46045,6010220381,Hospital Chargemaster,Incision of rectal abscess,Outpatient,Outpatient Default Percent / Case Rate,981," $1,224.00 ", $673.20 ," $1,442.00 "," $2,920.64 ", $856.80 , $477.36 ," $5,107.19 "," $3,505.36 "," $3,486.67 "," $2,920.64 "," $2,920.64 "," $1,133.44 "," $1,104.09 "," $3,066.68 "," $2,979.06 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,629.00 "," $2,920.64 ", $428.40 , $- , $- ," $5,107.19 ", $856.80
69120,6010220454,Hospital Chargemaster,Removal of external ear,Outpatient,Outpatient Default Percent / Case Rate,981," $1,500.00 ", $825.00 ," $1,442.00 "," $6,080.31 "," $1,050.00 ", $585.00 ," $9,678.56 "," $6,642.94 "," $6,607.52 "," $6,080.31 "," $6,080.31 "," $1,133.44 "," $1,104.09 "," $6,384.32 "," $6,201.91 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $6,080.31 ", $525.00 , $- , $- ," $9,678.56 "," $1,050.00 "
41252,6010220352,Hospital Chargemaster,Repair tongue laceration,Outpatient,Outpatient Default Percent / Case Rate,981, $645.00 , $354.75 ," $1,442.00 ", $252.93 , $451.50 , $251.55 , $450.95 , $309.51 , $307.86 , $252.93 , $252.93 ," $1,133.44 "," $1,104.09 ", $265.57 , $257.99 ," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,450.00 ", $252.93 , $225.75 , $- , $- ," $1,450.00 ", $451.50
69145,6010220455,Hospital Chargemaster,Remove ear canal lesion(s),Outpatient,Outpatient Default Percent / Case Rate,981, $773.00 , $425.15 ," $1,442.00 "," $2,834.62 ", $541.10 , $301.47 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,133.44 "," $1,104.09 "," $2,976.35 "," $2,891.31 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $2,834.62 ", $270.55 , $- , $- ," $5,202.81 ", $541.10
43020,6010220363,Hospital Chargemaster,Incision of esophagus,Outpatient,Outpatient Default Percent / Case Rate,981," $1,610.00 ", $885.50 ," $1,326.64 "," $1,617.20 "," $1,127.00 ", $627.90 ," $2,798.18 "," $1,920.55 "," $1,910.31 "," $1,617.20 "," $1,617.20 "," $1,294.72 "," $1,261.20 "," $1,698.06 "," $1,649.55 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,450.00 "," $1,617.20 ", $563.50 , $- , $- ," $2,798.18 "," $1,127.00 "
40650,6010220342,Hospital Chargemaster,Repair lip,Outpatient,Outpatient Default Percent / Case Rate,981, $850.00 , $467.50 ," $2,060.00 ", $540.69 , $595.00 , $331.50 ," $1,065.66 ", $731.42 , $727.52 , $540.69 , $540.69 ," $1,294.72 "," $1,261.20 ", $567.73 , $551.50 ," $1,300.00 "," $1,300.00 "," $1,300.00 "," $1,300.00 ", $540.69 , $297.50 , $- , $- ," $2,060.00 ", $595.00
45915,6010220378,Hospital Chargemaster,Remove rectal obstruction,Outpatient,Outpatient Default Percent / Case Rate,981, $470.00 , $258.50 ," $1,236.00 "," $1,239.71 ", $329.00 , $183.30 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 ", $844.48 , $822.61 ," $1,301.70 "," $1,264.51 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,239.71 ", $164.50 , $- , $- ," $2,143.42 ", $329.00
67930,6010220448,Hospital Chargemaster,Repair eyelid wound,Outpatient,Outpatient Default Percent / Case Rate,981," $1,500.00 ", $825.00 ," $1,442.00 "," $2,392.31 "," $1,050.00 ", $585.00 ," $3,965.46 "," $2,721.72 "," $2,707.21 "," $2,392.31 "," $2,392.31 ", $844.48 , $822.61 ," $2,511.93 "," $2,440.16 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,392.31 ", $525.00 , $- , $- ," $3,965.46 "," $1,050.00 "
46040,6010220380,Hospital Chargemaster,Incision of rectal abscess,Outpatient,Outpatient Default Percent / Case Rate,981," $1,185.00 ", $651.75 ," $2,060.00 "," $1,239.71 ", $829.50 , $462.15 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,294.72 "," $1,261.20 "," $1,301.70 "," $1,264.51 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,239.71 ", $414.75 , $- , $- ," $2,143.42 ", $829.50
41800,6010220354,Hospital Chargemaster,Drainage of gum lesion,Outpatient,Outpatient Default Percent / Case Rate,981, $417.00 , $229.35 ," $1,236.00 ", $134.80 , $291.90 , $162.63 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $844.48 , $822.61 , $141.54 , $137.50 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $134.80 , $145.95 , $- , $- ," $1,236.00 ", $291.90
56420,6010220416,Hospital Chargemaster,Drainage of gland abscess,Outpatient,Outpatient Default Percent / Case Rate,981, $282.00 , $155.10 ," $1,236.00 ", $203.67 , $197.40 , $109.98 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $844.48 , $822.61 , $213.85 , $207.74 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $203.67 , $98.70 , $- , $- ," $1,236.00 ", $197.40
42700,6010220359,Hospital Chargemaster,Drainage of tonsil abscess,Outpatient,Outpatient Default Percent / Case Rate,981, $424.00 , $233.20 ," $1,236.00 ", $252.93 , $296.80 , $165.36 , $450.95 , $309.51 , $307.86 , $252.93 , $252.93 , $844.48 , $822.61 , $265.57 , $257.99 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $252.93 , $148.40 , $- , $- ," $1,236.00 ", $296.80
54450,6010220410,Hospital Chargemaster,Preputial stretching,Outpatient,Outpatient Default Percent / Case Rate,981, $188.00 , $103.40 ," $1,236.00 ", $318.13 , $131.60 , $73.32 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $844.48 , $822.61 , $334.03 , $324.49 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $318.13 , $65.80 , $- , $- ," $1,236.00 ", $131.60
45300,6010220375,Hospital Chargemaster,Proctosigmoidoscopy dx,Outpatient,Outpatient Default Percent / Case Rate,981, $253.00 , $139.15 ," $1,236.00 ", $948.73 , $177.10 , $98.67 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $105.28 , $102.55 , $996.17 , $967.71 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $948.73 , $88.55 , $- , $- ," $1,629.53 ", $177.10
43200,6010220364,Hospital Chargemaster,Esophagoscopy flexible brush,Outpatient,Outpatient Default Percent / Case Rate,981, $506.00 , $278.30 ," $1,236.00 ", $967.36 , $354.20 , $197.34 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $967.36 , $177.10 , $- , $- ," $1,665.99 ", $354.20
43450,6010220368,Hospital Chargemaster,Dilate esophagus 1/mult pass,Outpatient,Outpatient Default Percent / Case Rate,981, $389.00 , $213.95 ," $1,236.00 ", $967.36 , $272.30 , $151.71 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $967.36 , $136.15 , $- , $- ," $1,665.99 ", $272.30
55100,6010220413,Hospital Chargemaster,Drainage of scrotum abscess,Outpatient,Outpatient Default Percent / Case Rate,981, $538.00 , $295.90 ," $1,236.00 "," $1,682.11 ", $376.60 , $209.82 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,682.11 ", $188.30 , $- , $- ," $3,009.07 ", $376.60
43215,6010220365,Hospital Chargemaster,Esophagoscopy flex remove fb,Outpatient,Outpatient Default Percent / Case Rate,981, $550.00 , $302.50 ," $1,236.00 "," $1,941.77 ", $385.00 , $214.50 ," $3,245.02 "," $2,227.24 "," $2,215.37 "," $1,941.77 "," $1,941.77 ", $844.48 , $822.61 ," $2,038.86 "," $1,980.61 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,941.77 ", $192.50 , $- , $- ," $3,245.02 ", $385.00
99291,6010220006,Hospital Chargemaster,Critical Care Init 30-74 Min,Outpatient,Outpatient Default Percent / Case Rate,981, $659.00 , $362.45 , $543.02 , $890.51 , $461.30 , $257.01 ," $3,645.69 "," $2,255.28 "," $2,178.27 ", $890.51 , $890.51 , $836.55 , $811.17 , $935.03 , $908.32 ," $1,078.51 "," $1,078.51 "," $1,106.30 "," $1,106.30 ", $890.51 , $263.60 , $- , $- ," $3,645.69 ", $461.30
59409,6010220425,Hospital Chargemaster,Obstetrical care,Outpatient,Outpatient Default Percent / Case Rate,981," $1,105.00 ", $607.75 ," $1,236.00 "," $3,136.64 ", $773.50 , $430.95 ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 ", $741.46 , $741.46 ," $3,293.47 "," $3,199.37 "," $1,105.00 "," $1,105.00 "," $1,105.00 "," $1,105.00 "," $3,136.64 ", $386.75 , $- , $- ," $5,165.58 ", $773.50
41250,6010220350,Hospital Chargemaster,Repair tongue laceration,Outpatient,Outpatient Default Percent / Case Rate,981, $439.00 , $241.45 ," $1,442.00 ", $324.46 , $307.30 , $171.21 , $232.95 , $159.88 , $159.03 , $324.46 , $324.46 ," $1,133.44 "," $1,104.09 ", $340.68 , $330.95 , $817.00 , $817.00 , $817.00 , $817.00 , $324.46 , $153.65 , $- , $- ," $1,442.00 ", $307.30
99285,6010220005,Hospital Chargemaster,ED High Severity&Threat Func,Outpatient,Outpatient Default Percent / Case Rate,981, $608.00 , $334.40 , $908.46 , $624.24 , $425.60 , $237.12 ," $2,587.86 "," $1,600.89 "," $1,546.23 ", $624.24 , $624.24 , $532.35 , $516.20 , $655.45 , $636.72 , $754.60 , $754.60 , $774.03 , $774.03 , $624.24 , $769.05 , $- , $- ," $2,587.86 ", $425.60
54220,6010220407,Hospital Chargemaster,Treatment of penis lesion,Outpatient,Outpatient Default Percent / Case Rate,981, $208.00 , $114.40 ," $1,236.00 ", $318.13 , $145.60 , $81.12 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $844.48 , $822.61 , $334.03 , $324.49 , $770.00 , $770.00 , $770.00 , $770.00 , $318.13 , $72.80 , $- , $- ," $1,236.00 ", $145.60
46700,6010220389,Hospital Chargemaster,Repair of anal stricture,Outpatient,Outpatient Default Percent / Case Rate,981," $1,861.00 "," $1,023.55 "," $2,060.00 "," $2,920.64 "," $1,302.70 ", $725.79 ," $5,107.19 "," $3,505.36 "," $3,486.67 "," $2,920.64 "," $2,920.64 "," $1,294.72 "," $1,261.20 "," $3,066.68 "," $2,979.06 ", $753.00 , $753.00 , $753.00 , $753.00 ," $2,920.64 ", $651.35 , $- , $- ," $5,107.19 "," $1,302.70 "
53600,6010220406,Hospital Chargemaster,Dilate urethra stricture,Outpatient,Outpatient Default Percent / Case Rate,981, $208.00 , $114.40 ," $1,236.00 ", $318.13 , $145.60 , $81.12 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $740.30 , $740.30 , $740.30 , $740.30 , $318.13 , $72.80 , $- , $- ," $1,236.00 ", $145.60
67700,6010220446,Hospital Chargemaster,Drainage of eyelid abscess,Outpatient,Outpatient Default Percent / Case Rate,981, $335.00 , $184.25 ," $1,236.00 ", $312.73 , $234.50 , $130.65 , $620.23 , $425.70 , $423.43 , $312.73 , $312.73 , $105.28 , $102.55 , $328.37 , $318.99 , $740.30 , $740.30 , $740.30 , $740.30 , $312.73 , $117.25 , $- , $- ," $1,236.00 ", $234.50
55000,6010220412,Hospital Chargemaster,Drainage of hydrocele,Outpatient,Outpatient Default Percent / Case Rate,981, $275.00 , $151.25 , $226.60 , $743.95 , $192.50 , $107.25 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $96.25 , $- , $- ," $1,267.38 ", $192.50
49900,6010220394,Hospital Chargemaster,Repair of abdominal wall,Outpatient,Outpatient Default Percent / Case Rate,981," $2,366.00 "," $1,301.30 "," $1,949.58 ", See APC Packaged Rates ," $1,656.20 ", $922.74 ," $2,679.96 "," $1,839.41 "," $1,829.60 ", See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $740.30 , $740.30 , $740.30 , $740.30 , See APC Packaged Rates , $828.10 , $- , $- ," $2,679.96 "," $1,656.20 "
51045,6010220395,Hospital Chargemaster,Incise bladder/drain ureter,Outpatient,Outpatient Default Percent / Case Rate,981," $1,547.00 ", $850.85 ," $2,591.48 "," $2,140.58 "," $1,082.90 ", $603.33 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 "," $1,599.36 "," $1,557.95 "," $2,247.61 "," $2,183.39 ", $699.00 , $699.00 , $699.00 , $699.00 ," $2,140.58 ", $541.45 , $- , $- ," $3,805.91 "," $1,082.90 "
69420,6010220460,Hospital Chargemaster,Incision of eardrum,Outpatient,Outpatient Default Percent / Case Rate,981, $315.00 , $173.25 ," $2,060.00 ", $252.93 , $220.50 , $122.85 , $450.95 , $309.51 , $307.86 , $252.93 , $252.93 , $844.48 , $822.61 , $265.57 , $257.99 , $685.00 , $685.00 , $685.00 , $685.00 , $252.93 , $110.25 , $- , $- ," $2,060.00 ", $220.50
43247,6010220367,Hospital Chargemaster,Egd remove foreign body,Outpatient,Outpatient Default Percent / Case Rate,981, $619.00 , $340.45 ," $1,442.00 ", $967.36 , $433.30 , $241.41 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 ," $1,133.44 "," $1,104.09 "," $1,015.72 ", $986.70 , $619.00 , $619.00 , $619.00 , $619.00 , $967.36 , $216.65 , $- , $- ," $1,665.99 ", $433.30
40830,6010220347,Hospital Chargemaster,Repair mouth laceration,Outpatient,Outpatient Default Percent / Case Rate,981, $493.00 , $271.15 , $406.23 , $252.93 , $345.10 , $192.27 , $450.95 , $309.51 , $307.86 , $252.93 , $252.93 , $844.48 , $822.61 , $265.57 , $257.99 , $590.00 , $590.00 , $590.00 , $590.00 , $252.93 , $172.55 , $- , $- , $844.48 , $345.10
45999,6010220379,Hospital Chargemaster,Rectum surgery procedure,Outpatient,Outpatient Default Percent / Case Rate,981, $495.00 , $272.25 , $407.88 , $948.73 , $346.50 , $193.05 , $477.63 , $479.70 , $254.93 , $948.73 , $948.73 , $332.15 , $332.15 , $996.17 , $967.71 , $590.00 , $590.00 , $590.00 , $590.00 , $948.73 , $173.25 , $- , $- , $996.17 , $346.50
37195,6010220337,Hospital Chargemaster,Thrombolytic therapy stroke,Outpatient,Outpatient Default Percent / Case Rate,981, $200.00 , $110.00 , $164.80 , $381.19 , $140.00 , $78.00 , $630.87 , $433.00 , $430.69 , $381.19 , $381.19 , $134.20 , $134.20 , $400.25 , $388.81 , $588.00 , $588.00 , $588.00 , $588.00 , $381.19 , $70.00 , $- , $- , $630.87 , $140.00
99284,6010220004,Hospital Chargemaster,ED Visit High/Urgent Severity,Outpatient,Outpatient Default Percent / Case Rate,981, $412.00 , $226.60 , $908.46 , $434.89 , $288.40 , $160.68 ," $1,775.33 "," $1,098.25 "," $1,060.75 ", $434.89 , $434.89 , $395.46 , $383.46 , $456.64 , $443.59 , $572.41 , $572.41 , $587.15 , $587.15 , $434.89 , $769.05 , $- , $- ," $1,775.33 ", $288.40
65235,6010220445,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,981," $2,034.00 "," $1,118.70 "," $1,442.00 "," $2,482.64 "," $1,423.80 ", $793.26 ," $4,194.02 "," $2,878.59 "," $2,863.25 "," $2,482.64 "," $2,482.64 "," $1,133.44 "," $1,104.09 "," $2,606.77 "," $2,532.29 ", $544.00 , $544.00 , $544.00 , $544.00 ," $2,482.64 ", $711.90 , $- , $- ," $4,194.02 "," $1,423.80 "
37212,6010220338,Hospital Chargemaster,Thrombolytic venous therapy,Outpatient,Outpatient Default Percent / Case Rate,981, $400.00 , $220.00 ," $1,236.00 "," $3,422.34 ", $280.00 , $156.00 ," $5,778.66 "," $3,966.22 "," $3,945.07 "," $3,422.34 "," $3,422.34 ", $844.48 , $822.61 ," $3,593.46 "," $3,490.79 ", $400.00 , $400.00 , $400.00 , $400.00 ," $3,422.34 ", $140.00 , $- , $- ," $5,778.66 ", $280.00
99283,6010220003,Hospital Chargemaster,ED Visit Moderate Severity,Outpatient,Outpatient Default Percent / Case Rate,981, $225.00 , $123.75 , $603.58 , $276.67 , $157.50 , $87.75 ," $1,098.54 ", $679.58 , $656.37 , $276.67 , $276.67 , $288.99 , $280.22 , $290.50 , $282.20 , $397.00 , $397.00 , $397.00 , $397.00 , $276.67 , $489.50 , $- , $- ," $1,098.54 ", $157.50
51700,6010220397,Hospital Chargemaster,Irrigation of bladder,Outpatient,Outpatient Default Percent / Case Rate,981, $144.00 , $79.20 ," $1,236.00 ", $318.13 , $100.80 , $56.16 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $386.01 , $386.01 , $395.95 , $395.95 , $318.13 , $50.40 , $- , $- ," $1,236.00 ", $100.80
54235,6010220408,Hospital Chargemaster,Penile injection,Outpatient,Outpatient Default Percent / Case Rate,981, $115.00 , $63.25 , $94.76 , $318.13 , $80.50 , $44.85 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $179.62 , $174.17 , $334.03 , $324.49 , $386.01 , $386.01 , $395.95 , $395.95 , $318.13 , $40.25 , $- , $- , $506.26 , $80.50
37780,6010220340,Hospital Chargemaster,Revision of leg vein,Outpatient,Outpatient Default Percent / Case Rate,981, $824.00 , $453.20 ," $2,060.00 "," $3,422.34 ", $576.80 , $321.36 ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $3,422.34 "," $3,422.34 "," $1,294.72 "," $1,261.20 "," $3,593.46 "," $3,490.79 ", $373.00 , $373.00 , $373.00 , $373.00 ," $3,422.34 ", $288.40 , $- , $- ," $3,593.46 ", $576.80
42000,6010220356,Hospital Chargemaster,Drainage mouth roof lesion,Outpatient,Outpatient Default Percent / Case Rate,981, $125.00 , $68.75 ," $1,442.00 ", $252.93 , $87.50 , $48.75 , $450.95 , $309.51 , $307.86 , $252.93 , $252.93 ," $1,133.44 "," $1,104.09 ", $265.57 , $257.99 , $363.00 , $363.00 , $363.00 , $363.00 , $252.93 , $43.75 , $- , $- ," $1,442.00 ", $87.50
67938,6010220449,Hospital Chargemaster,Remove eyelid foreign body,Outpatient,Outpatient Default Percent / Case Rate,981, $338.00 , $185.90 ," $1,236.00 ", $312.73 , $236.60 , $131.82 , $620.23 , $425.70 , $423.43 , $312.73 , $312.73 , $105.28 , $102.55 , $328.37 , $318.99 , $343.81 , $343.81 , $343.81 , $343.81 , $312.73 , $118.30 , $- , $- ," $1,236.00 ", $236.60
69000,6010220450,Hospital Chargemaster,Drain external ear lesion,Outpatient,Outpatient Default Percent / Case Rate,981, $360.00 , $198.00 ," $1,236.00 ", $743.95 , $252.00 , $140.40 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $126.00 , $- , $- ," $1,267.38 ", $252.00
40800,6010220344,Hospital Chargemaster,Drainage of mouth lesion,Outpatient,Outpatient Default Percent / Case Rate,981, $399.00 , $219.45 , $328.78 , $743.95 , $279.30 , $155.61 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $343.81 , $343.81 , $343.81 , $343.81 , $743.95 , $139.65 , $- , $- ," $1,267.38 ", $279.30
43752,6010220369,Hospital Chargemaster,Nasal/orogastric w/tube plmt,Outpatient,Outpatient Default Percent / Case Rate,981, $334.00 , $183.70 ," $1,442.00 ", $324.46 , $233.80 , $130.26 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $334.00 , $334.00 , $334.00 , $334.00 , $324.46 , $116.90 , $- , $- ," $1,442.00 ", $233.80
56405,6010220415,Hospital Chargemaster,I & d of vulva/perineum,Outpatient,Outpatient Default Percent / Case Rate,981, $331.00 , $182.05 ," $1,442.00 ", $337.17 , $231.70 , $129.09 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 ," $1,133.44 "," $1,104.09 ", $354.03 , $343.92 , $331.00 , $331.00 , $331.00 , $331.00 , $337.17 , $115.85 , $- , $- ," $1,442.00 ", $231.70
62273,6010220429,Hospital Chargemaster,Inject epidural patch,Outpatient,Outpatient Default Percent / Case Rate,981, $330.00 , $181.50 ," $1,236.00 ", $759.14 , $231.00 , $128.70 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $844.48 , $822.61 , $797.10 , $774.33 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $759.14 , $115.50 , $- , $- ," $1,309.97 ", $231.00
46083,6010220383,Hospital Chargemaster,Incise external hemorrhoid,Outpatient,Outpatient Default Percent / Case Rate,981, $317.00 , $174.35 ," $1,236.00 ", $318.13 , $221.90 , $123.63 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $317.00 , $317.00 , $317.00 , $317.00 , $318.13 , $110.95 , $- , $- ," $1,236.00 ", $221.90
46050,6010220382,Hospital Chargemaster,Incision of anal abscess,Outpatient,Outpatient Default Percent / Case Rate,981, $279.00 , $153.45 ," $1,236.00 ", $948.73 , $195.30 , $108.81 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $844.48 , $822.61 , $996.17 , $967.71 , $279.00 , $279.00 , $279.00 , $279.00 , $948.73 , $97.65 , $- , $- ," $1,629.53 ", $195.30
43753,6010220370,Hospital Chargemaster,Tx gastro intub w/asp,Outpatient,Outpatient Default Percent / Case Rate,981, $43.00 , $23.65 ," $1,236.00 ", $316.40 , $30.10 , $16.77 , $551.96 , $378.84 , $376.82 , $316.40 , $316.40 , $105.28 , $102.55 , $332.22 , $322.72 , $271.00 , $271.00 , $271.00 , $271.00 , $316.40 , $15.05 , $- , $- ," $1,236.00 ", $30.10
43754,6010220371,Hospital Chargemaster,Dx gastr intub w/asp spec,Outpatient,Outpatient Default Percent / Case Rate,981, $271.00 , $149.05 ," $1,236.00 ", $316.40 , $189.70 , $105.69 , $551.96 , $378.84 , $376.82 , $316.40 , $316.40 , $105.28 , $102.55 , $332.22 , $322.72 , $271.00 , $271.00 , $271.00 , $271.00 , $316.40 , $94.85 , $- , $- ," $1,236.00 ", $189.70
69090,6010220453,Hospital Chargemaster,Pierce earlobes,Outpatient,Outpatient Default Percent / Case Rate,981, $83.00 , $45.65 , $68.39 , See APC Packaged Rates , $58.10 , $32.37 , $89.74 , $61.59 , $61.26 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $271.00 , $271.00 , $271.00 , $271.00 , See APC Packaged Rates , $29.05 , $- , $- , $271.00 , $58.10
65222,6010220444,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,981, $171.00 , $94.05 , $140.90 , $134.80 , $119.70 , $66.69 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $271.00 , $271.00 , $271.00 , $271.00 , $134.80 , $59.85 , $- , $- , $271.00 , $119.70
69200,6010220456,Hospital Chargemaster,Clear outer ear canal,Outpatient,Outpatient Default Percent / Case Rate,981, $172.00 , $94.60 , $141.73 , $134.80 , $120.40 , $67.08 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $271.00 , $271.00 , $271.00 , $271.00 , $134.80 , $60.20 , $- , $- , $271.00 , $120.40
41599,6010220353,Hospital Chargemaster,Tongue and mouth surgery,Outpatient,Outpatient Default Percent / Case Rate,981, $275.00 , $151.25 , $226.60 , $252.93 , $192.50 , $107.25 , $265.35 , $266.50 , $141.63 , $252.93 , $252.93 , $184.53 , $184.53 , $265.57 , $257.99 , $271.00 , $271.00 , $271.00 , $271.00 , $252.93 , $96.25 , $- , $- , $271.00 , $192.50
99282,6010220002,Hospital Chargemaster,ED Visit Low/Moder Severity,Outpatient,Outpatient Default Percent / Case Rate,981, $150.00 , $82.50 , $374.92 , $157.03 , $105.00 , $58.50 , $630.39 , $389.97 , $376.65 , $157.03 , $157.03 , $197.73 , $191.73 , $164.88 , $160.17 , $267.00 , $267.00 , $267.00 , $267.00 , $157.03 , $349.16 , $- , $- , $630.39 , $105.00
51720,6010220403,Hospital Chargemaster,Treatment of bladder lesion,Outpatient,Outpatient Default Percent / Case Rate,981, $264.00 , $145.20 , $217.54 , $318.13 , $184.80 , $102.96 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $386.01 , $386.01 , $395.95 , $395.95 , $318.13 , $92.40 , $- , $- , $506.26 , $184.80
62270,6010220427,Hospital Chargemaster,Spinal fluid tap diagnostic,Outpatient,Outpatient Default Percent / Case Rate,981, $237.00 , $130.35 ," $1,236.00 ", $759.14 , $165.90 , $92.43 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $177.96 , $172.56 , $797.10 , $774.33 , $237.00 , $237.00 , $237.00 , $237.00 , $759.14 , $82.95 , $- , $- ," $1,309.97 ", $165.90
64405,6010220432,Hospital Chargemaster,N block inj occipital,Outpatient,Outpatient Default Percent / Case Rate,981, $229.00 , $125.95 ," $1,236.00 ", $312.35 , $160.30 , $89.31 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $185.94 , $180.29 , $327.96 , $318.59 , $740.30 , $740.30 , $740.30 , $740.30 , $312.35 , $80.15 , $- , $- ," $1,236.00 ", $160.30
57500,6010220421,Hospital Chargemaster,Biopsy of cervix,Outpatient,Outpatient Default Percent / Case Rate,981, $228.00 , $125.40 ," $1,236.00 ", $757.92 , $159.60 , $88.92 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $105.28 , $102.55 , $795.81 , $773.07 , $228.00 , $228.00 , $228.00 , $228.00 , $757.92 , $79.80 , $- , $- ," $1,236.00 ", $159.60
51703,6010220400,Hospital Chargemaster,Insert bladder cath complex,Outpatient,Outpatient Default Percent / Case Rate,981, $265.00 , $145.75 ," $1,236.00 ", $166.91 , $185.50 , $103.35 , $297.41 , $204.13 , $203.04 , $166.91 , $166.91 , $196.14 , $190.19 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $92.75 , $- , $- ," $1,236.00 ", $185.50
51705,6010220401,Hospital Chargemaster,Change of bladder tube,Outpatient,Outpatient Default Percent / Case Rate,981, $221.00 , $121.55 ," $1,236.00 ", $318.13 , $154.70 , $86.19 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $221.00 , $221.00 , $221.00 , $221.00 , $318.13 , $77.35 , $- , $- ," $1,236.00 ", $154.70
46320,6010220384,Hospital Chargemaster,Removal of hemorrhoid clot,Outpatient,Outpatient Default Percent / Case Rate,981, $318.00 , $174.90 ," $1,236.00 "," $1,239.71 ", $222.60 , $124.02 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 ", $105.28 , $102.55 ," $1,301.70 "," $1,264.51 ", $212.00 , $212.00 , $212.00 , $212.00 ," $1,239.71 ", $111.30 , $- , $- ," $2,143.42 ", $222.60
64450,6010220437,Hospital Chargemaster,N block other peripheral,Outpatient,Outpatient Default Percent / Case Rate,981, $208.00 , $114.40 ," $1,236.00 ", $759.14 , $145.60 , $81.12 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $168.83 , $163.71 , $797.10 , $774.33 , $208.00 , $208.00 , $208.00 , $208.00 , $759.14 , $72.80 , $- , $- ," $1,309.97 ", $145.60
58301,6010220423,Hospital Chargemaster,Remove intrauterine device,Outpatient,Outpatient Default Percent / Case Rate,981, $203.00 , $111.65 ," $1,236.00 ", $337.17 , $142.10 , $79.17 , $362.99 , $249.14 , $247.81 , $337.17 , $337.17 , $164.50 , $159.51 , $354.03 , $343.92 , $203.00 , $203.00 , $203.00 , $203.00 , $337.17 , $71.05 , $- , $- ," $1,236.00 ", $142.10
64400,6010220430,Hospital Chargemaster,N block inj trigeminal,Outpatient,Outpatient Default Percent / Case Rate,981, $194.00 , $106.70 ," $1,236.00 ", $312.35 , $135.80 , $75.66 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $157.25 , $152.48 , $327.96 , $318.59 , $194.00 , $194.00 , $194.00 , $194.00 , $312.35 , $67.90 , $- , $- ," $1,236.00 ", $135.80
42809,6010220360,Hospital Chargemaster,Remove pharynx foreign body,Outpatient,Outpatient Default Percent / Case Rate,981, $168.00 , $92.40 ," $1,236.00 ", $324.46 , $117.60 , $65.52 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $185.14 , $185.14 , $185.14 , $185.14 , $324.46 , $58.80 , $- , $- ," $1,236.00 ", $117.60
69220,6010220459,Hospital Chargemaster,Clean out mastoid cavity,Outpatient,Outpatient Default Percent / Case Rate,981, $192.00 , $105.60 , $158.21 , $214.68 , $134.40 , $74.88 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $185.14 , $185.14 , $185.14 , $185.14 , $214.68 , $67.20 , $- , $- , $386.01 , $134.40
43762,6010220372,Hospital Chargemaster,Rplc gtube no revj trc,Outpatient,Outpatient Default Percent / Case Rate,981, $174.00 , $95.70 ," $1,236.00 ", $318.13 , $121.80 , $67.86 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 ," $1,133.44 "," $1,104.09 ", $334.03 , $324.49 , $174.00 , $174.00 , $174.00 , $174.00 , $318.13 , $60.90 , $- , $- ," $1,236.00 ", $121.80
99281,6010220001,Hospital Chargemaster,ED Visit Limited/Minor Prob,Outpatient,Outpatient Default Percent / Case Rate,981, $75.00 , $41.25 , $225.57 , $86.72 , $52.50 , $29.25 , $343.52 , $212.51 , $205.25 , $86.72 , $86.72 , $76.05 , $73.74 , $91.05 , $88.45 , $163.00 , $163.00 , $163.00 , $163.00 , $86.72 , $349.16 , $- , $- , $349.16 , $52.50
65205,6010220441,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,981, $129.00 , $70.95 , $106.30 , $134.80 , $90.30 , $50.31 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $129.00 , $129.00 , $129.00 , $129.00 , $134.80 , $45.15 , $- , $- , $232.95 , $90.30
65220,6010220443,Hospital Chargemaster,Remove foreign body from eye,Outpatient,Outpatient Default Percent / Case Rate,981, $124.00 , $68.20 , $102.18 , $324.46 , $86.80 , $48.36 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $124.00 , $124.00 , $124.00 , $124.00 , $324.46 , $43.40 , $- , $- , $761.64 , $86.80
46600,6010220386,Hospital Chargemaster,Diagnostic anoscopy spx,Outpatient,Outpatient Default Percent / Case Rate,981, $116.00 , $63.80 ," $1,236.00 ", $134.80 , $81.20 , $45.24 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $116.00 , $116.00 , $116.00 , $116.00 , $134.80 , $40.60 , $- , $- ," $1,236.00 ", $81.20
64447,6010220436,Hospital Chargemaster,N block inj fem single,Outpatient,Outpatient Default Percent / Case Rate,981, $101.00 , $55.55 , $83.22 , $759.14 , $70.70 , $39.39 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $164.53 , $159.53 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $35.35 , $- , $- ," $1,309.97 ", $70.70
51702,6010220399,Hospital Chargemaster,Insert temp bladder cath,Outpatient,Outpatient Default Percent / Case Rate,981, $98.00 , $53.90 ," $1,236.00 ", $134.80 , $68.60 , $38.22 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $73.01 , $70.79 , $141.54 , $137.50 , $98.00 , $98.00 , $98.00 , $98.00 , $134.80 , $34.30 , $- , $- ," $1,236.00 ", $68.60
69210,6010220458,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,981, $97.00 , $53.35 ," $1,236.00 ", $66.55 , $67.90 , $37.83 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $65.09 , $65.09 , $69.87 , $67.88 , $97.00 , $97.00 , $97.00 , $97.00 , $66.55 , $33.95 , $- , $- ," $1,236.00 ", $67.90
49082,6010220391,Hospital Chargemaster,Abd paracentesis,Outpatient,Outpatient Default Percent / Case Rate,981, $93.00 , $51.15 ," $1,442.00 ", $967.36 , $65.10 , $36.27 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $93.00 , $93.00 , $93.00 , $93.00 , $967.36 , $32.55 , $- , $- ," $1,665.99 ", $65.10
49083,6010220392,Hospital Chargemaster,Abd paracentesis w/imaging,Outpatient,Outpatient Default Percent / Case Rate,981, $140.00 , $77.00 ," $1,442.00 ", $967.36 , $98.00 , $54.60 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $93.00 , $93.00 , $93.00 , $93.00 , $967.36 , $49.00 , $- , $- ," $1,665.99 ", $98.00
51701,6010220398,Hospital Chargemaster,Insert bladder catheter,Outpatient,Outpatient Default Percent / Case Rate,981, $88.00 , $48.40 ," $1,236.00 ", $134.80 , $61.60 , $34.32 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $66.83 , $64.80 , $141.54 , $137.50 , $88.00 , $88.00 , $88.00 , $88.00 , $134.80 , $30.80 , $- , $- ," $1,236.00 ", $61.60
45005,6010220374,Hospital Chargemaster,Drainage of rectal abscess,Outpatient,Outpatient Default Percent / Case Rate,981, $459.00 , $252.45 ," $1,442.00 "," $1,239.71 ", $321.30 , $179.01 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,133.44 "," $1,104.09 "," $1,301.70 "," $1,264.51 ", $76.00 , $76.00 , $76.00 , $76.00 ," $1,239.71 ", $160.65 , $- , $- ," $2,143.42 ", $321.30
69209,6010220457,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,981, $25.00 , $13.75 ," $1,236.00 ", $66.55 , $17.50 , $9.75 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $16.78 , $16.78 , $69.87 , $67.88 , $25.00 , $25.00 , $25.00 , $25.00 , $66.55 , $8.75 , $- , $- ," $1,236.00 ", $17.50
11732,6010220038,Hospital Chargemaster,Remove nail plate add-on,Outpatient,Outpatient Default Percent / Case Rate,981, $150.00 , $82.50 ," $1,236.00 ", See APC Packaged Rates , $105.00 , $58.50 , $56.49 , $38.77 , $38.57 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $139.50 , $139.50 , $139.50 , $139.50 , See APC Packaged Rates , $52.50 , $- , $- ," $1,236.00 ", $105.00
11045,6010220025,Hospital Chargemaster,Deb subq tissue add-on,Outpatient,Outpatient Default Percent / Case Rate,981, $54.00 , $29.70 ," $1,236.00 ", See APC Packaged Rates , $37.80 , $21.06 , $84.75 , $58.17 , $57.86 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $50.22 , $50.22 , $50.22 , $50.22 , See APC Packaged Rates , $18.90 , $- , $- ," $1,236.00 ", $37.80
11046,6010220026,Hospital Chargemaster,Deb musc/fascia add-on,Outpatient,Outpatient Default Percent / Case Rate,981, $286.00 , $157.30 ," $1,236.00 ", See APC Packaged Rates , $200.20 , $111.54 , $179.86 , $123.45 , $122.79 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $265.98 , $265.98 , $265.98 , $265.98 , See APC Packaged Rates , $100.10 , $- , $- ," $1,236.00 ", $200.20
13102,6010220080,Hospital Chargemaster,Cmplx rpr trunk addl 5cm/<,Outpatient,Outpatient Default Percent / Case Rate,981, $498.00 , $273.90 ," $1,236.00 ", See APC Packaged Rates , $348.60 , $194.22 , $241.38 , $165.67 , $164.79 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $463.14 , $463.14 , $463.14 , $463.14 , See APC Packaged Rates , $174.30 , $- , $- ," $1,236.00 ", $348.60
13122,6010220083,Hospital Chargemaster,Cmplx rpr s/a/l addl 5 cm/>,Outpatient,Outpatient Default Percent / Case Rate,981, $254.00 , $139.70 ," $1,236.00 ", See APC Packaged Rates , $177.80 , $99.06 , $278.51 , $191.16 , $190.14 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $236.22 , $236.22 , $236.22 , $236.22 , See APC Packaged Rates , $88.90 , $- , $- ," $1,236.00 ", $177.80
11047,6010220027,Hospital Chargemaster,Deb bone add-on,Outpatient,Outpatient Default Percent / Case Rate,981, $286.00 , $157.30 ," $1,236.00 ", See APC Packaged Rates , $200.20 , $111.54 , $318.48 , $218.59 , $217.42 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $265.98 , $265.98 , $265.98 , $265.98 , See APC Packaged Rates , $100.10 , $- , $- ," $1,236.00 ", $200.20
13133,6010220086,Hospital Chargemaster,Cmplx rpr f/c/c/m/n/ax/g/h/f,Outpatient,Outpatient Default Percent / Case Rate,981, $398.00 , $218.90 ," $1,236.00 ", See APC Packaged Rates , $278.60 , $155.22 , $425.53 , $292.06 , $290.51 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates , $370.14 , $370.14 , $370.14 , $370.14 , See APC Packaged Rates , $139.30 , $- , $- ," $1,236.00 ", $278.60
13153,6010220089,Hospital Chargemaster,Cmplx rpr e/n/e/l addl 5cm/<,Outpatient,Outpatient Default Percent / Case Rate,981, $429.00 , $235.95 ," $2,060.00 ", See APC Packaged Rates , $300.30 , $167.31 , $458.99 , $315.03 , $313.35 , See APC Packaged Rates , See APC Packaged Rates , $844.48 , $822.61 , See APC Packaged Rates , See APC Packaged Rates , $398.97 , $398.97 , $398.97 , $398.97 , See APC Packaged Rates , $150.15 , $- , $- ," $2,060.00 ", $300.30
36000,6010220319,Hospital Chargemaster,Place needle in vein,Outpatient,Outpatient Default Percent / Case Rate,981, $30.00 , $16.50 , $24.72 , See APC Packaged Rates , $21.00 , $11.70 , $30.17 , $20.71 , $20.60 , See APC Packaged Rates , See APC Packaged Rates , $20.13 , $20.13 , See APC Packaged Rates , See APC Packaged Rates , $27.90 , $27.90 , $27.90 , $27.90 , See APC Packaged Rates , $10.50 , $- , $- , $30.17 , $21.00
36410,6010220323,Hospital Chargemaster,Non-routine bl draw 3/> yrs,Outpatient,Outpatient Default Percent / Case Rate,981, $9.65 , $5.31 , $7.95 , See APC Packaged Rates , $6.76 , $3.76 , $30.17 , $20.71 , $20.60 , See APC Packaged Rates , See APC Packaged Rates , $21.29 , $20.65 , See APC Packaged Rates , See APC Packaged Rates , $8.97 , $8.97 , $8.97 , $8.97 , See APC Packaged Rates , $3.38 , $- , $- , $30.17 , $6.76
36400,6010220321,Hospital Chargemaster,Bl draw < 3 yrs fem/jugular,Outpatient,Outpatient Default Percent / Case Rate,981, $57.00 , $31.35 , $46.97 , See APC Packaged Rates , $39.90 , $22.23 , $59.07 , $40.55 , $40.33 , See APC Packaged Rates , See APC Packaged Rates , $44.34 , $43.00 , See APC Packaged Rates , See APC Packaged Rates , $53.01 , $53.01 , $53.01 , $53.01 , See APC Packaged Rates , $19.95 , $- , $- , $59.07 , $39.90
99292,6010220007,Hospital Chargemaster,Critical Care Addl 30 Min,Outpatient,Outpatient Default Percent / Case Rate,981, $329.00 , $180.95 , $271.10 , See APC Packaged Rates , $230.30 , $128.31 , $788.62 , $487.85 , $471.20 , See APC Packaged Rates , See APC Packaged Rates , $250.80 , $243.19 , See APC Packaged Rates , See APC Packaged Rates , $305.97 , $305.97 , $305.97 , $305.97 , See APC Packaged Rates , $131.60 , $- , $- , $788.62 , $230.30
99152,5012120003,Hospital Chargemaster,Mod Sed Same Phys/Qhp 5/>Yrs,Outpatient,Outpatient Default Percent / Case Rate,981, $45.00 , $24.75 , $37.08 , See APC Packaged Rates , $31.50 , $17.55 , $43.69 , $34.15 , $37.40 , See APC Packaged Rates , See APC Packaged Rates , $30.20 , $30.20 , See APC Packaged Rates , See APC Packaged Rates , $41.85 , $41.85 , $41.85 , $41.85 , See APC Packaged Rates , $15.75 , $- , $- , $43.69 , $31.50
23570,6010220132,Hospital Chargemaster,Treat shoulder blade fx,Outpatient,Outpatient Default Percent / Case Rate,981, $324.00 , $178.20 ," $1,236.00 ", $246.41 , $226.80 , $126.36 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 , $298.00 , $298.00 , $298.00 , $298.00 , $246.41 , $113.40 , $- , $- ," $1,236.00 ", $226.80
24605,6010220154,Hospital Chargemaster,Treat elbow dislocation,Outpatient,Outpatient Default Percent / Case Rate,981, $562.00 , $309.10 ," $1,442.00 "," $1,665.16 ", $393.40 , $219.18 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 "," $1,133.44 "," $1,104.09 "," $1,748.42 "," $1,698.46 "," $2,345.00 "," $2,345.00 "," $2,345.00 "," $2,345.00 "," $1,665.16 ", $196.70 , $- , $- ," $2,873.10 ", $393.40
25650,6010220176,Hospital Chargemaster,Treat wrist bone fracture,Outpatient,Outpatient Default Percent / Case Rate,981, $489.00 , $268.95 , $402.94 , $246.41 , $342.30 , $190.71 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $171.15 , $- , $- , $492.41 , $342.30
28600,6010220261,Hospital Chargemaster,Treat foot dislocation,Outpatient,Outpatient Default Percent / Case Rate,981, $246.00 , $135.30 ," $1,236.00 ", $246.41 , $172.20 , $95.94 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $86.10 , $- , $- ," $1,236.00 ", $172.20
31505,6010220302,Hospital Chargemaster,Diagnostic laryngoscopy,Outpatient,Outpatient Default Percent / Case Rate,981, $63.00 , $34.65 , $51.91 , $196.80 , $44.10 , $24.57 , $358.71 , $246.20 , $244.89 , $196.80 , $196.80 , $105.28 , $102.55 , $206.64 , $200.73 , $235.00 , $235.00 , $235.00 , $235.00 , $196.80 , $22.05 , $- , $- , $358.71 , $44.10
36620,6010220335,Hospital Chargemaster,Insertion catheter artery,Outpatient,Outpatient Default Percent / Case Rate,981, $57.00 , $31.35 ," $1,236.00 ", See APC Packaged Rates , $39.90 , $22.23 , $141.01 , $96.78 , $96.27 , See APC Packaged Rates , See APC Packaged Rates , $129.47 , $125.54 , See APC Packaged Rates , See APC Packaged Rates , $53.01 , $53.01 , $53.01 , $53.01 , See APC Packaged Rates , $19.95 , $- , $- ," $1,236.00 ", $39.90
G0168,6010220462,Hospital Chargemaster,Wound Closure by Adhesive,Outpatient,Outpatient Default Percent / Case Rate,981, $80.00 , $44.00 , $65.92 , See APC Packaged Rates , $56.00 , $31.20 , $77.19 , $77.53 , $41.20 , See APC Packaged Rates , See APC Packaged Rates , $53.68 , $53.68 , See APC Packaged Rates , See APC Packaged Rates , $74.40 , $74.40 , $74.40 , $74.40 , See APC Packaged Rates , $28.00 , $- , $- , $77.53 , $56.00
92950,6010220463,Hospital Chargemaster,Heart/Lung Resuscitation Cpr,Outpatient,Outpatient Default Percent / Case Rate,981, $890.00 , $489.50 , $733.36 , $316.40 , $623.00 , $347.10 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $684.45 , $663.68 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $311.50 , $- , $- , $733.36 , $623.00
92960,6010220464,Hospital Chargemaster,Cardioversion-ER,Outpatient,Outpatient Default Percent / Case Rate,981, $888.00 , $488.40 , $731.71 , $671.60 , $621.60 , $346.32 ," $1,292.64 "," $1,010.27 "," $1,106.60 ", $671.60 , $671.60 , $323.29 , $313.49 , $705.18 , $685.03 , $867.68 , $867.68 , $890.03 , $890.03 , $671.60 , $310.80 , $- , $- ," $1,292.64 ", $621.60
23620,6010220465,Hospital Chargemaster,Treat Humerus Fracture,Outpatient,Outpatient Default Percent / Case Rate,981, $306.00 , $168.30 ," $1,236.00 ", $246.41 , $214.20 , $119.34 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 , $368.00 , $368.00 , $368.00 , $368.00 , $246.41 , $107.10 , $- , $- ," $1,236.00 ", $214.20
25630,6010220466,Hospital Chargemaster,Treat Wrist Bone Fracture,Outpatient,Outpatient Default Percent / Case Rate,981, $410.00 , $225.50 ," $1,236.00 ", $246.41 , $287.00 , $159.90 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $143.50 , $- , $- ," $1,236.00 ", $287.00
27246,6010220467,Hospital Chargemaster,Treat Thigh Fracture,Outpatient,Outpatient Default Percent / Case Rate,981, $637.00 , $350.35 ," $1,236.00 ", $246.41 , $445.90 , $248.43 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 , $365.00 , $365.00 , $365.00 , $365.00 , $246.41 , $222.95 , $- , $- ," $1,236.00 ", $445.90
27520,6010220468,Hospital Chargemaster,Treat Kneecap Fracture,Outpatient,Outpatient Default Percent / Case Rate,981, $430.00 , $236.50 ," $1,236.00 ", $246.41 , $301.00 , $167.70 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 , $459.00 , $459.00 , $459.00 , $459.00 , $246.41 , $150.50 , $- , $- ," $1,236.00 ", $301.00
27842,6010220469,Hospital Chargemaster,Treat Ankle Dislocation,Outpatient,Outpatient Default Percent / Case Rate,981, $- , $- ," $1,236.00 "," $1,665.16 ", $- , $- ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $- , $- , $- ," $2,873.10 ", $-
27767,6010220470,Hospital Chargemaster,Cltx post ankle fx,Outpatient,Outpatient Default Percent / Case Rate,981, $388.00 , $213.40 ," $1,236.00 ", $246.41 , $271.60 , $151.32 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $135.80 , $- , $- ," $1,236.00 ", $271.60
99151,6010229151,Hospital Chargemaster,Mod sed same phys/qhp <5 yrs,Outpatient,Outpatient Default Percent / Case Rate,981, $45.00 , $24.75 , $37.08 , See APC Packaged Rates , $31.50 , $17.55 , $90.02 , $70.36 , $77.07 , See APC Packaged Rates , See APC Packaged Rates , $30.20 , $30.20 , See APC Packaged Rates , See APC Packaged Rates , $41.85 , $41.85 , $41.85 , $41.85 , See APC Packaged Rates , $15.75 , $- , $- , $90.02 , $31.50
99153,6010229153,Hospital Chargemaster,Mod Sed Same Phys/Qhp Ea,Outpatient,Outpatient Default Percent / Case Rate,981, $45.00 , $24.75 , $37.08 , See APC Packaged Rates , $31.50 , $17.55 , $41.22 , $32.22 , $35.29 , See APC Packaged Rates , See APC Packaged Rates , $30.20 , $30.20 , See APC Packaged Rates , See APC Packaged Rates , $41.85 , $41.85 , $41.85 , $41.85 , See APC Packaged Rates , $15.75 , $- , $- , $41.85 , $31.50
99218,6010229218,Hospital Chargemaster,"ED Observation, Detail",Outpatient,Outpatient Default Percent / Case Rate,981, $608.00 , $334.40 , $500.99 , See APC Packaged Rates , $425.60 , $237.12 , $586.66 , $589.21 , $313.13 , See APC Packaged Rates , See APC Packaged Rates ," $1,621.00 "," $1,621.00 ", See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $425.60
99236,6010229236,Hospital Chargemaster,"ED Observ, Adm/Dis High Comp",Outpatient,Outpatient Default Percent / Case Rate,981, $608.00 , $334.40 , $500.99 , See APC Packaged Rates , $425.60 , $237.12 , $586.66 , $589.21 , $313.13 , See APC Packaged Rates , See APC Packaged Rates ," $1,621.00 "," $1,621.00 ", See APC Packaged Rates , See APC Packaged Rates , $608.00 , $608.00 , $608.00 , $608.00 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $425.60
11981,6500020121,Hospital Chargemaster,Insert drug implant device,Outpatient,Outpatient Default Percent / Case Rate,983, $96.00 , $52.80 ," $1,236.00 ", $134.80 , $67.20 , $37.44 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $306.00 , $306.00 , $306.00 , $306.00 , $134.80 , $33.60 , $- , $- ," $1,236.00 ", $67.20
29130,6500020215,Hospital Chargemaster,Application of finger splint,Outpatient,Outpatient Default Percent / Case Rate,983, $34.00 , $18.70 , $28.02 , $134.80 , $23.80 , $13.26 , $122.28 , $83.93 , $83.48 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $110.05 , $110.05 , $112.89 , $112.89 , $134.80 , $11.90 , $- , $- , $147.89 , $23.80
11740,6500020117,Hospital Chargemaster,Drain blood from under nail,Outpatient,Outpatient Default Percent / Case Rate,983, $38.00 , $20.90 ," $1,236.00 ", $134.80 , $26.60 , $14.82 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $96.00 , $96.00 , $96.00 , $96.00 , $134.80 , $13.30 , $- , $- ," $1,236.00 ", $26.60
58671,6500021792,Hospital Chargemaster,Laparoscopy Tubal Block,Outpatient,Outpatient Default Percent / Case Rate,983, $415.00 , $228.25 ," $2,060.00 "," $6,049.19 ", $290.50 , $161.85 ," $10,054.00 "," $6,900.63 "," $6,863.84 "," $6,049.19 "," $6,049.19 "," $1,599.36 "," $1,557.95 "," $6,351.65 "," $6,170.18 "," $4,315.01 "," $4,315.01 "," $4,315.01 "," $4,315.01 "," $6,049.19 ", $145.25 , $- , $- ," $10,054.00 ", $290.50
29580,6500020218,Hospital Chargemaster,Application of paste boot,Outpatient,Outpatient Default Percent / Case Rate,983, $41.00 , $22.55 , $33.78 , $168.90 , $28.70 , $15.99 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $147.89 , $143.40 , $177.35 , $172.28 , $215.42 , $215.42 , $220.97 , $220.97 , $168.90 , $14.35 , $- , $- , $294.51 , $28.70
29085,6500020214,Hospital Chargemaster,Apply hand/wrist cast,Outpatient,Outpatient Default Percent / Case Rate,983, $79.00 , $43.45 , $65.10 , $168.90 , $55.30 , $30.81 , $294.51 , $202.14 , $201.06 , $168.90 , $168.90 , $266.32 , $258.23 , $177.35 , $172.28 , $197.00 , $197.00 , $197.00 , $197.00 , $168.90 , $27.65 , $- , $- , $294.51 , $55.30
11102,6500020080,Hospital Chargemaster,Tangntl bx skin single les,Outpatient,Outpatient Default Percent / Case Rate,983, $65.00 , $35.75 ," $1,236.00 ", $214.68 , $45.50 , $25.35 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $343.81 , $343.81 , $343.81 , $343.81 , $214.68 , $22.75 , $- , $- ," $1,236.00 ", $45.50
12002,6500020123,Hospital Chargemaster,Rpr s/n/ax/gen/trnk2.6-7.5cm,Outpatient,Outpatient Default Percent / Case Rate,983, $68.00 , $37.40 , $56.03 , $214.68 , $47.60 , $26.52 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $342.00 , $342.00 , $342.00 , $342.00 , $214.68 , $23.80 , $- , $- , $386.01 , $47.60
12001,6500020122,Hospital Chargemaster,Rpr s/n/ax/gen/trnk 2.5cm/<,Outpatient,Outpatient Default Percent / Case Rate,983, $51.00 , $28.05 ," $1,236.00 ", $214.68 , $35.70 , $19.89 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $330.00 , $330.00 , $330.00 , $330.00 , $214.68 , $17.85 , $- , $- ," $1,236.00 ", $35.70
10060,6500020063,Hospital Chargemaster,Drainage of skin abscess,Outpatient,Outpatient Default Percent / Case Rate,983, $114.00 , $62.70 ," $1,236.00 ", $214.68 , $79.80 , $44.46 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $106.02 , $106.02 , $106.02 , $106.02 , $214.68 , $39.90 , $- , $- ," $1,236.00 ", $79.80
17111,6500020609,Hospital Chargemaster,Destruct Lesion 15 Or More,Outpatient,Outpatient Default Percent / Case Rate,983, $100.00 , $55.00 ," $1,236.00 ", $214.68 , $70.00 , $39.00 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $105.28 , $102.55 , $225.42 , $218.98 , $245.00 , $245.00 , $245.00 , $245.00 , $214.68 , $35.00 , $- , $- ," $1,236.00 ", $70.00
11055,6500020077,Hospital Chargemaster,Trim skin lesion,Outpatient,Outpatient Default Percent / Case Rate,983, $18.00 , $9.90 ," $1,236.00 ", $214.68 , $12.60 , $7.02 , $386.01 , $264.94 , $263.52 , $214.68 , $214.68 , $61.61 , $59.74 , $225.42 , $218.98 , $239.00 , $239.00 , $239.00 , $239.00 , $214.68 , $6.30 , $- , $- ," $1,236.00 ", $12.60
11200,6500020086,Hospital Chargemaster,Removal of skin tags ,Outpatient,Outpatient Default Percent / Case Rate,983, $156.00 , $85.80 ," $1,236.00 ", $312.35 , $109.20 , $60.84 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $89.51 , $86.79 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $54.60 , $- , $- ," $1,236.00 ", $109.20
20600,6500020184,Hospital Chargemaster,Drain/inj joint/bursa w/o us,Outpatient,Outpatient Default Percent / Case Rate,983, $41.00 , $22.55 ," $1,236.00 ", $312.35 , $28.70 , $15.99 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $96.34 , $93.41 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $14.35 , $- , $- ," $1,236.00 ", $28.70
20552,6500020182,Hospital Chargemaster,Inj trigger point 1/2 muscl,Outpatient,Outpatient Default Percent / Case Rate,983, $44.00 , $24.20 ," $1,236.00 ", $312.35 , $30.80 , $17.16 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $80.71 , $78.26 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $15.40 , $- , $- ," $1,236.00 ", $30.80
20611,6500020188,Hospital Chargemaster,Drain/inj joint/bursa w/us,Outpatient,Outpatient Default Percent / Case Rate,983, $262.00 , $144.10 ," $1,236.00 ", $312.35 , $183.40 , $102.18 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $243.66 , $243.66 , $243.66 , $243.66 , $312.35 , $91.70 , $- , $- ," $1,236.00 ", $183.40
11983,6500020559,Hospital Chargemaster,Remove/Insert Drug Implant,Outpatient,Outpatient Default Percent / Case Rate,983, $203.00 , $111.65 ," $1,236.00 ", $324.46 , $142.10 , $79.17 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $844.48 , $822.61 , $340.68 , $330.95 , $343.81 , $343.81 , $343.81 , $343.81 , $324.46 , $71.05 , $- , $- ," $1,236.00 ", $142.10
11602,6500020105,Hospital Chargemaster,Exc tr-ext mal+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,983, $191.00 , $105.05 ," $1,236.00 ", $413.21 , $133.70 , $74.49 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $444.00 , $444.00 , $444.00 , $444.00 , $413.21 , $66.85 , $- , $- ," $1,236.00 ", $133.70
10061,6500020064,Hospital Chargemaster,Drainage of skin abscess,Outpatient,Outpatient Default Percent / Case Rate,983, $209.00 , $114.95 ," $1,236.00 ", $413.21 , $146.30 , $81.51 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $194.37 , $194.37 , $194.37 , $194.37 , $413.21 , $73.15 , $- , $- ," $1,236.00 ", $146.30
11104,6500020082,Hospital Chargemaster,Punch bx skin single lesion,Outpatient,Outpatient Default Percent / Case Rate,983, $80.00 , $44.00 , $65.92 , $413.21 , $56.00 , $31.20 , $386.01 , $264.94 , $263.52 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $28.00 , $- , $- , $433.88 , $56.00
11401,6500020092,Hospital Chargemaster,Exc tr-ext b9+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,983, $121.00 , $66.55 ," $1,236.00 ", $413.21 , $84.70 , $47.19 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $341.00 , $341.00 , $341.00 , $341.00 , $413.21 , $42.35 , $- , $- ," $1,236.00 ", $84.70
10160,6500020068,Hospital Chargemaster,Puncture drainage of lesion,Outpatient,Outpatient Default Percent / Case Rate,983, $111.00 , $61.05 ," $1,236.00 ", $413.21 , $77.70 , $43.29 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $103.23 , $103.23 , $103.23 , $103.23 , $413.21 , $38.85 , $- , $- ," $1,236.00 ", $77.70
10120,6500020066,Hospital Chargemaster,Remove foreign body,Outpatient,Outpatient Default Percent / Case Rate,983, $121.00 , $66.55 ," $1,236.00 ", $413.21 , $84.70 , $47.19 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $112.53 , $112.53 , $112.53 , $112.53 , $413.21 , $42.35 , $- , $- ," $1,236.00 ", $84.70
11300,6500020088,Hospital Chargemaster,Shave skin lesion 0.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,983, $41.00 , $22.55 , $33.78 , $413.21 , $28.70 , $15.99 , $386.01 , $264.94 , $263.52 , $413.21 , $413.21 , $66.99 , $64.96 , $433.88 , $421.48 , $185.14 , $185.14 , $185.14 , $185.14 , $413.21 , $14.35 , $- , $- , $433.88 , $28.70
11042,6500020071,Hospital Chargemaster,Deb subq tissue 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,983, $72.00 , $39.60 ," $1,442.00 ", $413.21 , $50.40 , $28.08 , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 ," $1,133.44 "," $1,104.09 ", $433.88 , $421.48 , $343.81 , $343.81 , $343.81 , $343.81 , $413.21 , $25.20 , $- , $- ," $1,442.00 ", $50.40
11106,6500020084,Hospital Chargemaster,Incal bx skn single les,Outpatient,Outpatient Default Percent / Case Rate,983, $98.00 , $53.90 ," $1,236.00 ", $626.13 , $68.60 , $38.22 , $687.09 , $471.59 , $469.08 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $34.30 , $- , $- ," $1,236.00 ", $68.60
11043,6500020072,Hospital Chargemaster,Deb musc/fascia 20 sq cm/<,Outpatient,Outpatient Default Percent / Case Rate,983, $180.00 , $99.00 ," $1,442.00 ", $626.13 , $126.00 , $70.20 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 ," $1,133.44 "," $1,104.09 ", $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $63.00 , $- , $- ," $1,442.00 ", $126.00
10005,6500020052,Hospital Chargemaster,Fna bx w/us gdn 1st les,Outpatient,Outpatient Default Percent / Case Rate,983, $117.00 , $64.35 ," $1,236.00 ", $743.95 , $81.90 , $45.63 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $108.81 , $108.81 , $108.81 , $108.81 , $743.95 , $40.95 , $- , $- ," $1,267.38 ", $81.90
11640,6500020109,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 0.5cm<,Outpatient,Outpatient Default Percent / Case Rate,983, $200.00 , $110.00 ," $1,442.00 ", $743.95 , $140.00 , $78.00 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $70.00 , $- , $- ," $1,442.00 ", $140.00
11402,6500020093,Hospital Chargemaster,Exc tr-ext b9+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,983, $133.00 , $73.15 ," $1,236.00 ", $743.95 , $93.10 , $51.87 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $46.55 , $- , $- ," $1,267.38 ", $93.10
11403,6500020094,Hospital Chargemaster,Exc tr-ext b9+marg 2.1-3cm,Outpatient,Outpatient Default Percent / Case Rate,983, $172.00 , $94.60 ," $1,236.00 ", $743.95 , $120.40 , $67.08 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $60.20 , $- , $- ," $1,267.38 ", $120.40
11442,6500020102,Hospital Chargemaster,Exc face-mm b9+marg 1.1-2 cm,Outpatient,Outpatient Default Percent / Case Rate,983, $169.00 , $92.95 ," $1,236.00 ", $743.95 , $118.30 , $65.91 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $59.15 , $- , $- ," $1,267.38 ", $118.30
11601,6500020104,Hospital Chargemaster,Exc tr-ext mal+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,983, $174.00 , $95.70 ," $1,236.00 ", $743.95 , $121.80 , $67.86 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $60.90 , $- , $- ," $1,267.38 ", $121.80
11622,6500020108,Hospital Chargemaster,Exc s/n/h/f/g mal+mrg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,983, $201.00 , $110.55 ," $1,236.00 ", $743.95 , $140.70 , $78.39 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $70.35 , $- , $- ," $1,267.38 ", $140.70
11603,6500020543,Hospital Chargemaster,Exc Tr-Ext Mal+Marg 2.1-3 Cm,Outpatient,Outpatient Default Percent / Case Rate,983, $229.00 , $125.95 ," $1,236.00 ", $743.95 , $160.30 , $89.31 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $80.15 , $- , $- ," $1,267.38 ", $160.30
11976,6500020556,Hospital Chargemaster,Remove Contraceptive Capsule,Outpatient,Outpatient Default Percent / Case Rate,983, $108.00 , $59.40 ," $1,236.00 ", $743.95 , $75.60 , $42.12 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $37.80 , $- , $- ," $1,267.38 ", $75.60
11421,6500020097,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,983, $129.00 , $70.95 ," $1,442.00 ", $743.95 , $90.30 , $50.31 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $45.15 , $- , $- ," $1,442.00 ", $90.30
11441,6500020101,Hospital Chargemaster,Exc face-mm b9+marg 0.6-1 cm,Outpatient,Outpatient Default Percent / Case Rate,983, $154.00 , $84.70 ," $1,442.00 ", $743.95 , $107.80 , $60.06 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $53.90 , $- , $- ," $1,442.00 ", $107.80
11604,6500020544,Hospital Chargemaster,Exc Tr-Ext Mal+Marg 3.1-4 Cm,Outpatient,Outpatient Default Percent / Case Rate,983, $252.00 , $138.60 ," $1,442.00 ", $743.95 , $176.40 , $98.28 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 ," $1,133.44 "," $1,104.09 ", $781.15 , $758.83 , $630.00 , $630.00 , $630.00 , $630.00 , $743.95 , $88.20 , $- , $- ," $1,442.00 ", $176.40
10080,6500020065,Hospital Chargemaster,Drainage of pilonidal cyst,Outpatient,Outpatient Default Percent / Case Rate,983, $120.00 , $66.00 ," $1,236.00 ", $743.95 , $84.00 , $46.80 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $111.60 , $111.60 , $111.60 , $111.60 , $743.95 , $42.00 , $- , $- ," $1,267.38 ", $84.00
11400,6500020091,Hospital Chargemaster,Exc tr-ext b9+marg 0.5 cm<,Outpatient,Outpatient Default Percent / Case Rate,983, $95.00 , $52.25 ," $1,236.00 ", $743.95 , $66.50 , $37.05 ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $234.00 , $234.00 , $234.00 , $234.00 , $743.95 , $33.25 , $- , $- ," $1,267.38 ", $66.50
20606,6500020186,Hospital Chargemaster,Drain/inj joint/bursa w/us,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 ", $759.14 , $- , $- ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $- , $- , $- , $- , $759.14 , $- , $- , $- ," $1,309.97 ", $-
27238,6500020946,Hospital Chargemaster,Treat Thigh Fracture,Outpatient,Outpatient Default Percent / Case Rate,983, $538.00 , $295.90 ," $1,236.00 "," $1,665.16 ", $376.60 , $209.82 ," $2,873.10 "," $1,971.97 "," $1,961.46 "," $1,665.16 "," $1,665.16 ", $844.48 , $822.61 ," $1,748.42 "," $1,698.46 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,665.16 ", $188.30 , $- , $- ," $2,873.10 ", $376.60
11423,6500020099,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 2.1-3,Outpatient,Outpatient Default Percent / Case Rate,983, $182.00 , $100.10 ," $1,236.00 "," $1,682.11 ", $127.40 , $70.98 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,682.11 ", $63.70 , $- , $- ," $3,009.07 ", $127.40
11406,6500020095,Hospital Chargemaster,Exc tr-ext b9+marg >4.0 cm,Outpatient,Outpatient Default Percent / Case Rate,983, $286.00 , $157.30 ," $1,442.00 "," $1,682.11 ", $200.20 , $111.54 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,682.11 ", $100.10 , $- , $- ," $3,009.07 ", $200.20
11424,6500020533,Hospital Chargemaster,Exc H-F-Nk-Sp B9+Marg 3.1-4,Outpatient,Outpatient Default Percent / Case Rate,983, $209.00 , $114.95 ," $1,442.00 "," $1,682.11 ", $146.30 , $81.51 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 "," $1,133.44 "," $1,104.09 "," $1,766.22 "," $1,715.75 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,483.00 "," $1,682.11 ", $73.15 , $- , $- ," $3,009.07 ", $146.30
11623,6500020546,Hospital Chargemaster,Exc S/N/H/F/G Mal+Mrg 2.1-3,Outpatient,Outpatient Default Percent / Case Rate,983, $247.00 , $135.85 ," $1,236.00 "," $1,682.11 ", $172.90 , $96.33 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,682.11 ", $86.45 , $- , $- ," $3,009.07 ", $172.90
19100,6500020612,Hospital Chargemaster,Bx Breast Percut W/O Image,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 "," $1,682.11 ", $- , $- ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $844.48 , $822.61 ," $1,766.22 "," $1,715.75 ", $740.30 , $740.30 , $740.30 , $740.30 ," $1,682.11 ", $- , $- , $- ," $3,009.07 ", $-
20520,6500020176,Hospital Chargemaster,Removal of foreign body,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,442.00 "," $1,682.11 ", $- , $- ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $740.30 , $740.30 , $740.30 , $740.30 ," $1,682.11 ", $- , $- , $- ," $3,009.07 ", $-
11422,6500020098,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 1.1-2,Outpatient,Outpatient Default Percent / Case Rate,983, $158.00 , $86.90 ," $1,236.00 "," $1,682.11 ", $110.60 , $61.62 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $400.00 , $400.00 , $400.00 , $400.00 ," $1,682.11 ", $55.30 , $- , $- ," $3,009.07 ", $110.60
10140,6500020067,Hospital Chargemaster,Drainage of hematoma/fluid,Outpatient,Outpatient Default Percent / Case Rate,983, $138.00 , $75.90 ," $1,236.00 "," $1,682.11 ", $96.60 , $53.82 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $128.34 , $128.34 , $128.34 , $128.34 ," $1,682.11 ", $48.30 , $- , $- ," $3,009.07 ", $96.60
11420,6500020096,Hospital Chargemaster,Exc h-f-nk-sp b9+marg 0.5/<,Outpatient,Outpatient Default Percent / Case Rate,983, $95.00 , $52.25 ," $1,442.00 "," $1,682.11 ", $66.50 , $37.05 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $1,682.11 "," $1,682.11 ", $105.28 , $102.55 ," $1,766.22 "," $1,715.75 ", $290.00 , $290.00 , $290.00 , $290.00 ," $1,682.11 ", $33.25 , $- , $- ," $3,009.07 ", $66.50
11426,6500020534,Hospital Chargemaster,Exc H-F-Nk-Sp B9+Marg >4 Cm,Outpatient,Outpatient Default Percent / Case Rate,983, $318.00 , $174.90 ," $1,442.00 "," $2,834.62 ", $222.60 , $124.02 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,133.44 "," $1,104.09 "," $2,976.35 "," $2,891.31 "," $2,557.00 "," $2,557.00 "," $2,557.00 "," $2,557.00 "," $2,834.62 ", $111.30 , $- , $- ," $5,202.81 ", $222.60
27759,6500021061,Hospital Chargemaster,Treatment Of Tibia Fracture,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $2,591.48 "," $14,741.45 ", $- , $- ," $23,437.94 "," $16,086.78 "," $16,001.02 "," $14,741.45 "," $14,741.45 "," $1,599.36 "," $1,557.95 "," $15,478.53 "," $15,036.28 "," $2,677.00 "," $2,677.00 "," $2,677.00 "," $2,677.00 "," $14,741.45 ", $- , $- , $- ," $23,437.94 ", $-
99224,6500029224,Hospital Chargemaster,Subsequent observ care low,Outpatient,Outpatient Default Percent / Case Rate,983, $175.00 , $96.25 , $144.20 , See APC Packaged Rates , $122.50 , $68.25 , $168.86 , $169.59 , $90.13 , See APC Packaged Rates , See APC Packaged Rates ," $1,621.00 "," $1,621.00 ", See APC Packaged Rates , See APC Packaged Rates , $162.75 , $162.75 , $162.75 , $162.75 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $122.50
99225,6500029225,Hospital Chargemaster,Subsequent observ care med,Outpatient,Outpatient Default Percent / Case Rate,983, $255.00 , $140.25 , $210.12 , See APC Packaged Rates , $178.50 , $99.45 ," $1,432.13 ", $432.09 , $591.83 , See APC Packaged Rates , See APC Packaged Rates ," $1,621.00 "," $1,621.00 ", See APC Packaged Rates , See APC Packaged Rates , $237.15 , $237.15 , $237.15 , $237.15 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $178.50
99226,6500029226,Hospital Chargemaster,Subsequent observ care high,Outpatient,Outpatient Default Percent / Case Rate,983, $300.00 , $165.00 , $247.20 , See APC Packaged Rates , $210.00 , $117.00 , $289.47 , $290.73 , $154.51 , See APC Packaged Rates , See APC Packaged Rates ," $1,621.00 "," $1,621.00 ", See APC Packaged Rates , See APC Packaged Rates , $279.00 , $279.00 , $279.00 , $279.00 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $210.00
99232,6500029232,Hospital Chargemaster,Subsequent hospital care med,Outpatient,Outpatient Default Percent / Case Rate,983, $105.00 , $57.75 , $86.52 , See APC Packaged Rates , $73.50 , $40.95 ," $1,424.53 ", $429.79 , $588.69 , See APC Packaged Rates , See APC Packaged Rates , $70.46 , $70.46 , See APC Packaged Rates , See APC Packaged Rates , $97.65 , $97.65 , $97.65 , $97.65 , See APC Packaged Rates , $36.75 , $- , $- ," $1,424.53 ", $73.50
99238,6500029238,Hospital Chargemaster,Hospital disch day 30 Min,Outpatient,Outpatient Default Percent / Case Rate,983, $190.00 , $104.50 , $156.56 , See APC Packaged Rates , $133.00 , $74.10 ," $1,443.30 ", $435.46 , $596.44 , See APC Packaged Rates , See APC Packaged Rates , $127.49 , $127.49 , See APC Packaged Rates , See APC Packaged Rates , $176.70 , $176.70 , $176.70 , $176.70 , See APC Packaged Rates , $66.50 , $- , $- ," $1,443.30 ", $133.00
99233,6500029233,Hospital Chargemaster,Subsequent hospital care high,Outpatient,Outpatient Default Percent / Case Rate,983, $286.00 , $157.30 , $235.66 , See APC Packaged Rates , $200.20 , $111.54 ," $2,034.99 ", $613.98 , $840.96 , See APC Packaged Rates , See APC Packaged Rates , $191.91 , $191.91 , See APC Packaged Rates , See APC Packaged Rates , $265.98 , $265.98 , $265.98 , $265.98 , See APC Packaged Rates , $100.10 , $- , $- ," $2,034.99 ", $200.20
99239,6500029239,Hospital Chargemaster,Hospital disch day > 30 Min,Outpatient,Outpatient Default Percent / Case Rate,983, $276.00 , $151.80 , $227.42 , See APC Packaged Rates , $193.20 , $107.64 ," $2,114.58 ", $637.99 , $873.85 , See APC Packaged Rates , See APC Packaged Rates , $185.20 , $185.20 , See APC Packaged Rates , See APC Packaged Rates , $256.68 , $256.68 , $256.68 , $256.68 , See APC Packaged Rates , $96.60 , $- , $- ," $2,114.58 ", $193.20
46250,6500021522,Hospital Chargemaster,Remove Ext Hem Groups 2+,Outpatient,Outpatient Default Percent / Case Rate,983, $370.00 , $203.50 ," $2,060.00 "," $2,920.64 ", $259.00 , $144.30 ," $5,107.19 "," $3,505.36 "," $3,486.67 "," $2,920.64 "," $2,920.64 "," $1,294.72 "," $1,261.20 "," $3,066.68 "," $2,979.06 "," $2,547.00 "," $2,547.00 "," $2,547.00 "," $2,547.00 "," $2,920.64 ", $129.50 , $- , $- ," $5,107.19 ", $259.00
56501,6500020408,Hospital Chargemaster,Destroy vulva lesions sim,Outpatient,Outpatient Default Percent / Case Rate,983, $152.00 , $83.60 ," $1,236.00 "," $2,047.65 ", $106.40 , $59.28 ," $3,388.54 "," $2,325.74 "," $2,313.34 "," $2,047.65 "," $2,047.65 ", $105.28 , $102.55 ," $2,150.03 "," $2,088.60 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,047.65 ", $53.20 , $- , $- ," $3,388.54 ", $106.40
58555,6500021786,Hospital Chargemaster,Hysteroscopy Dx Sep Proc,Outpatient,Outpatient Default Percent / Case Rate,983, $176.00 , $96.80 ," $1,236.00 "," $3,136.64 ", $123.20 , $68.64 ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 ", $844.48 , $822.61 ," $3,293.47 "," $3,199.37 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,136.64 ", $61.60 , $- , $- ," $5,165.58 ", $123.20
55250,6500021739,Hospital Chargemaster,Removal Of Sperm Duct(S),Outpatient,Outpatient Default Percent / Case Rate,983, $267.00 , $146.85 ," $1,442.00 "," $2,140.58 ", $186.90 , $104.13 ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $2,140.58 "," $2,140.58 ", $105.28 , $102.55 ," $2,247.61 "," $2,183.39 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $2,140.58 ", $93.45 , $- , $- ," $3,805.91 ", $186.90
46040,6500020347,Hospital Chargemaster,Incision of rectal abscess,Outpatient,Outpatient Default Percent / Case Rate,983, $500.00 , $275.00 ," $2,060.00 "," $1,239.71 ", $350.00 , $195.00 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,294.72 "," $1,261.20 "," $1,301.70 "," $1,264.51 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,185.00 "," $1,239.71 ", $175.00 , $- , $- ," $2,143.42 ", $350.00
46220,6500021519,Hospital Chargemaster,Excise Anal Ext Tag/Papilla,Outpatient,Outpatient Default Percent / Case Rate,983, $139.00 , $76.45 ," $1,236.00 "," $1,239.71 ", $97.30 , $54.21 ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 ", $844.48 , $822.61 ," $1,301.70 "," $1,264.51 "," $1,030.00 "," $1,030.00 "," $1,030.00 "," $1,030.00 "," $1,239.71 ", $48.65 , $- , $- ," $2,143.42 ", $97.30
46221,6500021520,Hospital Chargemaster,Ligation Of Hemorrhoid(S),Outpatient,Outpatient Default Percent / Case Rate,983, $223.00 , $122.65 ," $1,236.00 ", $948.73 , $156.10 , $86.97 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $105.28 , $102.55 , $996.17 , $967.71 , $781.00 , $781.00 , $781.00 , $781.00 , $948.73 , $78.05 , $- , $- ," $1,629.53 ", $156.10
51728,6500021629,Hospital Chargemaster,Cystometrogram W/Vp,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 ", $687.79 , $- , $- ," $1,229.98 ", $844.21 , $839.71 , $687.79 , $687.79 , $499.80 , $484.64 , $722.18 , $701.54 , $750.00 , $750.00 , $750.00 , $750.00 , $687.79 , $- , $- , $- ," $1,236.00 ", $-
49450,6500020376,Hospital Chargemaster,Replace g/c tube perc,Outpatient,Outpatient Default Percent / Case Rate,983, $78.00 , $42.90 ," $1,236.00 ", $967.36 , $54.60 , $30.42 ," $1,665.99 "," $1,143.47 "," $1,137.37 ", $967.36 , $967.36 , $844.48 , $822.61 ," $1,015.72 ", $986.70 , $740.30 , $740.30 , $740.30 , $740.30 , $967.36 , $27.30 , $- , $- ," $1,665.99 ", $54.60
56605,6500020409,Hospital Chargemaster,Biopsy of vulva/perineum,Outpatient,Outpatient Default Percent / Case Rate,983, $70.00 , $38.50 ," $1,236.00 ", $757.92 , $49.00 , $27.30 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $844.48 , $822.61 , $795.81 , $773.07 , $633.00 , $633.00 , $633.00 , $633.00 , $757.92 , $24.50 , $- , $- ," $1,236.00 ", $49.00
57100,6500020410,Hospital Chargemaster,Biopsy of vagina,Outpatient,Outpatient Default Percent / Case Rate,983, $77.00 , $42.35 ," $1,236.00 ", $757.92 , $53.90 , $30.03 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $105.28 , $102.55 , $795.81 , $773.07 , $633.00 , $633.00 , $633.00 , $633.00 , $757.92 , $26.95 , $- , $- ," $1,236.00 ", $53.90
99223,6500029223,Hospital Chargemaster,Initial hospital care high,Outpatient,Outpatient Default Percent / Case Rate,983, $285.00 , $156.75 , $234.84 , See APC Packaged Rates , $199.50 , $111.15 ," $3,961.17 "," $1,195.12 "," $1,636.96 ", See APC Packaged Rates , See APC Packaged Rates , $191.24 , $191.24 , See APC Packaged Rates , See APC Packaged Rates , $285.00 , $285.00 , $285.00 , $285.00 , See APC Packaged Rates , $99.75 , $- , $- ," $3,961.17 ", $199.50
99222,6500029222,Hospital Chargemaster,Initial hospital care med,Outpatient,Outpatient Default Percent / Case Rate,983, $195.00 , $107.25 , $160.68 , See APC Packaged Rates , $136.50 , $76.05 ," $2,681.33 ", $808.98 ," $1,108.06 ", See APC Packaged Rates , See APC Packaged Rates , $130.85 , $130.85 , See APC Packaged Rates , See APC Packaged Rates , $195.00 , $195.00 , $195.00 , $195.00 , See APC Packaged Rates , $68.25 , $- , $- ," $2,681.33 ", $136.50
64566,6500021827,Hospital Chargemaster,Neuroeltrd Stim Post Tibial,Outpatient,Outpatient Default Percent / Case Rate,983, $35.00 , $19.25 ," $1,236.00 ", $312.35 , $24.50 , $13.65 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $23.49 , $23.49 , $327.96 , $318.59 , $333.00 , $333.00 , $333.00 , $333.00 , $312.35 , $12.25 , $- , $- ," $1,236.00 ", $24.50
56405,6500020407,Hospital Chargemaster,I & d of vulva/perineum,Outpatient,Outpatient Default Percent / Case Rate,983, $146.00 , $80.30 ," $1,442.00 ", $337.17 , $102.20 , $56.94 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 ," $1,133.44 "," $1,104.09 ", $354.03 , $343.92 , $331.00 , $331.00 , $331.00 , $331.00 , $337.17 , $51.10 , $- , $- ," $1,442.00 ", $102.20
46083,6500020349,Hospital Chargemaster,Incise external hemorrhoid,Outpatient,Outpatient Default Percent / Case Rate,983, $124.00 , $68.20 ," $1,236.00 ", $318.13 , $86.80 , $48.36 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $317.00 , $317.00 , $317.00 , $317.00 , $318.13 , $43.40 , $- , $- ," $1,236.00 ", $86.80
46050,6500020348,Hospital Chargemaster,Incision of anal abscess,Outpatient,Outpatient Default Percent / Case Rate,983, $114.00 , $62.70 ," $1,236.00 ", $948.73 , $79.80 , $44.46 ," $1,629.53 "," $1,118.44 "," $1,112.48 ", $948.73 , $948.73 , $844.48 , $822.61 , $996.17 , $967.71 , $279.00 , $279.00 , $279.00 , $279.00 , $948.73 , $39.90 , $- , $- ," $1,629.53 ", $79.80
99221,6500029221,Hospital Chargemaster,Initial hospital care low,Outpatient,Outpatient Default Percent / Case Rate,983, $256.00 , $140.80 , $210.94 , See APC Packaged Rates , $179.20 , $99.84 ," $1,985.34 ", $598.99 , $820.44 , See APC Packaged Rates , See APC Packaged Rates , $171.78 , $171.78 , See APC Packaged Rates , See APC Packaged Rates , $256.00 , $256.00 , $256.00 , $256.00 , See APC Packaged Rates , $89.60 , $- , $- ," $1,985.34 ", $179.20
58100,6500020412,Hospital Chargemaster,Biopsy of uterus lining,Outpatient,Outpatient Default Percent / Case Rate,983, $101.00 , $55.55 ," $1,236.00 ", $203.67 , $70.70 , $39.39 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $105.28 , $102.55 , $213.85 , $207.74 , $232.00 , $232.00 , $232.00 , $232.00 , $203.67 , $35.35 , $- , $- ," $1,236.00 ", $70.70
64405,6500020450,Hospital Chargemaster,N block inj occipital,Outpatient,Outpatient Default Percent / Case Rate,983, $73.00 , $40.15 ," $1,236.00 ", $312.35 , $51.10 , $28.47 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $185.94 , $180.29 , $327.96 , $318.59 , $740.30 , $740.30 , $740.30 , $740.30 , $312.35 , $25.55 , $- , $- ," $1,236.00 ", $51.10
57500,6500020411,Hospital Chargemaster,Biopsy of cervix,Outpatient,Outpatient Default Percent / Case Rate,983, $88.00 , $48.40 ," $1,236.00 ", $757.92 , $61.60 , $34.32 ," $1,220.78 ", $837.89 , $833.42 , $757.92 , $757.92 , $105.28 , $102.55 , $795.81 , $773.07 , $228.00 , $228.00 , $228.00 , $228.00 , $757.92 , $30.80 , $- , $- ," $1,236.00 ", $61.60
51703,6500020400,Hospital Chargemaster,Insert bladder cath complex,Outpatient,Outpatient Default Percent / Case Rate,983, $90.00 , $49.50 ," $1,236.00 ", $166.91 , $63.00 , $35.10 , $297.41 , $204.13 , $203.04 , $166.91 , $166.91 , $196.14 , $190.19 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $31.50 , $- , $- ," $1,236.00 ", $63.00
51741,6500021630,Hospital Chargemaster,Electro-Uroflowmetry First,Outpatient,Outpatient Default Percent / Case Rate,983, $10.00 , $5.50 , $8.24 , $166.91 , $7.00 , $3.90 , $297.41 , $204.13 , $203.04 , $166.91 , $166.91 , $6.71 , $6.71 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $3.50 , $- , $- , $297.41 , $7.00
51705,6500020401,Hospital Chargemaster,Change of bladder tube,Outpatient,Outpatient Default Percent / Case Rate,983, $61.00 , $33.55 ," $1,236.00 ", $318.13 , $42.70 , $23.79 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 , $105.28 , $102.55 , $334.03 , $324.49 , $221.00 , $221.00 , $221.00 , $221.00 , $318.13 , $21.35 , $- , $- ," $1,236.00 ", $42.70
99218,6500029218,Hospital Chargemaster,Initial observation care low,Outpatient,Outpatient Default Percent / Case Rate,983, $218.00 , $119.90 , $179.63 , See APC Packaged Rates , $152.60 , $85.02 , $210.35 , $211.26 , $112.27 , See APC Packaged Rates , See APC Packaged Rates ," $1,621.00 "," $1,621.00 ", See APC Packaged Rates , See APC Packaged Rates , $146.00 , $146.00 , $146.00 , $146.00 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $152.60
58300,6500020413,Hospital Chargemaster,Insert intrauterine device,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 ", See APC Packaged Rates , $- , $- , $172.06 , $118.09 , $117.46 , See APC Packaged Rates , See APC Packaged Rates , $131.39 , $127.40 , See APC Packaged Rates , See APC Packaged Rates , $216.00 , $216.00 , $216.00 , $216.00 , See APC Packaged Rates , $- , $- , $- ," $1,236.00 ", $-
64450,6500020459,Hospital Chargemaster,N block other peripheral,Outpatient,Outpatient Default Percent / Case Rate,983, $53.00 , $29.15 ," $1,236.00 ", $759.14 , $37.10 , $20.67 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $168.83 , $163.71 , $797.10 , $774.33 , $208.00 , $208.00 , $208.00 , $208.00 , $759.14 , $18.55 , $- , $- ," $1,309.97 ", $37.10
58301,6500020414,Hospital Chargemaster,Remove intrauterine device,Outpatient,Outpatient Default Percent / Case Rate,983, $78.00 , $42.90 ," $1,236.00 ", $337.17 , $54.60 , $30.42 , $362.99 , $249.14 , $247.81 , $337.17 , $337.17 , $164.50 , $159.51 , $354.03 , $343.92 , $203.00 , $203.00 , $203.00 , $203.00 , $337.17 , $27.30 , $- , $- ," $1,236.00 ", $54.60
57452,6500021769,Hospital Chargemaster,Exam Of Cervix W/Scope,Outpatient,Outpatient Default Percent / Case Rate,983, $107.00 , $58.85 ," $1,442.00 ", $203.67 , $74.90 , $41.73 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $105.28 , $102.55 , $213.85 , $207.74 , $194.00 , $194.00 , $194.00 , $194.00 , $203.67 , $37.45 , $- , $- ," $1,442.00 ", $74.90
43762,6500020346,Hospital Chargemaster,Rplc gtube no revj trc,Outpatient,Outpatient Default Percent / Case Rate,983, $55.00 , $30.25 ," $1,236.00 ", $318.13 , $38.50 , $21.45 , $506.26 , $347.47 , $345.62 , $318.13 , $318.13 ," $1,133.44 "," $1,104.09 ", $334.03 , $324.49 , $174.00 , $174.00 , $174.00 , $174.00 , $318.13 , $19.25 , $- , $- ," $1,236.00 ", $38.50
99495,6500020025,Hospital Chargemaster,Trans care mgmt 14 day disch,Outpatient,Outpatient Default Percent / Case Rate,983, $165.00 , $90.75 , $135.96 , $142.05 , $115.50 , $64.35 , $284.43 , $222.30 , $243.50 , $142.05 , $142.05 , $110.72 , $110.72 , $149.15 , $144.89 , $85.00 , $85.00 , $85.00 , $85.00 , $142.05 , $57.75 , $- , $- , $284.43 , $115.50
99496,6500020026,Hospital Chargemaster,Trans care mgmt 7 day disch,Outpatient,Outpatient Default Percent / Case Rate,983, $224.00 , $123.20 , $184.58 , $142.05 , $156.80 , $87.36 , $284.43 , $222.30 , $243.50 , $142.05 , $142.05 , $150.30 , $150.30 , $149.15 , $144.89 , $93.00 , $93.00 , $93.00 , $93.00 , $142.05 , $78.40 , $- , $- , $284.43 , $156.80
99231,6500029231,Hospital Chargemaster,Subsequent hospital care low,Outpatient,Outpatient Default Percent / Case Rate,983, $106.00 , $58.30 , $87.34 , See APC Packaged Rates , $74.20 , $41.34 , $770.23 , $232.39 , $318.30 , See APC Packaged Rates , See APC Packaged Rates , $71.13 , $71.13 , See APC Packaged Rates , See APC Packaged Rates , $106.00 , $106.00 , $106.00 , $106.00 , See APC Packaged Rates , $37.10 , $- , $- , $770.23 , $74.20
51702,6500020399,Hospital Chargemaster,Insert temp bladder cath,Outpatient,Outpatient Default Percent / Case Rate,983, $30.00 , $16.50 ," $1,236.00 ", $134.80 , $21.00 , $11.70 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $73.01 , $70.79 , $141.54 , $137.50 , $98.00 , $98.00 , $98.00 , $98.00 , $134.80 , $10.50 , $- , $- ," $1,236.00 ", $21.00
90471,5720030001,Hospital Chargemaster,Immunization Admin,Outpatient,Outpatient Default Percent / Case Rate,983, $128.00 , $70.40 , $105.47 , $74.12 , $89.60 , $49.92 , $66.28 , $66.28 , $66.28 , $74.12 , $74.12 , $85.89 , $85.89 , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $44.80 , $- , $- , $105.47 , $89.60
90471,5720030003,Hospital Chargemaster,Admin Influenza Virus Vac,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , $74.12 , $- , $- , $66.28 , $66.28 , $66.28 , $74.12 , $74.12 , $- , $- , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $- , $- , $- , $97.86 , $-
90471,5720030004,Hospital Chargemaster,Admin Pneumococcal Vaccine,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , $74.12 , $- , $- , $66.28 , $66.28 , $66.28 , $74.12 , $74.12 , $- , $- , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $- , $- , $- , $97.86 , $-
96372,5720030014,Hospital Chargemaster,Ther/Proph/Diag Inj Sc/Im,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , $74.12 , $- , $- , $146.70 , $114.66 , $125.59 , $74.12 , $74.12 , $55.06 , $53.39 , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $- , $- , $- , $146.70 , $-
69210,6500020504,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,983, $38.00 , $20.90 ," $1,236.00 ", $66.55 , $26.60 , $14.82 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $25.50 , $25.50 , $69.87 , $67.88 , $97.00 , $97.00 , $97.00 , $97.00 , $66.55 , $13.30 , $- , $- ," $1,236.00 ", $26.60
51701,6500020398,Hospital Chargemaster,Insert bladder catheter,Outpatient,Outpatient Default Percent / Case Rate,983, $30.00 , $16.50 ," $1,236.00 ", $134.80 , $21.00 , $11.70 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $66.83 , $64.80 , $141.54 , $137.50 , $88.00 , $88.00 , $88.00 , $88.00 , $134.80 , $10.50 , $- , $- ," $1,236.00 ", $21.00
97802,6827430001,Hospital Chargemaster,Medical Nutrition Indiv In,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $123.00 , $96.13 , $105.30 , See APC Packaged Rates , See APC Packaged Rates , $77.36 , $75.01 , See APC Packaged Rates , See APC Packaged Rates , $49.17 , $49.17 , $50.44 , $50.44 , See APC Packaged Rates , $- , $- , $- , $123.00 , $-
97803,6827430003,Hospital Chargemaster,Med Nutrition Indiv Subseq,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $105.07 , $82.12 , $89.95 , See APC Packaged Rates , See APC Packaged Rates , $70.79 , $68.64 , See APC Packaged Rates , See APC Packaged Rates , $41.43 , $41.43 , $42.50 , $42.50 , See APC Packaged Rates , $- , $- , $- , $105.07 , $-
86580,5212030685,Hospital Chargemaster,Tb Intradermal Test,Outpatient,Outpatient Default Percent / Case Rate,983, $32.00 , $17.60 , $26.37 , $29.53 , $22.40 , $12.48 , $18.97 , $12.73 , $12.19 , $29.53 , $29.53 , $25.18 , $24.41 , $31.01 , $30.12 , $35.00 , $35.00 , $35.00 , $35.00 , $29.53 , $11.20 , $20.60 , $11.20 , $35.00 , $22.40
87880,5213030207,Hospital Chargemaster,Strep A Assay W/Optic,Outpatient,Outpatient Default Percent / Case Rate,983, $37.00 , $20.35 , $30.49 , See APC Packaged Rates , $25.90 , $14.43 , $72.96 , $48.96 , $46.88 , See APC Packaged Rates , See APC Packaged Rates , $50.43 , $48.90 , See APC Packaged Rates , See APC Packaged Rates , $26.16 , $26.16 , $26.84 , $26.84 , See APC Packaged Rates , $12.95 , $19.84 , $12.95 , $72.96 , $25.90
99211,6500029211,Hospital Chargemaster,Office Visit Establish Level 1,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $180.56 , $54.48 , $74.62 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $- , $- , $- , $180.56 , $-
99212,6500029212,Hospital Chargemaster,Office Visit Establish Level 2,Outpatient,Outpatient Default Percent / Case Rate,983, $41.00 , $22.55 , $33.78 , See APC Packaged Rates , $28.70 , $15.99 , $500.70 , $151.07 , $206.91 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $14.35 , $- , $- , $500.70 , $28.70
99202,6500029202,Hospital Chargemaster,Office Visit New Level 2,Outpatient,Outpatient Default Percent / Case Rate,983, $58.00 , $31.90 , $47.79 , See APC Packaged Rates , $40.60 , $22.62 , $996.65 , $300.70 , $411.87 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $20.30 , $- , $- , $996.65 , $40.60
99213,6500029213,Hospital Chargemaster,Office Visit Establish Level 3,Outpatient,Outpatient Default Percent / Case Rate,983, $77.00 , $42.35 , $63.45 , See APC Packaged Rates , $53.90 , $30.03 ," $1,001.28 ", $302.10 , $413.78 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $26.95 , $- , $- ," $1,001.28 ", $53.90
99203,6500029203,Hospital Chargemaster,Office Visit New Level 3,Outpatient,Outpatient Default Percent / Case Rate,983, $87.00 , $47.85 , $71.69 , See APC Packaged Rates , $60.90 , $33.93 ," $1,494.85 ", $451.01 , $617.75 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $30.45 , $- , $- ," $1,494.85 ", $60.90
99214,6500029214,Hospital Chargemaster,Office Visit Establish Level 4,Outpatient,Outpatient Default Percent / Case Rate,983, $114.00 , $62.70 , $93.94 , See APC Packaged Rates , $79.80 , $44.46 ," $1,543.79 ", $465.78 , $637.97 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $39.90 , $- , $- ," $1,543.79 ", $79.80
99215,6500029215,Hospital Chargemaster,Office Visit Establish Level 5,Outpatient,Outpatient Default Percent / Case Rate,983, $127.00 , $69.85 , $104.65 , See APC Packaged Rates , $88.90 , $49.53 ," $2,176.35 ", $656.62 , $899.38 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $44.45 , $- , $- ," $2,176.35 ", $88.90
99204,6500029204,Hospital Chargemaster,Office Visit New Level 4,Outpatient,Outpatient Default Percent / Case Rate,983, $148.00 , $81.40 , $121.95 , See APC Packaged Rates , $103.60 , $57.72 ," $2,530.46 ", $763.46 ," $1,045.72 ", See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $51.80 , $- , $- ," $2,530.46 ", $103.60
99205,6500029205,Hospital Chargemaster,Office Visit New Level 5,Outpatient,Outpatient Default Percent / Case Rate,983, $193.00 , $106.15 , $159.03 , See APC Packaged Rates , $135.10 , $75.27 ," $3,302.60 ", $996.42 ," $1,364.80 ", See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $67.55 , $- , $- ," $3,302.60 ", $135.10
99242,6500020012,Hospital Chargemaster,Office consultation,Outpatient,Outpatient Default Percent / Case Rate,983, $138.00 , $75.90 , $113.71 , See APC Packaged Rates , $96.60 , $53.82 , $133.16 , $133.74 , $71.07 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $48.30 , $- , $- , $133.74 , $96.60
99245,6500020014,Hospital Chargemaster,Office consultation,Outpatient,Outpatient Default Percent / Case Rate,983, $382.00 , $210.10 , $314.77 , See APC Packaged Rates , $267.40 , $148.98 , $368.59 , $370.20 , $196.74 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $133.70 , $- , $- , $370.20 , $267.40
99381,6500020036,Hospital Chargemaster,Init pm e/m new pat infant,Outpatient,Outpatient Default Percent / Case Rate,983, $192.00 , $105.60 , $158.21 , See APC Packaged Rates , $134.40 , $74.88 , $185.26 , $186.07 , $98.88 , See APC Packaged Rates , See APC Packaged Rates , $264.42 , $256.40 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $67.20 , $- , $- , $264.42 , $134.40
99382,6500020037,Hospital Chargemaster,Init pm e/m new pat 1-4 yrs,Outpatient,Outpatient Default Percent / Case Rate,983, $173.00 , $95.15 , $142.55 , See APC Packaged Rates , $121.10 , $67.47 , $166.93 , $167.65 , $89.10 , See APC Packaged Rates , See APC Packaged Rates , $283.14 , $274.55 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $60.55 , $- , $- , $283.14 , $121.10
99383,6500020038,Hospital Chargemaster,Prev visit new age 5-11,Outpatient,Outpatient Default Percent / Case Rate,983, $241.00 , $132.55 , $198.58 , See APC Packaged Rates , $168.70 , $93.99 , $232.54 , $233.55 , $124.12 , See APC Packaged Rates , See APC Packaged Rates , $276.12 , $267.74 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $84.35 , $- , $- , $276.12 , $168.70
99384,6500020039,Hospital Chargemaster,Prev visit new age 12-17,Outpatient,Outpatient Default Percent / Case Rate,983, $230.00 , $126.50 , $189.52 , See APC Packaged Rates , $161.00 , $89.70 , $221.93 , $222.89 , $118.45 , See APC Packaged Rates , See APC Packaged Rates , $308.88 , $299.51 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $80.50 , $- , $- , $308.88 , $161.00
99385,6500020040,Hospital Chargemaster,Prev visit new age 18-39,Outpatient,Outpatient Default Percent / Case Rate,983, $277.00 , $152.35 , $228.25 , See APC Packaged Rates , $193.90 , $108.03 , $267.28 , $268.44 , $142.66 , See APC Packaged Rates , See APC Packaged Rates , $313.56 , $304.05 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $96.95 , $- , $- , $313.56 , $193.90
99386,6500020041,Hospital Chargemaster,Prev visit new age 40-64,Outpatient,Outpatient Default Percent / Case Rate,983, $315.00 , $173.25 , $259.56 , See APC Packaged Rates , $220.50 , $122.85 , $303.94 , $305.27 , $162.23 , See APC Packaged Rates , See APC Packaged Rates , $367.38 , $356.23 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $110.25 , $- , $- , $367.38 , $220.50
99387,6500020042,Hospital Chargemaster,Init pm e/m new pat 65+ yrs,Outpatient,Outpatient Default Percent / Case Rate,983, $303.00 , $166.65 , $249.67 , See APC Packaged Rates , $212.10 , $118.17 , $292.36 , $293.64 , $156.05 , See APC Packaged Rates , See APC Packaged Rates , $383.76 , $372.12 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $106.05 , $- , $- , $383.76 , $212.10
99391,6500020043,Hospital Chargemaster,Per pm reeval est pat infant,Outpatient,Outpatient Default Percent / Case Rate,983, $200.00 , $110.00 , $164.80 , See APC Packaged Rates , $140.00 , $78.00 , $192.98 , $193.82 , $103.00 , See APC Packaged Rates , See APC Packaged Rates , $205.92 , $199.67 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $70.00 , $- , $- , $205.92 , $140.00
99392,6500020044,Hospital Chargemaster,Prev visit est age 1-4,Outpatient,Outpatient Default Percent / Case Rate,983, $227.00 , $124.85 , $187.05 , See APC Packaged Rates , $158.90 , $88.53 , $219.03 , $219.99 , $116.91 , See APC Packaged Rates , See APC Packaged Rates , $229.32 , $222.36 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $79.45 , $- , $- , $229.32 , $158.90
99393,6500020045,Hospital Chargemaster,Prev visit est age 5-11,Outpatient,Outpatient Default Percent / Case Rate,983, $220.00 , $121.00 , $181.28 , See APC Packaged Rates , $154.00 , $85.80 , $212.28 , $213.20 , $113.30 , See APC Packaged Rates , See APC Packaged Rates , $224.64 , $217.82 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $77.00 , $- , $- , $224.64 , $154.00
99394,6500020046,Hospital Chargemaster,Prev visit est age 12-17,Outpatient,Outpatient Default Percent / Case Rate,983, $243.00 , $133.65 , $200.23 , See APC Packaged Rates , $170.10 , $94.77 , $234.47 , $235.49 , $125.15 , See APC Packaged Rates , See APC Packaged Rates , $250.38 , $242.78 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $85.05 , $- , $- , $250.38 , $170.10
99395,6500020047,Hospital Chargemaster,Prev visit est age 18-39,Outpatient,Outpatient Default Percent / Case Rate,983, $243.00 , $133.65 , $200.23 , See APC Packaged Rates , $170.10 , $94.77 , $234.47 , $235.49 , $125.15 , See APC Packaged Rates , See APC Packaged Rates , $264.42 , $256.40 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $85.05 , $- , $- , $264.42 , $170.10
99396,6500020048,Hospital Chargemaster,Prev visit est age 40-64,Outpatient,Outpatient Default Percent / Case Rate,983, $265.00 , $145.75 , $218.36 , See APC Packaged Rates , $185.50 , $103.35 , $255.70 , $256.81 , $136.48 , See APC Packaged Rates , See APC Packaged Rates , $292.50 , $283.63 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $92.75 , $- , $- , $292.50 , $185.50
99397,6500020049,Hospital Chargemaster,Per pm reeval est pat 65+ yr,Outpatient,Outpatient Default Percent / Case Rate,983, $284.00 , $156.20 , $234.02 , See APC Packaged Rates , $198.80 , $110.76 , $274.03 , $275.22 , $146.27 , See APC Packaged Rates , See APC Packaged Rates , $297.18 , $288.16 , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $99.40 , $- , $- , $297.18 , $198.80
99243,6500029243,Hospital Chargemaster,Office consultation,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $- , $- , $- , $25.89 , $-
99245,6500029245,Hospital Chargemaster,Office consultation,Outpatient,Outpatient Default Percent / Case Rate,983, $655.00 , $360.25 , $539.72 , See APC Packaged Rates , $458.50 , $255.45 , $632.01 , $634.76 , $337.34 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $229.25 , $- , $- , $634.76 , $458.50
69209,6500020503,Hospital Chargemaster,Remove impacted ear wax uni,Outpatient,Outpatient Default Percent / Case Rate,983, $16.00 , $8.80 ," $1,236.00 ", $66.55 , $11.20 , $6.24 , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $10.74 , $10.74 , $69.87 , $67.88 , $25.00 , $25.00 , $25.00 , $25.00 , $66.55 , $5.60 , $- , $- ," $1,236.00 ", $11.20
83036,5212030380,Hospital Chargemaster,Glycosylated Hemoglobin Test,Outpatient,Outpatient Default Percent / Case Rate,983, $29.00 , $15.95 , $23.90 , See APC Packaged Rates , $20.30 , $11.31 , $52.33 , $35.12 , $33.62 , See APC Packaged Rates , See APC Packaged Rates , $29.39 , $28.50 , See APC Packaged Rates , See APC Packaged Rates , $16.52 , $16.52 , $16.95 , $16.95 , See APC Packaged Rates , $10.15 , $12.95 , $10.15 , $52.33 , $20.30
92551,5430030004,Hospital Chargemaster,Pure Tone Hearing Test Air,Outpatient,Outpatient Default Percent / Case Rate,983, $43.00 , $23.65 , $35.43 , See APC Packaged Rates , $30.10 , $16.77 , $45.34 , $35.44 , $38.82 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $29.50 , See APC Packaged Rates , See APC Packaged Rates , $14.12 , $14.12 , $14.49 , $14.49 , See APC Packaged Rates , $15.05 , $- , $- , $45.34 , $30.10
J0696,5710030463,Hospital Chargemaster,Ceftriaxone Sodium Inj 250 MG,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $0.63 , $0.63 , $0.63 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $0.48 , $- , $0.63 , $-
17003,6500020146,Hospital Chargemaster,Destruct premalg les 2-14,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 ", See APC Packaged Rates , $- , $- , $7.86 , $5.40 , $5.37 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- ," $1,236.00 ", $-
11103,6500020081,Hospital Chargemaster,Tangntl bx skin ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,983, $37.00 , $20.35 ," $1,236.00 ", See APC Packaged Rates , $25.90 , $14.43 , $74.66 , $51.25 , $50.97 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $34.41 , $34.41 , $34.41 , $34.41 , See APC Packaged Rates , $12.95 , $- , $- ," $1,236.00 ", $25.90
11105,6500020083,Hospital Chargemaster,Punch bx skin ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,983, $45.00 , $24.75 ," $1,236.00 ", See APC Packaged Rates , $31.50 , $17.55 , $88.21 , $60.54 , $60.22 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $41.85 , $41.85 , $41.85 , $41.85 , See APC Packaged Rates , $15.75 , $- , $- ," $1,236.00 ", $31.50
11107,6500020085,Hospital Chargemaster,Incal bx skn ea sep/addl,Outpatient,Outpatient Default Percent / Case Rate,983, $52.00 , $28.60 ," $1,236.00 ", See APC Packaged Rates , $36.40 , $20.28 , $105.14 , $72.16 , $71.78 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $48.36 , $48.36 , $48.36 , $48.36 , See APC Packaged Rates , $18.20 , $- , $- ," $1,236.00 ", $36.40
36416,6500020263,Hospital Chargemaster,Capillary blood draw,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $12.68 , $8.51 , $8.15 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $3.46 , $- , $12.68 , $-
90686,5710030020,Hospital Chargemaster,IIV4 Vac No Prsv 0.5Ml IM NChg,Outpatient,Outpatient Default Percent / Case Rate,983, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $19.58 , $19.58 , $19.58 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $20.53 , $0.00 , $20.53 , $0.01
90686,5710032732,Hospital Chargemaster,IIV4 Vac No Prsv 0.5 ML IM,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $19.58 , $19.58 , $19.58 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $20.53 , $- , $20.53 , $-
90472,5720030002,Hospital Chargemaster,Immunization Admin Each Add,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $22.02 , $22.02 , $22.02 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $22.02 , $-
90714,5710032342,Hospital Chargemaster,TD Vacc No Presv 7 Yrs+ IM,Outpatient,Outpatient Default Percent / Case Rate,983, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $25.27 , $25.27 , $25.27 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $27.70 , $0.00 , $27.70 , $0.01
90715,5710030016,Hospital Chargemaster,TDAP Vaccine 7 Yrs/> IM,Outpatient,Outpatient Default Percent / Case Rate,983, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $34.28 , $34.28 , $34.28 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $- , $- , $34.28 , $0.01
90715,5710030766,Hospital Chargemaster,TDAP Vaccine 7 Yrs/> IM No Chg,Outpatient,Outpatient Default Percent / Case Rate,983, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $34.28 , $34.28 , $34.28 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $- , $- , $34.28 , $0.01
90732,5710031998,Hospital Chargemaster,PPSV23 Vac 2Yrs+ Sub/IM No Chg,Outpatient,Outpatient Default Percent / Case Rate,983, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $119.92 , $119.92 , $119.92 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $133.47 , $0.00 , $133.47 , $0.01
90734,5710031534,Hospital Chargemaster,Menacwyd/Menacwycrm Vacc IM,Outpatient,Outpatient Default Percent / Case Rate,983, $231.00 , $127.05 , $190.34 , See APC Packaged Rates , $161.70 , $90.09 , $153.91 , $153.91 , $153.91 , See APC Packaged Rates , See APC Packaged Rates , $155.00 , $155.00 , See APC Packaged Rates , See APC Packaged Rates , $214.83 , $214.83 , $214.83 , $214.83 , See APC Packaged Rates , $80.85 , $169.89 , $80.85 , $214.83 , $161.70
88187,5219030014,Hospital Chargemaster,Flowcytometry/Read 2-8,Outpatient,Outpatient Default Percent / Case Rate,983, $431.00 , $72.08 , $355.14 , See APC Packaged Rates , $301.70 , $168.09 , $175.17 , $117.54 , $112.54 , See APC Packaged Rates , See APC Packaged Rates , $175.31 , $169.99 , See APC Packaged Rates , See APC Packaged Rates , $62.85 , $62.85 , $64.47 , $64.47 , See APC Packaged Rates , $150.85 , $46.70 , $46.70 , $355.14 , $301.70
94200,5310030013,Hospital Chargemaster,Lung Function Test (Mbc/Mvv),Outpatient,Outpatient Default Percent / Case Rate,983, $5.00 , $2.75 , $4.12 , $66.55 , $3.50 , $1.95 , $261.44 , $204.33 , $223.81 , $66.55 , $66.55 , $60.84 , $58.99 , $69.87 , $67.88 , $112.83 , $112.83 , $115.74 , $115.74 , $66.55 , $1.75 , $- , $- , $261.44 , $3.50
94618,5310030022,Hospital Chargemaster,Pulmonary Stress Testing,Outpatient,Outpatient Default Percent / Case Rate,983, $30.00 , $16.50 , $24.72 , $134.80 , $21.00 , $11.70 , $261.44 , $204.33 , $223.81 , $134.80 , $134.80 , $30.19 , $29.27 , $141.54 , $137.50 , $172.35 , $172.35 , $176.79 , $176.79 , $134.80 , $10.50 , $- , $- , $261.44 , $21.00
95806,5320030003,Hospital Chargemaster,Sleep Study Unatt&Resp Efft,Outpatient,Outpatient Default Percent / Case Rate,983, $225.00 , $123.75 , $185.40 , $166.91 , $157.50 , $87.75 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $- , $- , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $78.75 , $- , $- , $333.79 , $157.50
95816,5330020003,Hospital Chargemaster,EEG awake and drowsy,Outpatient,Outpatient Default Percent / Case Rate,983, $92.00 , $50.60 , $75.81 , $316.40 , $64.40 , $35.88 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $310.28 , $300.87 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $32.20 , $- , $- , $619.47 , $64.40
95819,5330020004,Hospital Chargemaster,EEG awake & asleep,Outpatient,Outpatient Default Percent / Case Rate,983, $92.00 , $50.60 , $75.81 , $316.40 , $64.40 , $35.88 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $343.75 , $333.32 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $32.20 , $- , $- , $619.47 , $64.40
95822,5330020005,Hospital Chargemaster,EEG coma or sleep only,Outpatient,Outpatient Default Percent / Case Rate,983, $90.00 , $49.50 , $74.16 , $316.40 , $63.00 , $35.10 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $407.63 , $395.26 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $31.50 , $- , $- , $619.47 , $63.00
95869,5330020020,Hospital Chargemaster,Muscle test thor paraspinal,Outpatient,Outpatient Default Percent / Case Rate,983, $35.00 , $19.25 , $28.84 , $166.91 , $24.50 , $13.65 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $106.47 , $103.24 , $175.26 , $170.25 , $209.96 , $209.96 , $215.37 , $215.37 , $166.91 , $12.25 , $- , $- , $333.79 , $24.50
95885,5330020024,Hospital Chargemaster,Musc tst done w/nerv tst lim,Outpatient,Outpatient Default Percent / Case Rate,983, $30.00 , $16.50 , $24.72 , See APC Packaged Rates , $21.00 , $11.70 , $164.03 , $128.20 , $140.42 , See APC Packaged Rates , See APC Packaged Rates , $99.24 , $96.23 , See APC Packaged Rates , See APC Packaged Rates , $27.90 , $27.90 , $27.90 , $27.90 , See APC Packaged Rates , $10.50 , $- , $- , $164.03 , $21.00
95886,5330020025,Hospital Chargemaster,Musc test done w/n test comp,Outpatient,Outpatient Default Percent / Case Rate,983, $72.00 , $39.60 , $59.33 , See APC Packaged Rates , $50.40 , $28.08 , $187.45 , $146.51 , $160.48 , See APC Packaged Rates , See APC Packaged Rates , $104.57 , $101.40 , See APC Packaged Rates , See APC Packaged Rates , $66.96 , $66.96 , $66.96 , $66.96 , See APC Packaged Rates , $25.20 , $- , $- , $187.45 , $50.40
95887,5330020026,Hospital Chargemaster,Musc tst done w/n tst nonext,Outpatient,Outpatient Default Percent / Case Rate,983, $59.00 , $32.45 , $48.62 , See APC Packaged Rates , $41.30 , $23.01 , $172.30 , $134.66 , $147.50 , See APC Packaged Rates , See APC Packaged Rates , $106.33 , $103.10 , See APC Packaged Rates , See APC Packaged Rates , $54.87 , $54.87 , $54.87 , $54.87 , See APC Packaged Rates , $20.65 , $- , $- , $172.30 , $41.30
95907,5330020028,Hospital Chargemaster,Nvr cndj tst 1-2 studies,Outpatient,Outpatient Default Percent / Case Rate,983, $84.00 , $46.20 , $69.22 , $166.91 , $58.80 , $32.76 , $333.79 , $260.88 , $285.75 , $166.91 , $166.91 , $111.17 , $107.80 , $175.26 , $170.25 , $215.76 , $215.76 , $221.32 , $221.32 , $166.91 , $29.40 , $- , $- , $333.79 , $58.80
95908,5330020029,Hospital Chargemaster,Nrv cndj tst 3-4 studies,Outpatient,Outpatient Default Percent / Case Rate,983, $105.00 , $57.75 , $86.52 , $316.40 , $73.50 , $40.95 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $134.25 , $130.17 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $36.75 , $- , $- , $619.47 , $73.50
95909,5330020030,Hospital Chargemaster,Nrv cndj tst 5-6 studies,Outpatient,Outpatient Default Percent / Case Rate,983, $125.00 , $68.75 , $103.00 , $316.40 , $87.50 , $48.75 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $161.32 , $156.42 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $43.75 , $- , $- , $619.47 , $87.50
95910,5330020031,Hospital Chargemaster,Nrv cndj test 7-8 studies,Outpatient,Outpatient Default Percent / Case Rate,983, $168.00 , $92.40 , $138.43 , $316.40 , $117.60 , $65.52 , $619.47 , $484.15 , $530.32 , $316.40 , $316.40 , $208.14 , $201.83 , $332.22 , $322.72 , $410.25 , $410.25 , $420.82 , $420.82 , $316.40 , $58.80 , $- , $- , $619.47 , $117.60
95911,5330020032,Hospital Chargemaster,Nrv cndj test 9-10 studies,Outpatient,Outpatient Default Percent / Case Rate,983, $210.00 , $115.50 , $173.04 , $583.57 , $147.00 , $81.90 ," $1,117.79 ", $873.62 , $956.92 , $583.57 , $583.57 , $241.42 , $234.09 , $612.75 , $595.24 , $666.00 , $666.00 , $666.00 , $666.00 , $583.57 , $73.50 , $- , $- ," $1,117.79 ", $147.00
95912,5330020033,Hospital Chargemaster,Nrv cndj test 11-12 studies,Outpatient,Outpatient Default Percent / Case Rate,983, $250.00 , $137.50 , $206.00 , $583.57 , $175.00 , $97.50 ," $1,117.79 ", $873.62 , $956.92 , $583.57 , $583.57 , $273.15 , $264.86 , $612.75 , $595.24 , $720.00 , $720.00 , $720.00 , $720.00 , $583.57 , $87.50 , $- , $- ," $1,117.79 ", $175.00
95913,5330020034,Hospital Chargemaster,Nrv cndj test 13/> studies,Outpatient,Outpatient Default Percent / Case Rate,983, $295.00 , $162.25 , $243.08 , $583.57 , $206.50 , $115.05 ," $1,117.79 ", $873.62 , $956.92 , $583.57 , $583.57 , $305.53 , $296.26 , $612.75 , $595.24 , $754.46 , $754.46 , $773.90 , $773.90 , $583.57 , $103.25 , $- , $- ," $1,117.79 ", $206.50
93306,5510030002,Hospital Chargemaster,Tte W/Doppler Complete,Outpatient,Outpatient Default Percent / Case Rate,983, $221.00 , $121.55 , $182.10 , $577.66 , $154.70 , $86.19 ," $1,221.45 ", $954.63 ," $1,045.66 ", $577.66 , $577.66 , $522.19 , $506.35 , $606.54 , $589.21 , $746.62 , $746.62 , $765.85 , $765.85 , $577.66 , $77.35 , $- , $- ," $1,221.45 ", $154.70
93308,5510030004,Hospital Chargemaster,Tte F-Up Or Lmtd,Outpatient,Outpatient Default Percent / Case Rate,983, $45.00 , $24.75 , $37.08 , $275.09 , $31.50 , $17.55 , $566.08 , $442.42 , $484.61 , $275.09 , $275.09 , $142.97 , $138.64 , $288.84 , $280.59 , $357.77 , $357.77 , $366.99 , $366.99 , $275.09 , $15.75 , $- , $- , $566.08 , $31.50
93042,5510030036,Hospital Chargemaster,Rhythm Ecg Report,Outpatient,Outpatient Default Percent / Case Rate,983, $24.00 , $13.20 , $19.78 , See APC Packaged Rates , $16.80 , $9.36 , $24.86 , $19.43 , $21.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $22.32 , $22.32 , $22.32 , $22.32 , See APC Packaged Rates , $8.40 , $- , $- , $24.86 , $16.80
93228,5510030037,Hospital Chargemaster,Remote 30 Day Ecg Rev/Report,Outpatient,Outpatient Default Percent / Case Rate,983, $73.00 , $40.15 , $60.15 , See APC Packaged Rates , $51.10 , $28.47 , $92.71 , $72.46 , $79.36 , See APC Packaged Rates , See APC Packaged Rates , $64.42 , $62.47 , See APC Packaged Rates , See APC Packaged Rates , $67.89 , $67.89 , $67.89 , $67.89 , See APC Packaged Rates , $25.55 , $- , $- , $92.71 , $51.10
93272,5510030040,Hospital Chargemaster,Ecg/Review Interpret Only,Outpatient,Outpatient Default Percent / Case Rate,983, $266.00 , $146.30 , $219.18 , See APC Packaged Rates , $186.20 , $103.74 , $90.09 , $70.41 , $77.12 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $44.35 , $44.35 , $45.49 , $45.49 , See APC Packaged Rates , $93.10 , $- , $- , $219.18 , $186.20
93291,5510030051,Hospital Chargemaster,Interrog Dev Eval Scrms Ip,Outpatient,Outpatient Default Percent / Case Rate,983, $52.00 , $28.60 , $42.85 , $29.53 , $36.40 , $20.28 , $42.15 , $32.94 , $36.08 , $29.53 , $29.53 , $45.16 , $43.79 , $31.01 , $30.12 , $37.87 , $37.87 , $38.85 , $38.85 , $29.53 , $18.20 , $- , $- , $45.16 , $36.40
90682,5710030021,Hospital Chargemaster,RIV4 Vacc Recombinant DNA IM,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $60.98 , $- , See APC Packaged Rates , $- , $- , $- , $- , $57.10 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $57.00 , $57.00 , $57.00 , $57.00 , See APC Packaged Rates , $- , $65.26 , $- , $65.26 , $-
90723,5710031130,Hospital Chargemaster,DTaP-Hep B-IPV Vac IM No Chrg,Outpatient,Outpatient Default Percent / Case Rate,983, $0.01 , $83.94 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $98.75 , $98.75 , $98.75 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $107.30 , $0.00 , $107.30 , $0.01
J9217,5710031156,Hospital Chargemaster,Leuprolide Acet Dep7.5mg No Ch,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $228.93 , $- , $162.82 , $- , $- , $224.45 , $224.45 , $224.45 , $162.82 , $162.82 , $- , $- , $170.96 , $166.07 , $- , $- , $- , $- , $162.82 , $- , $200.73 , $- , $228.93 , $-
J2930,5710033061,Hospital Chargemaster,methylPREDnisolone SS 125 mg,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $5.64 , $5.64 , $5.64 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $5.89 , $- , $5.89 , $-
J9030,5710033080,Hospital Chargemaster,BCG per instillation,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $2.85 , $- , See APC Packaged Rates , $- , $- , $2.79 , $2.79 , $2.79 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $2.83 , $- , $2.85 , $-
J0585,5710033088,Hospital Chargemaster,Onabotulinumtoxina 1 Unit Inj,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $5.96 , $- , $7.12 , $- , $- , $6.08 , $6.08 , $6.08 , $7.12 , $7.12 , $- , $- , $7.48 , $7.27 , $- , $- , $- , $- , $7.12 , $- , $6.19 , $- , $7.48 , $-
J2315,5710033094,Hospital Chargemaster,Naltrexone Depot 380 mg Inj,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $3.43 , $- , $4.13 , $- , $- , $3.26 , $3.26 , $3.26 , $4.13 , $4.13 , $- , $- , $4.34 , $4.21 , $- , $- , $- , $- , $4.13 , $- , $3.52 , $- , $4.34 , $-
J1885,5710033108,Hospital Chargemaster,Ketorolac tromethamin inj 60mg,Outpatient,Outpatient Default Percent / Case Rate,983, $33.00 , $- , $13.20 , See APC Packaged Rates , $23.10 , $12.87 , $0.67 , $0.67 , $0.67 , See APC Packaged Rates , See APC Packaged Rates , $22.14 , $22.14 , See APC Packaged Rates , See APC Packaged Rates , $30.69 , $30.69 , $30.69 , $30.69 , See APC Packaged Rates , $11.55 , $0.55 , $- , $30.69 , $23.10
J1726,5710033114,Hospital Chargemaster,Makena 10 MG 250 mg/mL IM oil,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $27.19 , $- , $19.68 , $- , $- , $31.12 , $31.12 , $31.12 , $19.68 , $19.68 , $- , $- , $20.67 , $20.08 , $9.47 , $9.47 , $9.47 , $9.47 , $19.68 , $- , $14.76 , $- , $31.12 , $-
J3420,5710033129,Hospital Chargemaster,Vitamin B12 Injection,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $1.84 , $1.84 , $1.84 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $1.80 , $- , $1.84 , $-
J7298,5710033138,Hospital Chargemaster,Levonorgestrel-rel IUD Mirena,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $972.58 , $- , See APC Packaged Rates , $- , $- ," $1,087.00 "," $1,087.00 "," $1,087.00 ", See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $953.51 , $953.51 , $978.11 , $978.11 , See APC Packaged Rates , $- ," $1,199.14 ", $- ," $1,199.14 ", $-
J7296,5710033139,Hospital Chargemaster,Levonorgestrel-rel IUD Kyleena,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $972.58 , $- , See APC Packaged Rates , $- , $- ," $1,087.00 "," $1,087.00 "," $1,087.00 ", See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $953.51 , $953.51 , $978.11 , $978.11 , See APC Packaged Rates , $- ," $1,199.14 ", $- ," $1,199.14 ", $-
J7307,5710033140,Hospital Chargemaster,Etonogestrel implant Nexplanon,Outpatient,Outpatient Default Percent / Case Rate,983," $2,812.00 "," $1,001.19 "," $1,124.80 ", See APC Packaged Rates ," $1,968.40 "," $1,096.68 "," $1,065.69 "," $1,065.69 "," $1,065.69 ", See APC Packaged Rates , See APC Packaged Rates ," $1,886.85 "," $1,886.85 ", See APC Packaged Rates , See APC Packaged Rates , $981.56 , $981.56 ," $1,006.88 "," $1,006.88 ", See APC Packaged Rates , $984.20 ," $1,236.77 ", $981.56 ," $1,968.40 "," $1,968.40 "
J7300,5710033141,Hospital Chargemaster,IUD copper contracept Paragard,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $902.19 , $- , See APC Packaged Rates , $- , $- ," $1,008.33 "," $1,008.33 "," $1,008.33 ", See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $884.50 , $884.50 , $906.00 , $906.00 , See APC Packaged Rates , $- ," $1,092.90 ", $- ," $1,092.90 ", $-
90715,5710033143,Hospital Chargemaster,Adacel Syringe age >/=7 yrs,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $34.28 , $34.28 , $34.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $34.28 , $-
90715,5710033144,Hospital Chargemaster,Boostrix Syringe age >/=7 yrs,Outpatient,Outpatient Default Percent / Case Rate,983, $101.00 , $- , $83.22 , See APC Packaged Rates , $70.70 , $39.39 , $34.28 , $34.28 , $34.28 , See APC Packaged Rates , See APC Packaged Rates , $67.77 , $67.77 , See APC Packaged Rates , See APC Packaged Rates , $93.93 , $93.93 , $93.93 , $93.93 , See APC Packaged Rates , $35.35 , $- , $- , $93.93 , $70.70
91300,5710033146,Hospital Chargemaster,Pfizer: COVID-19 Vaccine,Outpatient,Outpatient Default Percent / Case Rate,983, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $- , $- , $0.01 , $0.01
91301,5710033147,Hospital Chargemaster,Moderna: Covid-19 Vaccine,Outpatient,Outpatient Default Percent / Case Rate,983, $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.01 , $0.00 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , See APC Packaged Rates , See APC Packaged Rates , $0.01 , $0.01 , $0.01 , $0.01 , See APC Packaged Rates , $0.00 , $- , $- , $0.01 , $0.01
90715,5710033148,Hospital Chargemaster,TDaP Boostrix Vial,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $34.28 , $34.28 , $34.28 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $34.28 , $-
90715,5710033149,Hospital Chargemaster,TDaP Adacel Vial,Outpatient,Outpatient Default Percent / Case Rate,983, $101.00 , $- , $83.22 , See APC Packaged Rates , $70.70 , $39.39 , $34.28 , $34.28 , $34.28 , See APC Packaged Rates , See APC Packaged Rates , $67.77 , $67.77 , See APC Packaged Rates , See APC Packaged Rates , $93.93 , $93.93 , $93.93 , $93.93 , See APC Packaged Rates , $35.35 , $- , $- , $93.93 , $70.70
0001A,5720020025,Hospital Chargemaster,Pfizer Covid Vacc Admin dose 1,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , $46.82 , $- , $- , $- , $- , $- , $46.82 , $46.82 , $- , $- , $49.16 , $47.76 , $- , $- , $- , $- , $46.82 , $- , $- , $- , $49.16 , $-
90471,5720030008,Hospital Chargemaster,Immunization Admin,Outpatient,Outpatient Default Percent / Case Rate,983, $128.00 , $70.40 , $105.47 , $74.12 , $89.60 , $49.92 , $66.28 , $66.28 , $66.28 , $74.12 , $74.12 , $85.89 , $85.89 , $77.83 , $75.60 , $95.40 , $95.40 , $97.86 , $97.86 , $74.12 , $44.80 , $- , $- , $105.47 , $89.60
0001A,5720030025,Hospital Chargemaster,Pfizer Covid Vacc Admin dose 1,Outpatient,Outpatient Default Percent / Case Rate,983, $50.00 , $27.50 , $41.20 , $46.82 , $35.00 , $19.50 , $48.25 , $48.46 , $25.75 , $46.82 , $46.82 , $33.55 , $33.55 , $49.16 , $47.76 , $46.50 , $46.50 , $46.50 , $46.50 , $46.82 , $17.50 , $- , $- , $49.16 , $35.00
0002A,5720030026,Hospital Chargemaster,Pfizer Covid Vacc Admin dose 2,Outpatient,Outpatient Default Percent / Case Rate,983, $80.00 , $44.00 , $65.92 , $46.82 , $56.00 , $31.20 , $77.19 , $77.53 , $41.20 , $46.82 , $46.82 , $53.68 , $53.68 , $49.16 , $47.76 , $74.40 , $74.40 , $74.40 , $74.40 , $46.82 , $28.00 , $- , $- , $77.53 , $56.00
0011A,5720030027,Hospital Chargemaster,Moderna Covid Vacc Admn dose 1,Outpatient,Outpatient Default Percent / Case Rate,983, $50.00 , $27.50 , $41.20 , $46.82 , $35.00 , $19.50 , $48.25 , $48.46 , $25.75 , $46.82 , $46.82 , $33.55 , $33.55 , $49.16 , $47.76 , $46.50 , $46.50 , $46.50 , $46.50 , $46.82 , $17.50 , $- , $- , $49.16 , $35.00
0012A,5720030028,Hospital Chargemaster,Moderna Covid Vacc Admn dose 2,Outpatient,Outpatient Default Percent / Case Rate,983, $80.00 , $44.00 , $65.92 , $46.82 , $56.00 , $31.20 , $77.19 , $77.53 , $41.20 , $46.82 , $46.82 , $53.68 , $53.68 , $49.16 , $47.76 , $74.40 , $74.40 , $74.40 , $74.40 , $46.82 , $28.00 , $- , $- , $77.53 , $56.00
0031A,5720030029,Hospital Chargemaster,J & J Covid Vaccine S Admin,Outpatient,Outpatient Default Percent / Case Rate,983, $50.00 , $27.50 , $41.20 , $46.82 , $35.00 , $19.50 , $48.25 , $48.46 , $25.75 , $46.82 , $46.82 , $33.55 , $33.55 , $49.16 , $47.76 , $46.50 , $46.50 , $46.50 , $46.50 , $46.82 , $17.50 , $- , $- , $49.16 , $35.00
0003A,5720030030,Hospital Chargemaster,Pfizer Covid Vacc Admin dose 3,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , $46.82 , $- , $- , $- , $- , $- , $46.82 , $46.82 , $- , $- , $49.16 , $47.76 , $- , $- , $- , $- , $46.82 , $- , $- , $- , $49.16 , $-
99282,6010030002,Hospital Chargemaster,Ed Visit Low/Moder Severity,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $374.92 , $157.03 , $- , $- , $630.39 , $389.97 , $376.65 , $157.03 , $157.03 , $197.73 , $191.73 , $164.88 , $160.17 , $267.00 , $267.00 , $267.00 , $267.00 , $157.03 , $349.16 , $- , $- , $630.39 , $-
99291,6010030006,Hospital Chargemaster,Critical Care First Hour,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , $890.51 , $- , $- ," $3,645.69 "," $2,255.28 "," $2,178.27 ", $890.51 , $890.51 , $836.55 , $811.17 , $935.03 , $908.32 ," $1,078.51 "," $1,078.51 "," $1,106.30 "," $1,106.30 ", $890.51 , $- , $- , $- ," $3,645.69 ", $-
99292,6010030007,Hospital Chargemaster,Critical Care Addl 30 Min,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $788.62 , $487.85 , $471.20 , See APC Packaged Rates , See APC Packaged Rates , $250.80 , $243.19 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $788.62 , $-
99217,6010229217,Hospital Chargemaster,ED Observation Discharge,Outpatient,Outpatient Default Percent / Case Rate,983, $225.00 , $123.75 , $185.40 , See APC Packaged Rates , $157.50 , $87.75 , $523.42 , $323.80 , $312.74 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $165.32 , $165.32 , $169.58 , $169.58 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $157.50
99219,6010229219,Hospital Chargemaster,"ED Observation, Comp",Outpatient,Outpatient Default Percent / Case Rate,983, $608.00 , $334.40 , $500.99 , See APC Packaged Rates , $425.60 , $237.12 , $964.99 , $596.96 , $576.58 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $608.00 , $608.00 , $608.00 , $608.00 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $425.60
99220,6010229220,Hospital Chargemaster,"ED Observation, Complex",Outpatient,Outpatient Default Percent / Case Rate,983, $608.00 , $334.40 , $500.99 , See APC Packaged Rates , $425.60 , $237.12 , $586.66 , $589.21 , $313.13 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $608.00 , $608.00 , $608.00 , $608.00 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $425.60
99224,6010229224,Hospital Chargemaster,"ED Observ Sub, Problem Focus",Outpatient,Outpatient Default Percent / Case Rate,983, $120.00 , $66.00 , $98.88 , See APC Packaged Rates , $84.00 , $46.80 , $115.79 , $116.29 , $61.80 , See APC Packaged Rates , See APC Packaged Rates , $80.52 , $80.52 , See APC Packaged Rates , See APC Packaged Rates , $111.60 , $111.60 , $111.60 , $111.60 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $84.00
99225,6010229225,Hospital Chargemaster,ED Observ Sub Exp Prob Focus,Outpatient,Outpatient Default Percent / Case Rate,983, $225.00 , $123.75 , $185.40 , See APC Packaged Rates , $157.50 , $87.75 ," $1,432.13 ", $432.09 , $591.83 , See APC Packaged Rates , See APC Packaged Rates , $150.98 , $150.98 , See APC Packaged Rates , See APC Packaged Rates , $209.25 , $209.25 , $209.25 , $209.25 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $157.50
99226,6010229226,Hospital Chargemaster,"ED Observ Sub, Detail",Outpatient,Outpatient Default Percent / Case Rate,983, $318.00 , $174.90 , $262.03 , See APC Packaged Rates , $222.60 , $124.02 , $306.84 , $308.17 , $163.78 , See APC Packaged Rates , See APC Packaged Rates , $213.38 , $213.38 , See APC Packaged Rates , See APC Packaged Rates , $295.74 , $295.74 , $295.74 , $295.74 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $222.60
99234,6010229234,Hospital Chargemaster,"ED Observ, Adm/Dis Low Comp",Outpatient,Outpatient Default Percent / Case Rate,983, $608.00 , $334.40 , $500.99 , See APC Packaged Rates , $425.60 , $237.12 ," $2,602.93 ", $785.33 ," $1,075.66 ", See APC Packaged Rates , See APC Packaged Rates , $407.97 , $407.97 , See APC Packaged Rates , See APC Packaged Rates , $608.00 , $608.00 , $608.00 , $608.00 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $2,602.93 ", $425.60
99235,6010229235,Hospital Chargemaster,"ED Observ, Adm/Dis Mod Comp",Outpatient,Outpatient Default Percent / Case Rate,983, $608.00 , $334.40 , $500.99 , See APC Packaged Rates , $425.60 , $237.12 , $586.66 , $589.21 , $313.13 , See APC Packaged Rates , See APC Packaged Rates , $407.97 , $407.97 , See APC Packaged Rates , See APC Packaged Rates , $608.00 , $608.00 , $608.00 , $608.00 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $425.60
99241,6500020011,Hospital Chargemaster,Office consultation,Outpatient,Outpatient Default Percent / Case Rate,983, $118.00 , $64.90 , $97.23 , See APC Packaged Rates , $82.60 , $46.02 , $113.86 , $114.35 , $60.77 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $24.00 , $24.00 , $24.00 , $24.00 , See APC Packaged Rates , $41.30 , $- , $- , $114.35 , $82.60
99243,6500020013,Hospital Chargemaster,Office consultation,Outpatient,Outpatient Default Percent / Case Rate,983, $205.00 , $112.75 , $168.92 , See APC Packaged Rates , $143.50 , $79.95 , $197.80 , $198.67 , $105.58 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $71.75 , $- , $- , $198.67 , $143.50
99291,6500020015,Hospital Chargemaster,Critical care first hour,Outpatient,Outpatient Default Percent / Case Rate,983, $659.00 , $362.45 , $543.02 , $890.51 , $461.30 , $257.01 ," $3,645.69 "," $2,255.28 "," $2,178.27 ", $890.51 , $890.51 , $836.55 , $811.17 , $935.03 , $908.32 ," $1,078.51 "," $1,078.51 "," $1,106.30 "," $1,106.30 ", $890.51 , $263.60 , $- , $- ," $3,645.69 ", $461.30
99354,6500020017,Hospital Chargemaster,Prolong e&m/psyctx serv o/p,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
99355,6500020018,Hospital Chargemaster,Prolong e&m/psyctx serv o/p,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
99497,6500020027,Hospital Chargemaster,Advncd care plan 30 min,Outpatient,Outpatient Default Percent / Case Rate,983, $90.00 , $49.50 , $74.16 , $89.46 , $63.00 , $35.10 , $187.56 , $146.59 , $160.57 , $89.46 , $89.46 , $60.39 , $60.39 , $93.93 , $91.24 , $90.00 , $90.00 , $90.00 , $90.00 , $89.46 , $31.50 , $- , $- , $187.56 , $63.00
99498,6500020028,Hospital Chargemaster,Advncd care plan addl 30 min,Outpatient,Outpatient Default Percent / Case Rate,983, $70.00 , $38.50 , $57.68 , See APC Packaged Rates , $49.00 , $27.30 , $264.32 , $206.58 , $226.28 , See APC Packaged Rates , See APC Packaged Rates , $46.97 , $46.97 , See APC Packaged Rates , See APC Packaged Rates , $65.10 , $65.10 , $65.10 , $65.10 , See APC Packaged Rates , $24.50 , $- , $- , $264.32 , $49.00
11046,6500020075,Hospital Chargemaster,Deb musc/fascia add-on,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 ", See APC Packaged Rates , $- , $- , $179.86 , $123.45 , $122.79 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- ," $1,236.00 ", $-
11440,6500020100,Hospital Chargemaster,Exc face-mm b9+marg 0.5 cm/<,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,442.00 ", $743.95 , $- , $- ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $740.30 , $740.30 , $740.30 , $740.30 , $743.95 , $- , $- , $- ," $1,442.00 ", $-
11641,6500020110,Hospital Chargemaster,Exc f/e/e/n/l mal+mrg 0.6-1,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,442.00 ", $743.95 , $- , $- ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 , $558.00 , $558.00 , $558.00 , $558.00 , $743.95 , $- , $- , $- ," $1,442.00 ", $-
11750,6500020118,Hospital Chargemaster,Removal of nail bed,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 ", $413.21 , $- , $- , $687.09 , $471.59 , $469.08 , $413.21 , $413.21 , $105.28 , $102.55 , $433.88 , $421.48 , $526.00 , $526.00 , $526.00 , $526.00 , $413.21 , $- , $- , $- ," $1,236.00 ", $-
33285,6500020239,Hospital Chargemaster,Insj subq car rhythm mntr,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 "," $9,753.71 ", $- , $- ," $16,197.41 "," $11,117.20 "," $11,057.93 "," $9,753.71 "," $9,753.71 ", $105.28 , $102.55 ," $10,241.39 "," $9,948.78 "," $1,800.00 "," $1,800.00 "," $1,800.00 "," $1,800.00 "," $9,753.71 ", $- , $- , $- ," $16,197.41 ", $-
33286,6500020240,Hospital Chargemaster,Rmvl subq car rhythm mntr,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 ", $743.95 , $- , $- ," $1,267.38 ", $869.88 , $865.24 , $743.95 , $743.95 , $105.28 , $102.55 , $781.15 , $758.83 ," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $743.95 , $- , $- , $- ," $1,267.38 ", $-
36569,6500020271,Hospital Chargemaster,Insj picc 5 yr+ w/o imaging,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 "," $1,681.14 ", $- , $- ," $2,392.46 "," $1,642.08 "," $1,633.32 "," $1,681.14 "," $1,681.14 ", $844.48 , $822.61 ," $1,765.20 "," $1,714.76 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $2,540.00 "," $1,681.14 ", $- , $- , $- ," $2,540.00 ", $-
38222,6500020339,Hospital Chargemaster,Dx bone marrow bx & aspir,Outpatient,Outpatient Default Percent / Case Rate,983, $89.00 , $48.95 ," $1,236.00 "," $2,834.62 ", $62.30 , $34.71 ," $3,009.07 "," $2,065.30 "," $2,054.29 "," $2,834.62 "," $2,834.62 ", $105.28 , $102.55 ," $2,976.35 "," $2,891.31 ", $150.00 , $150.00 , $150.00 , $150.00 ," $2,834.62 ", $31.15 , $- , $- ," $3,009.07 ", $62.30
64400,6500020448,Hospital Chargemaster,N block inj trigeminal,Outpatient,Outpatient Default Percent / Case Rate,983, $194.00 , $106.70 ," $1,236.00 ", $312.35 , $135.80 , $75.66 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $157.25 , $152.48 , $327.96 , $318.59 , $194.00 , $194.00 , $194.00 , $194.00 , $312.35 , $67.90 , $- , $- ," $1,236.00 ", $135.80
64483,6500020462,Hospital Chargemaster,Inj foramen epidural l/s,Outpatient,Outpatient Default Percent / Case Rate,983, $327.00 , $179.85 ," $1,236.00 ", $984.14 , $228.90 , $127.53 ," $1,673.19 "," $1,148.40 "," $1,142.28 ", $984.14 , $984.14 , $264.05 , $256.03 ," $1,033.35 "," $1,003.82 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 ", $984.14 , $114.45 , $- , $- ," $1,673.19 ", $228.90
64484,6500020463,Hospital Chargemaster,Inj foramen epidural add-on,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 ", See APC Packaged Rates , $- , $- , $166.79 , $114.48 , $113.87 , See APC Packaged Rates , See APC Packaged Rates , $165.37 , $160.35 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- ," $1,236.00 ", $-
64612,6500020483,Hospital Chargemaster,Destroy nerve face muscle,Outpatient,Outpatient Default Percent / Case Rate,983, $135.00 , $74.25 ," $1,236.00 ", $312.35 , $94.50 , $52.65 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $446.00 , $446.00 , $446.00 , $446.00 , $312.35 , $47.25 , $- , $- ," $1,236.00 ", $94.50
64615,6500020484,Hospital Chargemaster,Chemodenerv musc migraine,Outpatient,Outpatient Default Percent / Case Rate,983, $230.00 , $126.50 ," $1,236.00 ", $312.35 , $161.00 , $89.70 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $154.33 , $154.33 , $327.96 , $318.59 , $415.00 , $415.00 , $415.00 , $415.00 , $312.35 , $80.50 , $- , $- ," $1,236.00 ", $161.00
64616,6500020485,Hospital Chargemaster,Chemodenerv musc neck dyston,Outpatient,Outpatient Default Percent / Case Rate,983, $168.00 , $92.40 ," $1,236.00 ", $312.35 , $117.60 , $65.52 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $740.30 , $740.30 , $740.30 , $740.30 , $312.35 , $58.80 , $- , $- ," $1,236.00 ", $117.60
64642,6500020492,Hospital Chargemaster,Chemodenerv 1 extremity 1-4,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 ", $759.14 , $- , $- ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $- , $- , $- ," $1,309.97 ", $-
64643,6500020493,Hospital Chargemaster,Chemodenerv 1 extrem 1-4 ea,Outpatient,Outpatient Default Percent / Case Rate,983, $130.00 , $71.50 ," $1,236.00 ", See APC Packaged Rates , $91.00 , $50.70 , $233.96 , $160.58 , $159.72 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $120.90 , $120.90 , $120.90 , $120.90 , See APC Packaged Rates , $45.50 , $- , $- ," $1,236.00 ", $91.00
64644,6500020494,Hospital Chargemaster,Chemodenerv 1 extrem 5/> mus,Outpatient,Outpatient Default Percent / Case Rate,983, $215.00 , $118.25 ," $1,236.00 ", $759.14 , $150.50 , $83.85 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $105.28 , $102.55 , $797.10 , $774.33 , $740.30 , $740.30 , $740.30 , $740.30 , $759.14 , $75.25 , $- , $- ," $1,309.97 ", $150.50
97597,6500020508,Hospital Chargemaster,Rmvl devital tis 20 cm/<,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 ", $214.68 , $- , $- , $875.52 , $556.51 , $546.42 , $214.68 , $214.68 , $126.90 , $123.05 , $225.42 , $218.98 , $78.00 , $78.00 , $78.00 , $78.00 , $214.68 , $- , $- , $- ," $1,236.00 ", $-
10180,6500020521,Hospital Chargemaster,Complex Drainage Wound,Outpatient,Outpatient Default Percent / Case Rate,983, $527.00 , $289.85 ," $1,442.00 "," $2,834.62 ", $368.90 , $205.53 ," $5,202.81 "," $3,570.98 "," $3,551.94 "," $2,834.62 "," $2,834.62 "," $1,133.44 "," $1,104.09 "," $2,976.35 "," $2,891.31 ", $490.11 , $490.11 , $490.11 , $490.11 ," $2,834.62 ", $184.45 , $- , $- ," $5,202.81 ", $368.90
11760,6500020552,Hospital Chargemaster,Repair Of Nail Bed,Outpatient,Outpatient Default Percent / Case Rate,983, $125.00 , $68.75 ," $1,236.00 ", $626.13 , $87.50 , $48.75 ," $1,056.38 ", $725.05 , $721.19 , $626.13 , $626.13 , $105.28 , $102.55 , $657.44 , $638.65 , $343.81 , $343.81 , $343.81 , $343.81 , $626.13 , $43.75 , $- , $- ," $1,236.00 ", $87.50
11982,6500020558,Hospital Chargemaster,Remove Drug Implant Device,Outpatient,Outpatient Default Percent / Case Rate,983, $116.00 , $63.80 ," $1,236.00 ", $324.46 , $81.20 , $45.24 , $761.64 , $522.76 , $519.97 , $324.46 , $324.46 , $105.28 , $102.55 , $340.68 , $330.95 , $343.81 , $343.81 , $343.81 , $343.81 , $324.46 , $40.60 , $- , $- ," $1,236.00 ", $81.20
23600,6500020698,Hospital Chargemaster,Treat Humerus Fracture,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 ", $246.41 , $- , $- , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $246.41 , $- , $- , $- ," $1,236.00 ", $-
24530,6500020742,Hospital Chargemaster,Treat Humerus Fracture,Outpatient,Outpatient Default Percent / Case Rate,983, $402.00 , $221.10 ," $1,236.00 ", $246.41 , $281.40 , $156.78 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $246.41 , $140.70 , $- , $- ," $1,236.00 ", $281.40
24650,6500020755,Hospital Chargemaster,Treat Radius Fracture,Outpatient,Outpatient Default Percent / Case Rate,983, $280.00 , $154.00 ," $1,236.00 ", $246.41 , $196.00 , $109.20 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $98.00 , $- , $- ," $1,236.00 ", $196.00
25530,6500020805,Hospital Chargemaster,Treat Fracture Of Ulna,Outpatient,Outpatient Default Percent / Case Rate,983, $277.00 , $152.35 ," $1,236.00 ", $246.41 , $193.90 , $108.03 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $96.95 , $- , $- ," $1,236.00 ", $193.90
25622,6500020817,Hospital Chargemaster,Treat Wrist Bone Fracture,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , $246.41 , $- , $- , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $- , $- , $- , $492.41 , $-
26600,6500020882,Hospital Chargemaster,Treat Metacarpal Fracture,Outpatient,Outpatient Default Percent / Case Rate,983, $337.00 , $185.35 , $277.69 , $246.41 , $235.90 , $131.43 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $325.00 , $325.00 , $325.00 , $325.00 , $246.41 , $117.95 , $- , $- , $492.41 , $235.90
26720,6500020897,Hospital Chargemaster,Treat Finger Fracture Each,Outpatient,Outpatient Default Percent / Case Rate,983, $214.00 , $117.70 ," $1,236.00 ", $246.41 , $149.80 , $83.46 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $74.90 , $- , $- ," $1,236.00 ", $149.80
26750,6500020904,Hospital Chargemaster,Treat Finger Fracture Each,Outpatient,Outpatient Default Percent / Case Rate,983, $214.00 , $117.70 , $176.34 , $246.41 , $149.80 , $83.46 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $74.90 , $- , $- , $492.41 , $149.80
27530,6500021014,Hospital Chargemaster,Treat Knee Fracture,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 ", $246.41 , $- , $- , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $246.41 , $- , $- , $- ," $1,236.00 ", $-
25600,6500021058,Hospital Chargemaster,Treat Fracture Radius/Ulna,Outpatient,Outpatient Default Percent / Case Rate,983, $362.00 , $199.10 ," $1,236.00 ", $246.41 , $253.40 , $141.18 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $126.70 , $- , $- ," $1,236.00 ", $253.40
27786,6500021071,Hospital Chargemaster,Treatment Of Ankle Fracture,Outpatient,Outpatient Default Percent / Case Rate,983, $333.00 , $183.15 ," $1,236.00 ", $246.41 , $233.10 , $129.87 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $246.41 , $116.55 , $- , $- ," $1,236.00 ", $233.10
28400,6500021128,Hospital Chargemaster,Treatment Of Heel Fracture,Outpatient,Outpatient Default Percent / Case Rate,983, $266.00 , $146.30 ," $1,236.00 ", $246.41 , $186.20 , $103.74 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $246.41 , $93.10 , $- , $- ," $1,236.00 ", $186.20
28470,6500021135,Hospital Chargemaster,Treat Metatarsal Fracture,Outpatient,Outpatient Default Percent / Case Rate,983, $240.00 , $132.00 ," $1,236.00 ", $246.41 , $168.00 , $93.60 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $84.00 , $- , $- ," $1,236.00 ", $168.00
28510,6500021139,Hospital Chargemaster,Treatment Of Toe Fracture,Outpatient,Outpatient Default Percent / Case Rate,983, $141.00 , $77.55 ," $1,236.00 ", $246.41 , $98.70 , $54.99 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $105.28 , $102.55 , $258.73 , $251.34 , $343.81 , $343.81 , $343.81 , $343.81 , $246.41 , $49.35 , $- , $- ," $1,236.00 ", $98.70
29065,6500021156,Hospital Chargemaster,Application Of Long Arm Cast,Outpatient,Outpatient Default Percent / Case Rate,983, $80.00 , $44.00 , $65.92 , $288.41 , $56.00 , $31.20 , $515.36 , $353.72 , $351.84 , $288.41 , $288.41 , $266.32 , $258.23 , $302.83 , $294.18 , $369.77 , $369.77 , $379.30 , $379.30 , $288.41 , $28.00 , $- , $- , $515.36 , $56.00
29125,6500021158,Hospital Chargemaster,Apply Forearm Splint,Outpatient,Outpatient Default Percent / Case Rate,983, $46.00 , $25.30 , $37.90 , $134.80 , $32.20 , $17.94 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $116.00 , $116.00 , $116.00 , $116.00 , $134.80 , $16.10 , $- , $- , $232.95 , $32.20
29260,6500021160,Hospital Chargemaster,Strapping Of Elbow Or Wrist,Outpatient,Outpatient Default Percent / Case Rate,983, $23.00 , $12.65 , $18.95 , $66.55 , $16.10 , $8.97 , $70.26 , $48.23 , $47.97 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $62.64 , $62.64 , $64.26 , $64.26 , $66.55 , $8.05 , $- , $- , $147.89 , $16.10
29530,6500021167,Hospital Chargemaster,Strapping Of Knee,Outpatient,Outpatient Default Percent / Case Rate,983, $22.00 , $12.10 , $18.13 , $134.80 , $15.40 , $8.58 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $125.00 , $125.00 , $125.00 , $125.00 , $134.80 , $7.70 , $- , $- , $232.95 , $15.40
44701,6500021478,Hospital Chargemaster,Intraop Colon Lavage Add-On,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
45382,6500021505,Hospital Chargemaster,Colonoscopy W/Control Bleed,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,442.00 "," $1,239.71 ", $- , $- ," $2,143.42 "," $1,471.15 "," $1,463.31 "," $1,239.71 "," $1,239.71 "," $1,133.44 "," $1,104.09 "," $1,301.70 "," $1,264.51 ", $900.00 , $900.00 , $900.00 , $900.00 ," $1,239.71 ", $- , $- , $- ," $2,143.42 ", $-
52224,6500021639,Hospital Chargemaster,Cystoscopy And Treatment,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,442.00 "," $3,675.67 ", $- , $- ," $3,805.91 "," $2,612.21 "," $2,598.29 "," $3,675.67 "," $3,675.67 "," $1,133.44 "," $1,104.09 "," $3,859.45 "," $3,749.18 ", $- , $- , $- , $- ," $3,675.67 ", $- , $- , $- ," $3,859.45 ", $-
57160,6500021755,Hospital Chargemaster,Insert pessary/other device,Outpatient,Outpatient Default Percent / Case Rate,983, $54.00 , $29.70 , $44.50 , $203.67 , $37.80 , $21.06 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $105.28 , $102.55 , $213.85 , $207.74 , $177.00 , $177.00 , $177.00 , $177.00 , $203.67 , $18.90 , $- , $- , $362.99 , $37.80
57420,6500021767,Hospital Chargemaster,Exam Of Vagina W/Scope,Outpatient,Outpatient Default Percent / Case Rate,983, $106.00 , $58.30 ," $1,236.00 ", $337.17 , $74.20 , $41.34 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 , $105.28 , $102.55 , $354.03 , $343.92 , $295.00 , $295.00 , $295.00 , $295.00 , $337.17 , $37.10 , $- , $- ," $1,236.00 ", $74.20
57454,6500021770,Hospital Chargemaster,Bx/Curett Of Cervix w/Scope,Outpatient,Outpatient Default Percent / Case Rate,983, $156.00 , $85.80 ," $1,442.00 ", $337.17 , $109.20 , $60.84 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 , $105.28 , $102.55 , $354.03 , $343.92 , $307.00 , $307.00 , $307.00 , $307.00 , $337.17 , $54.60 , $- , $- ," $1,442.00 ", $109.20
57455,6500021771,Hospital Chargemaster,Biopsy Of Cervix W/Scope,Outpatient,Outpatient Default Percent / Case Rate,983, $128.00 , $70.40 ," $1,236.00 ", $337.17 , $89.60 , $49.92 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 , $105.28 , $102.55 , $354.03 , $343.92 , $295.00 , $295.00 , $295.00 , $295.00 , $337.17 , $44.80 , $- , $- ," $1,236.00 ", $89.60
57456,6500021772,Hospital Chargemaster,Endocerv Curettage W/Scope,Outpatient,Outpatient Default Percent / Case Rate,983, $119.00 , $65.45 ," $1,236.00 ", $337.17 , $83.30 , $46.41 , $597.22 , $409.91 , $407.72 , $337.17 , $337.17 , $105.28 , $102.55 , $354.03 , $343.92 , $295.00 , $295.00 , $295.00 , $295.00 , $337.17 , $41.65 , $- , $- ," $1,236.00 ", $83.30
57522,6500021774,Hospital Chargemaster,Conization Of Cervix,Outpatient,Outpatient Default Percent / Case Rate,983, $294.00 , $161.70 ," $1,442.00 "," $3,136.64 ", $205.80 , $114.66 ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 "," $1,133.44 "," $1,104.09 "," $3,293.47 "," $3,199.37 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,136.64 ", $102.90 , $- , $- ," $5,165.58 ", $205.80
17340,6500021852,Hospital Chargemaster,Cryotherapy Of Skin,Outpatient,Outpatient Default Percent / Case Rate,983, $60.00 , $33.00 , $49.44 , $40.47 , $42.00 , $23.40 , $70.26 , $48.23 , $47.97 , $40.47 , $40.47 , $105.28 , $102.55 , $42.49 , $41.28 , $66.00 , $66.00 , $66.00 , $66.00 , $40.47 , $21.00 , $- , $- , $105.28 , $42.00
56606,6500021854,Hospital Chargemaster,Biopsy Of Vulva/Perineum,Outpatient,Outpatient Default Percent / Case Rate,983, $34.00 , $18.70 ," $1,236.00 ", See APC Packaged Rates , $23.80 , $13.26 , $95.04 , $65.23 , $64.88 , See APC Packaged Rates , See APC Packaged Rates , $105.28 , $102.55 , See APC Packaged Rates , See APC Packaged Rates , $31.62 , $31.62 , $31.62 , $31.62 , See APC Packaged Rates , $11.90 , $- , $- ," $1,236.00 ", $23.80
56820,6500021856,Hospital Chargemaster,Exam Of Vulva W/Scope,Outpatient,Outpatient Default Percent / Case Rate,983, $100.00 , $55.00 ," $1,236.00 ", $203.67 , $70.00 , $39.00 , $362.99 , $249.14 , $247.81 , $203.67 , $203.67 , $105.28 , $102.55 , $213.85 , $207.74 , $203.00 , $203.00 , $203.00 , $203.00 , $203.67 , $35.00 , $- , $- ," $1,236.00 ", $70.00
57460,6500021858,Hospital Chargemaster,Bx Of Cervix W/Scope Leep,Outpatient,Outpatient Default Percent / Case Rate,983, $187.00 , $102.85 ," $1,442.00 "," $3,136.64 ", $130.90 , $72.93 ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 ", $105.28 , $102.55 ," $3,293.47 "," $3,199.37 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $1,189.25 "," $3,136.64 ", $65.45 , $- , $- ," $5,165.58 ", $130.90
98925,6500021883,Hospital Chargemaster,Osteopath Manj 1-2 Regions,Outpatient,Outpatient Default Percent / Case Rate,983, $38.00 , $20.90 , $31.31 , $31.89 , $26.60 , $14.82 , $36.67 , $36.83 , $19.57 , $31.89 , $31.89 , $25.50 , $25.50 , $33.48 , $32.52 , $39.85 , $39.85 , $40.87 , $40.87 , $31.89 , $13.30 , $- , $- , $40.87 , $26.60
58558,6500021938,Hospital Chargemaster,Hysteroscopy Biopsy,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $2,060.00 "," $3,136.64 ", $- , $- ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 ", $844.48 , $822.61 ," $3,293.47 "," $3,199.37 "," $2,500.00 "," $2,500.00 "," $2,500.00 "," $2,500.00 "," $3,136.64 ", $- , $- , $- ," $5,165.58 ", $-
58562,6500021943,Hospital Chargemaster,Hysteroscopy Remove FB,Outpatient,Outpatient Default Percent / Case Rate,983, $258.00 , $141.90 ," $2,060.00 "," $3,136.64 ", $180.60 , $100.62 ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 ", $844.48 , $822.61 ," $3,293.47 "," $3,199.37 "," $2,500.00 "," $2,500.00 "," $2,500.00 "," $2,500.00 "," $3,136.64 ", $90.30 , $- , $- ," $5,165.58 ", $180.60
29280,6500022012,Hospital Chargemaster,Strapping of hand or finger,Outpatient,Outpatient Default Percent / Case Rate,983, $23.00 , $12.65 , $18.95 , $66.55 , $16.10 , $8.97 , $70.26 , $48.23 , $47.97 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $62.64 , $62.64 , $64.26 , $64.26 , $66.55 , $8.05 , $- , $- , $147.89 , $16.10
64611,6500022021,Hospital Chargemaster,Chemodenerv saliv gland,Outpatient,Outpatient Default Percent / Case Rate,983, $241.00 , $132.55 ," $1,236.00 ", $312.35 , $168.70 , $93.99 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $105.28 , $102.55 , $327.96 , $318.59 , $343.81 , $343.81 , $343.81 , $343.81 , $312.35 , $84.35 , $- , $- ," $1,236.00 ", $168.70
58670,6500022042,Hospital Chargemaster,Laparoscopy Tubal Cautery,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $2,060.00 "," $6,049.19 ", $- , $- ," $10,054.00 "," $6,900.63 "," $6,863.84 "," $6,049.19 "," $6,049.19 "," $1,599.36 "," $1,557.95 "," $6,351.65 "," $6,170.18 ", $- , $- , $- , $- ," $6,049.19 ", $- , $- , $- ," $10,054.00 ", $-
54401,6500022046,Hospital Chargemaster,Insert Self Controled Prosthes,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $2,060.00 "," $21,834.86 ", $- , $- ," $35,701.06 "," $24,503.65 "," $24,373.02 "," $21,834.86 "," $21,834.86 "," $1,599.36 "," $1,557.95 "," $22,926.61 "," $22,271.56 ", $- , $- , $- , $- ," $21,834.86 ", $- , $- , $- ," $35,701.06 ", $-
58561,6500022049,Hospital Chargemaster,Hysteroscopy Remove Myoma,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $2,060.00 "," $5,271.70 ", $- , $- ," $9,025.76 "," $6,194.89 "," $6,161.86 "," $5,271.70 "," $5,271.70 "," $1,294.72 "," $1,261.20 "," $5,535.28 "," $5,377.13 ", $- , $- , $- , $- ," $5,271.70 ", $- , $- , $- ," $9,025.76 ", $-
98926,6500028926,Hospital Chargemaster,Osteopath manj 3-4 regions,Outpatient,Outpatient Default Percent / Case Rate,983, $57.00 , $31.35 , $46.97 , $31.89 , $39.90 , $22.23 , $122.97 , $78.16 , $76.74 , $31.89 , $31.89 , $38.25 , $38.25 , $33.48 , $32.52 , $39.85 , $39.85 , $40.87 , $40.87 , $31.89 , $19.95 , $- , $- , $122.97 , $39.90
98927,6500028927,Hospital Chargemaster,Osteopath manj 5-6 regions,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , $31.89 , $- , $- , $122.97 , $78.16 , $76.74 , $31.89 , $31.89 , $- , $- , $33.48 , $32.52 , $39.85 , $39.85 , $40.87 , $40.87 , $31.89 , $- , $- , $- , $122.97 , $-
98928,6500028928,Hospital Chargemaster,Osteopath manj 7-8 regions,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , $31.89 , $- , $- , $122.97 , $78.16 , $76.74 , $31.89 , $31.89 , $- , $- , $33.48 , $32.52 , $39.85 , $39.85 , $40.87 , $40.87 , $31.89 , $- , $- , $- , $122.97 , $-
98929,6500028929,Hospital Chargemaster,Osteopath manj 9-10 regions,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , $31.89 , $- , $- , $- , $- , $- , $31.89 , $31.89 , $- , $- , $33.48 , $32.52 , $39.85 , $39.85 , $40.87 , $40.87 , $31.89 , $- , $- , $- , $40.87 , $-
99217,6500029217,Hospital Chargemaster,Observation care discharge,Outpatient,Outpatient Default Percent / Case Rate,983, $231.00 , $127.05 , $190.34 , See APC Packaged Rates , $161.70 , $90.09 , $523.42 , $323.80 , $312.74 , See APC Packaged Rates , See APC Packaged Rates ," $1,621.00 "," $1,621.00 ", See APC Packaged Rates , See APC Packaged Rates , $165.32 , $165.32 , $169.58 , $169.58 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $161.70
99219,6500029219,Hospital Chargemaster,Initial observation care med,Outpatient,Outpatient Default Percent / Case Rate,983, $400.00 , $220.00 , $329.60 , See APC Packaged Rates , $280.00 , $156.00 , $964.99 , $596.96 , $576.58 , See APC Packaged Rates , See APC Packaged Rates ," $1,621.00 "," $1,621.00 ", See APC Packaged Rates , See APC Packaged Rates , $608.00 , $608.00 , $608.00 , $608.00 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $280.00
99220,6500029220,Hospital Chargemaster,Initial observation care high,Outpatient,Outpatient Default Percent / Case Rate,983, $553.00 , $304.15 , $455.67 , See APC Packaged Rates , $387.10 , $215.67 , $533.59 , $535.91 , $284.81 , See APC Packaged Rates , See APC Packaged Rates ," $1,621.00 "," $1,621.00 ", See APC Packaged Rates , See APC Packaged Rates , $608.00 , $608.00 , $608.00 , $608.00 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $387.10
99234,6500029234,Hospital Chargemaster,Observ/hosp same date low,Outpatient,Outpatient Default Percent / Case Rate,983, $175.00 , $96.25 , $144.20 , See APC Packaged Rates , $122.50 , $68.25 ," $2,602.93 ", $785.33 ," $1,075.66 ", See APC Packaged Rates , See APC Packaged Rates ," $1,621.00 "," $1,621.00 ", See APC Packaged Rates , See APC Packaged Rates , $608.00 , $608.00 , $608.00 , $608.00 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $2,602.93 ", $122.50
99235,6500029235,Hospital Chargemaster,Observ/hosp same date med,Outpatient,Outpatient Default Percent / Case Rate,983, $225.00 , $123.75 , $185.40 , See APC Packaged Rates , $157.50 , $87.75 , $217.10 , $218.05 , $115.88 , See APC Packaged Rates , See APC Packaged Rates ," $1,621.00 "," $1,621.00 ", See APC Packaged Rates , See APC Packaged Rates , $608.00 , $608.00 , $608.00 , $608.00 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $157.50
99236,6500029236,Hospital Chargemaster,Observ/hosp same date high,Outpatient,Outpatient Default Percent / Case Rate,983, $310.00 , $170.50 , $255.44 , See APC Packaged Rates , $217.00 , $120.90 , $299.12 , $300.42 , $159.66 , See APC Packaged Rates , See APC Packaged Rates ," $1,621.00 "," $1,621.00 ", See APC Packaged Rates , See APC Packaged Rates , $608.00 , $608.00 , $608.00 , $608.00 , See APC Packaged Rates ," $1,676.48 ", $- , $- ," $1,676.48 ", $217.00
99241,6500029241,Hospital Chargemaster,Office consultation,Outpatient,Outpatient Default Percent / Case Rate,983, $118.00 , $64.90 , $97.23 , See APC Packaged Rates , $82.60 , $46.02 , $113.86 , $114.35 , $60.77 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $24.00 , $24.00 , $24.00 , $24.00 , See APC Packaged Rates , $41.30 , $- , $- , $114.35 , $82.60
99244,6500029244,Hospital Chargemaster,Office consultation,Outpatient,Outpatient Default Percent / Case Rate,983, $298.00 , $163.90 , $245.55 , See APC Packaged Rates , $208.60 , $116.22 , $287.54 , $288.79 , $153.48 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $25.89 , $25.89 , $25.89 , $25.89 , See APC Packaged Rates , $104.30 , $- , $- , $288.79 , $208.60
99251,6500029251,Hospital Chargemaster,Inpatient consultation,Outpatient,Outpatient Default Percent / Case Rate,983, $118.00 , $64.90 , $97.23 , See APC Packaged Rates , $82.60 , $46.02 , $113.86 , $114.35 , $60.77 , See APC Packaged Rates , See APC Packaged Rates , $79.18 , $79.18 , See APC Packaged Rates , See APC Packaged Rates , $118.00 , $118.00 , $118.00 , $118.00 , See APC Packaged Rates , $41.30 , $- , $- , $118.00 , $82.60
99252,6500029252,Hospital Chargemaster,Inpatient consultation,Outpatient,Outpatient Default Percent / Case Rate,983, $212.00 , $116.60 , $174.69 , See APC Packaged Rates , $148.40 , $82.68 , $204.56 , $205.45 , $109.18 , See APC Packaged Rates , See APC Packaged Rates , $142.25 , $142.25 , See APC Packaged Rates , See APC Packaged Rates , $177.29 , $177.29 , $181.85 , $181.85 , See APC Packaged Rates , $74.20 , $- , $- , $205.45 , $148.40
99253,6500029253,Hospital Chargemaster,Inpatient consultation,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
99254,6500029254,Hospital Chargemaster,Inpatient consultation,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
99255,6500029255,Hospital Chargemaster,Inpatient consultation,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $- , $-
27750,8004021058,Hospital Chargemaster,Treatment Of Tibia Fracture,Outpatient,Outpatient Default Percent / Case Rate,983, $370.00 , $203.50 ," $1,236.00 ", $246.41 , $259.00 , $144.30 , $492.41 , $337.97 , $336.16 , $246.41 , $246.41 , $844.48 , $822.61 , $258.73 , $251.34 ," $1,142.00 "," $1,142.00 "," $1,142.00 "," $1,142.00 ", $246.41 , $129.50 , $- , $- ," $1,236.00 ", $259.00
56700,8004026700,Hospital Chargemaster,Partial removal of hymen,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 "," $3,136.64 ", $- , $- ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 ", $844.48 , $822.61 ," $3,293.47 "," $3,199.37 ", $- , $- , $- , $- ," $3,136.64 ", $- , $- , $- ," $5,165.58 ", $-
29240,8004029240,Hospital Chargemaster,Strapping of shoulder,Outpatient,Outpatient Default Percent / Case Rate,983, $22.00 , $12.10 , $18.13 , $134.80 , $15.40 , $8.58 , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $125.00 , $125.00 , $125.00 , $125.00 , $134.80 , $7.70 , $- , $- , $232.95 , $15.40
29550,8004029550,Hospital Chargemaster,Stapping of Toes,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , $66.55 , $- , $- , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $85.99 , $85.99 , $88.21 , $88.21 , $66.55 , $- , $- , $- , $147.89 , $-
G0289,8004030010,Hospital Chargemaster,Scpe Knee Remv FB TM Surg Diff,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $282.07 , $193.60 , $192.57 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $282.07 , $-
29240,8004039240,Hospital Chargemaster,Strapping of shoulder,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , $134.80 , $- , $- , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $147.89 , $143.40 , $141.54 , $137.50 , $125.00 , $125.00 , $125.00 , $125.00 , $134.80 , $- , $- , $- , $232.95 , $-
29550,8004039550,Hospital Chargemaster,Stapping of Toes,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , $66.55 , $- , $- , $122.28 , $83.93 , $83.48 , $66.55 , $66.55 , $147.89 , $143.40 , $69.87 , $67.88 , $85.99 , $85.99 , $88.21 , $88.21 , $66.55 , $- , $- , $- , $147.89 , $-
33262,8009030001,Hospital Chargemaster,Rmvl& replc pulse gen 1 lead,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $2,060.00 "," $27,568.15 ", $- , $- ," $48,120.00 "," $33,027.48 "," $32,851.40 "," $27,568.15 "," $27,568.15 ", $105.28 , $102.55 ," $28,946.56 "," $28,119.52 ", $- , $- , $- , $- ," $27,568.15 ", $- , $- , $- ," $48,120.00 ", $-
33263,8009030002,Hospital Chargemaster,Rmvl & rplcmt dfb gen 2 lead,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $2,060.00 "," $27,568.15 ", $- , $- ," $48,120.00 "," $33,027.48 "," $32,851.40 "," $27,568.15 "," $27,568.15 ", $105.28 , $102.55 ," $28,946.56 "," $28,119.52 ", $- , $- , $- , $- ," $27,568.15 ", $- , $- , $- ," $48,120.00 ", $-
33264,8009030003,Hospital Chargemaster,Rmvl & rplcmt dfb gen mlt ld,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $2,060.00 "," $39,269.48 ", $- , $- ," $67,064.65 "," $46,030.26 "," $45,784.86 "," $39,269.48 "," $39,269.48 ", $105.28 , $102.55 ," $41,232.96 "," $40,054.87 ", $- , $- , $- , $- ," $39,269.48 ", $- , $- , $- ," $67,064.65 ", $-
G0250,8009030004,Hospital Chargemaster,Md inr test revie inter mgmt,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $32.63 , $25.51 , $27.94 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $32.63 , $-
33228,8009030005,Hospital Chargemaster,Remv&replc pm gen dual lead,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $2,060.00 "," $12,430.76 ", $- , $- ," $21,612.29 "," $14,833.74 "," $14,754.65 "," $12,430.76 "," $12,430.76 ", $105.28 , $102.55 ," $13,052.30 "," $12,679.38 ", $- , $- , $- , $- ," $12,430.76 ", $- , $- , $- ," $21,612.29 ", $-
33227,8009030006,Hospital Chargemaster,Remove&replace pm gen singl,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $2,060.00 "," $9,753.71 ", $- , $- ," $16,197.41 "," $11,117.20 "," $11,057.93 "," $9,753.71 "," $9,753.71 ", $105.28 , $102.55 ," $10,241.39 "," $9,948.78 ", $- , $- , $- , $- ," $9,753.71 ", $- , $- , $- ," $16,197.41 ", $-
G0101,8014020101,Hospital Chargemaster,Ca Screen; Pelvic/Breast Exam,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , $89.46 , $- , $- , $187.56 , $146.59 , $160.57 , $89.46 , $89.46 , $- , $- , $93.93 , $91.24 , $13.82 , $13.82 , $13.82 , $13.82 , $89.46 , $- , $- , $- , $187.56 , $-
64435,8014024435,Hospital Chargemaster,Njx aa&/strd paracrv nrv,Outpatient,Outpatient Default Percent / Case Rate,983, $96.00 , $52.80 ," $1,236.00 ", $759.14 , $67.20 , $37.44 ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $204.40 , $198.20 , $797.10 , $774.33 , $598.00 , $598.00 , $598.00 , $598.00 , $759.14 , $33.60 , $- , $- ," $1,309.97 ", $67.20
57265,8014027265,Hospital Chargemaster,Cmbn ap colprhy w/ntrcl rpr,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $2,976.70 "," $5,271.70 ", $- , $- ," $9,025.76 "," $6,194.89 "," $6,161.86 "," $5,271.70 "," $5,271.70 "," $2,528.96 "," $2,463.48 "," $5,535.28 "," $5,377.13 ", $- , $- , $- , $- ," $5,271.70 ", $- , $- , $- ," $9,025.76 ", $-
64435,8014034435,Hospital Chargemaster,Njx aa&/strd paracrv nrv,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 ", $759.14 , $- , $- ," $1,309.97 ", $899.10 , $894.31 , $759.14 , $759.14 , $204.40 , $198.20 , $797.10 , $774.33 , $598.00 , $598.00 , $598.00 , $598.00 , $759.14 , $- , $- , $- ," $1,309.97 ", $-
58120,8014038120,Hospital Chargemaster,Dilation and Curettage,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,442.00 "," $3,136.64 ", $- , $- ," $5,165.58 "," $3,545.43 "," $3,526.53 "," $3,136.64 "," $3,136.64 "," $1,133.44 "," $1,104.09 "," $3,293.47 "," $3,199.37 ", $- , $- , $- , $- ," $3,136.64 ", $- , $- , $- ," $5,165.58 ", $-
44604,8023024604,Hospital Chargemaster,Suture large intestine,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- ," $3,445.47 "," $2,364.82 "," $2,352.21 ", See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- ," $3,445.47 ", $-
47538,8023027538,Hospital Chargemaster,Perq plmt bile duct stent,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $2,060.00 "," $6,049.19 ", $- , $- ," $10,054.00 "," $6,900.63 "," $6,863.84 "," $6,049.19 "," $6,049.19 ", $844.48 , $822.61 ," $6,351.65 "," $6,170.18 ", $- , $- , $- , $- ," $6,049.19 ", $- , $- , $- ," $10,054.00 ", $-
50430,8027030430,Hospital Chargemaster,Njx px nfrosgrm &/urtrgrm,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 ", $687.79 , $- , $- ," $1,229.98 ", $844.21 , $839.71 , $687.79 , $687.79 , $105.28 , $102.55 , $722.18 , $701.54 , $892.65 , $892.65 , $915.65 , $915.65 , $687.79 , $- , $- , $- ," $1,236.00 ", $-
53661,8027033661,Hospital Chargemaster,Dilation of urethra,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , $134.80 , $- , $- , $232.95 , $159.88 , $159.03 , $134.80 , $134.80 , $105.28 , $102.55 , $141.54 , $137.50 , $- , $- , $- , $- , $134.80 , $- , $- , $- , $232.95 , $-
54660,8027034660,Hospital Chargemaster,Revision of testis,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,442.00 "," $5,274.50 ", $- , $- ," $8,795.44 "," $6,036.81 "," $6,004.62 "," $5,274.50 "," $5,274.50 "," $1,133.44 "," $1,104.09 "," $5,538.23 "," $5,379.99 ", $- , $- , $- , $- ," $5,274.50 ", $- , $- , $- ," $8,795.44 ", $-
64650,8037024650,Hospital Chargemaster,Chemodenerv eccrine glands,Outpatient,Outpatient Default Percent / Case Rate,983, $65.00 , $35.75 ," $1,236.00 ", $312.35 , $45.50 , $25.35 , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $43.62 , $43.62 , $327.96 , $318.59 , $365.00 , $365.00 , $365.00 , $365.00 , $312.35 , $22.75 , $- , $- ," $1,236.00 ", $45.50
95874,8037025874,Hospital Chargemaster,Guide nerv destr needle emg,Outpatient,Outpatient Default Percent / Case Rate,983, $31.00 , $17.05 , $25.54 , See APC Packaged Rates , $21.70 , $12.09 , $221.91 , $173.44 , $189.98 , See APC Packaged Rates , See APC Packaged Rates , $21.08 , $20.44 , See APC Packaged Rates , See APC Packaged Rates , $28.83 , $28.83 , $28.83 , $28.83 , See APC Packaged Rates , $10.85 , $- , $- , $221.91 , $21.70
64650,8037034650,Hospital Chargemaster,Chemodenerv eccrine glands,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- ," $1,236.00 ", $312.35 , $- , $- , $541.40 , $371.59 , $369.61 , $312.35 , $312.35 , $- , $- , $327.96 , $318.59 , $365.00 , $365.00 , $365.00 , $365.00 , $312.35 , $- , $- , $- ," $1,236.00 ", $-
95874,8037035874,Hospital Chargemaster,Guide nerv destr needle emg,Outpatient,Outpatient Default Percent / Case Rate,983, $- , $- , $- , See APC Packaged Rates , $- , $- , $221.91 , $173.44 , $189.98 , See APC Packaged Rates , See APC Packaged Rates , $21.08 , $20.44 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , $- , $- , See APC Packaged Rates , $- , $- , $- , $221.91 , $-
93272,5511020006,Hospital Chargemaster,Ecg/review interpret only,Outpatient,Outpatient Default Percent / Case Rate,985, $266.00 , $146.30 , $219.18 , See APC Packaged Rates , $186.20 , $103.74 , $90.09 , $70.41 , $77.12 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $44.35 , $44.35 , $45.49 , $45.49 , See APC Packaged Rates , $93.10 , $- , $- , $219.18 , $186.20
93227,5511020005,Hospital Chargemaster,Ecg monit/reprt up to 48 hrs,Outpatient,Outpatient Default Percent / Case Rate,985, $130.00 , $71.50 , $107.12 , See APC Packaged Rates , $91.00 , $50.70 , $94.23 , $73.65 , $80.67 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $44.35 , $44.35 , $45.49 , $45.49 , See APC Packaged Rates , $45.50 , $- , $- , $107.12 , $91.00
93010,5511020002,Hospital Chargemaster,Electrocardiogram report,Outpatient,Outpatient Default Percent / Case Rate,985, $36.00 , $19.80 , $29.66 , See APC Packaged Rates , $25.20 , $14.04 , $30.04 , $23.48 , $25.71 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $33.48 , $33.48 , $33.48 , $33.48 , See APC Packaged Rates , $12.60 , $- , $- , $33.48 , $25.20
93010,5511030002,Hospital Chargemaster,Electrocardiogram Report,Outpatient,Outpatient Default Percent / Case Rate,985, $36.00 , $19.80 , $29.66 , See APC Packaged Rates , $25.20 , $14.04 , $30.04 , $23.48 , $25.71 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $33.48 , $33.48 , $33.48 , $33.48 , See APC Packaged Rates , $12.60 , $- , $- , $33.48 , $25.20
93018,5511020004,Hospital Chargemaster,Cardiovascular stress test,Outpatient,Outpatient Default Percent / Case Rate,985, $180.00 , $99.00 , $148.32 , See APC Packaged Rates , $126.00 , $70.20 , $52.64 , $41.14 , $45.07 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $167.40 , $167.40 , $167.40 , $167.40 , See APC Packaged Rates , $63.00 , $- , $- , $167.40 , $126.00
93016,5511020003,Hospital Chargemaster,Cardiovascular stress test,Outpatient,Outpatient Default Percent / Case Rate,985, $75.00 , $41.25 , $61.80 , See APC Packaged Rates , $52.50 , $29.25 , $72.37 , $72.68 , $38.63 , See APC Packaged Rates , See APC Packaged Rates , $- , $- , See APC Packaged Rates , See APC Packaged Rates , $69.75 , $69.75 , $69.75 , $69.75 , See APC Packaged Rates , $26.25 , $- , $- , $72.68 , $52.50
93351,5510030009,Hospital Chargemaster,Stress tte complete,Outpatient,Outpatient Default Percent / Case Rate,985, $370.00 , $203.50 , $304.88 , $577.66 , $259.00 , $144.30 ," $1,221.45 ", $954.63 ," $1,045.66 ", $577.66 , $577.66 , $417.57 , $404.90 , $606.54 , $589.21 , $746.62 , $746.62 , $765.85 , $765.85 , $577.66 , $129.50 , $- , $- ," $1,221.45 ", $259.00
,795,Diagnosis Related Group,NORMAL NEWBORN,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $1,618.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,618.64 "," $1,618.64 ", Not Applicable , Not Applicable ," $1,699.58 "," $1,651.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,618.64 ", Not Applicable ," $1,357.00 "," $1,357.00 "," $1,699.58 ", Not Applicable
,298,Diagnosis Related Group,"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $4,148.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,148.89 "," $4,148.89 ", Not Applicable , Not Applicable ," $4,356.33 "," $4,231.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,148.89 ", Not Applicable , Not Applicable ," $4,148.89 "," $4,356.33 ", Not Applicable
,285,Diagnosis Related Group,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $4,198.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,198.97 "," $4,198.97 ", Not Applicable , Not Applicable ," $4,408.92 "," $4,282.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,198.97 ", Not Applicable , Not Applicable ," $4,198.97 "," $4,408.92 ", Not Applicable
,833,Diagnosis Related Group,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $4,558.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,558.01 "," $4,558.01 ", Not Applicable , Not Applicable ," $4,785.91 "," $4,649.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,558.01 ", Not Applicable ," $1,723.00 "," $1,723.00 "," $4,785.91 ", Not Applicable
,894,Diagnosis Related Group,"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $4,659.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,659.86 "," $4,659.86 ", Not Applicable , Not Applicable ," $4,892.86 "," $4,753.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,659.86 ", Not Applicable , Not Applicable ," $4,659.86 "," $4,892.86 ", Not Applicable
,951,Diagnosis Related Group,OTHER FACTORS INFLUENCING HEALTH STATUS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $4,749.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,749.83 "," $4,749.83 ", Not Applicable , Not Applicable ," $4,987.33 "," $4,844.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,749.83 ", Not Applicable , Not Applicable ," $4,749.83 "," $4,987.33 ", Not Applicable
,310,Diagnosis Related Group,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $4,746.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,746.44 "," $4,746.44 ", Not Applicable , Not Applicable ," $4,983.76 "," $4,841.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,746.44 ", Not Applicable , Not Applicable ," $4,746.44 "," $4,983.76 ", Not Applicable
,730,Diagnosis Related Group,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $4,828.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,828.77 "," $4,828.77 ", Not Applicable , Not Applicable ," $5,070.21 "," $4,925.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,828.77 ", Not Applicable , Not Applicable ," $4,828.77 "," $5,070.21 ", Not Applicable
,390,Diagnosis Related Group,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $4,949.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,949.30 "," $4,949.30 ", Not Applicable , Not Applicable ," $5,196.77 "," $5,048.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,949.30 ", Not Applicable , Not Applicable ," $4,949.30 "," $5,196.77 ", Not Applicable
,761,Diagnosis Related Group,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,014.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,014.66 "," $5,014.66 ", Not Applicable , Not Applicable ," $5,265.39 "," $5,114.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,014.66 ", Not Applicable , Not Applicable ," $5,014.66 "," $5,265.39 ", Not Applicable
,440,Diagnosis Related Group,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,146.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,146.22 "," $5,146.22 ", Not Applicable , Not Applicable ," $5,403.53 "," $5,249.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,146.22 ", Not Applicable , Not Applicable ," $5,146.22 "," $5,403.53 ", Not Applicable
,684,Diagnosis Related Group,RENAL FAILURE WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,159.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,159.80 "," $5,159.80 ", Not Applicable , Not Applicable ," $5,417.79 "," $5,263.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,159.80 ", Not Applicable , Not Applicable ," $5,159.80 "," $5,417.79 ", Not Applicable
,639,Diagnosis Related Group,DIABETES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,174.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,174.23 "," $5,174.23 ", Not Applicable , Not Applicable ," $5,432.94 "," $5,277.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,174.23 ", Not Applicable , Not Applicable ," $5,174.23 "," $5,432.94 ", Not Applicable
,434,Diagnosis Related Group,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,268.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,268.45 "," $5,268.45 ", Not Applicable , Not Applicable ," $5,531.87 "," $5,373.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,268.45 ", Not Applicable , Not Applicable ," $5,268.45 "," $5,531.87 ", Not Applicable
,379,Diagnosis Related Group,GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,408.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,408.50 "," $5,408.50 ", Not Applicable , Not Applicable ," $5,678.92 "," $5,516.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,408.50 ", Not Applicable , Not Applicable ," $5,408.50 "," $5,678.92 ", Not Applicable
,807,Diagnosis Related Group,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,451.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,451.78 "," $5,451.78 ", Not Applicable , Not Applicable ," $5,724.37 "," $5,560.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,451.78 ", Not Applicable ," $7,174.00 "," $5,451.78 "," $7,174.00 ", Not Applicable
,122,Diagnosis Related Group,ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,478.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,478.95 "," $5,478.95 ", Not Applicable , Not Applicable ," $5,752.89 "," $5,588.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,478.95 ", Not Applicable , Not Applicable ," $5,478.95 "," $5,752.89 ", Not Applicable
,724,Diagnosis Related Group,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,501.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,501.01 "," $5,501.01 ", Not Applicable , Not Applicable ," $5,776.07 "," $5,611.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,501.01 ", Not Applicable , Not Applicable ," $5,501.01 "," $5,776.07 ", Not Applicable
,395,Diagnosis Related Group,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,529.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,529.87 "," $5,529.87 ", Not Applicable , Not Applicable ," $5,806.37 "," $5,640.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,529.87 ", Not Applicable , Not Applicable ," $5,529.87 "," $5,806.37 ", Not Applicable
,293,Diagnosis Related Group,HEART FAILURE AND SHOCK WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,007.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,007.02 "," $5,007.02 ", Not Applicable , Not Applicable ," $5,257.37 "," $5,107.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,007.02 ", Not Applicable , Not Applicable ," $5,007.02 "," $5,257.37 ", Not Applicable
,159,Diagnosis Related Group,DENTAL AND ORAL DISEASES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,628.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,628.33 "," $5,628.33 ", Not Applicable , Not Applicable ," $5,909.75 "," $5,740.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,628.33 ", Not Applicable , Not Applicable ," $5,628.33 "," $5,909.75 ", Not Applicable
,916,Diagnosis Related Group,ALLERGIC REACTIONS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,588.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,588.44 "," $5,588.44 ", Not Applicable , Not Applicable ," $5,867.86 "," $5,700.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,588.44 ", Not Applicable , Not Applicable ," $5,588.44 "," $5,867.86 ", Not Applicable
,156,Diagnosis Related Group,"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,588.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,588.44 "," $5,588.44 ", Not Applicable , Not Applicable ," $5,867.86 "," $5,700.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,588.44 ", Not Applicable , Not Applicable ," $5,588.44 "," $5,867.86 ", Not Applicable
,816,Diagnosis Related Group,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,611.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,611.36 "," $5,611.36 ", Not Applicable , Not Applicable ," $5,891.93 "," $5,723.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,611.36 ", Not Applicable , Not Applicable ," $5,611.36 "," $5,891.93 ", Not Applicable
,443,Diagnosis Related Group,"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,629.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,629.18 "," $5,629.18 ", Not Applicable , Not Applicable ," $5,910.64 "," $5,741.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,629.18 ", Not Applicable , Not Applicable ," $5,629.18 "," $5,910.64 ", Not Applicable
,195,Diagnosis Related Group,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,651.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,651.25 "," $5,651.25 ", Not Applicable , Not Applicable ," $5,933.81 "," $5,764.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,651.25 ", Not Applicable , Not Applicable ," $5,651.25 "," $5,933.81 ", Not Applicable
,599,Diagnosis Related Group,MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,698.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,698.78 "," $5,698.78 ", Not Applicable , Not Applicable ," $5,983.72 "," $5,812.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,698.78 ", Not Applicable , Not Applicable ," $5,698.78 "," $5,983.72 ", Not Applicable
,303,Diagnosis Related Group,ATHEROSCLEROSIS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,751.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,751.41 "," $5,751.41 ", Not Applicable , Not Applicable ," $6,038.98 "," $5,866.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,751.41 ", Not Applicable , Not Applicable ," $5,751.41 "," $6,038.98 ", Not Applicable
,759,Diagnosis Related Group,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,800.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,800.64 "," $5,800.64 ", Not Applicable , Not Applicable ," $6,090.67 "," $5,916.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,800.64 ", Not Applicable , Not Applicable ," $5,800.64 "," $6,090.67 ", Not Applicable
,688,Diagnosis Related Group,KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,821.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,821.01 "," $5,821.01 ", Not Applicable , Not Applicable ," $6,112.06 "," $5,937.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,821.01 ", Not Applicable , Not Applicable ," $5,821.01 "," $6,112.06 ", Not Applicable
,601,Diagnosis Related Group,NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,829.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,829.50 "," $5,829.50 ", Not Applicable , Not Applicable ," $6,120.97 "," $5,946.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,829.50 ", Not Applicable , Not Applicable ," $5,829.50 "," $6,120.97 ", Not Applicable
,696,Diagnosis Related Group,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,872.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,872.78 "," $5,872.78 ", Not Applicable , Not Applicable ," $6,166.42 "," $5,990.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,872.78 ", Not Applicable , Not Applicable ," $5,872.78 "," $6,166.42 ", Not Applicable
,921,Diagnosis Related Group,COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,923.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,923.71 "," $5,923.71 ", Not Applicable , Not Applicable ," $6,219.90 "," $6,042.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,923.71 ", Not Applicable , Not Applicable ," $5,923.71 "," $6,219.90 ", Not Applicable
,192,Diagnosis Related Group,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,904.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,904.19 "," $5,904.19 ", Not Applicable , Not Applicable ," $6,199.40 "," $6,022.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,904.19 ", Not Applicable , Not Applicable ," $5,904.19 "," $6,199.40 ", Not Applicable
,311,Diagnosis Related Group,ANGINA PECTORIS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $5,928.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,928.81 "," $5,928.81 ", Not Applicable , Not Applicable ," $6,225.25 "," $6,047.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,928.81 ", Not Applicable , Not Applicable ," $5,928.81 "," $6,225.25 ", Not Applicable
,297,Diagnosis Related Group,"CARDIAC ARREST, UNEXPLAINED WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,000.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,000.95 "," $6,000.95 ", Not Applicable , Not Applicable ," $6,301.00 "," $6,120.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,000.95 ", Not Applicable , Not Applicable ," $6,000.95 "," $6,301.00 ", Not Applicable
,203,Diagnosis Related Group,BRONCHITIS AND ASTHMA WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,000.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,000.95 "," $6,000.95 ", Not Applicable , Not Applicable ," $6,301.00 "," $6,120.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,000.95 ", Not Applicable , Not Applicable ," $6,000.95 "," $6,301.00 ", Not Applicable
,201,Diagnosis Related Group,PNEUMOTHORAX WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,023.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,023.02 "," $6,023.02 ", Not Applicable , Not Applicable ," $6,324.17 "," $6,143.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,023.02 ", Not Applicable , Not Applicable ," $6,023.02 "," $6,324.17 ", Not Applicable
,153,Diagnosis Related Group,OTITIS MEDIA AND URI WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,053.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,053.58 "," $6,053.58 ", Not Applicable , Not Applicable ," $6,356.26 "," $6,174.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,053.58 ", Not Applicable , Not Applicable ," $6,053.58 "," $6,356.26 ", Not Applicable
,66,Diagnosis Related Group,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,040.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,040.00 "," $6,040.00 ", Not Applicable , Not Applicable ," $6,342.00 "," $6,160.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,040.00 ", Not Applicable , Not Applicable ," $6,040.00 "," $6,342.00 ", Not Applicable
,387,Diagnosis Related Group,INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,066.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,066.31 "," $6,066.31 ", Not Applicable , Not Applicable ," $6,369.62 "," $6,187.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,066.31 ", Not Applicable , Not Applicable ," $6,066.31 "," $6,369.62 ", Not Applicable
,313,Diagnosis Related Group,CHEST PAIN,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,123.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,123.18 "," $6,123.18 ", Not Applicable , Not Applicable ," $6,429.34 "," $6,245.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,123.18 ", Not Applicable , Not Applicable ," $6,123.18 "," $6,429.34 ", Not Applicable
,538,Diagnosis Related Group,"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,138.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,138.46 "," $6,138.46 ", Not Applicable , Not Applicable ," $6,445.38 "," $6,261.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,138.46 ", Not Applicable , Not Applicable ," $6,138.46 "," $6,445.38 ", Not Applicable
,282,Diagnosis Related Group,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,163.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,163.07 "," $6,163.07 ", Not Applicable , Not Applicable ," $6,471.23 "," $6,286.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,163.07 ", Not Applicable , Not Applicable ," $6,163.07 "," $6,471.23 ", Not Applicable
,869,Diagnosis Related Group,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,183.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,183.44 "," $6,183.44 ", Not Applicable , Not Applicable ," $6,492.61 "," $6,307.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,183.44 ", Not Applicable , Not Applicable ," $6,183.44 "," $6,492.61 ", Not Applicable
,79,Diagnosis Related Group,HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,185.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,185.99 "," $6,185.99 ", Not Applicable , Not Applicable ," $6,495.29 "," $6,309.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,185.99 ", Not Applicable , Not Applicable ," $6,185.99 "," $6,495.29 ", Not Applicable
,188,Diagnosis Related Group,PLEURAL EFFUSION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,191.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,191.93 "," $6,191.93 ", Not Applicable , Not Applicable ," $6,501.53 "," $6,315.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,191.93 ", Not Applicable , Not Applicable ," $6,191.93 "," $6,501.53 ", Not Applicable
,694,Diagnosis Related Group,URINARY STONES WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,545.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,545.88 "," $6,545.88 ", Not Applicable , Not Applicable ," $6,873.17 "," $6,676.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,545.88 ", Not Applicable , Not Applicable ," $6,545.88 "," $6,873.17 ", Not Applicable
,806,Diagnosis Related Group,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,235.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,235.22 "," $6,235.22 ", Not Applicable , Not Applicable ," $6,546.98 "," $6,359.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,235.22 ", Not Applicable ," $7,174.00 "," $6,235.22 "," $7,174.00 ", Not Applicable
,284,Diagnosis Related Group,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,140.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,140.15 "," $6,140.15 ", Not Applicable , Not Applicable ," $6,447.16 "," $6,262.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,140.15 ", Not Applicable , Not Applicable ," $6,140.15 "," $6,447.16 ", Not Applicable
,149,Diagnosis Related Group,DYSEQUILIBRIUM,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,255.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,255.59 "," $6,255.59 ", Not Applicable , Not Applicable ," $6,568.37 "," $6,380.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,255.59 ", Not Applicable , Not Applicable ," $6,255.59 "," $6,568.37 ", Not Applicable
,151,Diagnosis Related Group,EPISTAXIS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,267.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,267.47 "," $6,267.47 ", Not Applicable , Not Applicable ," $6,580.85 "," $6,392.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,267.47 ", Not Applicable , Not Applicable ," $6,267.47 "," $6,580.85 ", Not Applicable
,305,Diagnosis Related Group,HYPERTENSION WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,280.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,280.20 "," $6,280.20 ", Not Applicable , Not Applicable ," $6,594.21 "," $6,405.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,280.20 ", Not Applicable , Not Applicable ," $6,280.20 "," $6,594.21 ", Not Applicable
,950,Diagnosis Related Group,AFTERCARE WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,282.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,282.75 "," $6,282.75 ", Not Applicable , Not Applicable ," $6,596.89 "," $6,408.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,282.75 ", Not Applicable , Not Applicable ," $6,282.75 "," $6,596.89 ", Not Applicable
,198,Diagnosis Related Group,INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,309.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,309.91 "," $6,309.91 ", Not Applicable , Not Applicable ," $6,625.41 "," $6,436.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,309.91 ", Not Applicable , Not Applicable ," $6,309.91 "," $6,625.41 ", Not Applicable
,301,Diagnosis Related Group,PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,307.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,307.37 "," $6,307.37 ", Not Applicable , Not Applicable ," $6,622.73 "," $6,433.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,307.37 ", Not Applicable , Not Applicable ," $6,307.37 "," $6,622.73 ", Not Applicable
,726,Diagnosis Related Group,BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,320.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,320.95 "," $6,320.95 ", Not Applicable , Not Applicable ," $6,636.99 "," $6,447.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,320.95 ", Not Applicable , Not Applicable ," $6,320.95 "," $6,636.99 ", Not Applicable
,373,Diagnosis Related Group,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,320.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,320.10 "," $6,320.10 ", Not Applicable , Not Applicable ," $6,636.10 "," $6,446.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,320.10 ", Not Applicable , Not Applicable ," $6,320.10 "," $6,636.10 ", Not Applicable
,700,Diagnosis Related Group,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,336.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,336.22 "," $6,336.22 ", Not Applicable , Not Applicable ," $6,653.04 "," $6,462.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,336.22 ", Not Applicable , Not Applicable ," $6,336.22 "," $6,653.04 ", Not Applicable
,370,Diagnosis Related Group,MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,349.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,349.81 "," $6,349.81 ", Not Applicable , Not Applicable ," $6,667.30 "," $6,476.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,349.81 ", Not Applicable , Not Applicable ," $6,349.81 "," $6,667.30 ", Not Applicable
,309,Diagnosis Related Group,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,370.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,370.18 "," $6,370.18 ", Not Applicable , Not Applicable ," $6,688.69 "," $6,497.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,370.18 ", Not Applicable , Not Applicable ," $6,370.18 "," $6,688.69 ", Not Applicable
,316,Diagnosis Related Group,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,140.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,140.15 "," $6,140.15 ", Not Applicable , Not Applicable ," $6,447.16 "," $6,262.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,140.15 ", Not Applicable , Not Applicable ," $6,140.15 "," $6,447.16 ", Not Applicable
,566,Diagnosis Related Group,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,382.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,382.06 "," $6,382.06 ", Not Applicable , Not Applicable ," $6,701.16 "," $6,509.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,382.06 ", Not Applicable , Not Applicable ," $6,382.06 "," $6,701.16 ", Not Applicable
,641,Diagnosis Related Group,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,401.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,401.58 "," $6,401.58 ", Not Applicable , Not Applicable ," $6,721.66 "," $6,529.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,401.58 ", Not Applicable , Not Applicable ," $6,401.58 "," $6,721.66 ", Not Applicable
,392,Diagnosis Related Group,"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,500.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,500.04 "," $6,500.04 ", Not Applicable , Not Applicable ," $6,825.04 "," $6,630.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,500.04 ", Not Applicable , Not Applicable ," $6,500.04 "," $6,825.04 ", Not Applicable
,123,Diagnosis Related Group,NEUROLOGICAL EYE DISORDERS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,508.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,508.53 "," $6,508.53 ", Not Applicable , Not Applicable ," $6,833.96 "," $6,638.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,508.53 ", Not Applicable , Not Applicable ," $6,508.53 "," $6,833.96 ", Not Applicable
,645,Diagnosis Related Group,ENDOCRINE DISORDERS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,523.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,523.81 "," $6,523.81 ", Not Applicable , Not Applicable ," $6,850.00 "," $6,654.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,523.81 ", Not Applicable , Not Applicable ," $6,523.81 "," $6,850.00 ", Not Applicable
,382,Diagnosis Related Group,COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,523.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,523.81 "," $6,523.81 ", Not Applicable , Not Applicable ," $6,850.00 "," $6,654.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,523.81 ", Not Applicable , Not Applicable ," $6,523.81 "," $6,850.00 ", Not Applicable
,776,Diagnosis Related Group,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,573.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,573.89 "," $6,573.89 ", Not Applicable , Not Applicable ," $6,902.58 "," $6,705.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,573.89 ", Not Applicable , Not Applicable ," $6,573.89 "," $6,902.58 ", Not Applicable
,72,Diagnosis Related Group,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,550.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,550.12 "," $6,550.12 ", Not Applicable , Not Applicable ," $6,877.63 "," $6,681.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,550.12 ", Not Applicable , Not Applicable ," $6,550.12 "," $6,877.63 ", Not Applicable
,536,Diagnosis Related Group,FRACTURES OF HIP AND PELVIS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,550.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,550.12 "," $6,550.12 ", Not Applicable , Not Applicable ," $6,877.63 "," $6,681.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,550.12 ", Not Applicable , Not Applicable ," $6,550.12 "," $6,877.63 ", Not Applicable
,81,Diagnosis Related Group,NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,562.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,562.85 "," $6,562.85 ", Not Applicable , Not Applicable ," $6,890.99 "," $6,694.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,562.85 ", Not Applicable , Not Applicable ," $6,562.85 "," $6,890.99 ", Not Applicable
,185,Diagnosis Related Group,MAJOR CHEST TRAUMA WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,577.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,577.28 "," $6,577.28 ", Not Applicable , Not Applicable ," $6,906.15 "," $6,708.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,577.28 ", Not Applicable , Not Applicable ," $6,577.28 "," $6,906.15 ", Not Applicable
,544,Diagnosis Related Group,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,601.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,601.05 "," $6,601.05 ", Not Applicable , Not Applicable ," $6,931.10 "," $6,733.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,601.05 ", Not Applicable , Not Applicable ," $6,601.05 "," $6,931.10 ", Not Applicable
,832,Diagnosis Related Group,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,606.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,606.14 "," $6,606.14 ", Not Applicable , Not Applicable ," $6,936.45 "," $6,738.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,606.14 ", Not Applicable ," $1,723.00 "," $1,723.00 "," $6,936.45 ", Not Applicable
,93,Diagnosis Related Group,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,639.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,639.24 "," $6,639.24 ", Not Applicable , Not Applicable ," $6,971.21 "," $6,772.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,639.24 ", Not Applicable , Not Applicable ," $6,639.24 "," $6,971.21 ", Not Applicable
,948,Diagnosis Related Group,SIGNS AND SYMPTOMS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,680.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,680.83 "," $6,680.83 ", Not Applicable , Not Applicable ," $7,014.88 "," $6,814.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,680.83 ", Not Applicable , Not Applicable ," $6,680.83 "," $7,014.88 ", Not Applicable
,69,Diagnosis Related Group,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,680.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,680.83 "," $6,680.83 ", Not Applicable , Not Applicable ," $7,014.88 "," $6,814.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,680.83 ", Not Applicable , Not Applicable ," $6,680.83 "," $7,014.88 ", Not Applicable
,148,Diagnosis Related Group,"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,679.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,679.99 "," $6,679.99 ", Not Applicable , Not Applicable ," $7,013.98 "," $6,813.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,679.99 ", Not Applicable , Not Applicable ," $6,679.99 "," $7,013.98 ", Not Applicable
,182,Diagnosis Related Group,RESPIRATORY NEOPLASMS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,722.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,722.42 "," $6,722.42 ", Not Applicable , Not Applicable ," $7,058.55 "," $6,856.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,722.42 ", Not Applicable , Not Applicable ," $6,722.42 "," $7,058.55 ", Not Applicable
,534,Diagnosis Related Group,FRACTURES OF FEMUR WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,707.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,707.15 "," $6,707.15 ", Not Applicable , Not Applicable ," $7,042.50 "," $6,841.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,707.15 ", Not Applicable , Not Applicable ," $6,707.15 "," $7,042.50 ", Not Applicable
,554,Diagnosis Related Group,BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,726.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,726.67 "," $6,726.67 ", Not Applicable , Not Applicable ," $7,063.00 "," $6,861.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,726.67 ", Not Applicable , Not Applicable ," $6,726.67 "," $7,063.00 ", Not Applicable
,561,Diagnosis Related Group,"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,725.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,725.82 "," $6,725.82 ", Not Applicable , Not Applicable ," $7,062.11 "," $6,860.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,725.82 ", Not Applicable , Not Applicable ," $6,725.82 "," $7,062.11 ", Not Applicable
,918,Diagnosis Related Group,POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,719.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,719.03 "," $6,719.03 ", Not Applicable , Not Applicable ," $7,054.98 "," $6,853.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,719.03 ", Not Applicable , Not Applicable ," $6,719.03 "," $7,054.98 ", Not Applicable
,690,Diagnosis Related Group,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,739.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,739.40 "," $6,739.40 ", Not Applicable , Not Applicable ," $7,076.37 "," $6,874.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,739.40 ", Not Applicable , Not Applicable ," $6,739.40 "," $7,076.37 ", Not Applicable
,204,Diagnosis Related Group,RESPIRATORY SIGNS AND SYMPTOMS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,736.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,736.01 "," $6,736.01 ", Not Applicable , Not Applicable ," $7,072.81 "," $6,870.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,736.01 ", Not Applicable , Not Applicable ," $6,736.01 "," $7,072.81 ", Not Applicable
,881,Diagnosis Related Group,DEPRESSIVE NEUROSES,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,807.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,807.30 "," $6,807.30 ", Not Applicable , Not Applicable ," $7,147.67 "," $6,943.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,807.30 ", Not Applicable , Not Applicable ," $6,807.30 "," $7,147.67 ", Not Applicable
,728,Diagnosis Related Group,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,838.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,838.71 "," $6,838.71 ", Not Applicable , Not Applicable ," $7,180.64 "," $6,975.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,838.71 ", Not Applicable , Not Applicable ," $6,838.71 "," $7,180.64 ", Not Applicable
,556,Diagnosis Related Group,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,864.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,864.17 "," $6,864.17 ", Not Applicable , Not Applicable ," $7,207.38 "," $7,001.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,864.17 ", Not Applicable , Not Applicable ," $6,864.17 "," $7,207.38 ", Not Applicable
,446,Diagnosis Related Group,DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,931.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,931.23 "," $6,931.23 ", Not Applicable , Not Applicable ," $7,277.79 "," $7,069.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,931.23 ", Not Applicable , Not Applicable ," $6,931.23 "," $7,277.79 ", Not Applicable
,594,Diagnosis Related Group,SKIN ULCERS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,926.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,926.13 "," $6,926.13 ", Not Applicable , Not Applicable ," $7,272.44 "," $7,064.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,926.13 ", Not Applicable , Not Applicable ," $6,926.13 "," $7,272.44 ", Not Applicable
,389,Diagnosis Related Group,GASTROINTESTINAL OBSTRUCTION WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,987.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,987.25 "," $6,987.25 ", Not Applicable , Not Applicable ," $7,336.61 "," $7,126.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,987.25 ", Not Applicable , Not Applicable ," $6,987.25 "," $7,336.61 ", Not Applicable
,882,Diagnosis Related Group,NEUROSES EXCEPT DEPRESSIVE,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $6,990.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,990.64 "," $6,990.64 ", Not Applicable , Not Applicable ," $7,340.17 "," $7,130.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,990.64 ", Not Applicable , Not Applicable ," $6,990.64 "," $7,340.17 ", Not Applicable
,897,Diagnosis Related Group,"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,019.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,019.50 "," $7,019.50 ", Not Applicable , Not Applicable ," $7,370.48 "," $7,159.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,019.50 ", Not Applicable , Not Applicable ," $7,019.50 "," $7,370.48 ", Not Applicable
,607,Diagnosis Related Group,MINOR SKIN DISORDERS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,029.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,029.69 "," $7,029.69 ", Not Applicable , Not Applicable ," $7,381.17 "," $7,170.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,029.69 ", Not Applicable , Not Applicable ," $7,029.69 "," $7,381.17 ", Not Applicable
,798,Diagnosis Related Group,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,023.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,023.75 "," $7,023.75 ", Not Applicable , Not Applicable ," $7,374.93 "," $7,164.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,023.75 ", Not Applicable ," $7,174.00 "," $7,023.75 "," $7,374.93 ", Not Applicable
,103,Diagnosis Related Group,HEADACHES WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,040.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,040.72 "," $7,040.72 ", Not Applicable , Not Applicable ," $7,392.76 "," $7,181.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,040.72 ", Not Applicable , Not Applicable ," $7,040.72 "," $7,392.76 ", Not Applicable
,547,Diagnosis Related Group,CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,075.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,075.52 "," $7,075.52 ", Not Applicable , Not Applicable ," $7,429.30 "," $7,217.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,075.52 ", Not Applicable , Not Applicable ," $7,075.52 "," $7,429.30 ", Not Applicable
,125,Diagnosis Related Group,OTHER DISORDERS OF THE EYE WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,104.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,104.38 "," $7,104.38 ", Not Applicable , Not Applicable ," $7,459.60 "," $7,246.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,104.38 ", Not Applicable , Not Applicable ," $7,104.38 "," $7,459.60 ", Not Applicable
,312,Diagnosis Related Group,SYNCOPE AND COLLAPSE,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,118.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,118.81 "," $7,118.81 ", Not Applicable , Not Applicable ," $7,474.75 "," $7,261.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,118.81 ", Not Applicable , Not Applicable ," $7,118.81 "," $7,474.75 ", Not Applicable
,866,Diagnosis Related Group,VIRAL ILLNESS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,121.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,121.36 "," $7,121.36 ", Not Applicable , Not Applicable ," $7,477.42 "," $7,263.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,121.36 ", Not Applicable , Not Applicable ," $7,121.36 "," $7,477.42 ", Not Applicable
,541,Diagnosis Related Group,OSTEOMYELITIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,157.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,157.01 "," $7,157.01 ", Not Applicable , Not Applicable ," $7,514.86 "," $7,300.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,157.01 ", Not Applicable , Not Applicable ," $7,157.01 "," $7,514.86 ", Not Applicable
,138,Diagnosis Related Group,MOUTH PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,269.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,269.89 "," $7,269.89 ", Not Applicable , Not Applicable ," $7,633.39 "," $7,415.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,269.89 ", Not Applicable , Not Applicable ," $7,269.89 "," $7,633.39 ", Not Applicable
,439,Diagnosis Related Group,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,173.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,173.98 "," $7,173.98 ", Not Applicable , Not Applicable ," $7,532.68 "," $7,317.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,173.98 ", Not Applicable , Not Applicable ," $7,173.98 "," $7,532.68 ", Not Applicable
,603,Diagnosis Related Group,CELLULITIS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,245.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,245.28 "," $7,245.28 ", Not Applicable , Not Applicable ," $7,607.54 "," $7,390.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,245.28 ", Not Applicable , Not Applicable ," $7,245.28 "," $7,607.54 ", Not Applicable
,845,Diagnosis Related Group,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,205.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,205.39 "," $7,205.39 ", Not Applicable , Not Applicable ," $7,565.66 "," $7,349.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,205.39 ", Not Applicable , Not Applicable ," $7,205.39 "," $7,565.66 ", Not Applicable
,90,Diagnosis Related Group,CONCUSSION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,253.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,253.77 "," $7,253.77 ", Not Applicable , Not Applicable ," $7,616.46 "," $7,398.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,253.77 ", Not Applicable , Not Applicable ," $7,253.77 "," $7,616.46 ", Not Applicable
,558,Diagnosis Related Group,"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,311.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,311.49 "," $7,311.49 ", Not Applicable , Not Applicable ," $7,677.06 "," $7,457.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,311.49 ", Not Applicable , Not Applicable ," $7,311.49 "," $7,677.06 ", Not Applicable
,87,Diagnosis Related Group,TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,330.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,330.16 "," $7,330.16 ", Not Applicable , Not Applicable ," $7,696.67 "," $7,476.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,330.16 ", Not Applicable , Not Applicable ," $7,330.16 "," $7,696.67 ", Not Applicable
,194,Diagnosis Related Group,SIMPLE PNEUMONIA AND PLEURISY WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,332.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,332.71 "," $7,332.71 ", Not Applicable , Not Applicable ," $7,699.34 "," $7,479.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,332.71 ", Not Applicable , Not Applicable ," $7,332.71 "," $7,699.34 ", Not Applicable
,880,Diagnosis Related Group,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,337.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,337.80 "," $7,337.80 ", Not Applicable , Not Applicable ," $7,704.69 "," $7,484.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,337.80 ", Not Applicable , Not Applicable ," $7,337.80 "," $7,704.69 ", Not Applicable
,307,Diagnosis Related Group,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,387.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,387.88 "," $7,387.88 ", Not Applicable , Not Applicable ," $7,757.27 "," $7,535.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,387.88 ", Not Applicable , Not Applicable ," $7,387.88 "," $7,757.27 ", Not Applicable
,563,Diagnosis Related Group,"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,403.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,403.16 "," $7,403.16 ", Not Applicable , Not Applicable ," $7,773.31 "," $7,551.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,403.16 ", Not Applicable , Not Applicable ," $7,403.16 "," $7,773.31 ", Not Applicable
,179,Diagnosis Related Group,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,407.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,407.40 "," $7,407.40 ", Not Applicable , Not Applicable ," $7,777.77 "," $7,555.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,407.40 ", Not Applicable , Not Applicable ," $7,407.40 "," $7,777.77 ", Not Applicable
,864,Diagnosis Related Group,FEVER AND INFLAMMATORY CONDITIONS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,439.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,439.65 "," $7,439.65 ", Not Applicable , Not Applicable ," $7,811.64 "," $7,588.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,439.65 ", Not Applicable , Not Applicable ," $7,439.65 "," $7,811.64 ", Not Applicable
,683,Diagnosis Related Group,RENAL FAILURE WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,463.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,463.42 "," $7,463.42 ", Not Applicable , Not Applicable ," $7,836.59 "," $7,612.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,463.42 ", Not Applicable , Not Applicable ," $7,463.42 "," $7,836.59 ", Not Applicable
,638,Diagnosis Related Group,DIABETES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,464.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,464.27 "," $7,464.27 ", Not Applicable , Not Applicable ," $7,837.48 "," $7,613.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,464.27 ", Not Applicable , Not Applicable ," $7,464.27 "," $7,837.48 ", Not Applicable
,812,Diagnosis Related Group,RED BLOOD CELL DISORDERS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,471.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,471.91 "," $7,471.91 ", Not Applicable , Not Applicable ," $7,845.50 "," $7,621.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,471.91 ", Not Applicable , Not Applicable ," $7,471.91 "," $7,845.50 ", Not Applicable
,550,Diagnosis Related Group,SEPTIC ARTHRITIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,460.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,460.02 "," $7,460.02 ", Not Applicable , Not Applicable ," $7,833.03 "," $7,609.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,460.02 ", Not Applicable , Not Applicable ," $7,460.02 "," $7,833.03 ", Not Applicable
,191,Diagnosis Related Group,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,505.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,505.86 "," $7,505.86 ", Not Applicable , Not Applicable ," $7,881.15 "," $7,655.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,505.86 ", Not Applicable , Not Applicable ," $7,505.86 "," $7,881.15 ", Not Applicable
,206,Diagnosis Related Group,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,520.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,520.29 "," $7,520.29 ", Not Applicable , Not Applicable ," $7,896.30 "," $7,670.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,520.29 ", Not Applicable , Not Applicable ," $7,520.29 "," $7,896.30 ", Not Applicable
,176,Diagnosis Related Group,PULMONARY EMBOLISM WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,535.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,535.57 "," $7,535.57 ", Not Applicable , Not Applicable ," $7,912.34 "," $7,686.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,535.57 ", Not Applicable , Not Applicable ," $7,535.57 "," $7,912.34 ", Not Applicable
,101,Diagnosis Related Group,SEIZURES WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,540.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,540.66 "," $7,540.66 ", Not Applicable , Not Applicable ," $7,917.69 "," $7,691.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,540.66 ", Not Applicable , Not Applicable ," $7,540.66 "," $7,917.69 ", Not Applicable
,788,Diagnosis Related Group,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,532.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,532.17 "," $7,532.17 ", Not Applicable , Not Applicable ," $7,908.78 "," $7,682.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,532.17 ", Not Applicable ," $8,023.00 "," $7,532.17 "," $8,023.00 ", Not Applicable
,770,Diagnosis Related Group,"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,552.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,552.54 "," $7,552.54 ", Not Applicable , Not Applicable ," $7,930.17 "," $7,703.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,552.54 ", Not Applicable , Not Applicable ," $7,552.54 "," $7,930.17 ", Not Applicable
,68,Diagnosis Related Group,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,544.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,544.90 "," $7,544.90 ", Not Applicable , Not Applicable ," $7,922.15 "," $7,695.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,544.90 ", Not Applicable , Not Applicable ," $7,544.90 "," $7,922.15 ", Not Applicable
,914,Diagnosis Related Group,TRAUMATIC INJURY WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,527.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,527.93 "," $7,527.93 ", Not Applicable , Not Applicable ," $7,904.32 "," $7,678.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,527.93 ", Not Applicable , Not Applicable ," $7,527.93 "," $7,904.32 ", Not Applicable
,158,Diagnosis Related Group,DENTAL AND ORAL DISEASES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,640.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,640.82 "," $7,640.82 ", Not Applicable , Not Applicable ," $8,022.86 "," $7,793.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,640.82 ", Not Applicable , Not Applicable ," $7,640.82 "," $8,022.86 ", Not Applicable
,384,Diagnosis Related Group,UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,578.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,578.01 "," $7,578.01 ", Not Applicable , Not Applicable ," $7,956.91 "," $7,729.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,578.01 ", Not Applicable , Not Applicable ," $7,578.01 "," $7,956.91 ", Not Applicable
,437,Diagnosis Related Group,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,604.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,604.32 "," $7,604.32 ", Not Applicable , Not Applicable ," $7,984.53 "," $7,756.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,604.32 ", Not Applicable , Not Applicable ," $7,604.32 "," $7,984.53 ", Not Applicable
,292,Diagnosis Related Group,HEART FAILURE AND SHOCK WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,329.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,329.31 "," $7,329.31 ", Not Applicable , Not Applicable ," $7,695.78 "," $7,475.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,329.31 ", Not Applicable , Not Applicable ," $7,329.31 "," $7,695.78 ", Not Applicable
,376,Diagnosis Related Group,DIGESTIVE MALIGNANCY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,629.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,629.78 "," $7,629.78 ", Not Applicable , Not Applicable ," $8,011.27 "," $7,782.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,629.78 ", Not Applicable , Not Applicable ," $7,629.78 "," $8,011.27 ", Not Applicable
,84,Diagnosis Related Group,TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,686.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,686.65 "," $7,686.65 ", Not Applicable , Not Applicable ," $8,070.98 "," $7,840.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,686.65 ", Not Applicable , Not Applicable ," $7,686.65 "," $8,070.98 ", Not Applicable
,155,Diagnosis Related Group,"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,719.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,719.75 "," $7,719.75 ", Not Applicable , Not Applicable ," $8,105.74 "," $7,874.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,719.75 ", Not Applicable , Not Applicable ," $7,719.75 "," $8,105.74 ", Not Applicable
,605,Diagnosis Related Group,"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,672.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,672.22 "," $7,672.22 ", Not Applicable , Not Applicable ," $8,055.83 "," $7,825.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,672.22 ", Not Applicable , Not Applicable ," $7,672.22 "," $8,055.83 ", Not Applicable
,965,Diagnosis Related Group,OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,745.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,745.22 "," $7,745.22 ", Not Applicable , Not Applicable ," $8,132.48 "," $7,900.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,745.22 ", Not Applicable , Not Applicable ," $7,745.22 "," $8,132.48 ", Not Applicable
,785,Diagnosis Related Group,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,781.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,781.72 "," $7,781.72 ", Not Applicable , Not Applicable ," $8,170.80 "," $7,937.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,781.72 ", Not Applicable ," $8,023.00 "," $7,781.72 "," $8,170.80 ", Not Applicable
,60,Diagnosis Related Group,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,789.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,789.36 "," $7,789.36 ", Not Applicable , Not Applicable ," $8,178.82 "," $7,945.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,789.36 ", Not Applicable , Not Applicable ," $7,789.36 "," $8,178.82 ", Not Applicable
,756,Diagnosis Related Group,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,795.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,795.30 "," $7,795.30 ", Not Applicable , Not Applicable ," $8,185.06 "," $7,951.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,795.30 ", Not Applicable , Not Applicable ," $7,795.30 "," $8,185.06 ", Not Applicable
,797,Diagnosis Related Group,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,803.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,803.78 "," $7,803.78 ", Not Applicable , Not Applicable ," $8,193.97 "," $7,959.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,803.78 ", Not Applicable ," $7,174.00 "," $7,174.00 "," $8,193.97 ", Not Applicable
,760,Diagnosis Related Group,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,809.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,809.73 "," $7,809.73 ", Not Applicable , Not Applicable ," $8,200.21 "," $7,965.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,809.73 ", Not Applicable , Not Applicable ," $7,809.73 "," $8,200.21 ", Not Applicable
,714,Diagnosis Related Group,TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,883.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,883.57 "," $7,883.57 ", Not Applicable , Not Applicable ," $8,277.75 "," $8,041.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,883.57 ", Not Applicable , Not Applicable ," $7,883.57 "," $8,277.75 ", Not Applicable
,923,Diagnosis Related Group,"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,976.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,976.94 "," $7,976.94 ", Not Applicable , Not Applicable ," $8,375.78 "," $8,136.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,976.94 ", Not Applicable , Not Applicable ," $7,976.94 "," $8,375.78 ", Not Applicable
,442,Diagnosis Related Group,"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,893.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,893.76 "," $7,893.76 ", Not Applicable , Not Applicable ," $8,288.44 "," $8,051.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,893.76 ", Not Applicable , Not Applicable ," $7,893.76 "," $8,288.44 ", Not Applicable
,281,Diagnosis Related Group,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,898.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,898.85 "," $7,898.85 ", Not Applicable , Not Applicable ," $8,293.79 "," $8,056.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,898.85 ", Not Applicable , Not Applicable ," $7,898.85 "," $8,293.79 ", Not Applicable
,537,Diagnosis Related Group,"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,939.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,939.59 "," $7,939.59 ", Not Applicable , Not Applicable ," $8,336.57 "," $8,098.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,939.59 ", Not Applicable , Not Applicable ," $7,939.59 "," $8,336.57 ", Not Applicable
,747,Diagnosis Related Group,"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,971.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,971.00 "," $7,971.00 ", Not Applicable , Not Applicable ," $8,369.55 "," $8,130.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,971.00 ", Not Applicable , Not Applicable ," $7,971.00 "," $8,369.55 ", Not Applicable
,394,Diagnosis Related Group,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $7,986.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,986.27 "," $7,986.27 ", Not Applicable , Not Applicable ," $8,385.59 "," $8,146.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,986.27 ", Not Applicable , Not Applicable ," $7,986.27 "," $8,385.59 ", Not Applicable
,552,Diagnosis Related Group,MEDICAL BACK PROBLEMS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,007.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,007.49 "," $8,007.49 ", Not Applicable , Not Applicable ," $8,407.87 "," $8,167.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,007.49 ", Not Applicable , Not Applicable ," $8,007.49 "," $8,407.87 ", Not Applicable
,78,Diagnosis Related Group,HYPERTENSIVE ENCEPHALOPATHY WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,062.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,062.67 "," $8,062.67 ", Not Applicable , Not Applicable ," $8,465.80 "," $8,223.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,062.67 ", Not Applicable , Not Applicable ," $8,062.67 "," $8,465.80 ", Not Applicable
,976,Diagnosis Related Group,HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,060.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,060.12 "," $8,060.12 ", Not Applicable , Not Applicable ," $8,463.13 "," $8,221.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,060.12 ", Not Applicable , Not Applicable ," $8,060.12 "," $8,463.13 ", Not Applicable
,810,Diagnosis Related Group,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,162.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,162.82 "," $8,162.82 ", Not Applicable , Not Applicable ," $8,570.96 "," $8,326.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,162.82 ", Not Applicable , Not Applicable ," $8,162.82 "," $8,570.96 ", Not Applicable
,202,Diagnosis Related Group,BRONCHITIS AND ASTHMA WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,207.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,207.81 "," $8,207.81 ", Not Applicable , Not Applicable ," $8,618.20 "," $8,371.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,207.81 ", Not Applicable , Not Applicable ," $8,207.81 "," $8,618.20 ", Not Applicable
,758,Diagnosis Related Group,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,230.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,230.73 "," $8,230.73 ", Not Applicable , Not Applicable ," $8,642.26 "," $8,395.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,230.73 ", Not Applicable , Not Applicable ," $8,230.73 "," $8,642.26 ", Not Applicable
,315,Diagnosis Related Group,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,262.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,262.13 "," $8,262.13 ", Not Applicable , Not Applicable ," $8,675.24 "," $8,427.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,262.13 ", Not Applicable , Not Applicable ," $8,262.13 "," $8,675.24 ", Not Applicable
,670,Diagnosis Related Group,TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,305.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,305.42 "," $8,305.42 ", Not Applicable , Not Applicable ," $8,720.69 "," $8,471.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,305.42 ", Not Applicable , Not Applicable ," $8,305.42 "," $8,720.69 ", Not Applicable
,863,Diagnosis Related Group,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,584.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,584.67 "," $8,584.67 ", Not Applicable , Not Applicable ," $9,013.91 "," $8,756.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,584.67 ", Not Applicable , Not Applicable ," $8,584.67 "," $9,013.91 ", Not Applicable
,349,Diagnosis Related Group,ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,312.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,312.21 "," $8,312.21 ", Not Applicable , Not Applicable ," $8,727.82 "," $8,478.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,312.21 ", Not Applicable , Not Applicable ," $8,312.21 "," $8,727.82 ", Not Applicable
,76,Diagnosis Related Group,VIRAL MENINGITIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,359.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,359.74 "," $8,359.74 ", Not Applicable , Not Applicable ," $8,777.73 "," $8,526.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,359.74 ", Not Applicable , Not Applicable ," $8,359.74 "," $8,777.73 ", Not Applicable
,295,Diagnosis Related Group,DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,352.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,352.95 "," $8,352.95 ", Not Applicable , Not Applicable ," $8,770.60 "," $8,520.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,352.95 ", Not Applicable , Not Applicable ," $8,352.95 "," $8,770.60 ", Not Applicable
,92,Diagnosis Related Group,OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,393.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,393.69 "," $8,393.69 ", Not Applicable , Not Applicable ," $8,813.38 "," $8,561.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,393.69 ", Not Applicable , Not Applicable ," $8,393.69 "," $8,813.38 ", Not Applicable
,596,Diagnosis Related Group,MAJOR SKIN DISORDERS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,442.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,442.92 "," $8,442.92 ", Not Applicable , Not Applicable ," $8,865.07 "," $8,611.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,442.92 ", Not Applicable , Not Applicable ," $8,442.92 "," $8,865.07 ", Not Applicable
,815,Diagnosis Related Group,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,431.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,431.89 "," $8,431.89 ", Not Applicable , Not Applicable ," $8,853.48 "," $8,600.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,431.89 ", Not Applicable , Not Applicable ," $8,431.89 "," $8,853.48 ", Not Applicable
,378,Diagnosis Related Group,GASTROINTESTINAL HEMORRHAGE WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,432.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,432.74 "," $8,432.74 ", Not Applicable , Not Applicable ," $8,854.38 "," $8,601.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,432.74 ", Not Applicable , Not Applicable ," $8,432.74 "," $8,854.38 ", Not Applicable
,386,Diagnosis Related Group,INFLAMMATORY BOWEL DISEASE WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,446.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,446.32 "," $8,446.32 ", Not Applicable , Not Applicable ," $8,868.64 "," $8,615.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,446.32 ", Not Applicable , Not Applicable ," $8,446.32 "," $8,868.64 ", Not Applicable
,514,Diagnosis Related Group,"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,480.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,480.27 "," $8,480.27 ", Not Applicable , Not Applicable ," $8,904.28 "," $8,649.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,480.27 ", Not Applicable , Not Applicable ," $8,480.27 "," $8,904.28 ", Not Applicable
,667,Diagnosis Related Group,PROSTATECTOMY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,466.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,466.69 "," $8,466.69 ", Not Applicable , Not Applicable ," $8,890.02 "," $8,636.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,466.69 ", Not Applicable , Not Applicable ," $8,466.69 "," $8,890.02 ", Not Applicable
,600,Diagnosis Related Group,NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,461.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,461.60 "," $8,461.60 ", Not Applicable , Not Applicable ," $8,884.68 "," $8,630.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,461.60 ", Not Applicable , Not Applicable ," $8,461.60 "," $8,884.68 ", Not Applicable
,697,Diagnosis Related Group,URETHRAL STRICTURE,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,481.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,481.97 "," $8,481.97 ", Not Applicable , Not Applicable ," $8,906.07 "," $8,651.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,481.97 ", Not Applicable , Not Applicable ," $8,481.97 "," $8,906.07 ", Not Applicable
,819,Diagnosis Related Group,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,379.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,379.26 "," $8,379.26 ", Not Applicable , Not Applicable ," $8,798.23 "," $8,546.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,379.26 ", Not Applicable ," $1,723.00 "," $1,723.00 "," $8,798.23 ", Not Applicable
,729,Diagnosis Related Group,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,551.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,551.57 "," $8,551.57 ", Not Applicable , Not Applicable ," $8,979.15 "," $8,722.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,551.57 ", Not Applicable , Not Applicable ," $8,551.57 "," $8,979.15 ", Not Applicable
,197,Diagnosis Related Group,INTERSTITIAL LUNG DISEASE WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,547.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,547.33 "," $8,547.33 ", Not Applicable , Not Applicable ," $8,974.69 "," $8,718.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,547.33 ", Not Applicable , Not Applicable ," $8,547.33 "," $8,974.69 ", Not Applicable
,565,Diagnosis Related Group,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,566.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,566.85 "," $8,566.85 ", Not Applicable , Not Applicable ," $8,995.19 "," $8,738.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,566.85 ", Not Applicable , Not Applicable ," $8,566.85 "," $8,995.19 ", Not Applicable
,71,Diagnosis Related Group,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,588.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,588.07 "," $8,588.07 ", Not Applicable , Not Applicable ," $9,017.47 "," $8,759.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,588.07 ", Not Applicable , Not Applicable ," $8,588.07 "," $9,017.47 ", Not Applicable
,65,Diagnosis Related Group,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,657.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,657.67 "," $8,657.67 ", Not Applicable , Not Applicable ," $9,090.55 "," $8,830.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,657.67 ", Not Applicable , Not Applicable ," $8,657.67 "," $9,090.55 ", Not Applicable
,644,Diagnosis Related Group,ENDOCRINE DISORDERS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,655.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,655.97 "," $8,655.97 ", Not Applicable , Not Applicable ," $9,088.77 "," $8,829.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,655.97 ", Not Applicable , Not Applicable ," $8,655.97 "," $9,088.77 ", Not Applicable
,74,Diagnosis Related Group,CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,649.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,649.18 "," $8,649.18 ", Not Applicable , Not Applicable ," $9,081.64 "," $8,822.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,649.18 ", Not Applicable , Not Applicable ," $8,649.18 "," $9,081.64 ", Not Applicable
,872,Diagnosis Related Group,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,711.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,711.14 "," $8,711.14 ", Not Applicable , Not Applicable ," $9,146.70 "," $8,885.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,711.14 ", Not Applicable , Not Applicable ," $8,711.14 "," $9,146.70 ", Not Applicable
,290,Diagnosis Related Group,ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,716.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,716.23 "," $8,716.23 ", Not Applicable , Not Applicable ," $9,152.05 "," $8,890.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,716.23 ", Not Applicable , Not Applicable ," $8,716.23 "," $9,152.05 ", Not Applicable
,699,Diagnosis Related Group,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,717.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,717.08 "," $8,717.08 ", Not Applicable , Not Applicable ," $9,152.94 "," $8,891.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,717.08 ", Not Applicable , Not Applicable ," $8,717.08 "," $9,152.94 ", Not Applicable
,805,Diagnosis Related Group,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,741.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,741.70 "," $8,741.70 ", Not Applicable , Not Applicable ," $9,178.78 "," $8,916.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,741.70 ", Not Applicable ," $7,174.00 "," $7,174.00 "," $9,178.78 ", Not Applicable
,920,Diagnosis Related Group,COMPLICATIONS OF TREATMENT WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,696.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,696.71 "," $8,696.71 ", Not Applicable , Not Applicable ," $9,131.55 "," $8,870.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,696.71 ", Not Applicable , Not Applicable ," $8,696.71 "," $9,131.55 ", Not Applicable
,372,Diagnosis Related Group,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,736.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,736.61 "," $8,736.61 ", Not Applicable , Not Applicable ," $9,173.44 "," $8,911.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,736.61 ", Not Applicable , Not Applicable ," $8,736.61 "," $9,173.44 ", Not Applicable
,433,Diagnosis Related Group,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,741.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,741.70 "," $8,741.70 ", Not Applicable , Not Applicable ," $9,178.78 "," $8,916.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,741.70 ", Not Applicable , Not Applicable ," $8,741.70 "," $9,178.78 ", Not Applicable
,848,Diagnosis Related Group,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,762.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,762.07 "," $8,762.07 ", Not Applicable , Not Applicable ," $9,200.17 "," $8,937.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,762.07 ", Not Applicable , Not Applicable ," $8,762.07 "," $9,200.17 ", Not Applicable
,187,Diagnosis Related Group,PLEURAL EFFUSION WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,767.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,767.16 "," $8,767.16 ", Not Applicable , Not Applicable ," $9,205.52 "," $8,942.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,767.16 ", Not Applicable , Not Applicable ," $8,767.16 "," $9,205.52 ", Not Applicable
,117,Diagnosis Related Group,INTRAOCULAR PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,837.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,837.61 "," $8,837.61 ", Not Applicable , Not Applicable ," $9,279.49 "," $9,014.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,837.61 ", Not Applicable , Not Applicable ," $8,837.61 "," $9,279.49 ", Not Applicable
,184,Diagnosis Related Group,MAJOR CHEST TRAUMA WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,835.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,835.07 "," $8,835.07 ", Not Applicable , Not Applicable ," $9,276.82 "," $9,011.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,835.07 ", Not Applicable , Not Applicable ," $8,835.07 "," $9,276.82 ", Not Applicable
,779,Diagnosis Related Group,ABORTION WITHOUT D&C,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,988.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,988.70 "," $8,988.70 ", Not Applicable , Not Applicable ," $9,438.13 "," $9,168.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,988.70 ", Not Applicable , Not Applicable ," $8,988.70 "," $9,438.13 ", Not Applicable
,300,Diagnosis Related Group,PERIPHERAL VASCULAR DISORDERS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,859.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,859.68 "," $8,859.68 ", Not Applicable , Not Applicable ," $9,302.66 "," $9,036.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,859.68 ", Not Applicable , Not Applicable ," $8,859.68 "," $9,302.66 ", Not Applicable
,543,Diagnosis Related Group,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,871.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,871.56 "," $8,871.56 ", Not Applicable , Not Applicable ," $9,315.14 "," $9,048.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,871.56 ", Not Applicable , Not Applicable ," $8,871.56 "," $9,315.14 ", Not Applicable
,55,Diagnosis Related Group,NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,866.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,866.47 "," $8,866.47 ", Not Applicable , Not Applicable ," $9,309.79 "," $9,043.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,866.47 ", Not Applicable , Not Applicable ," $8,866.47 "," $9,309.79 ", Not Applicable
,687,Diagnosis Related Group,KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,913.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,913.15 "," $8,913.15 ", Not Applicable , Not Applicable ," $9,358.81 "," $9,091.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,913.15 ", Not Applicable , Not Applicable ," $8,913.15 "," $9,358.81 ", Not Applicable
,712,Diagnosis Related Group,TESTES PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,997.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,997.18 "," $8,997.18 ", Not Applicable , Not Applicable ," $9,447.04 "," $9,177.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,997.18 ", Not Applicable , Not Applicable ," $8,997.18 "," $9,447.04 ", Not Applicable
,868,Diagnosis Related Group,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,048.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,048.11 "," $9,048.11 ", Not Applicable , Not Applicable ," $9,500.52 "," $9,229.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,048.11 ", Not Applicable , Not Applicable ," $9,048.11 "," $9,500.52 ", Not Applicable
,381,Diagnosis Related Group,COMPLICATED PEPTIC ULCER WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $8,991.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,991.24 "," $8,991.24 ", Not Applicable , Not Applicable ," $9,440.81 "," $9,171.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,991.24 ", Not Applicable , Not Applicable ," $8,991.24 "," $9,440.81 ", Not Applicable
,89,Diagnosis Related Group,CONCUSSION WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,026.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,026.89 "," $9,026.89 ", Not Applicable , Not Applicable ," $9,478.24 "," $9,207.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,026.89 ", Not Applicable , Not Applicable ," $9,026.89 "," $9,478.24 ", Not Applicable
,787,Diagnosis Related Group,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,034.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,034.53 "," $9,034.53 ", Not Applicable , Not Applicable ," $9,486.26 "," $9,215.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,034.53 ", Not Applicable ," $8,023.00 "," $8,023.00 "," $9,486.26 ", Not Applicable
,661,Diagnosis Related Group,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,028.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,028.59 "," $9,028.59 ", Not Applicable , Not Applicable ," $9,480.02 "," $9,209.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,028.59 ", Not Applicable , Not Applicable ," $9,028.59 "," $9,480.02 ", Not Applicable
,796,Diagnosis Related Group,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,088.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,088.85 "," $9,088.85 ", Not Applicable , Not Applicable ," $9,543.30 "," $9,270.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,088.85 ", Not Applicable ," $7,174.00 "," $7,174.00 "," $9,543.30 ", Not Applicable
,200,Diagnosis Related Group,PNEUMOTHORAX WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,137.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,137.24 "," $9,137.24 ", Not Applicable , Not Applicable ," $9,594.10 "," $9,319.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,137.24 ", Not Applicable , Not Applicable ," $9,137.24 "," $9,594.10 ", Not Applicable
,560,Diagnosis Related Group,"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,132.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,132.99 "," $9,132.99 ", Not Applicable , Not Applicable ," $9,589.64 "," $9,315.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,132.99 ", Not Applicable , Not Applicable ," $9,132.99 "," $9,589.64 ", Not Applicable
,369,Diagnosis Related Group,MAJOR ESOPHAGEAL DISORDERS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,143.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,143.18 "," $9,143.18 ", Not Applicable , Not Applicable ," $9,600.34 "," $9,326.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,143.18 ", Not Applicable , Not Applicable ," $9,143.18 "," $9,600.34 ", Not Applicable
,445,Diagnosis Related Group,DISORDERS OF THE BILIARY TRACT WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,145.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,145.72 "," $9,145.72 ", Not Applicable , Not Applicable ," $9,603.01 "," $9,328.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,145.72 ", Not Applicable , Not Applicable ," $9,145.72 "," $9,603.01 ", Not Applicable
,152,Diagnosis Related Group,OTITIS MEDIA AND URI WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,171.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,171.19 "," $9,171.19 ", Not Applicable , Not Applicable ," $9,629.75 "," $9,354.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,171.19 ", Not Applicable , Not Applicable ," $9,171.19 "," $9,629.75 ", Not Applicable
,887,Diagnosis Related Group,OTHER MENTAL DISORDER DIAGNOSES,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,165.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,165.25 "," $9,165.25 ", Not Applicable , Not Applicable ," $9,623.51 "," $9,348.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,165.25 ", Not Applicable , Not Applicable ," $9,165.25 "," $9,623.51 ", Not Applicable
,723,Diagnosis Related Group,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,267.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,267.95 "," $9,267.95 ", Not Applicable , Not Applicable ," $9,731.35 "," $9,453.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,267.95 ", Not Applicable , Not Applicable ," $9,267.95 "," $9,731.35 ", Not Applicable
,302,Diagnosis Related Group,ATHEROSCLEROSIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,292.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,292.56 "," $9,292.56 ", Not Applicable , Not Applicable ," $9,757.19 "," $9,478.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,292.56 ", Not Applicable , Not Applicable ," $9,292.56 "," $9,757.19 ", Not Applicable
,624,Diagnosis Related Group,"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,327.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,327.36 "," $9,327.36 ", Not Applicable , Not Applicable ," $9,793.73 "," $9,513.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,327.36 ", Not Applicable , Not Applicable ," $9,327.36 "," $9,793.73 ", Not Applicable
,784,Diagnosis Related Group,CESAREAN SECTION WITH STERILIZATION WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,301.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,301.90 "," $9,301.90 ", Not Applicable , Not Applicable ," $9,767.00 "," $9,487.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,301.90 ", Not Applicable ," $8,023.00 "," $8,023.00 "," $9,767.00 ", Not Applicable
,842,Diagnosis Related Group,LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,311.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,311.24 "," $9,311.24 ", Not Applicable , Not Applicable ," $9,776.80 "," $9,497.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,311.24 ", Not Applicable , Not Applicable ," $9,311.24 "," $9,776.80 ", Not Applicable
,304,Diagnosis Related Group,HYPERTENSION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,311.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,311.24 "," $9,311.24 ", Not Applicable , Not Applicable ," $9,776.80 "," $9,497.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,311.24 ", Not Applicable , Not Applicable ," $9,311.24 "," $9,776.80 ", Not Applicable
,572,Diagnosis Related Group,SKIN DEBRIDEMENT WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,374.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,374.05 "," $9,374.05 ", Not Applicable , Not Applicable ," $9,842.75 "," $9,561.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,374.05 ", Not Applicable , Not Applicable ," $9,374.05 "," $9,842.75 ", Not Applicable
,352,Diagnosis Related Group,INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,374.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,374.05 "," $9,374.05 ", Not Applicable , Not Applicable ," $9,842.75 "," $9,561.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,374.05 ", Not Applicable , Not Applicable ," $9,374.05 "," $9,842.75 ", Not Applicable
,949,Diagnosis Related Group,AFTERCARE WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,420.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,420.73 "," $9,420.73 ", Not Applicable , Not Applicable ," $9,891.77 "," $9,609.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,420.73 ", Not Applicable , Not Applicable ," $9,420.73 "," $9,891.77 ", Not Applicable
,343,Diagnosis Related Group,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,409.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,409.70 "," $9,409.70 ", Not Applicable , Not Applicable ," $9,880.18 "," $9,597.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,409.70 ", Not Applicable , Not Applicable ," $9,409.70 "," $9,880.18 ", Not Applicable
,598,Diagnosis Related Group,MALIGNANT BREAST DISORDERS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,446.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,446.20 "," $9,446.20 ", Not Applicable , Not Applicable ," $9,918.50 "," $9,635.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,446.20 ", Not Applicable , Not Applicable ," $9,446.20 "," $9,918.50 ", Not Applicable
,689,Diagnosis Related Group,KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,457.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,457.23 "," $9,457.23 ", Not Applicable , Not Applicable ," $9,930.09 "," $9,646.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,457.23 ", Not Applicable , Not Applicable ," $9,457.23 "," $9,930.09 ", Not Applicable
,989,Diagnosis Related Group,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,537.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,537.02 "," $9,537.02 ", Not Applicable , Not Applicable ," $10,013.87 "," $9,727.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,537.02 ", Not Applicable , Not Applicable ," $9,537.02 "," $10,013.87 ", Not Applicable
,436,Diagnosis Related Group,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,519.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,519.19 "," $9,519.19 ", Not Applicable , Not Applicable ," $9,995.15 "," $9,709.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,519.19 ", Not Applicable , Not Applicable ," $9,519.19 "," $9,995.15 ", Not Applicable
,181,Diagnosis Related Group,RESPIRATORY NEOPLASMS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,507.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,507.31 "," $9,507.31 ", Not Applicable , Not Applicable ," $9,982.67 "," $9,697.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,507.31 ", Not Applicable , Not Applicable ," $9,507.31 "," $9,982.67 ", Not Applicable
,831,Diagnosis Related Group,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,521.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,521.74 "," $9,521.74 ", Not Applicable , Not Applicable ," $9,997.82 "," $9,712.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,521.74 ", Not Applicable ," $1,723.00 "," $1,723.00 "," $9,997.82 ", Not Applicable
,190,Diagnosis Related Group,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,549.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,549.75 "," $9,549.75 ", Not Applicable , Not Applicable ," $10,027.23 "," $9,740.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,549.75 ", Not Applicable , Not Applicable ," $9,549.75 "," $10,027.23 ", Not Applicable
,59,Diagnosis Related Group,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,568.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,568.42 "," $9,568.42 ", Not Applicable , Not Applicable ," $10,046.84 "," $9,759.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,568.42 ", Not Applicable , Not Applicable ," $9,568.42 "," $10,046.84 ", Not Applicable
,946,Diagnosis Related Group,REHABILITATION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,559.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,559.08 "," $9,559.08 ", Not Applicable , Not Applicable ," $10,037.04 "," $9,750.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,559.08 ", Not Applicable , Not Applicable ," $9,559.08 "," $10,037.04 ", Not Applicable
,755,Diagnosis Related Group,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,585.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,585.40 "," $9,585.40 ", Not Applicable , Not Applicable ," $10,064.67 "," $9,777.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,585.40 ", Not Applicable , Not Applicable ," $9,585.40 "," $10,064.67 ", Not Applicable
,743,Diagnosis Related Group,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,615.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,615.10 "," $9,615.10 ", Not Applicable , Not Applicable ," $10,095.86 "," $9,807.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,615.10 ", Not Applicable , Not Applicable ," $9,615.10 "," $10,095.86 ", Not Applicable
,903,Diagnosis Related Group,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,636.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,636.32 "," $9,636.32 ", Not Applicable , Not Applicable ," $10,118.14 "," $9,829.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,636.32 ", Not Applicable , Not Applicable ," $9,636.32 "," $10,118.14 ", Not Applicable
,53,Diagnosis Related Group,SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,645.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,645.66 "," $9,645.66 ", Not Applicable , Not Applicable ," $10,127.94 "," $9,838.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,645.66 ", Not Applicable , Not Applicable ," $9,645.66 "," $10,127.94 ", Not Applicable
,695,Diagnosis Related Group,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,656.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,656.70 "," $9,656.70 ", Not Applicable , Not Applicable ," $10,139.53 "," $9,849.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,656.70 ", Not Applicable , Not Applicable ," $9,656.70 "," $10,139.53 ", Not Applicable
,593,Diagnosis Related Group,SKIN ULCERS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,681.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,681.31 "," $9,681.31 ", Not Applicable , Not Applicable ," $10,165.38 "," $9,874.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,681.31 ", Not Applicable , Not Applicable ," $9,681.31 "," $10,165.38 ", Not Applicable
,39,Diagnosis Related Group,EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,668.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,668.58 "," $9,668.58 ", Not Applicable , Not Applicable ," $10,152.01 "," $9,861.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,668.58 ", Not Applicable , Not Applicable ," $9,668.58 "," $10,152.01 ", Not Applicable
,287,Diagnosis Related Group,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,464.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,464.87 "," $9,464.87 ", Not Applicable , Not Applicable ," $9,938.11 "," $9,654.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,464.87 ", Not Applicable , Not Applicable ," $9,464.87 "," $9,938.11 ", Not Applicable
,672,Diagnosis Related Group,URETHRAL PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,764.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,764.49 "," $9,764.49 ", Not Applicable , Not Applicable ," $10,252.72 "," $9,959.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,764.49 ", Not Applicable , Not Applicable ," $9,764.49 "," $10,252.72 ", Not Applicable
,102,Diagnosis Related Group,HEADACHES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,787.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,787.41 "," $9,787.41 ", Not Applicable , Not Applicable ," $10,276.78 "," $9,983.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,787.41 ", Not Applicable , Not Applicable ," $9,787.41 "," $10,276.78 ", Not Applicable
,476,Diagnosis Related Group,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,848.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,848.52 "," $9,848.52 ", Not Applicable , Not Applicable ," $10,340.95 "," $10,045.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,848.52 ", Not Applicable , Not Applicable ," $9,848.52 "," $10,340.95 ", Not Applicable
,257,Diagnosis Related Group,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,890.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,890.11 "," $9,890.11 ", Not Applicable , Not Applicable ," $10,384.62 "," $10,087.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,890.11 ", Not Applicable , Not Applicable ," $9,890.11 "," $10,384.62 ", Not Applicable
,836,Diagnosis Related Group,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,960.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,960.56 "," $9,960.56 ", Not Applicable , Not Applicable ," $10,458.59 "," $10,159.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,960.56 ", Not Applicable , Not Applicable ," $9,960.56 "," $10,458.59 ", Not Applicable
,745,Diagnosis Related Group,"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,930.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,930.85 "," $9,930.85 ", Not Applicable , Not Applicable ," $10,427.40 "," $10,129.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,930.85 ", Not Applicable , Not Applicable ," $9,930.85 "," $10,427.40 ", Not Applicable
,768,Diagnosis Related Group,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $9,927.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,927.46 "," $9,927.46 ", Not Applicable , Not Applicable ," $10,423.83 "," $10,126.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,927.46 ", Not Applicable ," $7,174.00 "," $7,174.00 "," $10,423.83 ", Not Applicable
,844,Diagnosis Related Group,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,051.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,051.38 "," $10,051.38 ", Not Applicable , Not Applicable ," $10,553.95 "," $10,252.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,051.38 ", Not Applicable , Not Applicable ," $10,051.38 "," $10,553.95 ", Not Applicable
,627,Diagnosis Related Group,"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,039.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,039.50 "," $10,039.50 ", Not Applicable , Not Applicable ," $10,541.47 "," $10,240.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,039.50 ", Not Applicable , Not Applicable ," $10,039.50 "," $10,541.47 ", Not Applicable
,664,Diagnosis Related Group,MINOR BLADDER PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,047.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,047.99 "," $10,047.99 ", Not Applicable , Not Applicable ," $10,550.39 "," $10,248.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,047.99 ", Not Applicable , Not Applicable ," $10,047.99 "," $10,550.39 ", Not Applicable
,121,Diagnosis Related Group,ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,105.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,105.71 "," $10,105.71 ", Not Applicable , Not Applicable ," $10,610.99 "," $10,307.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,105.71 ", Not Applicable , Not Applicable ," $10,105.71 "," $10,610.99 ", Not Applicable
,947,Diagnosis Related Group,SIGNS AND SYMPTOMS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,134.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,134.56 "," $10,134.56 ", Not Applicable , Not Applicable ," $10,641.29 "," $10,337.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,134.56 ", Not Applicable , Not Applicable ," $10,134.56 "," $10,641.29 ", Not Applicable
,499,Diagnosis Related Group,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,177.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,177.00 "," $10,177.00 ", Not Applicable , Not Applicable ," $10,685.85 "," $10,380.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,177.00 ", Not Applicable , Not Applicable ," $10,177.00 "," $10,685.85 ", Not Applicable
,308,Diagnosis Related Group,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,193.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,193.13 "," $10,193.13 ", Not Applicable , Not Applicable ," $10,702.79 "," $10,396.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,193.13 ", Not Applicable , Not Applicable ," $10,193.13 "," $10,702.79 ", Not Applicable
,375,Diagnosis Related Group,DIGESTIVE MALIGNANCY WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,250.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,250.00 "," $10,250.00 ", Not Applicable , Not Applicable ," $10,762.50 "," $10,455.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,250.00 ", Not Applicable , Not Applicable ," $10,250.00 "," $10,762.50 ", Not Applicable
,178,Diagnosis Related Group,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,251.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,251.70 "," $10,251.70 ", Not Applicable , Not Applicable ," $10,764.28 "," $10,456.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,251.70 ", Not Applicable , Not Applicable ," $10,251.70 "," $10,764.28 ", Not Applicable
,546,Diagnosis Related Group,CONNECTIVE TISSUE DISORDERS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,253.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,253.40 "," $10,253.40 ", Not Applicable , Not Applicable ," $10,766.07 "," $10,458.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,253.40 ", Not Applicable , Not Applicable ," $10,253.40 "," $10,766.07 ", Not Applicable
,145,Diagnosis Related Group,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,394.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,394.29 "," $10,394.29 ", Not Applicable , Not Applicable ," $10,914.01 "," $10,602.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,394.29 ", Not Applicable , Not Applicable ," $10,394.29 "," $10,914.01 ", Not Applicable
,886,Diagnosis Related Group,BEHAVIORAL AND DEVELOPMENTAL DISORDERS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,386.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,386.66 "," $10,386.66 ", Not Applicable , Not Applicable ," $10,905.99 "," $10,594.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,386.66 ", Not Applicable , Not Applicable ," $10,386.66 "," $10,905.99 ", Not Applicable
,809,Diagnosis Related Group,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,384.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,384.11 "," $10,384.11 ", Not Applicable , Not Applicable ," $10,903.31 "," $10,591.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,384.11 ", Not Applicable , Not Applicable ," $10,384.11 "," $10,903.31 ", Not Applicable
,189,Diagnosis Related Group,PULMONARY EDEMA AND RESPIRATORY FAILURE,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,407.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,407.03 "," $10,407.03 ", Not Applicable , Not Applicable ," $10,927.38 "," $10,615.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,407.03 ", Not Applicable , Not Applicable ," $10,407.03 "," $10,927.38 ", Not Applicable
,139,Diagnosis Related Group,SALIVARY GLAND PROCEDURES,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,474.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,474.93 "," $10,474.93 ", Not Applicable , Not Applicable ," $10,998.68 "," $10,684.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,474.93 ", Not Applicable , Not Applicable ," $10,474.93 "," $10,998.68 ", Not Applicable
,640,Diagnosis Related Group,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,446.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,446.92 "," $10,446.92 ", Not Applicable , Not Applicable ," $10,969.27 "," $10,655.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,446.92 ", Not Applicable , Not Applicable ," $10,446.92 "," $10,969.27 ", Not Applicable
,340,Diagnosis Related Group,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,425.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,425.70 "," $10,425.70 ", Not Applicable , Not Applicable ," $10,946.98 "," $10,634.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,425.70 ", Not Applicable , Not Applicable ," $10,425.70 "," $10,946.98 ", Not Applicable
,535,Diagnosis Related Group,FRACTURES OF HIP AND PELVIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,463.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,463.90 "," $10,463.90 ", Not Applicable , Not Applicable ," $10,987.09 "," $10,673.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,463.90 ", Not Applicable , Not Applicable ," $10,463.90 "," $10,987.09 ", Not Applicable
,718,Diagnosis Related Group,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,479.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,479.17 "," $10,479.17 ", Not Applicable , Not Applicable ," $11,003.13 "," $10,688.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,479.17 ", Not Applicable , Not Applicable ," $10,479.17 "," $11,003.13 ", Not Applicable
,885,Diagnosis Related Group,PSYCHOSES,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,519.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,519.92 "," $10,519.92 ", Not Applicable , Not Applicable ," $11,045.91 "," $10,730.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,519.92 ", Not Applicable , Not Applicable ," $10,519.92 "," $11,045.91 ", Not Applicable
,391,Diagnosis Related Group,"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,603.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,603.10 "," $10,603.10 ", Not Applicable , Not Applicable ," $11,133.25 "," $10,815.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,603.10 ", Not Applicable , Not Applicable ," $10,603.10 "," $11,133.25 ", Not Applicable
,549,Diagnosis Related Group,SEPTIC ARTHRITIS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,609.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,609.04 "," $10,609.04 ", Not Applicable , Not Applicable ," $11,139.49 "," $10,821.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,609.04 ", Not Applicable , Not Applicable ," $10,609.04 "," $11,139.49 ", Not Applicable
,822,Diagnosis Related Group,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,622.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,622.62 "," $10,622.62 ", Not Applicable , Not Applicable ," $11,153.75 "," $10,835.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,622.62 ", Not Applicable , Not Applicable ," $10,622.62 "," $11,153.75 ", Not Applicable
,136,Diagnosis Related Group,SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,656.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,656.57 "," $10,656.57 ", Not Applicable , Not Applicable ," $11,189.40 "," $10,869.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,656.57 ", Not Applicable , Not Applicable ," $10,656.57 "," $11,189.40 ", Not Applicable
,581,Diagnosis Related Group,"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,686.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,686.15 "," $11,686.15 ", Not Applicable , Not Applicable ," $12,270.46 "," $11,919.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,686.15 ", Not Applicable , Not Applicable ," $11,686.15 "," $12,270.46 ", Not Applicable
,57,Diagnosis Related Group,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,758.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,758.43 "," $10,758.43 ", Not Applicable , Not Applicable ," $11,296.35 "," $10,973.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,758.43 ", Not Applicable , Not Applicable ," $10,758.43 "," $11,296.35 ", Not Applicable
,553,Diagnosis Related Group,BONE DISEASES AND ARTHROPATHIES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,792.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,792.38 "," $10,792.38 ", Not Applicable , Not Applicable ," $11,332.00 "," $11,008.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,792.38 ", Not Applicable , Not Applicable ," $10,792.38 "," $11,332.00 ", Not Applicable
,693,Diagnosis Related Group,URINARY STONES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,335.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,335.60 "," $11,335.60 ", Not Applicable , Not Applicable ," $11,902.38 "," $11,562.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,335.60 ", Not Applicable , Not Applicable ," $11,335.60 "," $11,902.38 ", Not Applicable
,86,Diagnosis Related Group,TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,817.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,817.84 "," $10,817.84 ", Not Applicable , Not Applicable ," $11,358.73 "," $11,034.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,817.84 ", Not Applicable , Not Applicable ," $10,817.84 "," $11,358.73 ", Not Applicable
,346,Diagnosis Related Group,MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,825.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,825.48 "," $10,825.48 ", Not Applicable , Not Applicable ," $11,366.75 "," $11,041.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,825.48 ", Not Applicable , Not Applicable ," $10,825.48 "," $11,366.75 ", Not Applicable
,716,Diagnosis Related Group,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,828.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,828.88 "," $10,828.88 ", Not Applicable , Not Applicable ," $11,370.32 "," $11,045.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,828.88 ", Not Applicable , Not Applicable ," $10,828.88 "," $11,370.32 ", Not Applicable
,975,Diagnosis Related Group,HIV WITH MAJOR RELATED CONDITION WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,882.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,882.35 "," $10,882.35 ", Not Applicable , Not Applicable ," $11,426.47 "," $11,100.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,882.35 ", Not Applicable , Not Applicable ," $10,882.35 "," $11,426.47 ", Not Applicable
,741,Diagnosis Related Group,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,863.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,863.68 "," $10,863.68 ", Not Applicable , Not Applicable ," $11,406.86 "," $11,080.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,863.68 ", Not Applicable , Not Applicable ," $10,863.68 "," $11,406.86 ", Not Applicable
,725,Diagnosis Related Group,BENIGN PROSTATIC HYPERTROPHY WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,911.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,911.21 "," $10,911.21 ", Not Applicable , Not Applicable ," $11,456.77 "," $11,129.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,911.21 ", Not Applicable , Not Applicable ," $10,911.21 "," $11,456.77 ", Not Applicable
,294,Diagnosis Related Group,DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,888.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,888.29 "," $10,888.29 ", Not Applicable , Not Applicable ," $11,432.71 "," $11,106.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,888.29 ", Not Applicable , Not Applicable ," $10,888.29 "," $11,432.71 ", Not Applicable
,642,Diagnosis Related Group,INBORN AND OTHER DISORDERS OF METABOLISM,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,947.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,947.71 "," $10,947.71 ", Not Applicable , Not Applicable ," $11,495.09 "," $11,166.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,947.71 ", Not Applicable , Not Applicable ," $10,947.71 "," $11,495.09 ", Not Applicable
,540,Diagnosis Related Group,OSTEOMYELITIS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,047.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,047.86 "," $11,047.86 ", Not Applicable , Not Applicable ," $11,600.26 "," $11,268.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,047.86 ", Not Applicable , Not Applicable ," $11,047.86 "," $11,600.26 ", Not Applicable
,489,Diagnosis Related Group,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,019.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,019.00 "," $11,019.00 ", Not Applicable , Not Applicable ," $11,569.96 "," $11,239.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,019.00 ", Not Applicable , Not Applicable ," $11,019.00 "," $11,569.96 ", Not Applicable
,147,Diagnosis Related Group,"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,043.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,043.62 "," $11,043.62 ", Not Applicable , Not Applicable ," $11,595.80 "," $11,264.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,043.62 ", Not Applicable , Not Applicable ," $11,043.62 "," $11,595.80 ", Not Applicable
,618,Diagnosis Related Group,"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,061.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,061.44 "," $11,061.44 ", Not Applicable , Not Applicable ," $11,614.52 "," $11,282.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,061.44 ", Not Applicable , Not Applicable ," $11,061.44 "," $11,614.52 ", Not Applicable
,193,Diagnosis Related Group,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,136.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,136.14 "," $11,136.14 ", Not Applicable , Not Applicable ," $11,692.94 "," $11,358.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,136.14 ", Not Applicable , Not Applicable ," $11,136.14 "," $11,692.94 ", Not Applicable
,383,Diagnosis Related Group,UNCOMPLICATED PEPTIC ULCER WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,141.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,141.23 "," $11,141.23 ", Not Applicable , Not Applicable ," $11,698.29 "," $11,364.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,141.23 ", Not Applicable , Not Applicable ," $11,141.23 "," $11,698.29 ", Not Applicable
,419,Diagnosis Related Group,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,164.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,164.15 "," $11,164.15 ", Not Applicable , Not Applicable ," $11,722.36 "," $11,387.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,164.15 ", Not Applicable , Not Applicable ," $11,164.15 "," $11,722.36 ", Not Applicable
,818,Diagnosis Related Group,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,541.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,541.86 "," $11,541.86 ", Not Applicable , Not Applicable ," $12,118.95 "," $11,772.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,541.86 ", Not Applicable ," $1,723.00 "," $1,723.00 "," $12,118.95 ", Not Applicable
,977,Diagnosis Related Group,HIV WITH OR WITHOUT OTHER RELATED CONDITION,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,240.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,240.54 "," $11,240.54 ", Not Applicable , Not Applicable ," $11,802.57 "," $11,465.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,240.54 ", Not Applicable , Not Applicable ," $11,240.54 "," $11,802.57 ", Not Applicable
,150,Diagnosis Related Group,EPISTAXIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,267.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,267.70 "," $11,267.70 ", Not Applicable , Not Applicable ," $11,831.09 "," $11,493.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,267.70 ", Not Applicable , Not Applicable ," $11,267.70 "," $11,831.09 ", Not Applicable
,502,Diagnosis Related Group,SOFT TISSUE PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,312.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,312.69 "," $11,312.69 ", Not Applicable , Not Applicable ," $11,878.32 "," $11,538.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,312.69 ", Not Applicable , Not Applicable ," $11,312.69 "," $11,878.32 ", Not Applicable
,847,Diagnosis Related Group,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,340.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,340.70 "," $11,340.70 ", Not Applicable , Not Applicable ," $11,907.73 "," $11,567.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,340.70 ", Not Applicable , Not Applicable ," $11,340.70 "," $11,907.73 ", Not Applicable
,358,Diagnosis Related Group,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,451.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,451.04 "," $11,451.04 ", Not Applicable , Not Applicable ," $12,023.59 "," $11,680.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,451.04 ", Not Applicable , Not Applicable ," $11,451.04 "," $12,023.59 ", Not Applicable
,291,Diagnosis Related Group,HEART FAILURE AND SHOCK WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $10,765.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,765.22 "," $10,765.22 ", Not Applicable , Not Applicable ," $11,303.48 "," $10,980.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,765.22 ", Not Applicable , Not Applicable ," $10,765.22 "," $11,303.48 ", Not Applicable
,83,Diagnosis Related Group,TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,407.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,407.75 "," $11,407.75 ", Not Applicable , Not Applicable ," $11,978.14 "," $11,635.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,407.75 ", Not Applicable , Not Applicable ," $11,407.75 "," $11,978.14 ", Not Applicable
,348,Diagnosis Related Group,ANAL AND STOMAL PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,442.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,442.55 "," $11,442.55 ", Not Applicable , Not Applicable ," $12,014.68 "," $11,671.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,442.55 ", Not Applicable , Not Applicable ," $11,442.55 "," $12,014.68 ", Not Applicable
,748,Diagnosis Related Group,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,438.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,438.31 "," $11,438.31 ", Not Applicable , Not Applicable ," $12,010.22 "," $11,667.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,438.31 ", Not Applicable , Not Applicable ," $11,438.31 "," $12,010.22 ", Not Applicable
,858,Diagnosis Related Group,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,540.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,540.16 "," $11,540.16 ", Not Applicable , Not Applicable ," $12,117.17 "," $11,770.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,540.16 ", Not Applicable , Not Applicable ," $11,540.16 "," $12,117.17 ", Not Applicable
,355,Diagnosis Related Group,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,545.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,545.26 "," $11,545.26 ", Not Applicable , Not Applicable ," $12,122.52 "," $11,776.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,545.26 ", Not Applicable , Not Applicable ," $11,545.26 "," $12,122.52 ", Not Applicable
,555,Diagnosis Related Group,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,615.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,615.70 "," $11,615.70 ", Not Applicable , Not Applicable ," $12,196.49 "," $11,848.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,615.70 ", Not Applicable , Not Applicable ," $11,615.70 "," $12,196.49 ", Not Applicable
,804,Diagnosis Related Group,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,593.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,593.64 "," $11,593.64 ", Not Applicable , Not Applicable ," $12,173.32 "," $11,825.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,593.64 ", Not Applicable , Not Applicable ," $11,593.64 "," $12,173.32 ", Not Applicable
,54,Diagnosis Related Group,NERVOUS SYSTEM NEOPLASMS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,614.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,614.01 "," $11,614.01 ", Not Applicable , Not Applicable ," $12,194.71 "," $11,846.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,614.01 ", Not Applicable , Not Applicable ," $11,614.01 "," $12,194.71 ", Not Applicable
,168,Diagnosis Related Group,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,496.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,496.03 "," $11,496.03 ", Not Applicable , Not Applicable ," $12,070.83 "," $11,725.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,496.03 ", Not Applicable , Not Applicable ," $11,496.03 "," $12,070.83 ", Not Applicable
,909,Diagnosis Related Group,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,636.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,636.92 "," $11,636.92 ", Not Applicable , Not Applicable ," $12,218.77 "," $11,869.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,636.92 ", Not Applicable , Not Applicable ," $11,636.92 "," $12,218.77 ", Not Applicable
,637,Diagnosis Related Group,DIABETES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,684.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,684.46 "," $11,684.46 ", Not Applicable , Not Applicable ," $12,268.68 "," $11,918.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,684.46 ", Not Applicable , Not Applicable ," $11,684.46 "," $12,268.68 ", Not Applicable
,811,Diagnosis Related Group,RED BLOOD CELL DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,707.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,707.37 "," $11,707.37 ", Not Applicable , Not Applicable ," $12,292.74 "," $11,941.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,707.37 ", Not Applicable , Not Applicable ," $11,707.37 "," $12,292.74 ", Not Applicable
,557,Diagnosis Related Group,"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,875.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,875.43 "," $11,875.43 ", Not Applicable , Not Applicable ," $12,469.21 "," $12,112.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,875.43 ", Not Applicable , Not Applicable ," $11,875.43 "," $12,469.21 ", Not Applicable
,517,Diagnosis Related Group,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,867.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,867.80 "," $11,867.80 ", Not Applicable , Not Applicable ," $12,461.19 "," $12,105.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,867.80 ", Not Applicable , Not Applicable ," $11,867.80 "," $12,461.19 ", Not Applicable
,99,Diagnosis Related Group,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,899.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,899.20 "," $11,899.20 ", Not Applicable , Not Applicable ," $12,494.16 "," $12,137.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,899.20 ", Not Applicable , Not Applicable ," $11,899.20 "," $12,494.16 ", Not Applicable
,124,Diagnosis Related Group,OTHER DISORDERS OF THE EYE WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,900.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,900.05 "," $11,900.05 ", Not Applicable , Not Applicable ," $12,495.05 "," $12,138.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,900.05 ", Not Applicable , Not Applicable ," $11,900.05 "," $12,495.05 ", Not Applicable
,825,Diagnosis Related Group,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,895.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,895.81 "," $11,895.81 ", Not Applicable , Not Applicable ," $12,490.60 "," $12,133.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,895.81 ", Not Applicable , Not Applicable ," $11,895.81 "," $12,490.60 ", Not Applicable
,630,Diagnosis Related Group,"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,962.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,962.01 "," $11,962.01 ", Not Applicable , Not Applicable ," $12,560.11 "," $12,201.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,962.01 ", Not Applicable , Not Applicable ," $11,962.01 "," $12,560.11 ", Not Applicable
,794,Diagnosis Related Group,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,954.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,954.37 "," $11,954.37 ", Not Applicable , Not Applicable ," $12,552.09 "," $12,193.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,954.37 ", Not Applicable ," $1,357.00 "," $1,357.00 "," $12,552.09 ", Not Applicable
,562,Diagnosis Related Group,"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,983.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,983.23 "," $11,983.23 ", Not Applicable , Not Applicable ," $12,582.39 "," $12,222.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,983.23 ", Not Applicable , Not Applicable ," $11,983.23 "," $12,582.39 ", Not Applicable
,533,Diagnosis Related Group,FRACTURES OF FEMUR WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,020.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,020.58 "," $12,020.58 ", Not Applicable , Not Applicable ," $12,621.61 "," $12,260.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,020.58 ", Not Applicable , Not Applicable ," $12,020.58 "," $12,621.61 ", Not Applicable
,735,Diagnosis Related Group,"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,998.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,998.51 "," $11,998.51 ", Not Applicable , Not Applicable ," $12,598.44 "," $12,238.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,998.51 ", Not Applicable , Not Applicable ," $11,998.51 "," $12,598.44 ", Not Applicable
,508,Diagnosis Related Group,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $11,965.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,965.41 "," $11,965.41 ", Not Applicable , Not Applicable ," $12,563.68 "," $12,204.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,965.41 ", Not Applicable , Not Applicable ," $11,965.41 "," $12,563.68 ", Not Applicable
,520,Diagnosis Related Group,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,038.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,038.40 "," $12,038.40 ", Not Applicable , Not Applicable ," $12,640.32 "," $12,279.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,038.40 ", Not Applicable , Not Applicable ," $12,038.40 "," $12,640.32 ", Not Applicable
,727,Diagnosis Related Group,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,061.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,061.32 "," $12,061.32 ", Not Applicable , Not Applicable ," $12,664.39 "," $12,302.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,061.32 ", Not Applicable , Not Applicable ," $12,061.32 "," $12,664.39 ", Not Applicable
,416,Diagnosis Related Group,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,072.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,072.35 "," $12,072.35 ", Not Applicable , Not Applicable ," $12,675.97 "," $12,313.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,072.35 ", Not Applicable , Not Applicable ," $12,072.35 "," $12,675.97 ", Not Applicable
,67,Diagnosis Related Group,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,102.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,102.06 "," $12,102.06 ", Not Applicable , Not Applicable ," $12,707.17 "," $12,344.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,102.06 ", Not Applicable , Not Applicable ," $12,102.06 "," $12,707.17 ", Not Applicable
,342,Diagnosis Related Group,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,162.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,162.33 "," $12,162.33 ", Not Applicable , Not Applicable ," $12,770.44 "," $12,405.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,162.33 ", Not Applicable , Not Applicable ," $12,162.33 "," $12,770.44 ", Not Applicable
,602,Diagnosis Related Group,CELLULITIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,307.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,307.47 "," $12,307.47 ", Not Applicable , Not Applicable ," $12,922.84 "," $12,553.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,307.47 ", Not Applicable , Not Applicable ," $12,307.47 "," $12,922.84 ", Not Applicable
,660,Diagnosis Related Group,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,248.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,248.90 "," $12,248.90 ", Not Applicable , Not Applicable ," $12,861.35 "," $12,493.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,248.90 ", Not Applicable , Not Applicable ," $12,248.90 "," $12,861.35 ", Not Applicable
,884,Diagnosis Related Group,ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,284.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,284.55 "," $12,284.55 ", Not Applicable , Not Applicable ," $12,898.78 "," $12,530.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,284.55 ", Not Applicable , Not Applicable ," $12,284.55 "," $12,898.78 ", Not Applicable
,114,Diagnosis Related Group,ORBITAL PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,287.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,287.10 "," $12,287.10 ", Not Applicable , Not Applicable ," $12,901.45 "," $12,532.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,287.10 ", Not Applicable , Not Applicable ," $12,287.10 "," $12,901.45 ", Not Applicable
,73,Diagnosis Related Group,CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,332.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,332.08 "," $12,332.08 ", Not Applicable , Not Applicable ," $12,948.69 "," $12,578.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,332.08 ", Not Applicable , Not Applicable ," $12,332.08 "," $12,948.69 ", Not Applicable
,422,Diagnosis Related Group,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,338.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,338.03 "," $12,338.03 ", Not Applicable , Not Applicable ," $12,954.93 "," $12,584.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,338.03 ", Not Applicable , Not Applicable ," $12,338.03 "," $12,954.93 ", Not Applicable
,115,Diagnosis Related Group,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,363.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,363.49 "," $12,363.49 ", Not Applicable , Not Applicable ," $12,981.66 "," $12,610.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,363.49 ", Not Applicable , Not Applicable ," $12,363.49 "," $12,981.66 ", Not Applicable
,497,Diagnosis Related Group,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,320.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,320.20 "," $12,320.20 ", Not Applicable , Not Applicable ," $12,936.21 "," $12,566.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,320.20 ", Not Applicable , Not Applicable ," $12,320.20 "," $12,936.21 ", Not Applicable
,88,Diagnosis Related Group,CONCUSSION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,351.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,351.61 "," $12,351.61 ", Not Applicable , Not Applicable ," $12,969.19 "," $12,598.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,351.61 ", Not Applicable , Not Applicable ," $12,351.61 "," $12,969.19 ", Not Applicable
,750,Diagnosis Related Group,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,424.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,424.60 "," $12,424.60 ", Not Applicable , Not Applicable ," $13,045.83 "," $12,673.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,424.60 ", Not Applicable , Not Applicable ," $12,424.60 "," $13,045.83 ", Not Applicable
,137,Diagnosis Related Group,MOUTH PROCEDURES WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,814.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,814.20 "," $12,814.20 ", Not Applicable , Not Applicable ," $13,454.91 "," $13,070.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,814.20 ", Not Applicable , Not Applicable ," $12,814.20 "," $13,454.91 ", Not Applicable
,682,Diagnosis Related Group,RENAL FAILURE WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,500.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,500.15 "," $12,500.15 ", Not Applicable , Not Applicable ," $13,125.15 "," $12,750.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,500.15 ", Not Applicable , Not Applicable ," $12,500.15 "," $13,125.15 ", Not Applicable
,506,Diagnosis Related Group,MAJOR THUMB OR JOINT PROCEDURES,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,592.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,592.66 "," $12,592.66 ", Not Applicable , Not Applicable ," $13,222.30 "," $12,844.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,592.66 ", Not Applicable , Not Applicable ," $12,592.66 "," $13,222.30 ", Not Applicable
,830,Diagnosis Related Group,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,579.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,579.08 "," $12,579.08 ", Not Applicable , Not Applicable ," $13,208.04 "," $12,830.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,579.08 ", Not Applicable , Not Applicable ," $12,579.08 "," $13,208.04 ", Not Applicable
,738,Diagnosis Related Group,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,527.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,527.31 "," $12,527.31 ", Not Applicable , Not Applicable ," $13,153.67 "," $12,777.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,527.31 ", Not Applicable , Not Applicable ," $12,527.31 "," $13,153.67 ", Not Applicable
,917,Diagnosis Related Group,POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,549.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,549.37 "," $12,549.37 ", Not Applicable , Not Applicable ," $13,176.84 "," $12,800.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,549.37 ", Not Applicable , Not Applicable ," $12,549.37 "," $13,176.84 ", Not Applicable
,865,Diagnosis Related Group,VIRAL ILLNESS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,543.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,543.43 "," $12,543.43 ", Not Applicable , Not Applicable ," $13,170.61 "," $12,794.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,543.43 ", Not Applicable , Not Applicable ," $12,543.43 "," $13,170.61 ", Not Applicable
,945,Diagnosis Related Group,REHABILITATION WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,578.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,578.23 "," $12,578.23 ", Not Applicable , Not Applicable ," $13,207.15 "," $12,829.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,578.23 ", Not Applicable , Not Applicable ," $12,578.23 "," $13,207.15 ", Not Applicable
,839,Diagnosis Related Group,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,623.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,623.22 "," $12,623.22 ", Not Applicable , Not Applicable ," $13,254.38 "," $12,875.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,623.22 ", Not Applicable , Not Applicable ," $12,623.22 "," $13,254.38 ", Not Applicable
,964,Diagnosis Related Group,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,662.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,662.26 "," $12,662.26 ", Not Applicable , Not Applicable ," $13,295.38 "," $12,915.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,662.26 ", Not Applicable , Not Applicable ," $12,662.26 "," $13,295.38 ", Not Applicable
,351,Diagnosis Related Group,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,669.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,669.90 "," $12,669.90 ", Not Applicable , Not Applicable ," $13,303.40 "," $12,923.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,669.90 ", Not Applicable , Not Applicable ," $12,669.90 "," $13,303.40 ", Not Applicable
,604,Diagnosis Related Group,"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,544.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,544.28 "," $12,544.28 ", Not Applicable , Not Applicable ," $13,171.50 "," $12,795.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,544.28 ", Not Applicable , Not Applicable ," $12,544.28 "," $13,171.50 ", Not Applicable
,708,Diagnosis Related Group,MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,657.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,657.17 "," $12,657.17 ", Not Applicable , Not Applicable ," $13,290.03 "," $12,910.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,657.17 ", Not Applicable , Not Applicable ," $12,657.17 "," $13,290.03 ", Not Applicable
,713,Diagnosis Related Group,TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,675.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,675.84 "," $12,675.84 ", Not Applicable , Not Applicable ," $13,309.64 "," $12,929.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,675.84 ", Not Applicable , Not Applicable ," $12,675.84 "," $13,309.64 ", Not Applicable
,855,Diagnosis Related Group,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,899.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,899.93 "," $12,899.93 ", Not Applicable , Not Applicable ," $13,544.92 "," $13,157.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,899.93 ", Not Applicable , Not Applicable ," $12,899.93 "," $13,544.92 ", Not Applicable
,306,Diagnosis Related Group,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,794.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,794.68 "," $12,794.68 ", Not Applicable , Not Applicable ," $13,434.41 "," $13,050.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,794.68 ", Not Applicable , Not Applicable ," $12,794.68 "," $13,434.41 ", Not Applicable
,606,Diagnosis Related Group,MINOR SKIN DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,834.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,834.57 "," $12,834.57 ", Not Applicable , Not Applicable ," $13,476.30 "," $13,091.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,834.57 ", Not Applicable , Not Applicable ," $12,834.57 "," $13,476.30 ", Not Applicable
,388,Diagnosis Related Group,GASTROINTESTINAL OBSTRUCTION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,855.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,855.79 "," $12,855.79 ", Not Applicable , Not Applicable ," $13,498.58 "," $13,112.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,855.79 ", Not Applicable , Not Applicable ," $12,855.79 "," $13,498.58 ", Not Applicable
,564,Diagnosis Related Group,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,932.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,932.18 "," $12,932.18 ", Not Applicable , Not Applicable ," $13,578.79 "," $13,190.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,932.18 ", Not Applicable , Not Applicable ," $12,932.18 "," $13,578.79 ", Not Applicable
,757,Diagnosis Related Group,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $12,941.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,941.52 "," $12,941.52 ", Not Applicable , Not Applicable ," $13,588.59 "," $13,200.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,941.52 ", Not Applicable , Not Applicable ," $12,941.52 "," $13,588.59 ", Not Applicable
,299,Diagnosis Related Group,PERIPHERAL VASCULAR DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,008.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,008.57 "," $13,008.57 ", Not Applicable , Not Applicable ," $13,659.00 "," $13,268.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,008.57 ", Not Applicable , Not Applicable ," $13,008.57 "," $13,659.00 ", Not Applicable
,77,Diagnosis Related Group,HYPERTENSIVE ENCEPHALOPATHY WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,011.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,011.12 "," $13,011.12 ", Not Applicable , Not Applicable ," $13,661.67 "," $13,271.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,011.12 ", Not Applicable , Not Applicable ," $13,011.12 "," $13,661.67 ", Not Applicable
,669,Diagnosis Related Group,TRANSURETHRAL PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,270.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,270.85 "," $13,270.85 ", Not Applicable , Not Applicable ," $13,934.39 "," $13,536.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,270.85 ", Not Applicable , Not Applicable ," $13,270.85 "," $13,934.39 ", Not Applicable
,583,Diagnosis Related Group,MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,084.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,084.11 "," $13,084.11 ", Not Applicable , Not Applicable ," $13,738.32 "," $13,345.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,084.11 ", Not Applicable , Not Applicable ," $13,084.11 "," $13,738.32 ", Not Applicable
,154,Diagnosis Related Group,"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,129.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,129.10 "," $13,129.10 ", Not Applicable , Not Applicable ," $13,785.55 "," $13,391.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,129.10 ", Not Applicable , Not Applicable ," $13,129.10 "," $13,785.55 ", Not Applicable
,186,Diagnosis Related Group,PLEURAL EFFUSION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,103.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,103.64 "," $13,103.64 ", Not Applicable , Not Applicable ," $13,758.82 "," $13,365.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,103.64 ", Not Applicable , Not Applicable ," $13,103.64 "," $13,758.82 ", Not Applicable
,425,Diagnosis Related Group,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,094.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,094.30 "," $13,094.30 ", Not Applicable , Not Applicable ," $13,749.01 "," $13,356.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,094.30 ", Not Applicable , Not Applicable ," $13,094.30 "," $13,749.01 ", Not Applicable
,175,Diagnosis Related Group,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,122.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,122.31 "," $13,122.31 ", Not Applicable , Not Applicable ," $13,778.42 "," $13,384.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,122.31 ", Not Applicable , Not Applicable ," $13,122.31 "," $13,778.42 ", Not Applicable
,813,Diagnosis Related Group,COAGULATION DISORDERS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,114.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,114.67 "," $13,114.67 ", Not Applicable , Not Applicable ," $13,770.40 "," $13,376.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,114.67 ", Not Applicable , Not Applicable ," $13,114.67 "," $13,770.40 ", Not Applicable
,183,Diagnosis Related Group,MAJOR CHEST TRAUMA WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,231.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,231.80 "," $13,231.80 ", Not Applicable , Not Applicable ," $13,893.39 "," $13,496.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,231.80 ", Not Applicable , Not Applicable ," $13,231.80 "," $13,893.39 ", Not Applicable
,512,Diagnosis Related Group,"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,194.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,194.46 "," $13,194.46 ", Not Applicable , Not Applicable ," $13,854.18 "," $13,458.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,194.46 ", Not Applicable , Not Applicable ," $13,194.46 "," $13,854.18 ", Not Applicable
,513,Diagnosis Related Group,"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,342.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,342.99 "," $13,342.99 ", Not Applicable , Not Applicable ," $14,010.14 "," $13,609.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,342.99 ", Not Applicable , Not Applicable ," $13,342.99 "," $14,010.14 ", Not Applicable
,410,Diagnosis Related Group,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,311.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,311.59 "," $13,311.59 ", Not Applicable , Not Applicable ," $13,977.17 "," $13,577.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,311.59 ", Not Applicable , Not Applicable ," $13,311.59 "," $13,977.17 ", Not Applicable
,157,Diagnosis Related Group,DENTAL AND ORAL DISEASES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,378.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,378.64 "," $13,378.64 ", Not Applicable , Not Applicable ," $14,047.58 "," $13,646.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,378.64 ", Not Applicable , Not Applicable ," $13,378.64 "," $14,047.58 ", Not Applicable
,615,Diagnosis Related Group,ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,368.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,368.46 "," $13,368.46 ", Not Applicable , Not Applicable ," $14,036.88 "," $13,635.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,368.46 ", Not Applicable , Not Applicable ," $13,368.46 "," $14,036.88 ", Not Applicable
,345,Diagnosis Related Group,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,400.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,400.71 "," $13,400.71 ", Not Applicable , Not Applicable ," $14,070.75 "," $13,668.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,400.71 ", Not Applicable , Not Applicable ," $13,400.71 "," $14,070.75 ", Not Applicable
,883,Diagnosis Related Group,DISORDERS OF PERSONALITY AND IMPULSE CONTROL,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,426.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,426.18 "," $13,426.18 ", Not Applicable , Not Applicable ," $14,097.48 "," $13,694.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,426.18 ", Not Applicable , Not Applicable ," $13,426.18 "," $14,097.48 ", Not Applicable
,658,Diagnosis Related Group,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,393.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,393.07 "," $13,393.07 ", Not Applicable , Not Applicable ," $14,062.73 "," $13,660.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,393.07 ", Not Applicable , Not Applicable ," $13,393.07 "," $14,062.73 ", Not Applicable
,922,Diagnosis Related Group,"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,480.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,480.50 "," $13,480.50 ", Not Applicable , Not Applicable ," $14,154.52 "," $13,750.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,480.50 ", Not Applicable , Not Applicable ," $13,480.50 "," $14,154.52 ", Not Applicable
,786,Diagnosis Related Group,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,533.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,533.12 "," $13,533.12 ", Not Applicable , Not Applicable ," $14,209.78 "," $13,803.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,533.12 ", Not Applicable ," $8,023.00 "," $8,023.00 "," $14,209.78 ", Not Applicable
,241,Diagnosis Related Group,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,516.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,516.15 "," $13,516.15 ", Not Applicable , Not Applicable ," $14,191.96 "," $13,786.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,516.15 ", Not Applicable , Not Applicable ," $13,516.15 "," $14,191.96 ", Not Applicable
,895,Diagnosis Related Group,"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,573.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,573.87 "," $13,573.87 ", Not Applicable , Not Applicable ," $14,252.56 "," $13,845.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,573.87 ", Not Applicable , Not Applicable ," $13,573.87 "," $14,252.56 ", Not Applicable
,578,Diagnosis Related Group,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,539.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,539.91 "," $13,539.91 ", Not Applicable , Not Applicable ," $14,216.91 "," $13,810.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,539.91 ", Not Applicable , Not Applicable ," $13,539.91 "," $14,216.91 ", Not Applicable
,296,Diagnosis Related Group,"CARDIAC ARREST, UNEXPLAINED WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,539.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,539.91 "," $13,539.91 ", Not Applicable , Not Applicable ," $14,216.91 "," $13,810.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,539.91 ", Not Applicable , Not Applicable ," $13,539.91 "," $14,216.91 ", Not Applicable
,663,Diagnosis Related Group,MINOR BLADDER PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,576.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,576.41 "," $13,576.41 ", Not Applicable , Not Applicable ," $14,255.23 "," $13,847.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,576.41 ", Not Applicable , Not Applicable ," $13,576.41 "," $14,255.23 ", Not Applicable
,438,Diagnosis Related Group,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,561.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,561.98 "," $13,561.98 ", Not Applicable , Not Applicable ," $14,240.08 "," $13,833.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,561.98 ", Not Applicable , Not Applicable ," $13,561.98 "," $14,240.08 ", Not Applicable
,621,Diagnosis Related Group,O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,556.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,556.04 "," $13,556.04 ", Not Applicable , Not Applicable ," $14,233.84 "," $13,827.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,556.04 ", Not Applicable , Not Applicable ," $13,556.04 "," $14,233.84 ", Not Applicable
,710,Diagnosis Related Group,PENIS PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,594.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,594.24 "," $13,594.24 ", Not Applicable , Not Applicable ," $14,273.95 "," $13,866.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,594.24 ", Not Applicable , Not Applicable ," $13,594.24 "," $14,273.95 ", Not Applicable
,580,Diagnosis Related Group,"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,673.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,673.90 "," $14,673.90 ", Not Applicable , Not Applicable ," $15,407.59 "," $14,967.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,673.90 ", Not Applicable , Not Applicable ," $14,673.90 "," $15,407.59 ", Not Applicable
,698,Diagnosis Related Group,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,670.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,670.63 "," $13,670.63 ", Not Applicable , Not Applicable ," $14,354.16 "," $13,944.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,670.63 ", Not Applicable , Not Applicable ," $13,670.63 "," $14,354.16 ", Not Applicable
,142,Diagnosis Related Group,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,623.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,623.94 "," $13,623.94 ", Not Applicable , Not Applicable ," $14,305.14 "," $13,896.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,623.94 ", Not Applicable , Not Applicable ," $13,623.94 "," $14,305.14 ", Not Applicable
,334,Diagnosis Related Group,RECTAL RESECTION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,653.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,653.65 "," $13,653.65 ", Not Applicable , Not Applicable ," $14,336.33 "," $13,926.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,653.65 ", Not Applicable , Not Applicable ," $13,653.65 "," $14,336.33 ", Not Applicable
,746,Diagnosis Related Group,"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,678.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,678.27 "," $13,678.27 ", Not Applicable , Not Applicable ," $14,362.18 "," $13,951.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,678.27 ", Not Applicable , Not Applicable ," $13,678.27 "," $14,362.18 ", Not Applicable
,385,Diagnosis Related Group,INFLAMMATORY BOWEL DISEASE WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,769.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,769.94 "," $13,769.94 ", Not Applicable , Not Applicable ," $14,458.43 "," $14,045.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,769.94 ", Not Applicable , Not Applicable ," $13,769.94 "," $14,458.43 ", Not Applicable
,769,Diagnosis Related Group,POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,730.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,730.04 "," $13,730.04 ", Not Applicable , Not Applicable ," $14,416.55 "," $14,004.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,730.04 ", Not Applicable , Not Applicable ," $13,730.04 "," $14,416.55 ", Not Applicable
,841,Diagnosis Related Group,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,763.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,763.99 "," $13,763.99 ", Not Applicable , Not Applicable ," $14,452.19 "," $14,039.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,763.99 ", Not Applicable , Not Applicable ," $13,763.99 "," $14,452.19 ", Not Applicable
,551,Diagnosis Related Group,MEDICAL BACK PROBLEMS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,813.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,813.22 "," $13,813.22 ", Not Applicable , Not Applicable ," $14,503.89 "," $14,089.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,813.22 ", Not Applicable , Not Applicable ," $13,813.22 "," $14,503.89 ", Not Applicable
,75,Diagnosis Related Group,VIRAL MENINGITIS WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,809.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,809.83 "," $13,809.83 ", Not Applicable , Not Applicable ," $14,500.32 "," $14,086.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,809.83 ", Not Applicable , Not Applicable ," $13,809.83 "," $14,500.32 ", Not Applicable
,280,Diagnosis Related Group,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,639.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,639.22 "," $13,639.22 ", Not Applicable , Not Applicable ," $14,321.18 "," $13,912.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,639.22 ", Not Applicable , Not Applicable ," $13,639.22 "," $14,321.18 ", Not Applicable
,337,Diagnosis Related Group,PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,897.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,897.26 "," $13,897.26 ", Not Applicable , Not Applicable ," $14,592.12 "," $14,175.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,897.26 ", Not Applicable , Not Applicable ," $13,897.26 "," $14,592.12 ", Not Applicable
,571,Diagnosis Related Group,SKIN DEBRIDEMENT WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,881.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,881.13 "," $13,881.13 ", Not Applicable , Not Applicable ," $14,575.18 "," $14,158.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,881.13 ", Not Applicable , Not Applicable ," $13,881.13 "," $14,575.18 ", Not Applicable
,913,Diagnosis Related Group,TRAUMATIC INJURY WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,908.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,908.29 "," $13,908.29 ", Not Applicable , Not Applicable ," $14,603.70 "," $14,186.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,908.29 ", Not Applicable , Not Applicable ," $13,908.29 "," $14,603.70 ", Not Applicable
,597,Diagnosis Related Group,MALIGNANT BREAST DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,954.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,954.12 "," $13,954.12 ", Not Applicable , Not Applicable ," $14,651.83 "," $14,233.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,954.12 ", Not Applicable , Not Applicable ," $13,954.12 "," $14,651.83 ", Not Applicable
,487,Diagnosis Related Group,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,921.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,921.87 "," $13,921.87 ", Not Applicable , Not Applicable ," $14,617.96 "," $14,200.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,921.87 ", Not Applicable , Not Applicable ," $13,921.87 "," $14,617.96 ", Not Applicable
,582,Diagnosis Related Group,MASTECTOMY FOR MALIGNANCY WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,946.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,946.48 "," $13,946.48 ", Not Applicable , Not Applicable ," $14,643.81 "," $14,225.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,946.48 ", Not Applicable , Not Applicable ," $13,946.48 "," $14,643.81 ", Not Applicable
,289,Diagnosis Related Group,ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,950.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,950.73 "," $13,950.73 ", Not Applicable , Not Applicable ," $14,648.27 "," $14,229.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,950.73 ", Not Applicable , Not Applicable ," $13,950.73 "," $14,648.27 ", Not Applicable
,256,Diagnosis Related Group,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,955.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,955.82 "," $13,955.82 ", Not Applicable , Not Applicable ," $14,653.61 "," $14,234.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,955.82 ", Not Applicable , Not Applicable ," $13,955.82 "," $14,653.61 ", Not Applicable
,905,Diagnosis Related Group,SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,005.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,005.05 "," $14,005.05 ", Not Applicable , Not Applicable ," $14,705.30 "," $14,285.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,005.05 ", Not Applicable , Not Applicable ," $14,005.05 "," $14,705.30 ", Not Applicable
,482,Diagnosis Related Group,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $13,969.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,969.40 "," $13,969.40 ", Not Applicable , Not Applicable ," $14,667.87 "," $14,248.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,969.40 ", Not Applicable , Not Applicable ," $13,969.40 "," $14,667.87 ", Not Applicable
,91,Diagnosis Related Group,OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,011.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,011.84 "," $14,011.84 ", Not Applicable , Not Applicable ," $14,712.43 "," $14,292.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,011.84 ", Not Applicable , Not Applicable ," $14,011.84 "," $14,712.43 ", Not Applicable
,626,Diagnosis Related Group,"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,029.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,029.67 "," $14,029.67 ", Not Applicable , Not Applicable ," $14,731.15 "," $14,310.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,029.67 ", Not Applicable , Not Applicable ," $14,029.67 "," $14,731.15 ", Not Applicable
,393,Diagnosis Related Group,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,100.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,100.12 "," $14,100.12 ", Not Applicable , Not Applicable ," $14,805.12 "," $14,382.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,100.12 ", Not Applicable , Not Applicable ," $14,100.12 "," $14,805.12 ", Not Applicable
,983,Diagnosis Related Group,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,024.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,024.57 "," $14,024.57 ", Not Applicable , Not Applicable ," $14,725.80 "," $14,305.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,024.57 ", Not Applicable , Not Applicable ," $14,024.57 "," $14,725.80 ", Not Applicable
,38,Diagnosis Related Group,EXTRACRANIAL PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,079.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,079.75 "," $14,079.75 ", Not Applicable , Not Applicable ," $14,783.73 "," $14,361.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,079.75 ", Not Applicable , Not Applicable ," $14,079.75 "," $14,783.73 ", Not Applicable
,251,Diagnosis Related Group,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,076.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,076.35 "," $14,076.35 ", Not Applicable , Not Applicable ," $14,780.17 "," $14,357.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,076.35 ", Not Applicable , Not Applicable ," $14,076.35 "," $14,780.17 ", Not Applicable
,643,Diagnosis Related Group,ENDOCRINE DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,155.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,155.29 "," $14,155.29 ", Not Applicable , Not Applicable ," $14,863.05 "," $14,438.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,155.29 ", Not Applicable , Not Applicable ," $14,155.29 "," $14,863.05 ", Not Applicable
,328,Diagnosis Related Group,"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,148.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,148.50 "," $14,148.50 ", Not Applicable , Not Applicable ," $14,855.92 "," $14,431.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,148.50 ", Not Applicable , Not Applicable ," $14,148.50 "," $14,855.92 ", Not Applicable
,444,Diagnosis Related Group,DISORDERS OF THE BILIARY TRACT WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,188.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,188.39 "," $14,188.39 ", Not Applicable , Not Applicable ," $14,897.81 "," $14,472.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,188.39 ", Not Applicable , Not Applicable ," $14,188.39 "," $14,897.81 ", Not Applicable
,509,Diagnosis Related Group,ARTHROSCOPY,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,314.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,314.86 "," $14,314.86 ", Not Applicable , Not Applicable ," $15,030.60 "," $14,601.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,314.86 ", Not Applicable , Not Applicable ," $14,314.86 "," $15,030.60 ", Not Applicable
,70,Diagnosis Related Group,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,256.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,256.29 "," $14,256.29 ", Not Applicable , Not Applicable ," $14,969.11 "," $14,541.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,256.29 ", Not Applicable , Not Applicable ," $14,256.29 "," $14,969.11 ", Not Applicable
,828,Diagnosis Related Group,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,208.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,208.76 "," $14,208.76 ", Not Applicable , Not Applicable ," $14,919.20 "," $14,492.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,208.76 ", Not Applicable , Not Applicable ," $14,208.76 "," $14,919.20 ", Not Applicable
,988,Diagnosis Related Group,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,483.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,483.77 "," $14,483.77 ", Not Applicable , Not Applicable ," $15,207.96 "," $14,773.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,483.77 ", Not Applicable , Not Applicable ," $14,483.77 "," $15,207.96 ", Not Applicable
,205,Diagnosis Related Group,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,300.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,300.43 "," $14,300.43 ", Not Applicable , Not Applicable ," $15,015.45 "," $14,586.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,300.43 ", Not Applicable , Not Applicable ," $14,300.43 "," $15,015.45 ", Not Applicable
,801,Diagnosis Related Group,SPLENECTOMY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,293.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,293.64 "," $14,293.64 ", Not Applicable , Not Applicable ," $15,008.32 "," $14,579.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,293.64 ", Not Applicable , Not Applicable ," $14,293.64 "," $15,008.32 ", Not Applicable
,592,Diagnosis Related Group,SKIN ULCERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,381.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,381.07 "," $14,381.07 ", Not Applicable , Not Applicable ," $15,100.12 "," $14,668.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,381.07 ", Not Applicable , Not Applicable ," $14,381.07 "," $15,100.12 ", Not Applicable
,418,Diagnosis Related Group,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,336.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,336.08 "," $14,336.08 ", Not Applicable , Not Applicable ," $15,052.88 "," $14,622.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,336.08 ", Not Applicable , Not Applicable ," $14,336.08 "," $15,052.88 ", Not Applicable
,339,Diagnosis Related Group,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,407.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,407.38 "," $14,407.38 ", Not Applicable , Not Applicable ," $15,127.75 "," $14,695.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,407.38 ", Not Applicable , Not Applicable ," $14,407.38 "," $15,127.75 ", Not Applicable
,915,Diagnosis Related Group,ALLERGIC REACTIONS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,425.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,425.20 "," $14,425.20 ", Not Applicable , Not Applicable ," $15,146.46 "," $14,713.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,425.20 ", Not Applicable , Not Applicable ," $14,425.20 "," $15,146.46 ", Not Applicable
,262,Diagnosis Related Group,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,482.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,482.07 "," $14,482.07 ", Not Applicable , Not Applicable ," $15,206.18 "," $14,771.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,482.07 ", Not Applicable , Not Applicable ," $14,482.07 "," $15,206.18 ", Not Applicable
,722,Diagnosis Related Group,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,536.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,536.39 "," $14,536.39 ", Not Applicable , Not Applicable ," $15,263.21 "," $14,827.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,536.39 ", Not Applicable , Not Applicable ," $14,536.39 "," $15,263.21 ", Not Applicable
,63,Diagnosis Related Group,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,511.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,511.78 "," $14,511.78 ", Not Applicable , Not Applicable ," $15,237.37 "," $14,802.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,511.78 ", Not Applicable , Not Applicable ," $14,511.78 "," $15,237.37 ", Not Applicable
,331,Diagnosis Related Group,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,518.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,518.57 "," $14,518.57 ", Not Applicable , Not Applicable ," $15,244.50 "," $14,808.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,518.57 ", Not Applicable , Not Applicable ," $14,518.57 "," $15,244.50 ", Not Applicable
,742,Diagnosis Related Group,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,583.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,583.08 "," $14,583.08 ", Not Applicable , Not Applicable ," $15,312.23 "," $14,874.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,583.08 ", Not Applicable , Not Applicable ," $14,583.08 "," $15,312.23 ", Not Applicable
,789,Diagnosis Related Group,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,599.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,599.21 "," $14,599.21 ", Not Applicable , Not Applicable ," $15,329.17 "," $14,891.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,599.21 ", Not Applicable ," $1,357.00 "," $1,357.00 "," $15,329.17 ", Not Applicable
,33,Diagnosis Related Group,VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,617.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,617.88 "," $14,617.88 ", Not Applicable , Not Applicable ," $15,348.77 "," $14,910.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,617.88 ", Not Applicable , Not Applicable ," $14,617.88 "," $15,348.77 ", Not Applicable
,371,Diagnosis Related Group,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,694.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,694.27 "," $14,694.27 ", Not Applicable , Not Applicable ," $15,428.98 "," $14,988.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,694.27 ", Not Applicable , Not Applicable ," $14,694.27 "," $15,428.98 ", Not Applicable
,413,Diagnosis Related Group,CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,691.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,691.72 "," $14,691.72 ", Not Applicable , Not Applicable ," $15,426.31 "," $14,985.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,691.72 ", Not Applicable , Not Applicable ," $14,691.72 "," $15,426.31 ", Not Applicable
,666,Diagnosis Related Group,PROSTATECTOMY WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,766.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,766.42 "," $14,766.42 ", Not Applicable , Not Applicable ," $15,504.74 "," $15,061.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,766.42 ", Not Applicable , Not Applicable ," $14,766.42 "," $15,504.74 ", Not Applicable
,196,Diagnosis Related Group,INTERSTITIAL LUNG DISEASE WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,757.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,757.08 "," $14,757.08 ", Not Applicable , Not Applicable ," $15,494.93 "," $15,052.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,757.08 ", Not Applicable , Not Applicable ," $14,757.08 "," $15,494.93 ", Not Applicable
,58,Diagnosis Related Group,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,750.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,750.29 "," $14,750.29 ", Not Applicable , Not Applicable ," $15,487.80 "," $15,045.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,750.29 ", Not Applicable , Not Applicable ," $14,750.29 "," $15,487.80 ", Not Applicable
,180,Diagnosis Related Group,RESPIRATORY NEOPLASMS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,768.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,768.11 "," $14,768.11 ", Not Applicable , Not Applicable ," $15,506.52 "," $15,063.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,768.11 ", Not Applicable , Not Applicable ," $14,768.11 "," $15,506.52 ", Not Applicable
,585,Diagnosis Related Group,"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,765.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,765.57 "," $14,765.57 ", Not Applicable , Not Applicable ," $15,503.85 "," $15,060.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,765.57 ", Not Applicable , Not Applicable ," $14,765.57 "," $15,503.85 ", Not Applicable
,501,Diagnosis Related Group,SOFT TISSUE PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,888.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,888.64 "," $14,888.64 ", Not Applicable , Not Applicable ," $15,633.08 "," $15,186.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,888.64 ", Not Applicable , Not Applicable ," $14,888.64 "," $15,633.08 ", Not Applicable
,144,Diagnosis Related Group,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,951.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,951.45 "," $14,951.45 ", Not Applicable , Not Applicable ," $15,699.03 "," $15,250.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,951.45 ", Not Applicable , Not Applicable ," $14,951.45 "," $15,699.03 ", Not Applicable
,675,Diagnosis Related Group,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,893.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,893.74 "," $14,893.74 ", Not Applicable , Not Applicable ," $15,638.42 "," $15,191.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,893.74 ", Not Applicable , Not Applicable ," $14,893.74 "," $15,638.42 ", Not Applicable
,435,Diagnosis Related Group,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,882.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,882.70 "," $14,882.70 ", Not Applicable , Not Applicable ," $15,626.84 "," $15,180.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,882.70 ", Not Applicable , Not Applicable ," $14,882.70 "," $15,626.84 ", Not Applicable
,620,Diagnosis Related Group,O.R. PROCEDURES FOR OBESITY WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,961.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,961.64 "," $14,961.64 ", Not Applicable , Not Applicable ," $15,709.72 "," $15,260.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,961.64 ", Not Applicable , Not Applicable ," $14,961.64 "," $15,709.72 ", Not Applicable
,575,Diagnosis Related Group,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $14,965.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,965.88 "," $14,965.88 ", Not Applicable , Not Applicable ," $15,714.18 "," $15,265.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,965.88 ", Not Applicable , Not Applicable ," $14,965.88 "," $15,714.18 ", Not Applicable
,504,Diagnosis Related Group,FOOT PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,066.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,066.04 "," $15,066.04 ", Not Applicable , Not Applicable ," $15,819.34 "," $15,367.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,066.04 ", Not Applicable , Not Applicable ," $15,066.04 "," $15,819.34 ", Not Applicable
,505,Diagnosis Related Group,FOOT PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,066.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,066.04 "," $15,066.04 ", Not Applicable , Not Applicable ," $15,819.34 "," $15,367.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,066.04 ", Not Applicable , Not Applicable ," $15,066.04 "," $15,819.34 ", Not Applicable
,671,Diagnosis Related Group,URETHRAL PROCEDURES WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,119.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,119.51 "," $15,119.51 ", Not Applicable , Not Applicable ," $15,875.49 "," $15,421.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,119.51 ", Not Applicable , Not Applicable ," $15,119.51 "," $15,875.49 ", Not Applicable
,896,Diagnosis Related Group,"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,111.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,111.03 "," $15,111.03 ", Not Applicable , Not Applicable ," $15,866.58 "," $15,413.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,111.03 ", Not Applicable , Not Applicable ," $15,111.03 "," $15,866.58 ", Not Applicable
,354,Diagnosis Related Group,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,149.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,149.22 "," $15,149.22 ", Not Applicable , Not Applicable ," $15,906.68 "," $15,452.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,149.22 ", Not Applicable , Not Applicable ," $15,149.22 "," $15,906.68 ", Not Applicable
,199,Diagnosis Related Group,PNEUMOTHORAX WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,193.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,193.36 "," $15,193.36 ", Not Applicable , Not Applicable ," $15,953.03 "," $15,497.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,193.36 ", Not Applicable , Not Applicable ," $15,193.36 "," $15,953.03 ", Not Applicable
,906,Diagnosis Related Group,HAND PROCEDURES FOR INJURIES,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,310.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,310.49 "," $15,310.49 ", Not Applicable , Not Applicable ," $16,076.02 "," $15,616.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,310.49 ", Not Applicable , Not Applicable ," $15,310.49 "," $16,076.02 ", Not Applicable
,744,Diagnosis Related Group,"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,239.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,239.19 "," $15,239.19 ", Not Applicable , Not Applicable ," $16,001.15 "," $15,543.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,239.19 ", Not Applicable , Not Applicable ," $15,239.19 "," $16,001.15 ", Not Applicable
,717,Diagnosis Related Group,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,283.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,283.33 "," $15,283.33 ", Not Applicable , Not Applicable ," $16,047.50 "," $15,589.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,283.33 ", Not Applicable , Not Applicable ," $15,283.33 "," $16,047.50 ", Not Applicable
,377,Diagnosis Related Group,GASTROINTESTINAL HEMORRHAGE WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,288.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,288.42 "," $15,288.42 ", Not Applicable , Not Applicable ," $16,052.84 "," $15,594.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,288.42 ", Not Applicable , Not Applicable ," $15,288.42 "," $16,052.84 ", Not Applicable
,740,Diagnosis Related Group,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,291.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,291.82 "," $15,291.82 ", Not Applicable , Not Applicable ," $16,056.41 "," $15,597.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,291.82 ", Not Applicable , Not Applicable ," $15,291.82 "," $16,056.41 ", Not Applicable
,542,Diagnosis Related Group,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,356.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,356.33 "," $15,356.33 ", Not Applicable , Not Applicable ," $16,124.14 "," $15,663.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,356.33 ", Not Applicable , Not Applicable ," $15,356.33 "," $16,124.14 ", Not Applicable
,479,Diagnosis Related Group,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,358.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,358.87 "," $15,358.87 ", Not Applicable , Not Applicable ," $16,126.82 "," $15,666.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,358.87 ", Not Applicable , Not Applicable ," $15,358.87 "," $16,126.82 ", Not Applicable
,254,Diagnosis Related Group,OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,413.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,413.20 "," $15,413.20 ", Not Applicable , Not Applicable ," $16,183.86 "," $15,721.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,413.20 ", Not Applicable , Not Applicable ," $15,413.20 "," $16,183.86 ", Not Applicable
,754,Diagnosis Related Group,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,500.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,500.62 "," $15,500.62 ", Not Applicable , Not Applicable ," $16,275.65 "," $15,810.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,500.62 ", Not Applicable , Not Applicable ," $15,500.62 "," $16,275.65 ", Not Applicable
,584,Diagnosis Related Group,"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,589.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,589.74 "," $15,589.74 ", Not Applicable , Not Applicable ," $16,369.23 "," $15,901.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,589.74 ", Not Applicable , Not Applicable ," $15,589.74 "," $16,369.23 ", Not Applicable
,919,Diagnosis Related Group,COMPLICATIONS OF TREATMENT WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,652.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,652.55 "," $15,652.55 ", Not Applicable , Not Applicable ," $16,435.18 "," $15,965.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,652.55 ", Not Applicable , Not Applicable ," $15,652.55 "," $16,435.18 ", Not Applicable
,465,Diagnosis Related Group,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,652.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,652.55 "," $15,652.55 ", Not Applicable , Not Applicable ," $16,435.18 "," $15,965.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,652.55 ", Not Applicable , Not Applicable ," $15,652.55 "," $16,435.18 ", Not Applicable
,52,Diagnosis Related Group,SPINAL DISORDERS AND INJURIES WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,732.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,732.34 "," $15,732.34 ", Not Applicable , Not Applicable ," $16,518.96 "," $16,046.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,732.34 ", Not Applicable , Not Applicable ," $15,732.34 "," $16,518.96 ", Not Applicable
,177,Diagnosis Related Group,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,694.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,694.99 "," $15,694.99 ", Not Applicable , Not Applicable ," $16,479.74 "," $16,008.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,694.99 ", Not Applicable , Not Applicable ," $15,694.99 "," $16,479.74 ", Not Applicable
,36,Diagnosis Related Group,CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,722.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,722.16 "," $15,722.16 ", Not Applicable , Not Applicable ," $16,508.26 "," $16,036.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,722.16 ", Not Applicable , Not Applicable ," $15,722.16 "," $16,508.26 ", Not Applicable
,494,Diagnosis Related Group,"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,717.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,717.06 "," $15,717.06 ", Not Applicable , Not Applicable ," $16,502.92 "," $16,031.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,717.06 ", Not Applicable , Not Applicable ," $15,717.06 "," $16,502.92 ", Not Applicable
,167,Diagnosis Related Group,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,436.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,436.96 "," $15,436.96 ", Not Applicable , Not Applicable ," $16,208.81 "," $15,745.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,436.96 ", Not Applicable , Not Applicable ," $15,436.96 "," $16,208.81 ", Not Applicable
,283,Diagnosis Related Group,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,827.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,827.41 "," $15,827.41 ", Not Applicable , Not Applicable ," $16,618.78 "," $16,143.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,827.41 ", Not Applicable , Not Applicable ," $15,827.41 "," $16,618.78 ", Not Applicable
,559,Diagnosis Related Group,"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,832.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,832.50 "," $15,832.50 ", Not Applicable , Not Applicable ," $16,624.12 "," $16,149.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,832.50 ", Not Applicable , Not Applicable ," $15,832.50 "," $16,624.12 ", Not Applicable
,871,Diagnosis Related Group,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,891.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,891.07 "," $15,891.07 ", Not Applicable , Not Applicable ," $16,685.62 "," $16,208.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,891.07 ", Not Applicable , Not Applicable ," $15,891.07 "," $16,685.62 ", Not Applicable
,783,Diagnosis Related Group,CESAREAN SECTION WITH STERILIZATION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,913.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,913.98 "," $15,913.98 ", Not Applicable , Not Applicable ," $16,709.68 "," $16,232.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,913.98 ", Not Applicable ," $8,023.00 "," $8,023.00 "," $16,709.68 ", Not Applicable
,623,Diagnosis Related Group,"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,885.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,885.12 "," $15,885.12 ", Not Applicable , Not Applicable ," $16,679.38 "," $16,202.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,885.12 ", Not Applicable , Not Applicable ," $15,885.12 "," $16,679.38 ", Not Applicable
,686,Diagnosis Related Group,KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,917.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,917.38 "," $15,917.38 ", Not Applicable , Not Applicable ," $16,713.25 "," $16,235.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,917.38 ", Not Applicable , Not Applicable ," $15,917.38 "," $16,713.25 ", Not Applicable
,100,Diagnosis Related Group,SEIZURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,926.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,926.71 "," $15,926.71 ", Not Applicable , Not Applicable ," $16,723.05 "," $16,245.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,926.71 ", Not Applicable , Not Applicable ," $15,926.71 "," $16,723.05 ", Not Applicable
,116,Diagnosis Related Group,INTRAOCULAR PROCEDURES WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,980.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,980.19 "," $15,980.19 ", Not Applicable , Not Applicable ," $16,779.20 "," $16,299.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,980.19 ", Not Applicable , Not Applicable ," $15,980.19 "," $16,779.20 ", Not Applicable
,862,Diagnosis Related Group,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,099.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,099.02 "," $16,099.02 ", Not Applicable , Not Applicable ," $16,903.97 "," $16,421.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,099.02 ", Not Applicable , Not Applicable ," $16,099.02 "," $16,903.97 ", Not Applicable
,249,Diagnosis Related Group,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,903.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,903.80 "," $15,903.80 ", Not Applicable , Not Applicable ," $16,698.99 "," $16,221.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,903.80 ", Not Applicable , Not Applicable ," $15,903.80 "," $16,698.99 ", Not Applicable
,432,Diagnosis Related Group,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,964.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,964.06 "," $15,964.06 ", Not Applicable , Not Applicable ," $16,762.26 "," $16,283.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,964.06 ", Not Applicable , Not Applicable ," $15,964.06 "," $16,762.26 ", Not Applicable
,380,Diagnosis Related Group,COMPLICATED PEPTIC ULCER WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,013.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,013.29 "," $16,013.29 ", Not Applicable , Not Applicable ," $16,813.96 "," $16,333.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,013.29 ", Not Applicable , Not Applicable ," $16,013.29 "," $16,813.96 ", Not Applicable
,441,Diagnosis Related Group,"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $15,953.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,953.03 "," $15,953.03 ", Not Applicable , Not Applicable ," $16,750.68 "," $16,272.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,953.03 ", Not Applicable , Not Applicable ," $15,953.03 "," $16,750.68 ", Not Applicable
,803,Diagnosis Related Group,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,012.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,012.44 "," $16,012.44 ", Not Applicable , Not Applicable ," $16,813.06 "," $16,332.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,012.44 ", Not Applicable , Not Applicable ," $16,012.44 "," $16,813.06 ", Not Applicable
,42,Diagnosis Related Group,"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,137.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,137.21 "," $16,137.21 ", Not Applicable , Not Applicable ," $16,944.08 "," $16,459.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,137.21 ", Not Applicable , Not Applicable ," $16,137.21 "," $16,944.08 ", Not Applicable
,814,Diagnosis Related Group,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,056.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,056.58 "," $16,056.58 ", Not Applicable , Not Applicable ," $16,859.41 "," $16,377.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,056.58 ", Not Applicable , Not Applicable ," $16,056.58 "," $16,859.41 ", Not Applicable
,470,Diagnosis Related Group,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,129.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,129.58 "," $16,129.58 ", Not Applicable , Not Applicable ," $16,936.05 "," $16,452.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,129.58 ", Not Applicable , Not Applicable ," $16,129.58 "," $16,936.05 ", Not Applicable
,843,Diagnosis Related Group,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,191.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,191.54 "," $16,191.54 ", Not Applicable , Not Applicable ," $17,001.11 "," $16,515.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,191.54 ", Not Applicable , Not Applicable ," $16,191.54 "," $17,001.11 ", Not Applicable
,421,Diagnosis Related Group,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,190.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,190.69 "," $16,190.69 ", Not Applicable , Not Applicable ," $17,000.22 "," $16,514.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,190.69 ", Not Applicable , Not Applicable ," $16,190.69 "," $17,000.22 ", Not Applicable
,64,Diagnosis Related Group,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,287.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,287.45 "," $16,287.45 ", Not Applicable , Not Applicable ," $17,101.82 "," $16,613.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,287.45 ", Not Applicable , Not Applicable ," $16,287.45 "," $17,101.82 ", Not Applicable
,165,Diagnosis Related Group,MAJOR CHEST PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,267.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,267.93 "," $16,267.93 ", Not Applicable , Not Applicable ," $17,081.32 "," $16,593.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,267.93 ", Not Applicable , Not Applicable ," $16,267.93 "," $17,081.32 ", Not Applicable
,707,Diagnosis Related Group,MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,315.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,315.46 "," $16,315.46 ", Not Applicable , Not Applicable ," $17,131.23 "," $16,641.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,315.46 ", Not Applicable , Not Applicable ," $16,315.46 "," $17,131.23 ", Not Applicable
,941,Diagnosis Related Group,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,323.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,323.10 "," $16,323.10 ", Not Applicable , Not Applicable ," $17,139.25 "," $16,649.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,323.10 ", Not Applicable , Not Applicable ," $16,323.10 "," $17,139.25 ", Not Applicable
,935,Diagnosis Related Group,NON-EXTENSIVE BURNS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,406.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,406.28 "," $16,406.28 ", Not Applicable , Not Applicable ," $17,226.60 "," $16,734.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,406.28 ", Not Applicable , Not Applicable ," $16,406.28 "," $17,226.60 ", Not Applicable
,657,Diagnosis Related Group,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,421.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,421.56 "," $16,421.56 ", Not Applicable , Not Applicable ," $17,242.64 "," $16,749.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,421.56 ", Not Applicable , Not Applicable ," $16,421.56 "," $17,242.64 ", Not Applicable
,934,Diagnosis Related Group,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,474.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,474.18 "," $16,474.18 ", Not Applicable , Not Applicable ," $17,297.89 "," $16,803.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,474.18 ", Not Applicable , Not Applicable ," $16,474.18 "," $17,297.89 ", Not Applicable
,539,Diagnosis Related Group,OSTEOMYELITIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,531.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,531.90 "," $16,531.90 ", Not Applicable , Not Applicable ," $17,358.50 "," $16,862.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,531.90 ", Not Applicable , Not Applicable ," $16,531.90 "," $17,358.50 ", Not Applicable
,368,Diagnosis Related Group,MAJOR ESOPHAGEAL DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,543.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,543.79 "," $16,543.79 ", Not Applicable , Not Applicable ," $17,370.97 "," $16,874.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,543.79 ", Not Applicable , Not Applicable ," $16,543.79 "," $17,370.97 ", Not Applicable
,519,Diagnosis Related Group,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,636.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,636.30 "," $16,636.30 ", Not Applicable , Not Applicable ," $17,468.12 "," $16,969.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,636.30 ", Not Applicable , Not Applicable ," $16,636.30 "," $17,468.12 ", Not Applicable
,516,Diagnosis Related Group,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,660.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,660.07 "," $16,660.07 ", Not Applicable , Not Applicable ," $17,493.07 "," $16,993.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,660.07 ", Not Applicable , Not Applicable ," $16,660.07 "," $17,493.07 ", Not Applicable
,902,Diagnosis Related Group,WOUND DEBRIDEMENTS FOR INJURIES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,672.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,672.80 "," $16,672.80 ", Not Applicable , Not Applicable ," $17,506.44 "," $17,006.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,672.80 ", Not Applicable , Not Applicable ," $16,672.80 "," $17,506.44 ", Not Applicable
,511,Diagnosis Related Group,"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,699.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,699.11 "," $16,699.11 ", Not Applicable , Not Applicable ," $17,534.07 "," $17,033.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,699.11 ", Not Applicable , Not Applicable ," $16,699.11 "," $17,534.07 ", Not Applicable
,488,Diagnosis Related Group,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,769.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,769.56 "," $16,769.56 ", Not Applicable , Not Applicable ," $17,608.04 "," $17,104.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,769.56 ", Not Applicable , Not Applicable ," $16,769.56 "," $17,608.04 ", Not Applicable
,496,Diagnosis Related Group,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,860.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,860.38 "," $16,860.38 ", Not Applicable , Not Applicable ," $17,703.40 "," $17,197.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,860.38 ", Not Applicable , Not Applicable ," $16,860.38 "," $17,703.40 ", Not Applicable
,62,Diagnosis Related Group,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,876.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,876.51 "," $16,876.51 ", Not Applicable , Not Applicable ," $17,720.34 "," $17,214.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,876.51 ", Not Applicable , Not Applicable ," $16,876.51 "," $17,720.34 ", Not Applicable
,247,Diagnosis Related Group,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,748.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,748.34 "," $16,748.34 ", Not Applicable , Not Applicable ," $17,585.76 "," $17,083.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,748.34 ", Not Applicable , Not Applicable ," $16,748.34 "," $17,585.76 ", Not Applicable
,261,Diagnosis Related Group,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $16,924.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,924.04 "," $16,924.04 ", Not Applicable , Not Applicable ," $17,770.25 "," $17,262.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,924.04 ", Not Applicable , Not Applicable ," $16,924.04 "," $17,770.25 ", Not Applicable
,595,Diagnosis Related Group,MAJOR SKIN DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,115.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,115.87 "," $17,115.87 ", Not Applicable , Not Applicable ," $17,971.66 "," $17,458.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,115.87 ", Not Applicable , Not Applicable ," $17,115.87 "," $17,971.66 ", Not Applicable
,715,Diagnosis Related Group,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,159.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,159.16 "," $17,159.16 ", Not Applicable , Not Applicable ," $18,017.12 "," $17,502.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,159.16 ", Not Applicable , Not Applicable ," $17,159.16 "," $18,017.12 ", Not Applicable
,507,Diagnosis Related Group,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,492.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,492.73 "," $17,492.73 ", Not Applicable , Not Applicable ," $18,367.37 "," $17,842.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,492.73 ", Not Applicable , Not Applicable ," $17,492.73 "," $18,367.37 ", Not Applicable
,548,Diagnosis Related Group,SEPTIC ARTHRITIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,407.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,407.01 "," $17,407.01 ", Not Applicable , Not Applicable ," $18,277.36 "," $17,755.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,407.01 ", Not Applicable , Not Applicable ," $17,407.01 "," $18,277.36 ", Not Applicable
,415,Diagnosis Related Group,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,244.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,244.89 "," $17,244.89 ", Not Applicable , Not Applicable ," $18,107.13 "," $17,589.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,244.89 ", Not Applicable , Not Applicable ," $17,244.89 "," $18,107.13 ", Not Applicable
,146,Diagnosis Related Group,"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,324.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,324.67 "," $17,324.67 ", Not Applicable , Not Applicable ," $18,190.91 "," $17,671.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,324.67 ", Not Applicable , Not Applicable ," $17,324.67 "," $18,190.91 ", Not Applicable
,617,Diagnosis Related Group,"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,228.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,228.76 "," $17,228.76 ", Not Applicable , Not Applicable ," $18,090.20 "," $17,573.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,228.76 ", Not Applicable , Not Applicable ," $17,228.76 "," $18,090.20 ", Not Applicable
,857,Diagnosis Related Group,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,844.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,844.98 "," $17,844.98 ", Not Applicable , Not Applicable ," $18,737.23 "," $18,201.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,844.98 ", Not Applicable , Not Applicable ," $17,844.98 "," $18,737.23 ", Not Applicable
,908,Diagnosis Related Group,OTHER O.R. PROCEDURES FOR INJURIES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,403.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,403.61 "," $17,403.61 ", Not Applicable , Not Applicable ," $18,273.79 "," $17,751.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,403.61 ", Not Applicable , Not Applicable ," $17,403.61 "," $18,273.79 ", Not Applicable
,737,Diagnosis Related Group,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,468.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,468.97 "," $17,468.97 ", Not Applicable , Not Applicable ," $18,342.42 "," $17,818.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,468.97 ", Not Applicable , Not Applicable ," $17,468.97 "," $18,342.42 ", Not Applicable
,244,Diagnosis Related Group,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,513.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,513.10 "," $17,513.10 ", Not Applicable , Not Applicable ," $18,388.76 "," $17,863.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,513.10 ", Not Applicable , Not Applicable ," $17,513.10 "," $18,388.76 ", Not Applicable
,374,Diagnosis Related Group,DIGESTIVE MALIGNANCY WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,601.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,601.38 "," $17,601.38 ", Not Applicable , Not Applicable ," $18,481.45 "," $17,953.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,601.38 ", Not Applicable , Not Applicable ," $17,601.38 "," $18,481.45 ", Not Applicable
,655,Diagnosis Related Group,MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,657.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,657.40 "," $17,657.40 ", Not Applicable , Not Applicable ," $18,540.27 "," $18,010.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,657.40 ", Not Applicable , Not Applicable ," $17,657.40 "," $18,540.27 ", Not Applicable
,314,Diagnosis Related Group,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,694.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,694.75 "," $17,694.75 ", Not Applicable , Not Applicable ," $18,579.48 "," $18,048.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,694.75 ", Not Applicable , Not Applicable ," $17,694.75 "," $18,579.48 ", Not Applicable
,80,Diagnosis Related Group,NONTRAUMATIC STUPOR AND COMA WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,785.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,785.57 "," $17,785.57 ", Not Applicable , Not Applicable ," $18,674.84 "," $18,141.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,785.57 ", Not Applicable , Not Applicable ," $17,785.57 "," $18,674.84 ", Not Applicable
,854,Diagnosis Related Group,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,013.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,013.04 "," $18,013.04 ", Not Applicable , Not Applicable ," $18,913.69 "," $18,373.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,013.04 ", Not Applicable , Not Applicable ," $18,013.04 "," $18,913.69 ", Not Applicable
,481,Diagnosis Related Group,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,791.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,791.51 "," $17,791.51 ", Not Applicable , Not Applicable ," $18,681.08 "," $18,147.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,791.51 ", Not Applicable , Not Applicable ," $17,791.51 "," $18,681.08 ", Not Applicable
,98,Diagnosis Related Group,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,930.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,930.71 "," $17,930.71 ", Not Applicable , Not Applicable ," $18,827.25 "," $18,289.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,930.71 ", Not Applicable , Not Applicable ," $17,930.71 "," $18,827.25 ", Not Applicable
,835,Diagnosis Related Group,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,940.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,940.90 "," $17,940.90 ", Not Applicable , Not Applicable ," $18,837.94 "," $18,299.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,940.90 ", Not Applicable , Not Applicable ," $17,940.90 "," $18,837.94 ", Not Applicable
,409,Diagnosis Related Group,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,963.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,963.81 "," $17,963.81 ", Not Applicable , Not Applicable ," $18,862.00 "," $18,323.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,963.81 ", Not Applicable , Not Applicable ," $17,963.81 "," $18,862.00 ", Not Applicable
,407,Diagnosis Related Group,"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,977.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,977.39 "," $17,977.39 ", Not Applicable , Not Applicable ," $18,876.26 "," $18,336.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,977.39 ", Not Applicable , Not Applicable ," $17,977.39 "," $18,876.26 ", Not Applicable
,259,Diagnosis Related Group,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $17,732.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,732.94 "," $17,732.94 ", Not Applicable , Not Applicable ," $18,619.59 "," $18,087.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,732.94 ", Not Applicable , Not Applicable ," $17,732.94 "," $18,619.59 ", Not Applicable
,711,Diagnosis Related Group,TESTES PROCEDURES WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,092.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,092.83 "," $18,092.83 ", Not Applicable , Not Applicable ," $18,997.47 "," $18,454.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,092.83 ", Not Applicable , Not Applicable ," $18,092.83 "," $18,997.47 ", Not Applicable
,135,Diagnosis Related Group,SINUS AND MASTOID PROCEDURES WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,193.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,193.84 "," $18,193.84 ", Not Applicable , Not Applicable ," $19,103.53 "," $18,557.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,193.84 ", Not Applicable , Not Applicable ," $18,193.84 "," $19,103.53 ", Not Applicable
,333,Diagnosis Related Group,RECTAL RESECTION WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,175.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,175.16 "," $18,175.16 ", Not Applicable , Not Applicable ," $19,083.92 "," $18,538.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,175.16 ", Not Applicable , Not Applicable ," $18,175.16 "," $19,083.92 ", Not Applicable
,486,Diagnosis Related Group,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,243.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,243.91 "," $18,243.91 ", Not Applicable , Not Applicable ," $19,156.11 "," $18,608.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,243.91 ", Not Applicable , Not Applicable ," $18,243.91 "," $19,156.11 ", Not Applicable
,821,Diagnosis Related Group,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,293.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,293.14 "," $18,293.14 ", Not Applicable , Not Applicable ," $19,207.80 "," $18,659.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,293.14 ", Not Applicable , Not Applicable ," $18,293.14 "," $19,207.80 ", Not Applicable
,808,Diagnosis Related Group,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,552.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,552.87 "," $18,552.87 ", Not Applicable , Not Applicable ," $19,480.52 "," $18,923.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,552.87 ", Not Applicable , Not Applicable ," $18,552.87 "," $19,480.52 ", Not Applicable
,56,Diagnosis Related Group,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,633.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,633.51 "," $18,633.51 ", Not Applicable , Not Applicable ," $19,565.18 "," $19,006.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,633.51 ", Not Applicable , Not Applicable ," $18,633.51 "," $19,565.18 ", Not Applicable
,522,Diagnosis Related Group,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,583.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,583.43 "," $18,583.43 ", Not Applicable , Not Applicable ," $19,512.60 "," $18,955.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,583.43 ", Not Applicable , Not Applicable ," $18,583.43 "," $19,512.60 ", Not Applicable
,113,Diagnosis Related Group,ORBITAL PROCEDURES WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,625.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,625.87 "," $18,625.87 ", Not Applicable , Not Applicable ," $19,557.16 "," $18,998.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,625.87 ", Not Applicable , Not Applicable ," $18,625.87 "," $19,557.16 ", Not Applicable
,475,Diagnosis Related Group,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,642.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,642.00 "," $18,642.00 ", Not Applicable , Not Applicable ," $19,574.10 "," $19,014.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,642.00 ", Not Applicable , Not Applicable ," $18,642.00 "," $19,574.10 ", Not Applicable
,141,Diagnosis Related Group,MAJOR HEAD AND NECK PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,725.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,725.18 "," $18,725.18 ", Not Applicable , Not Applicable ," $19,661.44 "," $19,099.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,725.18 ", Not Applicable , Not Applicable ," $18,725.18 "," $19,661.44 ", Not Applicable
,32,Diagnosis Related Group,VENTRICULAR SHUNT PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,813.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,813.45 "," $18,813.45 ", Not Applicable , Not Applicable ," $19,754.13 "," $19,189.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,813.45 ", Not Applicable , Not Applicable ," $18,813.45 "," $19,754.13 ", Not Applicable
,286,Diagnosis Related Group,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,132.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,132.72 "," $18,132.72 ", Not Applicable , Not Applicable ," $19,039.36 "," $18,495.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,132.72 ", Not Applicable , Not Applicable ," $18,132.72 "," $19,039.36 ", Not Applicable
,940,Diagnosis Related Group,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,850.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,850.80 "," $18,850.80 ", Not Applicable , Not Applicable ," $19,793.34 "," $19,227.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,850.80 ", Not Applicable , Not Applicable ," $18,850.80 "," $19,793.34 ", Not Applicable
,734,Diagnosis Related Group,"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,879.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,879.66 "," $18,879.66 ", Not Applicable , Not Applicable ," $19,823.64 "," $19,257.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,879.66 ", Not Applicable , Not Applicable ," $18,879.66 "," $19,823.64 ", Not Applicable
,867,Diagnosis Related Group,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $18,988.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,988.30 "," $18,988.30 ", Not Applicable , Not Applicable ," $19,937.72 "," $19,368.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,988.30 ", Not Applicable , Not Applicable ," $18,988.30 "," $19,937.72 ", Not Applicable
,357,Diagnosis Related Group,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,254.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,254.82 "," $19,254.82 ", Not Applicable , Not Applicable ," $20,217.57 "," $19,639.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,254.82 ", Not Applicable , Not Applicable ," $19,254.82 "," $20,217.57 ", Not Applicable
,933,Diagnosis Related Group,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,207.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,207.29 "," $19,207.29 ", Not Applicable , Not Applicable ," $20,167.66 "," $19,591.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,207.29 ", Not Applicable , Not Applicable ," $19,207.29 "," $20,167.66 ", Not Applicable
,82,Diagnosis Related Group,TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,215.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,215.78 "," $19,215.78 ", Not Applicable , Not Applicable ," $20,176.57 "," $19,600.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,215.78 ", Not Applicable , Not Applicable ," $19,215.78 "," $20,176.57 ", Not Applicable
,838,Diagnosis Related Group,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,184.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,184.37 "," $19,184.37 ", Not Applicable , Not Applicable ," $20,143.59 "," $19,568.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,184.37 ", Not Applicable , Not Applicable ," $19,184.37 "," $20,143.59 ", Not Applicable
,412,Diagnosis Related Group,CHOLECYSTECTOMY WITH C.D.E. WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,331.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,331.22 "," $19,331.22 ", Not Applicable , Not Applicable ," $20,297.78 "," $19,717.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,331.22 ", Not Applicable , Not Applicable ," $19,331.22 "," $20,297.78 ", Not Applicable
,424,Diagnosis Related Group,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,387.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,387.24 "," $19,387.24 ", Not Applicable , Not Applicable ," $20,356.60 "," $19,774.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,387.24 ", Not Applicable , Not Applicable ," $19,387.24 "," $20,356.60 ", Not Applicable
,336,Diagnosis Related Group,PERITONEAL ADHESIOLYSIS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,448.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,448.35 "," $19,448.35 ", Not Applicable , Not Applicable ," $20,420.77 "," $19,837.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,448.35 ", Not Applicable , Not Applicable ," $19,448.35 "," $20,420.77 ", Not Applicable
,817,Diagnosis Related Group,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,579.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,579.91 "," $19,579.91 ", Not Applicable , Not Applicable ," $20,558.91 "," $19,971.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,579.91 ", Not Applicable ," $1,723.00 "," $1,723.00 "," $20,558.91 ", Not Applicable
,263,Diagnosis Related Group,VEIN LIGATION AND STRIPPING,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,634.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,634.23 "," $19,634.23 ", Not Applicable , Not Applicable ," $20,615.95 "," $20,026.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,634.23 ", Not Applicable , Not Applicable ," $19,634.23 "," $20,615.95 ", Not Applicable
,85,Diagnosis Related Group,TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,621.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,621.50 "," $19,621.50 ", Not Applicable , Not Applicable ," $20,602.58 "," $20,013.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,621.50 ", Not Applicable , Not Applicable ," $19,621.50 "," $20,602.58 ", Not Applicable
,709,Diagnosis Related Group,PENIS PROCEDURES WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,657.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,657.15 "," $19,657.15 ", Not Applicable , Not Applicable ," $20,640.01 "," $20,050.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,657.15 ", Not Applicable , Not Applicable ," $19,657.15 "," $20,640.01 ", Not Applicable
,341,Diagnosis Related Group,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,712.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,712.32 "," $19,712.32 ", Not Applicable , Not Applicable ," $20,697.94 "," $20,106.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,712.32 ", Not Applicable , Not Applicable ," $19,712.32 "," $20,697.94 ", Not Applicable
,493,Diagnosis Related Group,"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,741.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,741.18 "," $19,741.18 ", Not Applicable , Not Applicable ," $20,728.24 "," $20,136.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,741.18 ", Not Applicable , Not Applicable ," $19,741.18 "," $20,728.24 ", Not Applicable
,96,Diagnosis Related Group,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,799.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,799.75 "," $19,799.75 ", Not Applicable , Not Applicable ," $20,789.74 "," $20,195.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,799.75 ", Not Applicable , Not Applicable ," $19,799.75 "," $20,789.74 ", Not Applicable
,792,Diagnosis Related Group,PREMATURITY WITHOUT MAJOR PROBLEMS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,839.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,839.64 "," $19,839.64 ", Not Applicable , Not Applicable ," $20,831.62 "," $20,236.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,839.64 ", Not Applicable ," $1,357.00 "," $1,357.00 "," $20,831.62 ", Not Applicable
,35,Diagnosis Related Group,CAROTID ARTERY STENT PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,859.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,859.16 "," $19,859.16 ", Not Applicable , Not Applicable ," $20,852.12 "," $20,256.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,859.16 ", Not Applicable , Not Applicable ," $19,859.16 "," $20,852.12 ", Not Applicable
,629,Diagnosis Related Group,"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,906.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,906.70 "," $19,906.70 ", Not Applicable , Not Applicable ," $20,902.03 "," $20,304.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,906.70 ", Not Applicable , Not Applicable ," $19,906.70 "," $20,902.03 ", Not Applicable
,41,Diagnosis Related Group,"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $19,944.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,944.04 "," $19,944.04 ", Not Applicable , Not Applicable ," $20,941.24 "," $20,342.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,944.04 ", Not Applicable , Not Applicable ," $19,944.04 "," $20,941.24 ", Not Applicable
,478,Diagnosis Related Group,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $20,017.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,017.89 "," $20,017.89 ", Not Applicable , Not Applicable ," $21,018.78 "," $20,418.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,017.89 ", Not Applicable , Not Applicable ," $20,017.89 "," $21,018.78 ", Not Applicable
,30,Diagnosis Related Group,SPINAL PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $20,004.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,004.31 "," $20,004.31 ", Not Applicable , Not Applicable ," $21,004.52 "," $20,404.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,004.31 ", Not Applicable , Not Applicable ," $20,004.31 "," $21,004.52 ", Not Applicable
,824,Diagnosis Related Group,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $20,068.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,068.81 "," $20,068.81 ", Not Applicable , Not Applicable ," $21,072.26 "," $20,470.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,068.81 ", Not Applicable , Not Applicable ," $20,068.81 "," $21,072.26 ", Not Applicable
,674,Diagnosis Related Group,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $20,228.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,228.39 "," $20,228.39 ", Not Applicable , Not Applicable ," $21,239.81 "," $20,632.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,228.39 ", Not Applicable , Not Applicable ," $20,228.39 "," $21,239.81 ", Not Applicable
,483,Diagnosis Related Group,MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $20,249.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,249.61 "," $20,249.61 ", Not Applicable , Not Applicable ," $21,262.09 "," $20,654.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,249.61 ", Not Applicable , Not Applicable ," $20,249.61 "," $21,262.09 ", Not Applicable
,614,Diagnosis Related Group,ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $20,283.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,283.56 "," $20,283.56 ", Not Applicable , Not Applicable ," $21,297.74 "," $20,689.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,283.56 ", Not Applicable , Not Applicable ," $20,283.56 "," $21,297.74 ", Not Applicable
,417,Diagnosis Related Group,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $20,577.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,577.24 "," $20,577.24 ", Not Applicable , Not Applicable ," $21,606.10 "," $20,988.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,577.24 ", Not Applicable , Not Applicable ," $20,577.24 "," $21,606.10 ", Not Applicable
,320,Diagnosis Related Group,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $20,418.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,418.52 "," $20,418.52 ", Not Applicable , Not Applicable ," $21,439.44 "," $20,826.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,418.52 ", Not Applicable , Not Applicable ," $20,418.52 "," $21,439.44 ", Not Applicable
,350,Diagnosis Related Group,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $20,836.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,836.12 "," $20,836.12 ", Not Applicable , Not Applicable ," $21,877.93 "," $21,252.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,836.12 ", Not Applicable , Not Applicable ," $20,836.12 "," $21,877.93 ", Not Applicable
,347,Diagnosis Related Group,ANAL AND STOMAL PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $20,920.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,920.15 "," $20,920.15 ", Not Applicable , Not Applicable ," $21,966.16 "," $21,338.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,920.15 ", Not Applicable , Not Applicable ," $20,920.15 "," $21,966.16 ", Not Applicable
,849,Diagnosis Related Group,RADIOTHERAPY,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $21,165.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,165.45 "," $21,165.45 ", Not Applicable , Not Applicable ," $22,223.72 "," $21,588.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,165.45 ", Not Applicable , Not Applicable ," $21,165.45 "," $22,223.72 ", Not Applicable
,827,Diagnosis Related Group,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $21,224.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,224.87 "," $21,224.87 ", Not Applicable , Not Applicable ," $22,286.11 "," $21,649.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,224.87 ", Not Applicable , Not Applicable ," $21,224.87 "," $22,286.11 ", Not Applicable
,545,Diagnosis Related Group,CONNECTIVE TISSUE DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $21,246.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,246.09 "," $21,246.09 ", Not Applicable , Not Applicable ," $22,308.39 "," $21,671.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,246.09 ", Not Applicable , Not Applicable ," $21,246.09 "," $22,308.39 ", Not Applicable
,95,Diagnosis Related Group,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $21,281.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,281.74 "," $21,281.74 ", Not Applicable , Not Applicable ," $22,345.82 "," $21,707.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,281.74 ", Not Applicable , Not Applicable ," $21,281.74 "," $22,345.82 ", Not Applicable
,27,Diagnosis Related Group,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $21,341.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,341.15 "," $21,341.15 ", Not Applicable , Not Applicable ," $22,408.21 "," $21,767.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,341.15 ", Not Applicable , Not Applicable ," $21,341.15 "," $22,408.21 ", Not Applicable
,250,Diagnosis Related Group,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $21,404.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,404.81 "," $21,404.81 ", Not Applicable , Not Applicable ," $22,475.05 "," $21,832.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,404.81 ", Not Applicable , Not Applicable ," $21,404.81 "," $22,475.05 ", Not Applicable
,243,Diagnosis Related Group,PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $21,376.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,376.80 "," $21,376.80 ", Not Applicable , Not Applicable ," $22,445.64 "," $21,804.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,376.80 ", Not Applicable , Not Applicable ," $21,376.80 "," $22,445.64 ", Not Applicable
,330,Diagnosis Related Group,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $21,638.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,638.23 "," $21,638.23 ", Not Applicable , Not Applicable ," $22,720.14 "," $22,070.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,638.23 ", Not Applicable , Not Applicable ," $21,638.23 "," $22,720.14 ", Not Applicable
,473,Diagnosis Related Group,CERVICAL SPINAL FUSION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $21,550.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,550.80 "," $21,550.80 ", Not Applicable , Not Applicable ," $22,628.34 "," $21,981.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,550.80 ", Not Applicable , Not Applicable ," $21,550.80 "," $22,628.34 ", Not Applicable
,982,Diagnosis Related Group,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $21,530.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,530.43 "," $21,530.43 ", Not Applicable , Not Applicable ," $22,606.95 "," $21,961.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,530.43 ", Not Applicable , Not Applicable ," $21,530.43 "," $22,606.95 ", Not Applicable
,208,Diagnosis Related Group,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $21,600.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,600.03 "," $21,600.03 ", Not Applicable , Not Applicable ," $22,680.04 "," $22,032.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,600.03 ", Not Applicable , Not Applicable ," $21,600.03 "," $22,680.04 ", Not Applicable
,255,Diagnosis Related Group,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $21,519.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,519.40 "," $21,519.40 ", Not Applicable , Not Applicable ," $22,595.37 "," $21,949.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,519.40 ", Not Applicable , Not Applicable ," $21,519.40 "," $22,595.37 ", Not Applicable
,577,Diagnosis Related Group,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $21,640.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,640.78 "," $21,640.78 ", Not Applicable , Not Applicable ," $22,722.81 "," $22,073.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,640.78 ", Not Applicable , Not Applicable ," $21,640.78 "," $22,722.81 ", Not Applicable
,498,Diagnosis Related Group,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $21,930.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,930.21 "," $21,930.21 ", Not Applicable , Not Applicable ," $23,026.72 "," $22,368.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,930.21 ", Not Applicable , Not Applicable ," $21,930.21 "," $23,026.72 ", Not Applicable
,327,Diagnosis Related Group,"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $21,768.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,768.94 "," $21,768.94 ", Not Applicable , Not Applicable ," $22,857.39 "," $22,204.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,768.94 ", Not Applicable , Not Applicable ," $21,768.94 "," $22,857.39 ", Not Applicable
,503,Diagnosis Related Group,FOOT PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $22,413.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,413.18 "," $22,413.18 ", Not Applicable , Not Applicable ," $23,533.83 "," $22,861.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,413.18 ", Not Applicable , Not Applicable ," $22,413.18 "," $23,533.83 ", Not Applicable
,164,Diagnosis Related Group,MAJOR CHEST PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $22,540.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,540.49 "," $22,540.49 ", Not Applicable , Not Applicable ," $23,667.52 "," $22,991.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,540.49 ", Not Applicable , Not Applicable ," $22,540.49 "," $23,667.52 ", Not Applicable
,253,Diagnosis Related Group,OTHER VASCULAR PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $22,523.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,523.52 "," $22,523.52 ", Not Applicable , Not Applicable ," $23,649.69 "," $22,973.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,523.52 ", Not Applicable , Not Applicable ," $22,523.52 "," $23,649.69 ", Not Applicable
,659,Diagnosis Related Group,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $22,632.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,632.16 "," $22,632.16 ", Not Applicable , Not Applicable ," $23,763.77 "," $23,084.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,632.16 ", Not Applicable , Not Applicable ," $22,632.16 "," $23,763.77 ", Not Applicable
,846,Diagnosis Related Group,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $22,687.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,687.33 "," $22,687.33 ", Not Applicable , Not Applicable ," $23,821.70 "," $23,141.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,687.33 ", Not Applicable , Not Applicable ," $22,687.33 "," $23,821.70 ", Not Applicable
,288,Diagnosis Related Group,ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $22,793.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,793.43 "," $22,793.43 ", Not Applicable , Not Applicable ," $23,933.11 "," $23,249.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,793.43 ", Not Applicable , Not Applicable ," $22,793.43 "," $23,933.11 ", Not Applicable
,974,Diagnosis Related Group,HIV WITH MAJOR RELATED CONDITION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $22,836.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,836.72 "," $22,836.72 ", Not Applicable , Not Applicable ," $23,978.56 "," $23,293.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,836.72 ", Not Applicable , Not Applicable ," $22,836.72 "," $23,978.56 ", Not Applicable
,272,Diagnosis Related Group,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $22,818.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,818.05 "," $22,818.05 ", Not Applicable , Not Applicable ," $23,958.95 "," $23,274.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,818.05 ", Not Applicable , Not Applicable ," $22,818.05 "," $23,958.95 ", Not Applicable
,749,Diagnosis Related Group,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $23,034.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,034.49 "," $23,034.49 ", Not Applicable , Not Applicable ," $24,186.21 "," $23,495.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,034.49 ", Not Applicable , Not Applicable ," $23,034.49 "," $24,186.21 ", Not Applicable
,13,Diagnosis Related Group,"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $23,119.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,119.37 "," $23,119.37 ", Not Applicable , Not Applicable ," $24,275.34 "," $23,581.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,119.37 ", Not Applicable , Not Applicable ," $23,119.37 "," $24,275.34 ", Not Applicable
,963,Diagnosis Related Group,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $23,171.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,171.15 "," $23,171.15 ", Not Applicable , Not Applicable ," $24,329.70 "," $23,634.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,171.15 ", Not Applicable , Not Applicable ," $23,171.15 "," $24,329.70 ", Not Applicable
,510,Diagnosis Related Group,"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $23,288.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,288.28 "," $23,288.28 ", Not Applicable , Not Applicable ," $24,452.69 "," $23,754.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,288.28 ", Not Applicable , Not Applicable ," $23,288.28 "," $24,452.69 ", Not Applicable
,959,Diagnosis Related Group,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $23,223.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,223.77 "," $23,223.77 ", Not Applicable , Not Applicable ," $24,384.96 "," $23,688.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,223.77 ", Not Applicable , Not Applicable ," $23,223.77 "," $24,384.96 ", Not Applicable
,668,Diagnosis Related Group,TRANSURETHRAL PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $23,819.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,819.62 "," $23,819.62 ", Not Applicable , Not Applicable ," $25,010.60 "," $24,296.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,819.62 ", Not Applicable , Not Applicable ," $23,819.62 "," $25,010.60 ", Not Applicable
,240,Diagnosis Related Group,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $23,671.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,671.08 "," $23,671.08 ", Not Applicable , Not Applicable ," $24,854.64 "," $24,144.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,671.08 ", Not Applicable , Not Applicable ," $23,671.08 "," $24,854.64 ", Not Applicable
,338,Diagnosis Related Group,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $23,743.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,743.23 "," $23,743.23 ", Not Applicable , Not Applicable ," $24,930.39 "," $24,218.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,743.23 ", Not Applicable , Not Applicable ," $23,743.23 "," $24,930.39 ", Not Applicable
,344,Diagnosis Related Group,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $23,922.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,922.33 "," $23,922.33 ", Not Applicable , Not Applicable ," $25,118.44 "," $24,400.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,922.33 ", Not Applicable , Not Applicable ," $23,922.33 "," $25,118.44 ", Not Applicable
,468,Diagnosis Related Group,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $23,786.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,786.52 "," $23,786.52 ", Not Applicable , Not Applicable ," $24,975.84 "," $24,262.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,786.52 ", Not Applicable , Not Applicable ," $23,786.52 "," $24,975.84 ", Not Applicable
,570,Diagnosis Related Group,SKIN DEBRIDEMENT WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $24,120.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,120.09 "," $24,120.09 ", Not Applicable , Not Applicable ," $25,326.10 "," $24,602.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,120.09 ", Not Applicable , Not Applicable ," $24,120.09 "," $25,326.10 ", Not Applicable
,625,Diagnosis Related Group,"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $24,107.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,107.36 "," $24,107.36 ", Not Applicable , Not Applicable ," $25,312.73 "," $24,589.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,107.36 ", Not Applicable , Not Applicable ," $24,107.36 "," $25,312.73 ", Not Applicable
,406,Diagnosis Related Group,"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $24,452.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,452.82 "," $24,452.82 ", Not Applicable , Not Applicable ," $25,675.46 "," $24,941.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,452.82 ", Not Applicable , Not Applicable ," $24,452.82 "," $25,675.46 ", Not Applicable
,61,Diagnosis Related Group,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $24,540.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,540.25 "," $24,540.25 ", Not Applicable , Not Applicable ," $25,767.26 "," $25,031.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,540.25 ", Not Applicable , Not Applicable ," $24,540.25 "," $25,767.26 ", Not Applicable
,654,Diagnosis Related Group,MAJOR BLADDER PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $24,638.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,638.71 "," $24,638.71 ", Not Applicable , Not Applicable ," $25,870.64 "," $25,131.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,638.71 ", Not Applicable , Not Applicable ," $24,638.71 "," $25,870.64 ", Not Applicable
,579,Diagnosis Related Group,"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $26,693.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,693.63 "," $26,693.63 ", Not Applicable , Not Applicable ," $28,028.31 "," $27,227.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,693.63 ", Not Applicable , Not Applicable ," $26,693.63 "," $28,028.31 ", Not Applicable
,662,Diagnosis Related Group,MINOR BLADDER PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $24,931.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,931.54 "," $24,931.54 ", Not Applicable , Not Applicable ," $26,178.11 "," $25,430.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,931.54 ", Not Applicable , Not Applicable ," $24,931.54 "," $26,178.11 ", Not Applicable
,970,Diagnosis Related Group,HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $25,367.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,367.82 "," $25,367.82 ", Not Applicable , Not Applicable ," $26,636.21 "," $25,875.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,367.82 ", Not Applicable , Not Applicable ," $25,367.82 "," $26,636.21 ", Not Applicable
,800,Diagnosis Related Group,SPLENECTOMY WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $25,072.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,072.44 "," $25,072.44 ", Not Applicable , Not Applicable ," $26,326.06 "," $25,573.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,072.44 ", Not Applicable , Not Applicable ," $25,072.44 "," $26,326.06 ", Not Applicable
,143,Diagnosis Related Group,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $25,292.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,292.27 "," $25,292.27 ", Not Applicable , Not Applicable ," $26,556.89 "," $25,798.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,292.27 ", Not Applicable , Not Applicable ," $25,292.27 "," $26,556.89 ", Not Applicable
,464,Diagnosis Related Group,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $25,259.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,259.17 "," $25,259.17 ", Not Applicable , Not Applicable ," $26,522.13 "," $25,764.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,259.17 ", Not Applicable , Not Applicable ," $25,259.17 "," $26,522.13 ", Not Applicable
,353,Diagnosis Related Group,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $25,675.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,675.08 "," $25,675.08 ", Not Applicable , Not Applicable ," $26,958.83 "," $26,188.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,675.08 ", Not Applicable , Not Applicable ," $25,675.08 "," $26,958.83 ", Not Applicable
,929,Diagnosis Related Group,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $25,581.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,581.71 "," $25,581.71 ", Not Applicable , Not Applicable ," $26,860.80 "," $26,093.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,581.71 ", Not Applicable , Not Applicable ," $25,581.71 "," $26,860.80 ", Not Applicable
,480,Diagnosis Related Group,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $25,682.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,682.72 "," $25,682.72 ", Not Applicable , Not Applicable ," $26,966.85 "," $26,196.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,682.72 ", Not Applicable , Not Applicable ," $25,682.72 "," $26,966.85 ", Not Applicable
,665,Diagnosis Related Group,PROSTATECTOMY WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $25,817.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,817.68 "," $25,817.68 ", Not Applicable , Not Applicable ," $27,108.56 "," $26,334.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,817.68 ", Not Applicable , Not Applicable ," $25,817.68 "," $27,108.56 ", Not Applicable
,472,Diagnosis Related Group,CERVICAL SPINAL FUSION WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $25,919.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,919.53 "," $25,919.53 ", Not Applicable , Not Applicable ," $27,215.51 "," $26,437.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,919.53 ", Not Applicable , Not Applicable ," $25,919.53 "," $27,215.51 ", Not Applicable
,26,Diagnosis Related Group,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $25,989.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,989.98 "," $25,989.98 ", Not Applicable , Not Applicable ," $27,289.48 "," $26,509.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,989.98 ", Not Applicable , Not Applicable ," $25,989.98 "," $27,289.48 ", Not Applicable
,619,Diagnosis Related Group,O.R. PROCEDURES FOR OBESITY WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $25,987.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,987.43 "," $25,987.43 ", Not Applicable , Not Applicable ," $27,286.81 "," $26,507.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,987.43 ", Not Applicable , Not Applicable ," $25,987.43 "," $27,286.81 ", Not Applicable
,521,Diagnosis Related Group,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $26,025.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,025.63 "," $26,025.63 ", Not Applicable , Not Applicable ," $27,326.91 "," $26,546.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,025.63 ", Not Applicable , Not Applicable ," $26,025.63 "," $27,326.91 ", Not Applicable
,469,Diagnosis Related Group,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $26,192.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,192.84 "," $26,192.84 ", Not Applicable , Not Applicable ," $27,502.48 "," $26,716.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,192.84 ", Not Applicable , Not Applicable ," $26,192.84 "," $27,502.48 ", Not Applicable
,246,Diagnosis Related Group,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $26,518.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,518.78 "," $26,518.78 ", Not Applicable , Not Applicable ," $27,844.72 "," $27,049.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,518.78 ", Not Applicable , Not Applicable ," $26,518.78 "," $27,844.72 ", Not Applicable
,515,Diagnosis Related Group,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $26,657.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,657.13 "," $26,657.13 ", Not Applicable , Not Applicable ," $27,989.99 "," $27,190.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,657.13 ", Not Applicable , Not Applicable ," $26,657.13 "," $27,989.99 ", Not Applicable
,462,Diagnosis Related Group,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $26,663.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,663.92 "," $26,663.92 ", Not Applicable , Not Applicable ," $27,997.12 "," $27,197.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,663.92 ", Not Applicable , Not Applicable ," $26,663.92 "," $27,997.12 ", Not Applicable
,500,Diagnosis Related Group,SOFT TISSUE PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $27,072.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,072.19 "," $27,072.19 ", Not Applicable , Not Applicable ," $28,425.80 "," $27,613.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,072.19 ", Not Applicable , Not Applicable ," $27,072.19 "," $28,425.80 ", Not Applicable
,248,Diagnosis Related Group,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $26,840.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,840.47 "," $26,840.47 ", Not Applicable , Not Applicable ," $28,182.49 "," $27,377.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,840.47 ", Not Applicable , Not Applicable ," $26,840.47 "," $28,182.49 ", Not Applicable
,652,Diagnosis Related Group,KIDNEY TRANSPLANT,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $27,034.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,034.84 "," $27,034.84 ", Not Applicable , Not Applicable ," $28,386.58 "," $27,575.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,034.84 ", Not Applicable , Not Applicable ," $27,034.84 "," $28,386.58 ", Not Applicable
,258,Diagnosis Related Group,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $26,890.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,890.55 "," $26,890.55 ", Not Applicable , Not Applicable ," $28,235.08 "," $27,428.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,890.55 ", Not Applicable , Not Applicable ," $26,890.55 "," $28,235.08 ", Not Applicable
,829,Diagnosis Related Group,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $27,232.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,232.61 "," $27,232.61 ", Not Applicable , Not Applicable ," $28,594.24 "," $27,777.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,232.61 ", Not Applicable , Not Applicable ," $27,232.61 "," $28,594.24 ", Not Applicable
,840,Diagnosis Related Group,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $27,335.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,335.31 "," $27,335.31 ", Not Applicable , Not Applicable ," $28,702.08 "," $27,882.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,335.31 ", Not Applicable , Not Applicable ," $27,335.31 "," $28,702.08 ", Not Applicable
,574,Diagnosis Related Group,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $27,556.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,556.00 "," $27,556.00 ", Not Applicable , Not Applicable ," $28,933.80 "," $28,107.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,556.00 ", Not Applicable , Not Applicable ," $27,556.00 "," $28,933.80 ", Not Applicable
,264,Diagnosis Related Group,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $27,616.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,616.26 "," $27,616.26 ", Not Applicable , Not Applicable ," $28,997.08 "," $28,168.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,616.26 ", Not Applicable , Not Applicable ," $27,616.26 "," $28,997.08 ", Not Applicable
,876,Diagnosis Related Group,O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $27,738.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,738.49 "," $27,738.49 ", Not Applicable , Not Applicable ," $29,125.41 "," $28,293.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,738.49 ", Not Applicable , Not Applicable ," $27,738.49 "," $29,125.41 ", Not Applicable
,987,Diagnosis Related Group,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $27,805.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,805.54 "," $27,805.54 ", Not Applicable , Not Applicable ," $29,195.82 "," $28,361.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,805.54 ", Not Applicable , Not Applicable ," $27,805.54 "," $29,195.82 ", Not Applicable
,37,Diagnosis Related Group,EXTRACRANIAL PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $27,819.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,819.97 "," $27,819.97 ", Not Applicable , Not Applicable ," $29,210.97 "," $28,376.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,819.97 ", Not Applicable , Not Applicable ," $27,819.97 "," $29,210.97 ", Not Applicable
,656,Diagnosis Related Group,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $27,882.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,882.78 "," $27,882.78 ", Not Applicable , Not Applicable ," $29,276.92 "," $28,440.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,882.78 ", Not Applicable , Not Applicable ," $27,882.78 "," $29,276.92 ", Not Applicable
,274,Diagnosis Related Group,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $27,896.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,896.37 "," $27,896.37 ", Not Applicable , Not Applicable ," $29,291.18 "," $28,454.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,896.37 ", Not Applicable , Not Applicable ," $27,896.37 "," $29,291.18 ", Not Applicable
,29,Diagnosis Related Group,SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $27,982.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,982.94 "," $27,982.94 ", Not Applicable , Not Applicable ," $29,382.09 "," $28,542.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,982.94 ", Not Applicable , Not Applicable ," $27,982.94 "," $29,382.09 ", Not Applicable
,252,Diagnosis Related Group,OTHER VASCULAR PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $28,228.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,228.24 "," $28,228.24 ", Not Applicable , Not Applicable ," $29,639.65 "," $28,792.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,228.24 ", Not Applicable , Not Applicable ," $28,228.24 "," $29,639.65 ", Not Applicable
,477,Diagnosis Related Group,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $28,510.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,510.04 "," $28,510.04 ", Not Applicable , Not Applicable ," $29,935.54 "," $29,080.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,510.04 ", Not Applicable , Not Applicable ," $28,510.04 "," $29,935.54 ", Not Applicable
,265,Diagnosis Related Group,AICD LEAD PROCEDURES,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $28,566.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,566.06 "," $28,566.06 ", Not Applicable , Not Applicable ," $29,994.36 "," $29,137.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,566.06 ", Not Applicable , Not Applicable ," $28,566.06 "," $29,994.36 ", Not Applicable
,939,Diagnosis Related Group,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $28,643.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,643.30 "," $28,643.30 ", Not Applicable , Not Applicable ," $30,075.47 "," $29,216.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,643.30 ", Not Applicable , Not Applicable ," $28,643.30 "," $30,075.47 ", Not Applicable
,485,Diagnosis Related Group,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $28,940.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,940.38 "," $28,940.38 ", Not Applicable , Not Applicable ," $30,387.40 "," $29,519.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,940.38 ", Not Applicable , Not Applicable ," $28,940.38 "," $30,387.40 ", Not Applicable
,673,Diagnosis Related Group,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $29,438.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,438.62 "," $29,438.62 ", Not Applicable , Not Applicable ," $30,910.55 "," $30,027.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,438.62 ", Not Applicable , Not Applicable ," $29,438.62 "," $30,910.55 ", Not Applicable
,492,Diagnosis Related Group,"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $29,453.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,453.05 "," $29,453.05 ", Not Applicable , Not Applicable ," $30,925.70 "," $30,042.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,453.05 ", Not Applicable , Not Applicable ," $29,453.05 "," $30,925.70 ", Not Applicable
,420,Diagnosis Related Group,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $29,847.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,847.74 "," $29,847.74 ", Not Applicable , Not Applicable ," $31,340.12 "," $30,444.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,847.74 ", Not Applicable , Not Applicable ," $29,847.74 "," $31,340.12 ", Not Applicable
,271,Diagnosis Related Group,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $30,262.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,262.79 "," $30,262.79 ", Not Applicable , Not Applicable ," $31,775.93 "," $30,868.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,262.79 ", Not Applicable , Not Applicable ," $30,262.79 "," $31,775.93 ", Not Applicable
,467,Diagnosis Related Group,REVISION OF HIP OR KNEE REPLACEMENT WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $30,365.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,365.50 "," $30,365.50 ", Not Applicable , Not Applicable ," $31,883.77 "," $30,972.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,365.50 ", Not Applicable , Not Applicable ," $30,365.50 "," $31,883.77 ", Not Applicable
,260,Diagnosis Related Group,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $30,278.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,278.92 "," $30,278.92 ", Not Applicable , Not Applicable ," $31,792.87 "," $30,884.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,278.92 ", Not Applicable , Not Applicable ," $30,278.92 "," $31,792.87 ", Not Applicable
,518,Diagnosis Related Group,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $30,445.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,445.28 "," $30,445.28 ", Not Applicable , Not Applicable ," $31,967.55 "," $31,054.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,445.28 ", Not Applicable , Not Applicable ," $30,445.28 "," $31,967.55 ", Not Applicable
,622,Diagnosis Related Group,"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $30,682.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,682.95 "," $30,682.95 ", Not Applicable , Not Applicable ," $32,217.09 "," $31,296.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,682.95 ", Not Applicable , Not Applicable ," $30,682.95 "," $32,217.09 ", Not Applicable
,10,Diagnosis Related Group,PANCREAS TRANSPLANT,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $30,726.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,726.23 "," $30,726.23 ", Not Applicable , Not Applicable ," $32,262.55 "," $31,340.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,726.23 ", Not Applicable , Not Applicable ," $30,726.23 "," $32,262.55 ", Not Applicable
,414,Diagnosis Related Group,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $30,796.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,796.68 "," $30,796.68 ", Not Applicable , Not Applicable ," $32,336.52 "," $31,412.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,796.68 ", Not Applicable , Not Applicable ," $30,796.68 "," $32,336.52 ", Not Applicable
,94,Diagnosis Related Group,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $30,878.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,878.17 "," $30,878.17 ", Not Applicable , Not Applicable ," $32,422.08 "," $31,495.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,878.17 ", Not Applicable , Not Applicable ," $30,878.17 "," $32,422.08 ", Not Applicable
,495,Diagnosis Related Group,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $30,912.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,912.12 "," $30,912.12 ", Not Applicable , Not Applicable ," $32,457.73 "," $31,530.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,912.12 ", Not Applicable , Not Applicable ," $30,912.12 "," $32,457.73 ", Not Applicable
,651,Diagnosis Related Group,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $31,391.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,391.69 "," $31,391.69 ", Not Applicable , Not Applicable ," $32,961.27 "," $32,019.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,391.69 ", Not Applicable , Not Applicable ," $31,391.69 "," $32,961.27 ", Not Applicable
,628,Diagnosis Related Group,"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $31,230.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,230.42 "," $31,230.42 ", Not Applicable , Not Applicable ," $32,791.94 "," $31,855.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,230.42 ", Not Applicable , Not Applicable ," $31,230.42 "," $32,791.94 ", Not Applicable
,802,Diagnosis Related Group,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $31,504.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,504.58 "," $31,504.58 ", Not Applicable , Not Applicable ," $33,079.80 "," $32,134.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,504.58 ", Not Applicable , Not Applicable ," $31,504.58 "," $33,079.80 ", Not Applicable
,904,Diagnosis Related Group,SKIN GRAFTS FOR INJURIES WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $31,634.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,634.44 "," $31,634.44 ", Not Applicable , Not Applicable ," $33,216.16 "," $32,267.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,634.44 ", Not Applicable , Not Applicable ," $31,634.44 "," $33,216.16 ", Not Applicable
,242,Diagnosis Related Group,PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $31,639.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,639.53 "," $31,639.53 ", Not Applicable , Not Applicable ," $33,221.51 "," $32,272.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,639.53 ", Not Applicable , Not Applicable ," $31,639.53 "," $33,221.51 ", Not Applicable
,408,Diagnosis Related Group,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $31,854.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,854.28 "," $31,854.28 ", Not Applicable , Not Applicable ," $33,446.99 "," $32,491.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,854.28 ", Not Applicable , Not Applicable ," $31,854.28 "," $33,446.99 ", Not Applicable
,411,Diagnosis Related Group,CHOLECYSTECTOMY WITH C.D.E. WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $31,859.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,859.37 "," $31,859.37 ", Not Applicable , Not Applicable ," $33,452.34 "," $32,496.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,859.37 ", Not Applicable , Not Applicable ," $31,859.37 "," $33,452.34 ", Not Applicable
,97,Diagnosis Related Group,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $31,917.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,917.94 "," $31,917.94 ", Not Applicable , Not Applicable ," $33,513.83 "," $32,556.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,917.94 ", Not Applicable , Not Applicable ," $31,917.94 "," $33,513.83 ", Not Applicable
,166,Diagnosis Related Group,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $31,604.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,604.73 "," $31,604.73 ", Not Applicable , Not Applicable ," $33,184.97 "," $32,236.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,604.73 ", Not Applicable , Not Applicable ," $31,604.73 "," $33,184.97 ", Not Applicable
,739,Diagnosis Related Group,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $32,457.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,457.77 "," $32,457.77 ", Not Applicable , Not Applicable ," $34,080.66 "," $33,106.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,457.77 ", Not Applicable , Not Applicable ," $32,457.77 "," $34,080.66 ", Not Applicable
,12,Diagnosis Related Group,"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $32,532.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,532.46 "," $32,532.46 ", Not Applicable , Not Applicable ," $34,159.08 "," $33,183.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,532.46 ", Not Applicable , Not Applicable ," $32,532.46 "," $34,159.08 ", Not Applicable
,273,Diagnosis Related Group,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $32,480.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,480.69 "," $32,480.69 ", Not Applicable , Not Applicable ," $34,104.72 "," $33,130.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,480.69 ", Not Applicable , Not Applicable ," $32,480.69 "," $34,104.72 ", Not Applicable
,956,Diagnosis Related Group,"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $32,678.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,678.45 "," $32,678.45 ", Not Applicable , Not Applicable ," $34,312.38 "," $33,332.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,678.45 ", Not Applicable , Not Applicable ," $32,678.45 "," $34,312.38 ", Not Applicable
,791,Diagnosis Related Group,PREMATURITY WITH MAJOR PROBLEMS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $32,880.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,880.47 "," $32,880.47 ", Not Applicable , Not Applicable ," $34,524.49 "," $33,538.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,880.47 ", Not Applicable ," $1,357.00 "," $1,357.00 "," $34,524.49 ", Not Applicable
,335,Diagnosis Related Group,PERITONEAL ADHESIOLYSIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $33,217.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,217.44 "," $33,217.44 ", Not Applicable , Not Applicable ," $34,878.31 "," $33,881.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,217.44 ", Not Applicable , Not Applicable ," $33,217.44 "," $34,878.31 ", Not Applicable
,24,Diagnosis Related Group,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $33,433.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,433.88 "," $33,433.88 ", Not Applicable , Not Applicable ," $35,105.57 "," $34,102.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,433.88 ", Not Applicable , Not Applicable ," $33,433.88 "," $35,105.57 ", Not Applicable
,460,Diagnosis Related Group,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $33,363.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,363.43 "," $33,363.43 ", Not Applicable , Not Applicable ," $35,031.60 "," $34,030.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,363.43 ", Not Applicable , Not Applicable ," $33,363.43 "," $35,031.60 ", Not Applicable
,907,Diagnosis Related Group,OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $33,511.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,511.97 "," $33,511.97 ", Not Applicable , Not Applicable ," $35,187.56 "," $34,182.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,511.97 ", Not Applicable , Not Applicable ," $33,511.97 "," $35,187.56 ", Not Applicable
,40,Diagnosis Related Group,"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $32,804.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,804.07 "," $32,804.07 ", Not Applicable , Not Applicable ," $34,444.28 "," $33,460.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,804.07 ", Not Applicable , Not Applicable ," $32,804.07 "," $34,444.28 ", Not Applicable
,34,Diagnosis Related Group,CAROTID ARTERY STENT PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $33,765.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,765.75 "," $33,765.75 ", Not Applicable , Not Applicable ," $35,454.04 "," $34,441.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,765.75 ", Not Applicable , Not Applicable ," $33,765.75 "," $35,454.04 ", Not Applicable
,793,Diagnosis Related Group,FULL TERM NEONATE WITH MAJOR PROBLEMS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $33,775.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,775.09 "," $33,775.09 ", Not Applicable , Not Applicable ," $35,463.85 "," $34,450.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,775.09 ", Not Applicable ," $1,357.00 "," $1,357.00 "," $35,463.85 ", Not Applicable
,140,Diagnosis Related Group,MAJOR HEAD AND NECK PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $33,764.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,764.06 "," $33,764.06 ", Not Applicable , Not Applicable ," $35,452.26 "," $34,439.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,764.06 ", Not Applicable , Not Applicable ," $33,764.06 "," $35,452.26 ", Not Applicable
,229,Diagnosis Related Group,OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $29,208.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,208.60 "," $29,208.60 ", Not Applicable , Not Applicable ," $30,669.03 "," $29,792.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,208.60 ", Not Applicable , Not Applicable ," $29,208.60 "," $30,669.03 ", Not Applicable
,616,Diagnosis Related Group,"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $33,664.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,664.75 "," $33,664.75 ", Not Applicable , Not Applicable ," $35,347.99 "," $34,338.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,664.75 ", Not Applicable , Not Applicable ," $33,664.75 "," $35,347.99 ", Not Applicable
,474,Diagnosis Related Group,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $34,597.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,597.57 "," $34,597.57 ", Not Applicable , Not Applicable ," $36,327.45 "," $35,289.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,597.57 ", Not Applicable , Not Applicable ," $34,597.57 "," $36,327.45 ", Not Applicable
,236,Diagnosis Related Group,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $34,774.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,774.97 "," $34,774.97 ", Not Applicable , Not Applicable ," $36,513.72 "," $35,470.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,774.97 ", Not Applicable , Not Applicable ," $34,774.97 "," $36,513.72 ", Not Applicable
,332,Diagnosis Related Group,RECTAL RESECTION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $35,322.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,322.44 "," $35,322.44 ", Not Applicable , Not Applicable ," $37,088.56 "," $36,028.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,322.44 ", Not Applicable , Not Applicable ," $35,322.44 "," $37,088.56 ", Not Applicable
,423,Diagnosis Related Group,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $35,529.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,529.54 "," $35,529.54 ", Not Applicable , Not Applicable ," $37,306.02 "," $36,240.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,529.54 ", Not Applicable , Not Applicable ," $35,529.54 "," $37,306.02 ", Not Applicable
,958,Diagnosis Related Group,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $35,697.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,697.60 "," $35,697.60 ", Not Applicable , Not Applicable ," $37,482.48 "," $36,411.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,697.60 ", Not Applicable , Not Applicable ," $35,697.60 "," $37,482.48 ", Not Applicable
,736,Diagnosis Related Group,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $36,164.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,164.44 "," $36,164.44 ", Not Applicable , Not Applicable ," $37,972.66 "," $36,887.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,164.44 ", Not Applicable , Not Applicable ," $36,164.44 "," $37,972.66 ", Not Applicable
,901,Diagnosis Related Group,WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $36,232.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,232.34 "," $36,232.34 ", Not Applicable , Not Applicable ," $38,043.96 "," $36,956.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,232.34 ", Not Applicable , Not Applicable ," $36,232.34 "," $38,043.96 ", Not Applicable
,356,Diagnosis Related Group,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $36,564.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,564.22 "," $36,564.22 ", Not Applicable , Not Applicable ," $38,392.43 "," $37,295.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,564.22 ", Not Applicable , Not Applicable ," $36,564.22 "," $38,392.43 ", Not Applicable
,269,Diagnosis Related Group,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $36,626.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,626.18 "," $36,626.18 ", Not Applicable , Not Applicable ," $38,457.49 "," $37,358.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,626.18 ", Not Applicable , Not Applicable ," $36,626.18 "," $38,457.49 ", Not Applicable
,319,Diagnosis Related Group,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $36,649.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,649.95 "," $36,649.95 ", Not Applicable , Not Applicable ," $38,482.44 "," $37,382.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,649.95 ", Not Applicable , Not Applicable ," $36,649.95 "," $38,482.44 ", Not Applicable
,31,Diagnosis Related Group,VENTRICULAR SHUNT PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $37,106.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,106.60 "," $37,106.60 ", Not Applicable , Not Applicable ," $38,961.93 "," $37,848.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,106.60 ", Not Applicable , Not Applicable ," $37,106.60 "," $38,961.93 ", Not Applicable
,25,Diagnosis Related Group,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $38,173.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,173.53 "," $38,173.53 ", Not Applicable , Not Applicable ," $40,082.20 "," $38,937.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,173.53 ", Not Applicable , Not Applicable ," $38,173.53 "," $40,082.20 ", Not Applicable
,823,Diagnosis Related Group,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $38,210.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,210.87 "," $38,210.87 ", Not Applicable , Not Applicable ," $40,121.42 "," $38,975.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,210.87 ", Not Applicable , Not Applicable ," $38,210.87 "," $40,121.42 ", Not Applicable
,650,Diagnosis Related Group,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $38,371.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,371.29 "," $38,371.29 ", Not Applicable , Not Applicable ," $40,289.86 "," $39,138.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,371.29 ", Not Applicable , Not Applicable ," $38,371.29 "," $40,289.86 ", Not Applicable
,856,Diagnosis Related Group,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $39,586.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,586.76 "," $39,586.76 ", Not Applicable , Not Applicable ," $41,566.10 "," $40,378.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,586.76 ", Not Applicable , Not Applicable ," $39,586.76 "," $41,566.10 ", Not Applicable
,221,Diagnosis Related Group,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $38,873.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,873.78 "," $38,873.78 ", Not Applicable , Not Applicable ," $40,817.47 "," $39,651.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,873.78 ", Not Applicable , Not Applicable ," $38,873.78 "," $40,817.47 ", Not Applicable
,981,Diagnosis Related Group,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $39,167.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,167.46 "," $39,167.46 ", Not Applicable , Not Applicable ," $41,125.83 "," $39,950.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,167.46 ", Not Applicable , Not Applicable ," $39,167.46 "," $41,125.83 ", Not Applicable
,6,Diagnosis Related Group,LIVER TRANSPLANT WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $39,862.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,862.62 "," $39,862.62 ", Not Applicable , Not Applicable ," $41,855.75 "," $40,659.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,862.62 ", Not Applicable , Not Applicable ," $39,862.62 "," $41,855.75 ", Not Applicable
,455,Diagnosis Related Group,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $40,583.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,583.24 "," $40,583.24 ", Not Applicable , Not Applicable ," $42,612.41 "," $41,394.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,583.24 ", Not Applicable , Not Applicable ," $40,583.24 "," $42,612.41 ", Not Applicable
,239,Diagnosis Related Group,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $40,877.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,877.77 "," $40,877.77 ", Not Applicable , Not Applicable ," $42,921.66 "," $41,695.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,877.77 ", Not Applicable , Not Applicable ," $40,877.77 "," $42,921.66 ", Not Applicable
,17,Diagnosis Related Group,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $41,214.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,214.74 "," $41,214.74 ", Not Applicable , Not Applicable ," $43,275.48 "," $42,039.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,214.74 ", Not Applicable , Not Applicable ," $41,214.74 "," $43,275.48 ", Not Applicable
,329,Diagnosis Related Group,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $41,473.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,473.63 "," $41,473.63 ", Not Applicable , Not Applicable ," $43,547.31 "," $42,303.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,473.63 ", Not Applicable , Not Applicable ," $41,473.63 "," $43,547.31 ", Not Applicable
,22,Diagnosis Related Group,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $41,105.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,105.25 "," $41,105.25 ", Not Applicable , Not Applicable ," $43,160.51 "," $41,927.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,105.25 ", Not Applicable , Not Applicable ," $41,105.25 "," $43,160.51 ", Not Applicable
,853,Diagnosis Related Group,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $42,166.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,166.24 "," $42,166.24 ", Not Applicable , Not Applicable ," $44,274.55 "," $43,009.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,166.24 ", Not Applicable , Not Applicable ," $42,166.24 "," $44,274.55 ", Not Applicable
,163,Diagnosis Related Group,MAJOR CHEST PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $42,497.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,497.27 "," $42,497.27 ", Not Applicable , Not Applicable ," $44,622.13 "," $43,347.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,497.27 ", Not Applicable , Not Applicable ," $42,497.27 "," $44,622.13 ", Not Applicable
,11,Diagnosis Related Group,"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $42,621.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,621.19 "," $42,621.19 ", Not Applicable , Not Applicable ," $44,752.25 "," $43,473.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,621.19 ", Not Applicable , Not Applicable ," $42,621.19 "," $44,752.25 ", Not Applicable
,471,Diagnosis Related Group,CERVICAL SPINAL FUSION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $42,606.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,606.76 "," $42,606.76 ", Not Applicable , Not Applicable ," $44,737.10 "," $43,458.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,606.76 ", Not Applicable , Not Applicable ," $42,606.76 "," $44,737.10 ", Not Applicable
,458,Diagnosis Related Group,"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $42,504.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,504.06 "," $42,504.06 ", Not Applicable , Not Applicable ," $44,629.26 "," $43,354.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,504.06 ", Not Applicable , Not Applicable ," $42,504.06 "," $44,629.26 ", Not Applicable
,826,Diagnosis Related Group,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $42,817.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,817.26 "," $42,817.26 ", Not Applicable , Not Applicable ," $44,958.13 "," $43,673.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,817.26 ", Not Applicable , Not Applicable ," $42,817.26 "," $44,958.13 ", Not Applicable
,576,Diagnosis Related Group,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $42,980.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,980.23 "," $42,980.23 ", Not Applicable , Not Applicable ," $45,129.24 "," $43,839.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,980.23 ", Not Applicable , Not Applicable ," $42,980.23 "," $45,129.24 ", Not Applicable
,218,Diagnosis Related Group,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $51,855.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,855.19 "," $51,855.19 ", Not Applicable , Not Applicable ," $54,447.95 "," $52,892.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,855.19 ", Not Applicable , Not Applicable ," $51,855.19 "," $54,447.95 ", Not Applicable
,799,Diagnosis Related Group,SPLENECTOMY WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $43,690.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $43,690.67 "," $43,690.67 ", Not Applicable , Not Applicable ," $45,875.20 "," $44,564.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $43,690.67 ", Not Applicable , Not Applicable ," $43,690.67 "," $45,875.20 ", Not Applicable
,270,Diagnosis Related Group,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $44,026.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $44,026.79 "," $44,026.79 ", Not Applicable , Not Applicable ," $46,228.13 "," $44,907.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $44,026.79 ", Not Applicable , Not Applicable ," $44,026.79 "," $46,228.13 ", Not Applicable
,227,Diagnosis Related Group,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $44,239.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $44,239.84 "," $44,239.84 ", Not Applicable , Not Applicable ," $46,451.83 "," $45,124.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $44,239.84 ", Not Applicable , Not Applicable ," $44,239.84 "," $46,451.83 ", Not Applicable
,234,Diagnosis Related Group,CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $45,291.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,291.49 "," $45,291.49 ", Not Applicable , Not Applicable ," $47,556.06 "," $46,197.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,291.49 ", Not Applicable , Not Applicable ," $45,291.49 "," $47,556.06 ", Not Applicable
,466,Diagnosis Related Group,REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $45,373.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,373.82 "," $45,373.82 ", Not Applicable , Not Applicable ," $47,642.51 "," $46,281.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,373.82 ", Not Applicable , Not Applicable ," $45,373.82 "," $47,642.51 ", Not Applicable
,463,Diagnosis Related Group,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $45,582.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,582.62 "," $45,582.62 ", Not Applicable , Not Applicable ," $47,861.75 "," $46,494.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,582.62 ", Not Applicable , Not Applicable ," $45,582.62 "," $47,861.75 ", Not Applicable
,326,Diagnosis Related Group,"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $45,124.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,124.28 "," $45,124.28 ", Not Applicable , Not Applicable ," $47,380.49 "," $46,026.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,124.28 ", Not Applicable , Not Applicable ," $45,124.28 "," $47,380.49 ", Not Applicable
,220,Diagnosis Related Group,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $45,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,879.70 "," $45,879.70 ", Not Applicable , Not Applicable ," $48,173.68 "," $46,797.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,879.70 ", Not Applicable , Not Applicable ," $45,879.70 "," $48,173.68 ", Not Applicable
,245,Diagnosis Related Group,AICD GENERATOR PROCEDURES,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $45,985.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,985.80 "," $45,985.80 ", Not Applicable , Not Applicable ," $48,285.09 "," $46,905.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,985.80 ", Not Applicable , Not Applicable ," $45,985.80 "," $48,285.09 ", Not Applicable
,8,Diagnosis Related Group,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $46,117.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $46,117.36 "," $46,117.36 ", Not Applicable , Not Applicable ," $48,423.23 "," $47,039.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $46,117.36 ", Not Applicable , Not Applicable ," $46,117.36 "," $48,423.23 ", Not Applicable
,653,Diagnosis Related Group,MAJOR BLADDER PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $46,337.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $46,337.20 "," $46,337.20 ", Not Applicable , Not Applicable ," $48,654.06 "," $47,263.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $46,337.20 ", Not Applicable , Not Applicable ," $46,337.20 "," $48,654.06 ", Not Applicable
,573,Diagnosis Related Group,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $47,015.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $47,015.38 "," $47,015.38 ", Not Applicable , Not Applicable ," $49,366.15 "," $47,955.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $47,015.38 ", Not Applicable , Not Applicable ," $47,015.38 "," $49,366.15 ", Not Applicable
,267,Diagnosis Related Group,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $47,515.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $47,515.32 "," $47,515.32 ", Not Applicable , Not Applicable ," $49,891.09 "," $48,465.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $47,515.32 ", Not Applicable , Not Applicable ," $47,515.32 "," $49,891.09 ", Not Applicable
,225,Diagnosis Related Group,"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITHOUT MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $47,683.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $47,683.38 "," $47,683.38 ", Not Applicable , Not Applicable ," $50,067.55 "," $48,637.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $47,683.38 ", Not Applicable , Not Applicable ," $47,683.38 "," $50,067.55 ", Not Applicable
,23,Diagnosis Related Group,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $48,142.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,142.58 "," $48,142.58 ", Not Applicable , Not Applicable ," $50,549.71 "," $49,105.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,142.58 ", Not Applicable , Not Applicable ," $48,142.58 "," $50,549.71 ", Not Applicable
,790,Diagnosis Related Group,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $48,144.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,144.27 "," $48,144.27 ", Not Applicable , Not Applicable ," $50,551.49 "," $49,107.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,144.27 ", Not Applicable ," $1,357.00 "," $1,357.00 "," $50,551.49 ", Not Applicable
,820,Diagnosis Related Group,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $48,310.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,310.64 "," $48,310.64 ", Not Applicable , Not Applicable ," $50,726.17 "," $49,276.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,310.64 ", Not Applicable , Not Applicable ," $48,310.64 "," $50,726.17 ", Not Applicable
,837,Diagnosis Related Group,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $48,375.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,375.15 "," $48,375.15 ", Not Applicable , Not Applicable ," $50,793.90 "," $49,342.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,375.15 ", Not Applicable , Not Applicable ," $48,375.15 "," $50,793.90 ", Not Applicable
,207,Diagnosis Related Group,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $48,687.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,687.50 "," $48,687.50 ", Not Applicable , Not Applicable ," $51,121.88 "," $49,661.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,687.50 ", Not Applicable , Not Applicable ," $48,687.50 "," $51,121.88 ", Not Applicable
,405,Diagnosis Related Group,"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $48,700.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,700.23 "," $48,700.23 ", Not Applicable , Not Applicable ," $51,135.24 "," $49,674.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,700.23 ", Not Applicable , Not Applicable ," $48,700.23 "," $51,135.24 ", Not Applicable
,969,Diagnosis Related Group,HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $49,670.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,670.40 "," $49,670.40 ", Not Applicable , Not Applicable ," $52,153.92 "," $50,663.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,670.40 ", Not Applicable , Not Applicable ," $49,670.40 "," $52,153.92 ", Not Applicable
,28,Diagnosis Related Group,SPINAL PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $49,425.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,425.95 "," $49,425.95 ", Not Applicable , Not Applicable ," $51,897.25 "," $50,414.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,425.95 ", Not Applicable , Not Applicable ," $49,425.95 "," $51,897.25 ", Not Applicable
,232,Diagnosis Related Group,CORONARY BYPASS WITH PTCA WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $50,535.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $50,535.32 "," $50,535.32 ", Not Applicable , Not Applicable ," $53,062.08 "," $51,546.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $50,535.32 ", Not Applicable , Not Applicable ," $50,535.32 "," $53,062.08 ", Not Applicable
,235,Diagnosis Related Group,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $51,811.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,811.05 "," $51,811.05 ", Not Applicable , Not Applicable ," $54,401.60 "," $52,847.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,811.05 ", Not Applicable , Not Applicable ," $51,811.05 "," $54,401.60 ", Not Applicable
,834,Diagnosis Related Group,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $51,370.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,370.53 "," $51,370.53 ", Not Applicable , Not Applicable ," $53,939.06 "," $52,397.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,370.53 ", Not Applicable , Not Applicable ," $51,370.53 "," $53,939.06 ", Not Applicable
,461,Diagnosis Related Group,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $51,620.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,620.92 "," $51,620.92 ", Not Applicable , Not Applicable ," $54,201.97 "," $52,653.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,620.92 ", Not Applicable , Not Applicable ," $51,620.92 "," $54,201.97 ", Not Applicable
,454,Diagnosis Related Group,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $51,717.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,717.68 "," $51,717.68 ", Not Applicable , Not Applicable ," $54,303.57 "," $52,752.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,717.68 ", Not Applicable , Not Applicable ," $51,717.68 "," $54,303.57 ", Not Applicable
,223,Diagnosis Related Group,"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK WITHOUT MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $49,217.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,217.99 "," $49,217.99 ", Not Applicable , Not Applicable ," $51,678.89 "," $50,202.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,217.99 ", Not Applicable , Not Applicable ," $49,217.99 "," $51,678.89 ", Not Applicable
,228,Diagnosis Related Group,OTHER CARDIOTHORACIC PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $45,243.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,243.11 "," $45,243.11 ", Not Applicable , Not Applicable ," $47,505.26 "," $46,147.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,243.11 ", Not Applicable , Not Applicable ," $45,243.11 "," $47,505.26 ", Not Applicable
,955,Diagnosis Related Group,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $53,383.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $53,383.01 "," $53,383.01 ", Not Applicable , Not Applicable ," $56,052.16 "," $54,450.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $53,383.01 ", Not Applicable , Not Applicable ," $53,383.01 "," $56,052.16 ", Not Applicable
,870,Diagnosis Related Group,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $54,653.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $54,653.65 "," $54,653.65 ", Not Applicable , Not Applicable ," $57,386.34 "," $55,746.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $54,653.65 ", Not Applicable , Not Applicable ," $54,653.65 "," $57,386.34 ", Not Applicable
,217,Diagnosis Related Group,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $55,031.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,031.36 "," $55,031.36 ", Not Applicable , Not Applicable ," $57,782.93 "," $56,131.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,031.36 ", Not Applicable , Not Applicable ," $55,031.36 "," $57,782.93 ", Not Applicable
,457,Diagnosis Related Group,"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $55,136.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,136.61 "," $55,136.61 ", Not Applicable , Not Applicable ," $57,893.45 "," $56,239.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,136.61 ", Not Applicable , Not Applicable ," $55,136.61 "," $57,893.45 ", Not Applicable
,928,Diagnosis Related Group,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $55,439.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,439.63 "," $55,439.63 ", Not Applicable , Not Applicable ," $58,211.61 "," $56,548.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,439.63 ", Not Applicable , Not Applicable ," $55,439.63 "," $58,211.61 ", Not Applicable
,226,Diagnosis Related Group,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $55,723.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,723.13 "," $55,723.13 ", Not Applicable , Not Applicable ," $58,509.29 "," $56,837.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,723.13 ", Not Applicable , Not Applicable ," $55,723.13 "," $58,509.29 ", Not Applicable
,19,Diagnosis Related Group,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $56,696.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $56,696.69 "," $56,696.69 ", Not Applicable , Not Applicable ," $59,531.53 "," $57,830.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $56,696.69 ", Not Applicable , Not Applicable ," $56,696.69 "," $59,531.53 ", Not Applicable
,16,Diagnosis Related Group,AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $57,177.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $57,177.11 "," $57,177.11 ", Not Applicable , Not Applicable ," $60,035.96 "," $58,320.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $57,177.11 ", Not Applicable , Not Applicable ," $57,177.11 "," $60,035.96 ", Not Applicable
,459,Diagnosis Related Group,SPINAL FUSION EXCEPT CERVICAL WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $57,153.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $57,153.34 "," $57,153.34 ", Not Applicable , Not Applicable ," $60,011.01 "," $58,296.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $57,153.34 ", Not Applicable , Not Applicable ," $57,153.34 "," $60,011.01 ", Not Applicable
,268,Diagnosis Related Group,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $59,103.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $59,103.86 "," $59,103.86 ", Not Applicable , Not Applicable ," $62,059.06 "," $60,285.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $59,103.86 ", Not Applicable , Not Applicable ," $59,103.86 "," $62,059.06 ", Not Applicable
,266,Diagnosis Related Group,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $59,821.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $59,821.94 "," $59,821.94 ", Not Applicable , Not Applicable ," $62,813.04 "," $61,018.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $59,821.94 ", Not Applicable , Not Applicable ," $59,821.94 "," $62,813.04 ", Not Applicable
,224,Diagnosis Related Group,"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $63,821.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $63,821.44 "," $63,821.44 ", Not Applicable , Not Applicable ," $67,012.52 "," $65,097.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $63,821.44 ", Not Applicable , Not Applicable ," $63,821.44 "," $67,012.52 ", Not Applicable
,957,Diagnosis Related Group,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $62,987.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $62,987.93 "," $62,987.93 ", Not Applicable , Not Applicable ," $66,137.33 "," $64,247.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $62,987.93 ", Not Applicable , Not Applicable ," $62,987.93 "," $66,137.33 ", Not Applicable
,21,Diagnosis Related Group,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $64,028.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $64,028.55 "," $64,028.55 ", Not Applicable , Not Applicable ," $67,229.98 "," $65,309.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $64,028.55 ", Not Applicable , Not Applicable ," $64,028.55 "," $67,229.98 ", Not Applicable
,233,Diagnosis Related Group,CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $67,243.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $67,243.77 "," $67,243.77 ", Not Applicable , Not Applicable ," $70,605.96 "," $68,588.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $67,243.77 ", Not Applicable , Not Applicable ," $67,243.77 "," $70,605.96 ", Not Applicable
,219,Diagnosis Related Group,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $68,392.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $68,392.18 "," $68,392.18 ", Not Applicable , Not Applicable ," $71,811.79 "," $69,760.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $68,392.18 ", Not Applicable , Not Applicable ," $68,392.18 "," $71,811.79 ", Not Applicable
,222,Diagnosis Related Group,"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $67,487.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $67,487.37 "," $67,487.37 ", Not Applicable , Not Applicable ," $70,861.74 "," $68,837.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $67,487.37 ", Not Applicable , Not Applicable ," $67,487.37 "," $70,861.74 ", Not Applicable
,231,Diagnosis Related Group,CORONARY BYPASS WITH PTCA WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $73,979.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $73,979.77 "," $73,979.77 ", Not Applicable , Not Applicable ," $77,678.76 "," $75,459.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $73,979.77 ", Not Applicable , Not Applicable ," $73,979.77 "," $77,678.76 ", Not Applicable
,456,Diagnosis Related Group,"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $72,996.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $72,996.03 "," $72,996.03 ", Not Applicable , Not Applicable ," $76,645.83 "," $74,455.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $72,996.03 ", Not Applicable , Not Applicable ," $72,996.03 "," $76,645.83 ", Not Applicable
,453,Diagnosis Related Group,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $77,986.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $77,986.92 "," $77,986.92 ", Not Applicable , Not Applicable ," $81,886.26 "," $79,546.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $77,986.92 ", Not Applicable , Not Applicable ," $77,986.92 "," $81,886.26 ", Not Applicable
,5,Diagnosis Related Group,LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $86,873.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $86,873.76 "," $86,873.76 ", Not Applicable , Not Applicable ," $91,217.45 "," $88,611.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $86,873.76 ", Not Applicable , Not Applicable ," $86,873.76 "," $91,217.45 ", Not Applicable
,20,Diagnosis Related Group,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $87,739.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $87,739.53 "," $87,739.53 ", Not Applicable , Not Applicable ," $92,126.50 "," $89,494.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $87,739.53 ", Not Applicable , Not Applicable ," $87,739.53 "," $92,126.50 ", Not Applicable
,216,Diagnosis Related Group,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $85,212.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $85,212.67 "," $85,212.67 ", Not Applicable , Not Applicable ," $89,473.31 "," $86,916.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $85,212.67 ", Not Applicable , Not Applicable ," $85,212.67 "," $89,473.31 ", Not Applicable
,215,Diagnosis Related Group,OTHER HEART ASSIST SYSTEM IMPLANT,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $89,618.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $89,618.75 "," $89,618.75 ", Not Applicable , Not Applicable ," $94,099.69 "," $91,411.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $89,618.75 ", Not Applicable , Not Applicable ," $89,618.75 "," $94,099.69 ", Not Applicable
,7,Diagnosis Related Group,LUNG TRANSPLANT,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $98,290.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $98,290.00 "," $98,290.00 ", Not Applicable , Not Applicable ," $103,204.50 "," $100,255.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $98,290.00 ", Not Applicable , Not Applicable ," $98,290.00 "," $103,204.50 ", Not Applicable
,4,Diagnosis Related Group,"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $101,197.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $101,197.11 "," $101,197.11 ", Not Applicable , Not Applicable ," $106,256.96 "," $103,221.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $101,197.11 ", Not Applicable , Not Applicable ," $101,197.11 "," $106,256.96 ", Not Applicable
,14,Diagnosis Related Group,ALLOGENEIC BONE MARROW TRANSPLANT,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $90,625.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $90,625.42 "," $90,625.42 ", Not Applicable , Not Applicable ," $95,156.69 "," $92,437.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $90,625.42 ", Not Applicable , Not Applicable ," $90,625.42 "," $95,156.69 ", Not Applicable
,2,Diagnosis Related Group,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $127,064.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $127,064.86 "," $127,064.86 ", Not Applicable , Not Applicable ," $133,418.10 "," $129,606.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $127,064.86 ", Not Applicable , Not Applicable ," $127,064.86 "," $133,418.10 ", Not Applicable
,3,Diagnosis Related Group,"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $162,165.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $162,165.76 "," $162,165.76 ", Not Applicable , Not Applicable ," $170,274.05 "," $165,409.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $162,165.76 ", Not Applicable , Not Applicable ," $162,165.76 "," $170,274.05 ", Not Applicable
,927,Diagnosis Related Group,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $179,021.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $179,021.06 "," $179,021.06 ", Not Applicable , Not Applicable ," $187,972.11 "," $182,601.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $179,021.06 ", Not Applicable , Not Applicable ," $179,021.06 "," $187,972.11 ", Not Applicable
,1,Diagnosis Related Group,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $245,412.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $245,412.64 "," $245,412.64 ", Not Applicable , Not Applicable ," $257,683.27 "," $250,320.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $245,412.64 ", Not Applicable , Not Applicable ," $245,412.64 "," $257,683.27 ", Not Applicable
,18,Diagnosis Related Group,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL IMMUNOTHERAPY,Inpatient,MS-DRG,, Not Applicable , Not Applicable , Not Applicable ," $317,873.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $317,873.08 "," $317,873.08 ", Not Applicable , Not Applicable ," $333,766.73 "," $324,230.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $317,873.08 ", Not Applicable , Not Applicable ," $317,873.08 "," $333,766.73 ", Not Applicable
,001-1,Diagnosis Related Group,LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $60,841.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $95,442.54 "," $115,138.82 "," $104,255.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $60,841.52 "," $115,138.82 ", Not Applicable
,001-2,Diagnosis Related Group,LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $61,903.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $97,109.05 "," $117,149.26 "," $106,075.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $61,903.88 "," $117,149.26 ", Not Applicable
,001-3,Diagnosis Related Group,LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $75,391.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $118,267.34 "," $142,673.93 "," $129,187.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $75,391.60 "," $142,673.93 ", Not Applicable
,001-4,Diagnosis Related Group,LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $121,307.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $190,296.25 "," $229,567.31 "," $207,867.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $121,307.70 "," $229,567.31 ", Not Applicable
,002-1,Diagnosis Related Group,LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $76,733.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $120,372.77 "," $145,213.85 "," $131,487.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $76,733.74 "," $145,213.85 ", Not Applicable
,002-2,Diagnosis Related Group,LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $87,204.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $136,797.55 "," $165,028.18 "," $149,428.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $87,204.00 "," $165,028.18 ", Not Applicable
,002-3,Diagnosis Related Group,HEART &/OR LUNG TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $104,894.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $164,548.97 "," $198,506.62 "," $179,742.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $104,894.64 "," $198,506.62 ", Not Applicable
,002-4,Diagnosis Related Group,HEART &/OR LUNG TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $161,762.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $253,757.60 "," $306,125.05 "," $277,188.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $161,762.25 "," $306,125.05 ", Not Applicable
,003-1,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $38,421.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $60,271.46 "," $72,709.57 "," $65,836.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,421.11 "," $72,709.57 ", Not Applicable
,003-2,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $53,271.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $83,567.59 "," $100,813.27 "," $91,283.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $53,271.63 "," $100,813.27 ", Not Applicable
,003-3,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $84,703.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $132,875.70 "," $160,296.99 "," $145,144.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $84,703.95 "," $160,296.99 ", Not Applicable
,003-4,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $142,793.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $224,000.68 "," $270,227.26 "," $244,684.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $142,793.18 "," $270,227.26 ", Not Applicable
,004-1,Diagnosis Related Group,HEART &/OR LUNG TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $43,875.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $68,828.23 "," $83,032.18 "," $75,183.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $43,875.77 "," $83,032.18 ", Not Applicable
,004-2,Diagnosis Related Group,HEART &/OR LUNG TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $56,472.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $88,588.75 "," $106,870.63 "," $96,768.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $56,472.46 "," $106,870.63 ", Not Applicable
,004-3,Diagnosis Related Group,TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $79,579.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $124,836.17 "," $150,598.36 "," $136,363.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $79,579.01 "," $150,598.36 ", Not Applicable
,004-4,Diagnosis Related Group,TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $118,020.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $185,140.05 "," $223,347.03 "," $202,235.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $118,020.78 "," $223,347.03 ", Not Applicable
,005-1,Diagnosis Related Group,TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $40,149.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $62,983.27 "," $75,981.00 "," $68,798.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,149.79 "," $75,981.00 ", Not Applicable
,005-2,Diagnosis Related Group,TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $42,871.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $67,253.55 "," $81,132.53 "," $73,463.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,871.96 "," $81,132.53 ", Not Applicable
,005-3,Diagnosis Related Group,TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $55,241.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $86,657.53 "," $104,540.88 "," $94,659.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,241.37 "," $104,540.88 ", Not Applicable
,005-4,Diagnosis Related Group,TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $76,720.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $120,352.51 "," $145,189.42 "," $131,465.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $76,720.83 "," $145,189.42 ", Not Applicable
,006-1,Diagnosis Related Group,TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $48,415.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $75,949.42 "," $91,622.95 "," $82,962.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,415.29 "," $91,622.95 ", Not Applicable
,006-2,Diagnosis Related Group,TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $64,453.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $101,107.88 "," $121,973.32 "," $110,443.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $64,453.00 "," $121,973.32 ", Not Applicable
,006-3,Diagnosis Related Group,PANCREAS TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $79,846.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $125,256.17 "," $151,105.04 "," $136,821.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $79,846.75 "," $151,105.04 ", Not Applicable
,006-4,Diagnosis Related Group,PANCREAS TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $120,310.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $188,732.38 "," $227,680.70 "," $206,159.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $120,310.78 "," $227,680.70 ", Not Applicable
,020-1,Diagnosis Related Group,HEAD TRAUMA WITH DEEP COMA,Inpatient,APR-DRG,, Not Applicable ," $15,105.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,695.87 "," $28,585.94 "," $25,883.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,105.35 "," $28,585.94 ", Not Applicable
,020-2,Diagnosis Related Group,HEAD TRAUMA WITH DEEP COMA,Inpatient,APR-DRG,, Not Applicable ," $19,707.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,915.65 "," $37,295.65 "," $33,770.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,707.72 "," $37,295.65 ", Not Applicable
,020-3,Diagnosis Related Group,CRANIOTOMY FOR TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $26,873.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,157.21 "," $50,857.11 "," $46,049.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,873.85 "," $50,857.11 ", Not Applicable
,020-4,Diagnosis Related Group,CRANIOTOMY FOR TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $53,465.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $83,871.45 "," $101,179.84 "," $91,615.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $53,465.33 "," $101,179.84 ", Not Applicable
,021-1,Diagnosis Related Group,CRANIOTOMY FOR TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $16,542.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,949.86 "," $31,305.08 "," $28,345.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,542.19 "," $31,305.08 ", Not Applicable
,021-2,Diagnosis Related Group,CRANIOTOMY FOR TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $21,350.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,492.40 "," $40,404.16 "," $36,584.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,350.32 "," $40,404.16 ", Not Applicable
,021-3,Diagnosis Related Group,CRANIOTOMY EXCEPT FOR TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $31,704.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,734.86 "," $59,998.55 "," $54,327.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,704.36 "," $59,998.55 ", Not Applicable
,021-4,Diagnosis Related Group,CRANIOTOMY EXCEPT FOR TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $54,222.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $85,059.89 "," $102,613.53 "," $92,914.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $54,222.93 "," $102,613.53 ", Not Applicable
,022-1,Diagnosis Related Group,CRANIOTOMY EXCEPT FOR TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $10,510.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,488.25 "," $19,890.90 "," $18,010.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,510.73 "," $19,890.90 ", Not Applicable
,022-2,Diagnosis Related Group,CRANIOTOMY EXCEPT FOR TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $12,409.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,467.46 "," $23,484.92 "," $21,265.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,409.87 "," $23,484.92 ", Not Applicable
,022-3,Diagnosis Related Group,VENTRICULAR SHUNT PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $19,317.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,303.87 "," $36,557.62 "," $33,102.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,317.74 "," $36,557.62 ", Not Applicable
,022-4,Diagnosis Related Group,VENTRICULAR SHUNT PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $42,642.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $66,894.32 "," $80,699.16 "," $73,071.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,642.96 "," $80,699.16 ", Not Applicable
,023-1,Diagnosis Related Group,VENTRICULAR SHUNT PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $10,753.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,869.10 "," $20,350.34 "," $18,426.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,753.50 "," $20,350.34 ", Not Applicable
,023-2,Diagnosis Related Group,VENTRICULAR SHUNT PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $15,278.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,967.32 "," $28,913.41 "," $26,180.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,278.39 "," $28,913.41 ", Not Applicable
,023-3,Diagnosis Related Group,SPINAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $29,919.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $46,935.28 "," $56,621.22 "," $51,269.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,919.72 "," $56,621.22 ", Not Applicable
,023-4,Diagnosis Related Group,SPINAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $54,260.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $85,119.31 "," $102,685.22 "," $92,978.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $54,260.81 "," $102,685.22 ", Not Applicable
,024-1,Diagnosis Related Group,SPINAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $9,585.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,036.47 "," $18,139.51 "," $16,424.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,585.26 "," $18,139.51 ", Not Applicable
,024-2,Diagnosis Related Group,SPINAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $12,211.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,155.49 "," $23,108.57 "," $20,924.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,211.01 "," $23,108.57 ", Not Applicable
,024-3,Diagnosis Related Group,EXTRACRANIAL VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $23,033.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,132.63 "," $43,589.25 "," $39,468.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,033.38 "," $43,589.25 ", Not Applicable
,024-4,Diagnosis Related Group,EXTRACRANIAL VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $45,989.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $72,143.71 "," $87,031.86 "," $78,805.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,989.28 "," $87,031.86 ", Not Applicable
,026-1,Diagnosis Related Group,EXTRACRANIAL VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $9,778.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,340.33 "," $18,506.08 "," $16,756.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,778.96 "," $18,506.08 ", Not Applicable
,026-2,Diagnosis Related Group,EXTRACRANIAL VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $13,098.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,547.86 "," $24,788.28 "," $22,445.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,098.59 "," $24,788.28 ", Not Applicable
,026-3,Diagnosis Related Group,OTHER NERVOUS SYSTEM & RELATED PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $19,411.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,451.07 "," $36,735.20 "," $33,262.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,411.57 "," $36,735.20 ", Not Applicable
,026-4,Diagnosis Related Group,OTHER NERVOUS SYSTEM & RELATED PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $37,260.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $58,450.99 "," $70,513.41 "," $63,848.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,260.61 "," $70,513.41 ", Not Applicable
,040-1,Diagnosis Related Group,OTHER NERVOUS SYSTEM & RELATED PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $6,984.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,956.61 "," $13,217.70 "," $11,968.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,984.48 "," $13,217.70 ", Not Applicable
,040-2,Diagnosis Related Group,OTHER NERVOUS SYSTEM & RELATED PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $8,260.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,958.05 "," $15,632.17 "," $14,154.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,260.34 "," $15,632.17 ", Not Applicable
,040-3,Diagnosis Related Group,SPINAL DISORDERS & INJURIES,Inpatient,APR-DRG,, Not Applicable ," $11,538.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,100.75 "," $21,836.17 "," $19,772.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,538.64 "," $21,836.17 ", Not Applicable
,040-4,Diagnosis Related Group,SPINAL DISORDERS & INJURIES,Inpatient,APR-DRG,, Not Applicable ," $26,043.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,853.98 "," $49,284.93 "," $44,626.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,043.09 "," $49,284.93 ", Not Applicable
,041-1,Diagnosis Related Group,SPINAL DISORDERS & INJURIES,Inpatient,APR-DRG,, Not Applicable ," $5,972.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,368.42 "," $11,301.76 "," $10,233.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,972.06 "," $11,301.76 ", Not Applicable
,041-2,Diagnosis Related Group,SPINAL DISORDERS & INJURIES,Inpatient,APR-DRG,, Not Applicable ," $6,276.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,846.50 "," $11,878.50 "," $10,755.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,276.82 "," $11,878.50 ", Not Applicable
,041-3,Diagnosis Related Group,NERVOUS SYSTEM MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $8,735.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,703.52 "," $16,531.49 "," $14,968.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,735.55 "," $16,531.49 ", Not Applicable
,041-4,Diagnosis Related Group,NERVOUS SYSTEM MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $13,685.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,468.90 "," $25,899.39 "," $23,451.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,685.73 "," $25,899.39 ", Not Applicable
,042-1,Diagnosis Related Group,NERVOUS SYSTEM MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $4,468.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,009.10 "," $8,455.55 "," $7,656.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,468.07 "," $8,455.55 ", Not Applicable
,042-2,Diagnosis Related Group,NERVOUS SYSTEM MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $6,468.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,147.66 "," $12,241.81 "," $11,084.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,468.80 "," $12,241.81 ", Not Applicable
,042-3,Diagnosis Related Group,DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS,Inpatient,APR-DRG,, Not Applicable ," $8,923.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,997.93 "," $16,886.66 "," $15,290.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,923.23 "," $16,886.66 ", Not Applicable
,042-4,Diagnosis Related Group,DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS,Inpatient,APR-DRG,, Not Applicable ," $21,143.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,168.28 "," $40,013.15 "," $36,230.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,143.70 "," $40,013.15 ", Not Applicable
,043-1,Diagnosis Related Group,DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS,Inpatient,APR-DRG,, Not Applicable ," $5,823.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,134.78 "," $11,019.91 "," $9,978.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,823.13 "," $11,019.91 ", Not Applicable
,043-2,Diagnosis Related Group,DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS,Inpatient,APR-DRG,, Not Applicable ," $7,448.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,684.53 "," $14,095.84 "," $12,763.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,448.51 "," $14,095.84 ", Not Applicable
,043-3,Diagnosis Related Group,MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES,Inpatient,APR-DRG,, Not Applicable ," $11,416.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,908.98 "," $21,604.82 "," $19,562.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,416.39 "," $21,604.82 ", Not Applicable
,043-4,Diagnosis Related Group,MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES,Inpatient,APR-DRG,, Not Applicable ," $25,236.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,588.56 "," $47,758.37 "," $43,244.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,236.42 "," $47,758.37 ", Not Applicable
,044-1,Diagnosis Related Group,MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES,Inpatient,APR-DRG,, Not Applicable ," $6,164.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,670.93 "," $11,666.70 "," $10,563.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,164.90 "," $11,666.70 ", Not Applicable
,044-2,Diagnosis Related Group,MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES,Inpatient,APR-DRG,, Not Applicable ," $8,238.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,924.29 "," $15,591.44 "," $14,117.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,238.81 "," $15,591.44 ", Not Applicable
,044-3,Diagnosis Related Group,INTRACRANIAL HEMORRHAGE,Inpatient,APR-DRG,, Not Applicable ," $11,578.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,162.87 "," $21,911.11 "," $19,839.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,578.24 "," $21,911.11 ", Not Applicable
,044-4,Diagnosis Related Group,INTRACRANIAL HEMORRHAGE,Inpatient,APR-DRG,, Not Applicable ," $22,099.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,667.34 "," $41,821.56 "," $37,868.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,099.30 "," $41,821.56 ", Not Applicable
,045-1,Diagnosis Related Group,INTRACRANIAL HEMORRHAGE,Inpatient,APR-DRG,, Not Applicable ," $6,442.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,105.79 "," $12,191.30 "," $11,038.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,442.11 "," $12,191.30 ", Not Applicable
,045-2,Diagnosis Related Group,INTRACRANIAL HEMORRHAGE,Inpatient,APR-DRG,, Not Applicable ," $7,721.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,112.63 "," $14,612.29 "," $13,231.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,721.41 "," $14,612.29 ", Not Applicable
,045-3,Diagnosis Related Group,CVA & PRECEREBRAL OCCLUSION W INFARCT,Inpatient,APR-DRG,, Not Applicable ," $10,608.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,640.86 "," $20,075.00 "," $18,177.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,608.01 "," $20,075.00 ", Not Applicable
,045-4,Diagnosis Related Group,CVA & PRECEREBRAL OCCLUSION W INFARCT,Inpatient,APR-DRG,, Not Applicable ," $20,566.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,262.09 "," $38,919.96 "," $35,241.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,566.04 "," $38,919.96 ", Not Applicable
,046-1,Diagnosis Related Group,CVA & PRECEREBRAL OCCLUSION W INFARCT,Inpatient,APR-DRG,, Not Applicable ," $5,652.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,867.38 "," $10,697.33 "," $9,686.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,652.67 "," $10,697.33 ", Not Applicable
,046-2,Diagnosis Related Group,CVA & PRECEREBRAL OCCLUSION W INFARCT,Inpatient,APR-DRG,, Not Applicable ," $6,640.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,417.76 "," $12,567.65 "," $11,379.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,640.98 "," $12,567.65 ", Not Applicable
,046-3,Diagnosis Related Group,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT,Inpatient,APR-DRG,, Not Applicable ," $9,073.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,234.27 "," $17,171.77 "," $15,548.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,073.89 "," $17,171.77 ", Not Applicable
,046-4,Diagnosis Related Group,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT,Inpatient,APR-DRG,, Not Applicable ," $22,277.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,946.89 "," $42,158.81 "," $38,173.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,277.51 "," $42,158.81 ", Not Applicable
,047-1,Diagnosis Related Group,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT,Inpatient,APR-DRG,, Not Applicable ," $5,128.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,044.93 "," $9,705.14 "," $8,787.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,128.38 "," $9,705.14 ", Not Applicable
,047-2,Diagnosis Related Group,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT,Inpatient,APR-DRG,, Not Applicable ," $5,670.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,895.74 "," $10,731.54 "," $9,717.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,670.75 "," $10,731.54 ", Not Applicable
,047-3,Diagnosis Related Group,TRANSIENT ISCHEMIA,Inpatient,APR-DRG,, Not Applicable ," $7,030.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,029.53 "," $13,305.68 "," $12,047.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,030.97 "," $13,305.68 ", Not Applicable
,047-4,Diagnosis Related Group,TRANSIENT ISCHEMIA,Inpatient,APR-DRG,, Not Applicable ," $12,737.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,982.00 "," $24,105.64 "," $21,827.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,737.88 "," $24,105.64 ", Not Applicable
,048-1,Diagnosis Related Group,TRANSIENT ISCHEMIA,Inpatient,APR-DRG,, Not Applicable ," $4,672.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,330.51 "," $8,843.30 "," $8,007.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,672.97 "," $8,843.30 ", Not Applicable
,048-2,Diagnosis Related Group,TRANSIENT ISCHEMIA,Inpatient,APR-DRG,, Not Applicable ," $5,458.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,563.52 "," $10,330.76 "," $9,354.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,458.97 "," $10,330.76 ", Not Applicable
,048-3,Diagnosis Related Group,"PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $7,443.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,676.42 "," $14,086.06 "," $12,754.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,443.34 "," $14,086.06 ", Not Applicable
,048-4,Diagnosis Related Group,"PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $17,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,843.26 "," $33,589.22 "," $30,414.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,749.18 "," $33,589.22 ", Not Applicable
,049-1,Diagnosis Related Group,"PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $7,773.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,195.02 "," $14,711.68 "," $13,321.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,773.93 "," $14,711.68 ", Not Applicable
,049-2,Diagnosis Related Group,"PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $15,157.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,776.90 "," $28,683.70 "," $25,972.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,157.01 "," $28,683.70 ", Not Applicable
,049-3,Diagnosis Related Group,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM,Inpatient,APR-DRG,, Not Applicable ," $19,342.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,343.03 "," $36,604.87 "," $33,144.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,342.70 "," $36,604.87 ", Not Applicable
,049-4,Diagnosis Related Group,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM,Inpatient,APR-DRG,, Not Applicable ," $34,090.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $53,478.45 "," $64,514.69 "," $58,416.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,090.78 "," $64,514.69 ", Not Applicable
,050-1,Diagnosis Related Group,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM,Inpatient,APR-DRG,, Not Applicable ," $5,125.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,040.88 "," $9,700.26 "," $8,783.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,125.80 "," $9,700.26 ", Not Applicable
,050-2,Diagnosis Related Group,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM,Inpatient,APR-DRG,, Not Applicable ," $8,944.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,031.70 "," $16,927.39 "," $15,327.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,944.75 "," $16,927.39 ", Not Applicable
,050-3,Diagnosis Related Group,NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS,Inpatient,APR-DRG,, Not Applicable ," $14,753.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,143.52 "," $27,919.60 "," $25,280.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,753.24 "," $27,919.60 ", Not Applicable
,050-4,Diagnosis Related Group,NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS,Inpatient,APR-DRG,, Not Applicable ," $30,648.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,077.80 "," $57,999.52 "," $52,517.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,648.04 "," $57,999.52 ", Not Applicable
,051-1,Diagnosis Related Group,NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS,Inpatient,APR-DRG,, Not Applicable ," $4,560.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,153.60 "," $8,629.87 "," $7,814.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,560.19 "," $8,629.87 ", Not Applicable
,051-2,Diagnosis Related Group,NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS,Inpatient,APR-DRG,, Not Applicable ," $6,374.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,000.45 "," $12,064.23 "," $10,923.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,374.96 "," $12,064.23 ", Not Applicable
,051-3,Diagnosis Related Group,VIRAL MENINGITIS,Inpatient,APR-DRG,, Not Applicable ," $10,754.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,870.45 "," $20,351.97 "," $18,428.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,754.36 "," $20,351.97 ", Not Applicable
,051-4,Diagnosis Related Group,VIRAL MENINGITIS,Inpatient,APR-DRG,, Not Applicable ," $21,677.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,005.59 "," $41,023.26 "," $37,145.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,677.46 "," $41,023.26 ", Not Applicable
,052-1,Diagnosis Related Group,VIRAL MENINGITIS,Inpatient,APR-DRG,, Not Applicable ," $4,600.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,217.07 "," $8,706.44 "," $7,883.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,600.65 "," $8,706.44 ", Not Applicable
,052-2,Diagnosis Related Group,VIRAL MENINGITIS,Inpatient,APR-DRG,, Not Applicable ," $5,334.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,367.70 "," $10,094.52 "," $9,140.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,334.14 "," $10,094.52 ", Not Applicable
,052-3,Diagnosis Related Group,ALTERATION IN CONSCIOUSNESS,Inpatient,APR-DRG,, Not Applicable ," $7,223.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,332.05 "," $13,670.62 "," $12,378.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,223.81 "," $13,670.62 ", Not Applicable
,052-4,Diagnosis Related Group,ALTERATION IN CONSCIOUSNESS,Inpatient,APR-DRG,, Not Applicable ," $16,868.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,461.70 "," $31,922.54 "," $28,905.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,868.47 "," $31,922.54 ", Not Applicable
,053-1,Diagnosis Related Group,ALTERATION IN CONSCIOUSNESS,Inpatient,APR-DRG,, Not Applicable ," $3,907.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,129.92 "," $7,394.94 "," $6,695.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,907.63 "," $7,394.94 ", Not Applicable
,053-2,Diagnosis Related Group,ALTERATION IN CONSCIOUSNESS,Inpatient,APR-DRG,, Not Applicable ," $4,821.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,562.80 "," $9,123.52 "," $8,261.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,821.04 "," $9,123.52 ", Not Applicable
,053-3,Diagnosis Related Group,SEIZURE,Inpatient,APR-DRG,, Not Applicable ," $6,769.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,618.98 "," $12,810.40 "," $11,599.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,769.26 "," $12,810.40 ", Not Applicable
,053-4,Diagnosis Related Group,SEIZURE,Inpatient,APR-DRG,, Not Applicable ," $16,657.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,130.82 "," $31,523.39 "," $28,543.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,657.55 "," $31,523.39 ", Not Applicable
,054-1,Diagnosis Related Group,SEIZURE,Inpatient,APR-DRG,, Not Applicable ," $4,274.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,705.23 "," $8,088.98 "," $7,324.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,274.37 "," $8,088.98 ", Not Applicable
,054-2,Diagnosis Related Group,SEIZURE,Inpatient,APR-DRG,, Not Applicable ," $5,202.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,161.07 "," $9,845.26 "," $8,914.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,202.42 "," $9,845.26 ", Not Applicable
,054-3,Diagnosis Related Group,MIGRAINE & OTHER HEADACHES,Inpatient,APR-DRG,, Not Applicable ," $6,365.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,985.60 "," $12,046.30 "," $10,907.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,365.49 "," $12,046.30 ", Not Applicable
,054-4,Diagnosis Related Group,MIGRAINE & OTHER HEADACHES,Inpatient,APR-DRG,, Not Applicable ," $10,653.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,712.44 "," $20,161.35 "," $18,255.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,653.64 "," $20,161.35 ", Not Applicable
,055-1,Diagnosis Related Group,MIGRAINE & OTHER HEADACHES,Inpatient,APR-DRG,, Not Applicable ," $4,918.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,715.41 "," $9,307.62 "," $8,427.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,918.32 "," $9,307.62 ", Not Applicable
,055-2,Diagnosis Related Group,MIGRAINE & OTHER HEADACHES,Inpatient,APR-DRG,, Not Applicable ," $6,709.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,525.80 "," $12,697.98 "," $11,497.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,709.85 "," $12,697.98 ", Not Applicable
,055-3,Diagnosis Related Group,HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE,Inpatient,APR-DRG,, Not Applicable ," $10,583.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,603.05 "," $20,029.38 "," $18,136.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,583.90 "," $20,029.38 ", Not Applicable
,055-4,Diagnosis Related Group,HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE,Inpatient,APR-DRG,, Not Applicable ," $23,178.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,360.86 "," $43,864.58 "," $39,718.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,178.87 "," $43,864.58 ", Not Applicable
,056-1,Diagnosis Related Group,HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE,Inpatient,APR-DRG,, Not Applicable ," $4,856.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,618.17 "," $9,190.32 "," $8,321.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,856.34 "," $9,190.32 ", Not Applicable
,056-2,Diagnosis Related Group,HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE,Inpatient,APR-DRG,, Not Applicable ," $6,876.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,786.44 "," $13,012.42 "," $11,782.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,876.01 "," $13,012.42 ", Not Applicable
,056-3,Diagnosis Related Group,"BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA",Inpatient,APR-DRG,, Not Applicable ," $11,006.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,266.14 "," $20,829.32 "," $18,860.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,006.61 "," $20,829.32 ", Not Applicable
,056-4,Diagnosis Related Group,"BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA",Inpatient,APR-DRG,, Not Applicable ," $25,816.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,498.79 "," $48,856.45 "," $44,238.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,816.67 "," $48,856.45 ", Not Applicable
,057-1,Diagnosis Related Group,"BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA",Inpatient,APR-DRG,, Not Applicable ," $4,496.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,053.66 "," $8,509.31 "," $7,704.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,496.48 "," $8,509.31 ", Not Applicable
,057-2,Diagnosis Related Group,"BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA",Inpatient,APR-DRG,, Not Applicable ," $6,118.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,598.00 "," $11,578.72 "," $10,484.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,118.42 "," $11,578.72 ", Not Applicable
,057-3,Diagnosis Related Group,"CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA",Inpatient,APR-DRG,, Not Applicable ," $9,142.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,342.31 "," $17,302.10 "," $15,666.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,142.76 "," $17,302.10 ", Not Applicable
,057-4,Diagnosis Related Group,"CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA",Inpatient,APR-DRG,, Not Applicable ," $19,637.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,804.91 "," $37,162.05 "," $33,649.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,637.13 "," $37,162.05 ", Not Applicable
,058-1,Diagnosis Related Group,"CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA",Inpatient,APR-DRG,, Not Applicable ," $4,893.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,676.24 "," $9,260.37 "," $8,385.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,893.36 "," $9,260.37 ", Not Applicable
,058-2,Diagnosis Related Group,"CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA",Inpatient,APR-DRG,, Not Applicable ," $6,022.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,446.75 "," $11,396.25 "," $10,319.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,022.00 "," $11,396.25 ", Not Applicable
,058-3,Diagnosis Related Group,OTHER DISORDERS OF NERVOUS SYSTEM,Inpatient,APR-DRG,, Not Applicable ," $8,154.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,791.94 "," $15,431.78 "," $13,973.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,154.44 "," $15,431.78 ", Not Applicable
,058-4,Diagnosis Related Group,OTHER DISORDERS OF NERVOUS SYSTEM,Inpatient,APR-DRG,, Not Applicable ," $17,340.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,201.77 "," $32,815.35 "," $29,713.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,340.25 "," $32,815.35 ", Not Applicable
,070-1,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $7,138.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,198.35 "," $13,509.33 "," $12,232.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,138.58 "," $13,509.33 ", Not Applicable
,070-2,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $9,883.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,505.09 "," $18,704.85 "," $16,936.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,883.99 "," $18,704.85 ", Not Applicable
,070-3,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $16,799.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,353.66 "," $31,792.21 "," $28,787.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,799.60 "," $31,792.21 ", Not Applicable
,070-4,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $42,176.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $66,162.35 "," $79,816.14 "," $72,271.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,176.35 "," $79,816.14 ", Not Applicable
,073-1,Diagnosis Related Group,ANOXIC & OTHER SEVERE BRAIN DAMAGE,Inpatient,APR-DRG,, Not Applicable ," $6,538.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,257.05 "," $12,373.77 "," $11,204.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,538.54 "," $12,373.77 ", Not Applicable
,073-2,Diagnosis Related Group,ANOXIC & OTHER SEVERE BRAIN DAMAGE,Inpatient,APR-DRG,, Not Applicable ," $7,699.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,077.52 "," $14,569.94 "," $13,192.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,699.03 "," $14,569.94 ", Not Applicable
,073-3,Diagnosis Related Group,ORBIT AND EYE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $11,763.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,453.23 "," $22,261.39 "," $20,157.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,763.34 "," $22,261.39 ", Not Applicable
,073-4,Diagnosis Related Group,ORBIT AND EYE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $26,554.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,656.17 "," $50,252.67 "," $45,502.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,554.46 "," $50,252.67 ", Not Applicable
,080-1,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $3,439.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,395.25 "," $6,508.65 "," $5,893.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,439.30 "," $6,508.65 ", Not Applicable
,080-2,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $4,532.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,110.38 "," $8,577.74 "," $7,766.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,532.64 "," $8,577.74 ", Not Applicable
,080-3,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $8,082.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,679.84 "," $15,296.56 "," $13,850.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,082.99 "," $15,296.56 ", Not Applicable
,080-4,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $13,506.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,187.99 "," $25,560.52 "," $23,144.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,506.66 "," $25,560.52 ", Not Applicable
,082-1,Diagnosis Related Group,ORBIT AND EYE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $3,737.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,862.52 "," $7,072.36 "," $6,403.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,737.17 "," $7,072.36 ", Not Applicable
,082-2,Diagnosis Related Group,ORBIT AND EYE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $4,933.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,739.72 "," $9,336.95 "," $8,454.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,933.82 "," $9,336.95 ", Not Applicable
,082-3,Diagnosis Related Group,EYE INFECTIONS AND OTHER EYE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $6,869.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,775.64 "," $12,999.39 "," $11,770.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,869.12 "," $12,999.39 ", Not Applicable
,082-4,Diagnosis Related Group,EYE INFECTIONS AND OTHER EYE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $12,203.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,143.34 "," $23,093.91 "," $20,910.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,203.26 "," $23,093.91 ", Not Applicable
,089-1,Diagnosis Related Group,EYE INFECTIONS AND OTHER EYE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $12,778.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,045.47 "," $24,182.22 "," $21,896.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,778.34 "," $24,182.22 ", Not Applicable
,089-2,Diagnosis Related Group,EYE INFECTIONS AND OTHER EYE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $16,458.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,818.86 "," $31,147.05 "," $28,202.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,458.69 "," $31,147.05 ", Not Applicable
,089-3,Diagnosis Related Group,MAJOR CRANIAL/FACIAL BONE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $27,915.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $43,791.31 "," $52,828.44 "," $47,834.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,915.54 "," $52,828.44 ", Not Applicable
,089-4,Diagnosis Related Group,MAJOR CRANIAL/FACIAL BONE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $48,819.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $76,584.15 "," $92,388.67 "," $83,655.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,819.92 "," $92,388.67 ", Not Applicable
,090-1,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $7,526.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,807.42 "," $14,244.10 "," $12,897.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,526.85 "," $14,244.10 ", Not Applicable
,090-2,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $19,812.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,080.41 "," $37,494.41 "," $33,950.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,812.75 "," $37,494.41 ", Not Applicable
,090-3,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $31,187.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,924.56 "," $59,021.03 "," $53,442.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,187.82 "," $59,021.03 ", Not Applicable
,090-4,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $56,336.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $88,375.37 "," $106,613.22 "," $96,535.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $56,336.44 "," $106,613.22 ", Not Applicable
,091-1,Diagnosis Related Group,MAJOR CRANIAL/FACIAL BONE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $11,260.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,664.54 "," $21,309.94 "," $19,295.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,260.57 "," $21,309.94 ", Not Applicable
,091-2,Diagnosis Related Group,MAJOR CRANIAL/FACIAL BONE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $16,527.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,926.90 "," $31,277.38 "," $28,320.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,527.56 "," $31,277.38 ", Not Applicable
,091-3,Diagnosis Related Group,OTHER MAJOR HEAD & NECK PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $29,058.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,584.78 "," $54,992.02 "," $49,793.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,058.82 "," $54,992.02 ", Not Applicable
,091-4,Diagnosis Related Group,OTHER MAJOR HEAD & NECK PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $44,907.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $70,447.48 "," $84,985.59 "," $76,952.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $44,907.99 "," $84,985.59 ", Not Applicable
,092-1,Diagnosis Related Group,OTHER MAJOR HEAD & NECK PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $9,005.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,126.23 "," $17,041.43 "," $15,430.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,005.01 "," $17,041.43 ", Not Applicable
,092-2,Diagnosis Related Group,OTHER MAJOR HEAD & NECK PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $12,458.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,543.09 "," $23,576.15 "," $21,347.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,458.08 "," $23,576.15 ", Not Applicable
,092-3,Diagnosis Related Group,FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $18,794.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,482.77 "," $35,567.07 "," $32,205.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,794.31 "," $35,567.07 ", Not Applicable
,092-4,Diagnosis Related Group,FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $40,122.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $62,940.05 "," $75,928.87 "," $68,751.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,122.24 "," $75,928.87 ", Not Applicable
,093-1,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $8,418.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,206.54 "," $15,931.95 "," $14,425.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,418.74 "," $15,931.95 ", Not Applicable
,093-2,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $11,080.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,382.29 "," $20,969.43 "," $18,987.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,080.64 "," $20,969.43 ", Not Applicable
,093-3,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $17,892.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,068.79 "," $33,861.29 "," $30,660.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,892.95 "," $33,861.29 ", Not Applicable
,093-4,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $28,036.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $43,981.73 "," $53,058.16 "," $48,042.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,036.93 "," $53,058.16 ", Not Applicable
,095-1,Diagnosis Related Group,FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $5,991.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,398.13 "," $11,337.60 "," $10,265.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,991.00 "," $11,337.60 ", Not Applicable
,095-2,Diagnosis Related Group,FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $6,848.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,743.23 "," $12,960.29 "," $11,735.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,848.46 "," $12,960.29 ", Not Applicable
,095-3,Diagnosis Related Group,CLEFT LIP & PALATE REPAIR,Inpatient,APR-DRG,, Not Applicable ," $9,995.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,679.31 "," $18,915.01 "," $17,127.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,995.05 "," $18,915.01 ", Not Applicable
,095-4,Diagnosis Related Group,CLEFT LIP & PALATE REPAIR,Inpatient,APR-DRG,, Not Applicable ," $21,005.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,952.20 "," $39,752.48 "," $35,994.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,005.96 "," $39,752.48 ", Not Applicable
,097-1,Diagnosis Related Group,CLEFT LIP & PALATE REPAIR,Inpatient,APR-DRG,, Not Applicable ," $3,684.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,780.14 "," $6,972.98 "," $6,313.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,684.65 "," $6,972.98 ", Not Applicable
,097-2,Diagnosis Related Group,CLEFT LIP & PALATE REPAIR,Inpatient,APR-DRG,, Not Applicable ," $5,437.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,529.76 "," $10,290.03 "," $9,317.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,437.44 "," $10,290.03 ", Not Applicable
,097-3,Diagnosis Related Group,TONSIL & ADENOID PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $9,680.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,186.37 "," $18,320.35 "," $16,588.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,680.82 "," $18,320.35 ", Not Applicable
,097-4,Diagnosis Related Group,TONSIL & ADENOID PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $28,011.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $43,942.57 "," $53,010.91 "," $48,000.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,011.96 "," $53,010.91 ", Not Applicable
,098-1,Diagnosis Related Group,TONSIL & ADENOID PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $6,271.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,838.39 "," $11,868.72 "," $10,746.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,271.66 "," $11,868.72 ", Not Applicable
,098-2,Diagnosis Related Group,TONSIL & ADENOID PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $8,194.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,854.06 "," $15,506.73 "," $14,040.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,194.05 "," $15,506.73 ", Not Applicable
,098-3,Diagnosis Related Group,"OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $13,056.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,481.68 "," $24,708.45 "," $22,372.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,056.41 "," $24,708.45 ", Not Applicable
,098-4,Diagnosis Related Group,"OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $28,736.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,079.69 "," $54,382.70 "," $49,242.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,736.84 "," $54,382.70 ", Not Applicable
,110-1,Diagnosis Related Group,"EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES",Inpatient,APR-DRG,, Not Applicable ," $4,580.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,186.01 "," $8,668.97 "," $7,849.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,580.85 "," $8,668.97 ", Not Applicable
,110-2,Diagnosis Related Group,"EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES",Inpatient,APR-DRG,, Not Applicable ," $5,779.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,065.91 "," $10,936.82 "," $9,903.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,779.22 "," $10,936.82 ", Not Applicable
,110-3,Diagnosis Related Group,"EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES",Inpatient,APR-DRG,, Not Applicable ," $9,821.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,406.50 "," $18,585.91 "," $16,829.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,821.15 "," $18,585.91 ", Not Applicable
,110-4,Diagnosis Related Group,"EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES",Inpatient,APR-DRG,, Not Applicable ," $19,096.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,956.79 "," $36,138.91 "," $32,722.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,096.48 "," $36,138.91 ", Not Applicable
,111-1,Diagnosis Related Group,VERTIGO & OTHER LABYRINTH DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $4,180.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,558.03 "," $7,911.40 "," $7,163.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,180.53 "," $7,911.40 ", Not Applicable
,111-2,Diagnosis Related Group,VERTIGO & OTHER LABYRINTH DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $4,831.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,579.01 "," $9,143.07 "," $8,278.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,831.37 "," $9,143.07 ", Not Applicable
,111-3,Diagnosis Related Group,VERTIGO & OTHER LABYRINTH DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $5,997.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,408.93 "," $11,350.64 "," $10,277.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,997.89 "," $11,350.64 ", Not Applicable
,111-4,Diagnosis Related Group,VERTIGO & OTHER LABYRINTH DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $11,506.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,050.78 "," $21,775.89 "," $19,717.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,506.79 "," $21,775.89 ", Not Applicable
,113-1,Diagnosis Related Group,INFECTIONS OF UPPER RESPIRATORY TRACT,Inpatient,APR-DRG,, Not Applicable ," $2,459.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,858.38 "," $4,654.62 "," $4,214.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,459.59 "," $4,654.62 ", Not Applicable
,113-2,Diagnosis Related Group,INFECTIONS OF UPPER RESPIRATORY TRACT,Inpatient,APR-DRG,, Not Applicable ," $3,666.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,751.78 "," $6,938.76 "," $6,282.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,666.57 "," $6,938.76 ", Not Applicable
,113-3,Diagnosis Related Group,INFECTIONS OF UPPER RESPIRATORY TRACT,Inpatient,APR-DRG,, Not Applicable ," $5,687.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,921.40 "," $10,762.50 "," $9,745.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,687.11 "," $10,762.50 ", Not Applicable
,113-4,Diagnosis Related Group,INFECTIONS OF UPPER RESPIRATORY TRACT,Inpatient,APR-DRG,, Not Applicable ," $10,465.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,418.03 "," $19,806.18 "," $17,934.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,465.96 "," $19,806.18 ", Not Applicable
,114-1,Diagnosis Related Group,DENTAL DISEASES AND DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $3,418.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,362.84 "," $6,469.55 "," $5,858.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,418.63 "," $6,469.55 ", Not Applicable
,114-2,Diagnosis Related Group,DENTAL DISEASES AND DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $4,759.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,466.91 "," $9,007.85 "," $8,156.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,759.92 "," $9,007.85 ", Not Applicable
,114-3,Diagnosis Related Group,DENTAL DISEASES AND DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $7,934.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,447.56 "," $15,016.34 "," $13,596.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,934.92 "," $15,016.34 ", Not Applicable
,114-4,Diagnosis Related Group,DENTAL DISEASES AND DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $17,056.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,756.11 "," $32,277.71 "," $29,226.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,056.15 "," $32,277.71 ", Not Applicable
,115-1,Diagnosis Related Group,"OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $3,540.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,554.61 "," $6,700.90 "," $6,067.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,540.88 "," $6,700.90 ", Not Applicable
,115-2,Diagnosis Related Group,"OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $4,897.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,682.99 "," $9,268.52 "," $8,392.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,897.66 "," $9,268.52 ", Not Applicable
,115-3,Diagnosis Related Group,"OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $7,212.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,314.49 "," $13,649.44 "," $12,359.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,212.62 "," $13,649.44 ", Not Applicable
,115-4,Diagnosis Related Group,"OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $14,270.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,385.89 "," $27,005.62 "," $24,452.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,270.28 "," $27,005.62 ", Not Applicable
,120-1,Diagnosis Related Group,MAJOR RESPIRATORY & CHEST PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $15,353.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,084.82 "," $29,055.15 "," $26,308.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,353.29 "," $29,055.15 ", Not Applicable
,120-2,Diagnosis Related Group,MAJOR RESPIRATORY & CHEST PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $19,173.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,078.34 "," $36,285.54 "," $32,855.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,173.96 "," $36,285.54 ", Not Applicable
,120-3,Diagnosis Related Group,MAJOR RESPIRATORY & CHEST PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $27,126.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,554.26 "," $51,336.09 "," $46,483.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,126.96 "," $51,336.09 ", Not Applicable
,120-4,Diagnosis Related Group,MAJOR RESPIRATORY & CHEST PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $45,086.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $70,727.04 "," $85,322.83 "," $77,257.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,086.19 "," $85,322.83 ", Not Applicable
,121-1,Diagnosis Related Group,OTHER RESPIRATORY & CHEST PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $10,265.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,103.36 "," $19,426.58 "," $17,590.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,265.37 "," $19,426.58 ", Not Applicable
,121-2,Diagnosis Related Group,OTHER RESPIRATORY & CHEST PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $13,183.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,681.56 "," $24,949.57 "," $22,591.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,183.82 "," $24,949.57 ", Not Applicable
,121-3,Diagnosis Related Group,OTHER RESPIRATORY & CHEST PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $19,992.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,362.66 "," $37,834.91 "," $34,258.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,992.68 "," $37,834.91 ", Not Applicable
,121-4,Diagnosis Related Group,OTHER RESPIRATORY & CHEST PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $37,470.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $58,780.51 "," $70,910.93 "," $64,208.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,470.67 "," $70,910.93 ", Not Applicable
,130-1,Diagnosis Related Group,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS,Inpatient,APR-DRG,, Not Applicable ," $23,810.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,352.13 "," $45,060.41 "," $40,801.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,810.77 "," $45,060.41 ", Not Applicable
,130-2,Diagnosis Related Group,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS,Inpatient,APR-DRG,, Not Applicable ," $24,537.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,491.95 "," $46,435.46 "," $42,046.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,537.37 "," $46,435.46 ", Not Applicable
,130-3,Diagnosis Related Group,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS,Inpatient,APR-DRG,, Not Applicable ," $31,028.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,674.72 "," $58,719.63 "," $53,169.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,028.56 "," $58,719.63 ", Not Applicable
,130-4,Diagnosis Related Group,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS,Inpatient,APR-DRG,, Not Applicable ," $42,061.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $65,982.73 "," $79,599.45 "," $72,075.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,061.85 "," $79,599.45 ", Not Applicable
,131-1,Diagnosis Related Group,CYSTIC FIBROSIS - PULMONARY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $9,539.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,964.89 "," $18,053.17 "," $16,346.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,539.63 "," $18,053.17 ", Not Applicable
,131-2,Diagnosis Related Group,CYSTIC FIBROSIS - PULMONARY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $12,245.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,209.51 "," $23,173.74 "," $20,983.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,245.44 "," $23,173.74 ", Not Applicable
,131-3,Diagnosis Related Group,CYSTIC FIBROSIS - PULMONARY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $16,017.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,126.05 "," $30,311.27 "," $27,446.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,017.04 "," $30,311.27 ", Not Applicable
,131-4,Diagnosis Related Group,CYSTIC FIBROSIS - PULMONARY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $21,193.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,246.61 "," $40,107.65 "," $36,316.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,193.64 "," $40,107.65 ", Not Applicable
,132-1,Diagnosis Related Group,BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD,Inpatient,APR-DRG,, Not Applicable ," $4,010.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,291.98 "," $7,590.44 "," $6,872.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,010.93 "," $7,590.44 ", Not Applicable
,132-2,Diagnosis Related Group,BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD,Inpatient,APR-DRG,, Not Applicable ," $4,305.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,753.85 "," $8,147.63 "," $7,377.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,305.36 "," $8,147.63 ", Not Applicable
,132-3,Diagnosis Related Group,BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD,Inpatient,APR-DRG,, Not Applicable ," $6,435.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,094.99 "," $12,178.27 "," $11,027.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,435.23 "," $12,178.27 ", Not Applicable
,132-4,Diagnosis Related Group,BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD,Inpatient,APR-DRG,, Not Applicable ," $10,425.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,354.56 "," $19,729.61 "," $17,864.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,425.50 "," $19,729.61 ", Not Applicable
,133-1,Diagnosis Related Group,RESPIRATORY FAILURE,Inpatient,APR-DRG,, Not Applicable ," $3,181.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,991.45 "," $6,021.52 "," $5,452.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,181.89 "," $6,021.52 ", Not Applicable
,133-2,Diagnosis Related Group,RESPIRATORY FAILURE,Inpatient,APR-DRG,, Not Applicable ," $6,421.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,073.38 "," $12,152.20 "," $11,003.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,421.45 "," $12,152.20 ", Not Applicable
,133-3,Diagnosis Related Group,RESPIRATORY FAILURE,Inpatient,APR-DRG,, Not Applicable ," $9,434.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,800.13 "," $17,854.40 "," $16,166.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,434.60 "," $17,854.40 ", Not Applicable
,133-4,Diagnosis Related Group,RESPIRATORY FAILURE,Inpatient,APR-DRG,, Not Applicable ," $16,469.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,835.07 "," $31,166.60 "," $28,220.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,469.02 "," $31,166.60 ", Not Applicable
,134-1,Diagnosis Related Group,PULMONARY EMBOLISM,Inpatient,APR-DRG,, Not Applicable ," $5,696.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,936.26 "," $10,780.42 "," $9,761.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,696.58 "," $10,780.42 ", Not Applicable
,134-2,Diagnosis Related Group,PULMONARY EMBOLISM,Inpatient,APR-DRG,, Not Applicable ," $7,239.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,356.35 "," $13,699.94 "," $12,404.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,239.31 "," $13,699.94 ", Not Applicable
,134-3,Diagnosis Related Group,PULMONARY EMBOLISM,Inpatient,APR-DRG,, Not Applicable ," $10,353.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,241.11 "," $19,592.76 "," $17,740.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,353.18 "," $19,592.76 ", Not Applicable
,134-4,Diagnosis Related Group,PULMONARY EMBOLISM,Inpatient,APR-DRG,, Not Applicable ," $17,495.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,444.86 "," $33,108.60 "," $29,979.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,495.21 "," $33,108.60 ", Not Applicable
,135-1,Diagnosis Related Group,MAJOR CHEST & RESPIRATORY TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $5,361.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,410.91 "," $10,146.66 "," $9,187.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,361.69 "," $10,146.66 ", Not Applicable
,135-2,Diagnosis Related Group,MAJOR CHEST & RESPIRATORY TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $6,854.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,752.68 "," $12,971.69 "," $11,745.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,854.49 "," $12,971.69 ", Not Applicable
,135-3,Diagnosis Related Group,MAJOR CHEST & RESPIRATORY TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $10,020.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,718.47 "," $18,962.26 "," $17,169.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,020.02 "," $18,962.26 ", Not Applicable
,135-4,Diagnosis Related Group,MAJOR CHEST & RESPIRATORY TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $18,833.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,544.89 "," $35,642.01 "," $32,272.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,833.91 "," $35,642.01 ", Not Applicable
,136-1,Diagnosis Related Group,RESPIRATORY MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $4,804.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,537.14 "," $9,092.57 "," $8,233.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,804.68 "," $9,092.57 ", Not Applicable
,136-2,Diagnosis Related Group,RESPIRATORY MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $6,699.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,509.59 "," $12,678.43 "," $11,480.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,699.52 "," $12,678.43 ", Not Applicable
,136-3,Diagnosis Related Group,RESPIRATORY MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $10,290.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,142.53 "," $19,473.83 "," $17,633.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,290.34 "," $19,473.83 ", Not Applicable
,136-4,Diagnosis Related Group,RESPIRATORY MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $16,469.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,835.07 "," $31,166.60 "," $28,220.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,469.02 "," $31,166.60 ", Not Applicable
,137-1,Diagnosis Related Group,MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS,Inpatient,APR-DRG,, Not Applicable ," $5,411.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,489.24 "," $10,241.15 "," $9,273.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,411.62 "," $10,241.15 ", Not Applicable
,137-2,Diagnosis Related Group,MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS,Inpatient,APR-DRG,, Not Applicable ," $7,055.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,067.35 "," $13,351.29 "," $12,089.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,055.08 "," $13,351.29 ", Not Applicable
,137-3,Diagnosis Related Group,MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS,Inpatient,APR-DRG,, Not Applicable ," $10,011.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,704.96 "," $18,945.97 "," $17,155.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,011.41 "," $18,945.97 ", Not Applicable
,137-4,Diagnosis Related Group,MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS,Inpatient,APR-DRG,, Not Applicable ," $16,381.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,697.31 "," $31,000.42 "," $28,070.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,381.21 "," $31,000.42 ", Not Applicable
,138-1,Diagnosis Related Group,BRONCHIOLITIS & RSV PNEUMONIA,Inpatient,APR-DRG,, Not Applicable ," $2,296.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,601.78 "," $4,345.08 "," $3,934.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,296.02 "," $4,345.08 ", Not Applicable
,138-2,Diagnosis Related Group,BRONCHIOLITIS & RSV PNEUMONIA,Inpatient,APR-DRG,, Not Applicable ," $3,322.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,211.58 "," $6,287.08 "," $5,692.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,322.21 "," $6,287.08 ", Not Applicable
,138-3,Diagnosis Related Group,BRONCHIOLITIS & RSV PNEUMONIA,Inpatient,APR-DRG,, Not Applicable ," $7,018.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,009.28 "," $13,281.24 "," $12,025.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,018.06 "," $13,281.24 ", Not Applicable
,138-4,Diagnosis Related Group,BRONCHIOLITIS & RSV PNEUMONIA,Inpatient,APR-DRG,, Not Applicable ," $17,768.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,872.97 "," $33,625.06 "," $30,446.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,768.12 "," $33,625.06 ", Not Applicable
,139-1,Diagnosis Related Group,OTHER PNEUMONIA,Inpatient,APR-DRG,, Not Applicable ," $3,803.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,966.51 "," $7,197.81 "," $6,517.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.46 "," $7,197.81 ", Not Applicable
,139-2,Diagnosis Related Group,OTHER PNEUMONIA,Inpatient,APR-DRG,, Not Applicable ," $5,405.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,479.79 "," $10,229.75 "," $9,262.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,405.59 "," $10,229.75 ", Not Applicable
,139-3,Diagnosis Related Group,OTHER PNEUMONIA,Inpatient,APR-DRG,, Not Applicable ," $8,200.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,863.51 "," $15,518.13 "," $14,051.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,200.07 "," $15,518.13 ", Not Applicable
,139-4,Diagnosis Related Group,OTHER PNEUMONIA,Inpatient,APR-DRG,, Not Applicable ," $14,780.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,186.73 "," $27,971.73 "," $25,327.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,780.79 "," $27,971.73 ", Not Applicable
,140-1,Diagnosis Related Group,CHRONIC OBSTRUCTIVE PULMONARY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $4,430.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,949.67 "," $8,383.86 "," $7,591.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,430.19 "," $8,383.86 ", Not Applicable
,140-2,Diagnosis Related Group,CHRONIC OBSTRUCTIVE PULMONARY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $5,501.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,629.70 "," $10,410.59 "," $9,426.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,501.15 "," $10,410.59 ", Not Applicable
,140-3,Diagnosis Related Group,CHRONIC OBSTRUCTIVE PULMONARY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $7,307.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,463.04 "," $13,828.65 "," $12,521.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,307.32 "," $13,828.65 ", Not Applicable
,140-4,Diagnosis Related Group,CHRONIC OBSTRUCTIVE PULMONARY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $13,557.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,267.67 "," $25,656.64 "," $23,231.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,557.45 "," $25,656.64 ", Not Applicable
,141-1,Diagnosis Related Group,ASTHMA,Inpatient,APR-DRG,, Not Applicable ," $2,938.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,609.26 "," $5,560.46 "," $5,034.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,938.25 "," $5,560.46 ", Not Applicable
,141-2,Diagnosis Related Group,ASTHMA,Inpatient,APR-DRG,, Not Applicable ," $4,285.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,722.79 "," $8,110.16 "," $7,343.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,285.56 "," $8,110.16 ", Not Applicable
,141-3,Diagnosis Related Group,ASTHMA,Inpatient,APR-DRG,, Not Applicable ," $6,213.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,746.56 "," $11,757.94 "," $10,646.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,213.12 "," $11,757.94 ", Not Applicable
,141-4,Diagnosis Related Group,ASTHMA,Inpatient,APR-DRG,, Not Applicable ," $11,317.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,753.67 "," $21,417.46 "," $19,392.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,317.39 "," $21,417.46 ", Not Applicable
,142-1,Diagnosis Related Group,INTERSTITIAL & ALVEOLAR LUNG DISEASES,Inpatient,APR-DRG,, Not Applicable ," $5,072.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,957.15 "," $9,599.25 "," $8,691.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,072.42 "," $9,599.25 ", Not Applicable
,142-2,Diagnosis Related Group,INTERSTITIAL & ALVEOLAR LUNG DISEASES,Inpatient,APR-DRG,, Not Applicable ," $6,208.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,739.81 "," $11,749.79 "," $10,639.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,208.81 "," $11,749.79 ", Not Applicable
,142-3,Diagnosis Related Group,INTERSTITIAL & ALVEOLAR LUNG DISEASES,Inpatient,APR-DRG,, Not Applicable ," $8,944.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,031.70 "," $16,927.39 "," $15,327.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,944.75 "," $16,927.39 ", Not Applicable
,142-4,Diagnosis Related Group,INTERSTITIAL & ALVEOLAR LUNG DISEASES,Inpatient,APR-DRG,, Not Applicable ," $15,862.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,882.96 "," $30,018.01 "," $27,180.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,862.08 "," $30,018.01 ", Not Applicable
,143-1,Diagnosis Related Group,"OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $3,949.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,196.09 "," $7,474.77 "," $6,768.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,949.81 "," $7,474.77 ", Not Applicable
,143-2,Diagnosis Related Group,"OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $5,644.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,853.88 "," $10,681.04 "," $9,671.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,644.06 "," $10,681.04 ", Not Applicable
,143-3,Diagnosis Related Group,"OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $8,333.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,072.84 "," $15,770.66 "," $14,279.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,333.51 "," $15,770.66 ", Not Applicable
,143-4,Diagnosis Related Group,"OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $13,504.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,183.94 "," $25,555.63 "," $23,139.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,504.08 "," $25,555.63 ", Not Applicable
,144-1,Diagnosis Related Group,"RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $3,805.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,969.21 "," $7,201.06 "," $6,520.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,805.18 "," $7,201.06 ", Not Applicable
,144-2,Diagnosis Related Group,"RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $4,706.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,383.18 "," $8,906.84 "," $8,064.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,706.54 "," $8,906.84 ", Not Applicable
,144-3,Diagnosis Related Group,"RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $6,425.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,080.13 "," $12,160.35 "," $11,010.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,425.76 "," $12,160.35 ", Not Applicable
,144-4,Diagnosis Related Group,"RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $10,330.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,206.00 "," $19,550.40 "," $17,702.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,330.80 "," $19,550.40 ", Not Applicable
,160-1,Diagnosis Related Group,MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $25,014.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,240.13 "," $47,338.04 "," $42,863.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,014.31 "," $47,338.04 ", Not Applicable
,160-2,Diagnosis Related Group,MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $28,717.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,049.98 "," $54,346.85 "," $49,209.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,717.90 "," $54,346.85 ", Not Applicable
,160-3,Diagnosis Related Group,MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $41,951.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $65,809.87 "," $79,390.92 "," $71,886.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,951.66 "," $79,390.92 ", Not Applicable
,160-4,Diagnosis Related Group,MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $78,044.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $122,429.58 "," $147,695.13 "," $133,734.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $78,044.89 "," $147,695.13 ", Not Applicable
,161-1,Diagnosis Related Group,CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT,Inpatient,APR-DRG,, Not Applicable ," $33,659.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $52,801.85 "," $63,698.46 "," $57,677.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,659.47 "," $63,698.46 ", Not Applicable
,161-2,Diagnosis Related Group,CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT,Inpatient,APR-DRG,, Not Applicable ," $44,355.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $69,580.46 "," $83,939.64 "," $76,005.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $44,355.29 "," $83,939.64 ", Not Applicable
,161-3,Diagnosis Related Group,CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT,Inpatient,APR-DRG,, Not Applicable ," $69,307.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $108,723.35 "," $131,160.38 "," $118,762.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $69,307.62 "," $131,160.38 ", Not Applicable
,161-4,Diagnosis Related Group,CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT,Inpatient,APR-DRG,, Not Applicable ," $174,956.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $274,455.36 "," $331,094.17 "," $299,797.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $174,956.40 "," $331,094.17 ", Not Applicable
,162-1,Diagnosis Related Group,CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $35,394.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,523.11 "," $66,981.30 "," $60,649.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,394.18 "," $66,981.30 ", Not Applicable
,162-2,Diagnosis Related Group,CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $42,254.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $66,285.24 "," $79,964.39 "," $72,405.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,254.69 "," $79,964.39 ", Not Applicable
,162-3,Diagnosis Related Group,CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $53,962.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $84,650.69 "," $102,119.89 "," $92,467.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $53,962.07 "," $102,119.89 ", Not Applicable
,162-4,Diagnosis Related Group,CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $81,266.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $127,483.15 "," $153,791.59 "," $139,254.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $81,266.38 "," $153,791.59 ", Not Applicable
,163-1,Diagnosis Related Group,CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $31,735.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,783.48 "," $60,057.20 "," $54,380.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,735.36 "," $60,057.20 ", Not Applicable
,163-2,Diagnosis Related Group,CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $36,942.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $57,951.31 "," $69,910.60 "," $63,302.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,942.08 "," $69,910.60 ", Not Applicable
,163-3,Diagnosis Related Group,CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $45,296.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $71,056.56 "," $85,720.36 "," $77,617.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,296.25 "," $85,720.36 ", Not Applicable
,163-4,Diagnosis Related Group,CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $70,086.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $109,945.56 "," $132,634.80 "," $120,097.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $70,086.73 "," $132,634.80 ", Not Applicable
,165-1,Diagnosis Related Group,CORONARY BYPASS W AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $34,822.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $54,626.37 "," $65,899.51 "," $59,670.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,822.54 "," $65,899.51 ", Not Applicable
,165-2,Diagnosis Related Group,CORONARY BYPASS W AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $38,021.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $59,644.83 "," $71,953.62 "," $65,152.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,021.65 "," $71,953.62 ", Not Applicable
,165-3,Diagnosis Related Group,CORONARY BYPASS W AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $46,079.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $72,285.51 "," $87,202.93 "," $78,960.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $46,079.67 "," $87,202.93 ", Not Applicable
,165-4,Diagnosis Related Group,CORONARY BYPASS W AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $64,553.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $101,265.89 "," $122,163.93 "," $110,616.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $64,553.73 "," $122,163.93 ", Not Applicable
,166-1,Diagnosis Related Group,CORONARY BYPASS W/O AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $29,235.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,861.63 "," $55,326.00 "," $50,096.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,235.30 "," $55,326.00 ", Not Applicable
,166-2,Diagnosis Related Group,CORONARY BYPASS W/O AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $32,529.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,029.99 "," $61,560.95 "," $55,741.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,529.97 "," $61,560.95 ", Not Applicable
,166-3,Diagnosis Related Group,CORONARY BYPASS W/O AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $39,282.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $61,621.96 "," $74,338.77 "," $67,311.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,282.01 "," $74,338.77 ", Not Applicable
,166-4,Diagnosis Related Group,CORONARY BYPASS W/O AMI OR COMPLEX PDX,Inpatient,APR-DRG,, Not Applicable ," $57,197.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $89,725.87 "," $108,242.42 "," $98,010.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $57,197.34 "," $108,242.42 ", Not Applicable
,167-1,Diagnosis Related Group,OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $24,438.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,336.64 "," $46,248.10 "," $41,876.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,438.37 "," $46,248.10 ", Not Applicable
,167-2,Diagnosis Related Group,OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $27,485.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $43,116.06 "," $52,013.84 "," $47,097.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,485.09 "," $52,013.84 ", Not Applicable
,167-3,Diagnosis Related Group,OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $35,785.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $56,137.58 "," $67,722.59 "," $61,321.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,785.89 "," $67,722.59 ", Not Applicable
,167-4,Diagnosis Related Group,OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $59,526.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $93,378.97 "," $112,649.40 "," $102,001.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $59,526.07 "," $112,649.40 ", Not Applicable
,169-1,Diagnosis Related Group,MAJOR ABDOMINAL VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $15,106.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,697.22 "," $28,587.57 "," $25,885.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,106.21 "," $28,587.57 ", Not Applicable
,169-2,Diagnosis Related Group,MAJOR ABDOMINAL VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $19,118.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,991.90 "," $36,181.27 "," $32,761.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,118.87 "," $36,181.27 ", Not Applicable
,169-3,Diagnosis Related Group,MAJOR ABDOMINAL VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $30,357.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $47,622.68 "," $57,450.48 "," $52,019.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,357.92 "," $57,450.48 ", Not Applicable
,169-4,Diagnosis Related Group,MAJOR ABDOMINAL VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $53,328.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $83,656.72 "," $100,920.79 "," $91,381.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $53,328.45 "," $100,920.79 ", Not Applicable
,170-1,Diagnosis Related Group,"PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK",Inpatient,APR-DRG,, Not Applicable ," $18,667.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,284.24 "," $35,327.57 "," $31,988.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,667.76 "," $35,327.57 ", Not Applicable
,170-2,Diagnosis Related Group,"PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK",Inpatient,APR-DRG,, Not Applicable ," $21,252.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,338.44 "," $40,218.43 "," $36,416.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,252.18 "," $40,218.43 ", Not Applicable
,170-3,Diagnosis Related Group,"PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK",Inpatient,APR-DRG,, Not Applicable ," $25,765.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,419.11 "," $48,760.33 "," $44,151.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,765.88 "," $48,760.33 ", Not Applicable
,170-4,Diagnosis Related Group,"PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK",Inpatient,APR-DRG,, Not Applicable ," $37,727.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $59,182.96 "," $71,396.43 "," $64,647.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,727.22 "," $71,396.43 ", Not Applicable
,171-1,Diagnosis Related Group,"PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK",Inpatient,APR-DRG,, Not Applicable ," $13,836.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,705.24 "," $26,184.50 "," $23,709.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,836.38 "," $26,184.50 ", Not Applicable
,171-2,Diagnosis Related Group,"PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK",Inpatient,APR-DRG,, Not Applicable ," $16,077.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,220.59 "," $30,425.31 "," $27,549.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,077.31 "," $30,425.31 ", Not Applicable
,171-3,Diagnosis Related Group,"PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK",Inpatient,APR-DRG,, Not Applicable ," $20,292.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,832.64 "," $38,401.87 "," $34,771.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,292.27 "," $38,401.87 ", Not Applicable
,171-4,Diagnosis Related Group,"PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK",Inpatient,APR-DRG,, Not Applicable ," $31,826.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,926.63 "," $60,229.89 "," $54,536.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,826.61 "," $60,229.89 ", Not Applicable
,174-1,Diagnosis Related Group,PERCUTANEOUS CORONARY INTERVENTION W AMI,Inpatient,APR-DRG,, Not Applicable ," $17,707.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,778.43 "," $33,511.01 "," $30,343.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,707.85 "," $33,511.01 ", Not Applicable
,174-2,Diagnosis Related Group,PERCUTANEOUS CORONARY INTERVENTION W AMI,Inpatient,APR-DRG,, Not Applicable ," $18,864.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,592.16 "," $35,699.03 "," $32,324.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,864.04 "," $35,699.03 ", Not Applicable
,174-3,Diagnosis Related Group,PERCUTANEOUS CORONARY INTERVENTION W AMI,Inpatient,APR-DRG,, Not Applicable ," $23,246.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,466.20 "," $43,991.66 "," $39,833.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,246.02 "," $43,991.66 ", Not Applicable
,174-4,Diagnosis Related Group,PERCUTANEOUS CORONARY INTERVENTION W AMI,Inpatient,APR-DRG,, Not Applicable ," $35,485.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,666.26 "," $67,153.99 "," $60,806.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,485.44 "," $67,153.99 ", Not Applicable
,175-1,Diagnosis Related Group,PERCUTANEOUS CORONARY INTERVENTION W/O AMI,Inpatient,APR-DRG,, Not Applicable ," $15,793.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,774.92 "," $29,887.67 "," $27,062.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,793.21 "," $29,887.67 ", Not Applicable
,175-2,Diagnosis Related Group,PERCUTANEOUS CORONARY INTERVENTION W/O AMI,Inpatient,APR-DRG,, Not Applicable ," $17,568.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,559.65 "," $33,247.08 "," $30,104.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,568.39 "," $33,247.08 ", Not Applicable
,175-3,Diagnosis Related Group,PERCUTANEOUS CORONARY INTERVENTION W/O AMI,Inpatient,APR-DRG,, Not Applicable ," $22,424.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,177.82 "," $42,437.40 "," $38,426.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,424.72 "," $42,437.40 ", Not Applicable
,175-4,Diagnosis Related Group,PERCUTANEOUS CORONARY INTERVENTION W/O AMI,Inpatient,APR-DRG,, Not Applicable ," $40,148.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $62,980.57 "," $75,977.74 "," $68,795.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,148.07 "," $75,977.74 ", Not Applicable
,176-1,Diagnosis Related Group,CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $11,849.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,588.28 "," $22,424.31 "," $20,304.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,849.43 "," $22,424.31 ", Not Applicable
,176-2,Diagnosis Related Group,CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $21,326.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,454.59 "," $40,358.54 "," $36,543.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,326.21 "," $40,358.54 ", Not Applicable
,176-3,Diagnosis Related Group,CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $23,768.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,285.95 "," $44,980.58 "," $40,728.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,768.59 "," $44,980.58 ", Not Applicable
,176-4,Diagnosis Related Group,CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $36,021.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $56,507.62 "," $68,168.99 "," $61,725.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,021.78 "," $68,168.99 ", Not Applicable
,177-1,Diagnosis Related Group,CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $9,418.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,774.47 "," $17,823.45 "," $16,138.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,418.25 "," $17,823.45 ", Not Applicable
,177-2,Diagnosis Related Group,CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $12,363.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,394.53 "," $23,396.94 "," $21,185.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,363.38 "," $23,396.94 ", Not Applicable
,177-3,Diagnosis Related Group,CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $17,798.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,920.24 "," $33,682.08 "," $30,498.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,798.25 "," $33,682.08 ", Not Applicable
,177-4,Diagnosis Related Group,CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $34,194.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $53,640.51 "," $64,710.19 "," $58,593.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,194.09 "," $64,710.19 ", Not Applicable
,180-1,Diagnosis Related Group,OTHER CIRCULATORY SYSTEM PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $9,202.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,435.49 "," $17,414.52 "," $15,768.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,202.16 "," $17,414.52 ", Not Applicable
,180-2,Diagnosis Related Group,OTHER CIRCULATORY SYSTEM PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $11,685.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,330.34 "," $22,113.13 "," $20,022.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,685.00 "," $22,113.13 ", Not Applicable
,180-3,Diagnosis Related Group,OTHER CIRCULATORY SYSTEM PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $18,082.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,365.90 "," $34,219.72 "," $30,985.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,082.34 "," $34,219.72 ", Not Applicable
,180-4,Diagnosis Related Group,OTHER CIRCULATORY SYSTEM PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $31,081.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,758.45 "," $58,820.64 "," $53,260.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,081.93 "," $58,820.64 ", Not Applicable
,181-1,Diagnosis Related Group,LOWER EXTREMITY ARTERIAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $12,730.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,969.84 "," $24,090.98 "," $21,813.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,730.13 "," $24,090.98 ", Not Applicable
,181-2,Diagnosis Related Group,LOWER EXTREMITY ARTERIAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $17,108.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,838.49 "," $32,377.09 "," $29,316.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,108.67 "," $32,377.09 ", Not Applicable
,181-3,Diagnosis Related Group,LOWER EXTREMITY ARTERIAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $26,798.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,039.71 "," $50,715.37 "," $45,921.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,798.96 "," $50,715.37 ", Not Applicable
,181-4,Diagnosis Related Group,LOWER EXTREMITY ARTERIAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $47,991.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $75,284.97 "," $90,821.38 "," $82,236.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $47,991.73 "," $90,821.38 ", Not Applicable
,182-1,Diagnosis Related Group,OTHER PERIPHERAL VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $15,694.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,619.62 "," $29,700.32 "," $26,892.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,694.21 "," $29,700.32 ", Not Applicable
,182-2,Diagnosis Related Group,OTHER PERIPHERAL VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $18,225.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,590.09 "," $34,490.16 "," $31,229.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,225.25 "," $34,490.16 ", Not Applicable
,182-3,Diagnosis Related Group,OTHER PERIPHERAL VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $24,273.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,077.35 "," $45,935.29 "," $41,593.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,273.08 "," $45,935.29 ", Not Applicable
,182-4,Diagnosis Related Group,OTHER PERIPHERAL VASCULAR PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $42,098.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $66,040.80 "," $79,669.51 "," $72,138.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,098.87 "," $79,669.51 ", Not Applicable
,190-1,Diagnosis Related Group,ACUTE MYOCARDIAL INFARCTION,Inpatient,APR-DRG,, Not Applicable ," $6,937.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,883.68 "," $13,129.72 "," $11,888.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,937.99 "," $13,129.72 ", Not Applicable
,190-2,Diagnosis Related Group,ACUTE MYOCARDIAL INFARCTION,Inpatient,APR-DRG,, Not Applicable ," $7,661.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,018.10 "," $14,498.25 "," $13,127.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,661.15 "," $14,498.25 ", Not Applicable
,190-3,Diagnosis Related Group,ACUTE MYOCARDIAL INFARCTION,Inpatient,APR-DRG,, Not Applicable ," $10,082.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,817.06 "," $19,081.19 "," $17,277.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,082.86 "," $19,081.19 ", Not Applicable
,190-4,Diagnosis Related Group,ACUTE MYOCARDIAL INFARCTION,Inpatient,APR-DRG,, Not Applicable ," $17,391.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,281.45 "," $32,911.47 "," $29,800.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,391.04 "," $32,911.47 ", Not Applicable
,191-1,Diagnosis Related Group,CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $7,618.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,950.57 "," $14,416.79 "," $13,054.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,618.10 "," $14,416.79 ", Not Applicable
,191-2,Diagnosis Related Group,CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $8,810.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,821.02 "," $16,673.23 "," $15,097.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,810.45 "," $16,673.23 ", Not Applicable
,191-3,Diagnosis Related Group,CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $11,518.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,069.69 "," $21,798.70 "," $19,738.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,518.84 "," $21,798.70 ", Not Applicable
,191-4,Diagnosis Related Group,CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $21,366.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,518.06 "," $40,435.11 "," $36,612.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,366.68 "," $40,435.11 ", Not Applicable
,192-1,Diagnosis Related Group,CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS,Inpatient,APR-DRG,, Not Applicable ," $7,938.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,452.96 "," $15,022.85 "," $13,602.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,938.36 "," $15,022.85 ", Not Applicable
,192-2,Diagnosis Related Group,CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS,Inpatient,APR-DRG,, Not Applicable ," $9,734.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,270.10 "," $18,421.36 "," $16,680.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,734.20 "," $18,421.36 ", Not Applicable
,192-3,Diagnosis Related Group,CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS,Inpatient,APR-DRG,, Not Applicable ," $13,773.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,606.65 "," $26,065.57 "," $23,601.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,773.54 "," $26,065.57 ", Not Applicable
,192-4,Diagnosis Related Group,CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS,Inpatient,APR-DRG,, Not Applicable ," $24,601.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,593.24 "," $46,557.65 "," $42,156.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,601.94 "," $46,557.65 ", Not Applicable
,193-1,Diagnosis Related Group,ACUTE & SUBACUTE ENDOCARDITIS,Inpatient,APR-DRG,, Not Applicable ," $7,203.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,299.63 "," $13,631.52 "," $12,343.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,203.15 "," $13,631.52 ", Not Applicable
,193-2,Diagnosis Related Group,ACUTE & SUBACUTE ENDOCARDITIS,Inpatient,APR-DRG,, Not Applicable ," $9,451.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,827.14 "," $17,886.99 "," $16,196.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,451.82 "," $17,886.99 ", Not Applicable
,193-3,Diagnosis Related Group,ACUTE & SUBACUTE ENDOCARDITIS,Inpatient,APR-DRG,, Not Applicable ," $13,838.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,707.94 "," $26,187.76 "," $23,712.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,838.11 "," $26,187.76 ", Not Applicable
,193-4,Diagnosis Related Group,ACUTE & SUBACUTE ENDOCARDITIS,Inpatient,APR-DRG,, Not Applicable ," $22,434.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,192.68 "," $42,455.32 "," $38,442.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,434.19 "," $42,455.32 ", Not Applicable
,194-1,Diagnosis Related Group,HEART FAILURE,Inpatient,APR-DRG,, Not Applicable ," $4,400.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,902.41 "," $8,326.84 "," $7,539.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,400.06 "," $8,326.84 ", Not Applicable
,194-2,Diagnosis Related Group,HEART FAILURE,Inpatient,APR-DRG,, Not Applicable ," $5,588.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,767.45 "," $10,576.77 "," $9,577.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,588.96 "," $10,576.77 ", Not Applicable
,194-3,Diagnosis Related Group,HEART FAILURE,Inpatient,APR-DRG,, Not Applicable ," $8,103.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,712.26 "," $15,335.66 "," $13,886.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,103.65 "," $15,335.66 ", Not Applicable
,194-4,Diagnosis Related Group,HEART FAILURE,Inpatient,APR-DRG,, Not Applicable ," $14,308.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,445.31 "," $27,077.30 "," $24,517.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,308.16 "," $27,077.30 ", Not Applicable
,196-1,Diagnosis Related Group,CARDIAC ARREST & SHOCK,Inpatient,APR-DRG,, Not Applicable ," $4,004.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,281.18 "," $7,577.41 "," $6,861.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,004.05 "," $7,577.41 ", Not Applicable
,196-2,Diagnosis Related Group,CARDIAC ARREST & SHOCK,Inpatient,APR-DRG,, Not Applicable ," $4,565.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,161.70 "," $8,639.65 "," $7,822.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,565.35 "," $8,639.65 ", Not Applicable
,196-3,Diagnosis Related Group,CARDIAC ARREST & SHOCK,Inpatient,APR-DRG,, Not Applicable ," $8,416.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,202.49 "," $15,927.06 "," $14,421.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,416.16 "," $15,927.06 ", Not Applicable
,196-4,Diagnosis Related Group,CARDIAC ARREST & SHOCK,Inpatient,APR-DRG,, Not Applicable ," $20,795.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,621.33 "," $39,353.33 "," $35,633.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,795.04 "," $39,353.33 ", Not Applicable
,197-1,Diagnosis Related Group,PERIPHERAL & OTHER VASCULAR DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $3,840.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,024.58 "," $7,267.86 "," $6,580.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,840.47 "," $7,267.86 ", Not Applicable
,197-2,Diagnosis Related Group,PERIPHERAL & OTHER VASCULAR DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $5,205.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,165.12 "," $9,850.14 "," $8,919.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,205.00 "," $9,850.14 ", Not Applicable
,197-3,Diagnosis Related Group,PERIPHERAL & OTHER VASCULAR DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $7,776.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,199.07 "," $14,716.56 "," $13,325.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,776.51 "," $14,716.56 ", Not Applicable
,197-4,Diagnosis Related Group,PERIPHERAL & OTHER VASCULAR DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $14,810.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,232.65 "," $28,027.13 "," $25,377.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,810.06 "," $28,027.13 ", Not Applicable
,198-1,Diagnosis Related Group,ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS,Inpatient,APR-DRG,, Not Applicable ," $3,721.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,838.21 "," $7,043.03 "," $6,377.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,721.67 "," $7,043.03 ", Not Applicable
,198-2,Diagnosis Related Group,ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS,Inpatient,APR-DRG,, Not Applicable ," $4,400.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,903.76 "," $8,328.47 "," $7,541.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,400.92 "," $8,328.47 ", Not Applicable
,198-3,Diagnosis Related Group,ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS,Inpatient,APR-DRG,, Not Applicable ," $5,989.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,395.43 "," $11,334.34 "," $10,262.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,989.28 "," $11,334.34 ", Not Applicable
,198-4,Diagnosis Related Group,ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS,Inpatient,APR-DRG,, Not Applicable ," $12,718.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,950.94 "," $24,068.17 "," $21,793.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,718.08 "," $24,068.17 ", Not Applicable
,199-1,Diagnosis Related Group,HYPERTENSION,Inpatient,APR-DRG,, Not Applicable ," $3,856.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,050.24 "," $7,298.82 "," $6,608.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,856.83 "," $7,298.82 ", Not Applicable
,199-2,Diagnosis Related Group,HYPERTENSION,Inpatient,APR-DRG,, Not Applicable ," $4,714.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,395.34 "," $8,921.50 "," $8,078.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,714.29 "," $8,921.50 ", Not Applicable
,199-3,Diagnosis Related Group,HYPERTENSION,Inpatient,APR-DRG,, Not Applicable ," $6,544.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,266.50 "," $12,385.18 "," $11,214.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,544.56 "," $12,385.18 ", Not Applicable
,199-4,Diagnosis Related Group,HYPERTENSION,Inpatient,APR-DRG,, Not Applicable ," $13,374.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,981.37 "," $25,311.25 "," $22,918.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,374.94 "," $25,311.25 ", Not Applicable
,200-1,Diagnosis Related Group,CARDIAC STRUCTURAL & VALVULAR DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $4,016.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,301.43 "," $7,601.85 "," $6,883.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,016.96 "," $7,601.85 ", Not Applicable
,200-2,Diagnosis Related Group,CARDIAC STRUCTURAL & VALVULAR DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $4,972.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,800.49 "," $9,410.26 "," $8,520.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,972.56 "," $9,410.26 ", Not Applicable
,200-3,Diagnosis Related Group,CARDIAC STRUCTURAL & VALVULAR DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $7,657.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,012.70 "," $14,491.73 "," $13,121.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,657.71 "," $14,491.73 ", Not Applicable
,200-4,Diagnosis Related Group,CARDIAC STRUCTURAL & VALVULAR DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $14,766.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,163.78 "," $27,944.04 "," $25,302.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,766.16 "," $27,944.04 ", Not Applicable
,201-1,Diagnosis Related Group,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $3,622.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,682.90 "," $6,855.67 "," $6,207.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,622.67 "," $6,855.67 ", Not Applicable
,201-2,Diagnosis Related Group,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $4,718.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,402.09 "," $8,929.65 "," $8,085.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,718.59 "," $8,929.65 ", Not Applicable
,201-3,Diagnosis Related Group,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $7,166.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,241.56 "," $13,561.46 "," $12,279.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,166.13 "," $13,561.46 ", Not Applicable
,201-4,Diagnosis Related Group,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $13,984.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,937.52 "," $26,464.72 "," $23,963.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,984.46 "," $26,464.72 ", Not Applicable
,203-1,Diagnosis Related Group,CHEST PAIN,Inpatient,APR-DRG,, Not Applicable ," $3,651.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,728.82 "," $6,911.07 "," $6,257.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,651.94 "," $6,911.07 ", Not Applicable
,203-2,Diagnosis Related Group,CHEST PAIN,Inpatient,APR-DRG,, Not Applicable ," $4,412.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,921.31 "," $8,349.65 "," $7,560.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,412.11 "," $8,349.65 ", Not Applicable
,203-3,Diagnosis Related Group,CHEST PAIN,Inpatient,APR-DRG,, Not Applicable ," $5,671.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,897.09 "," $10,733.17 "," $9,718.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,671.61 "," $10,733.17 ", Not Applicable
,203-4,Diagnosis Related Group,CHEST PAIN,Inpatient,APR-DRG,, Not Applicable ," $8,850.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,883.14 "," $16,748.18 "," $15,165.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,850.05 "," $16,748.18 ", Not Applicable
,204-1,Diagnosis Related Group,SYNCOPE & COLLAPSE,Inpatient,APR-DRG,, Not Applicable ," $4,214.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,610.70 "," $7,974.93 "," $7,221.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,214.11 "," $7,974.93 ", Not Applicable
,204-2,Diagnosis Related Group,SYNCOPE & COLLAPSE,Inpatient,APR-DRG,, Not Applicable ," $4,963.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,785.63 "," $9,392.34 "," $8,504.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,963.09 "," $9,392.34 ", Not Applicable
,204-3,Diagnosis Related Group,SYNCOPE & COLLAPSE,Inpatient,APR-DRG,, Not Applicable ," $6,309.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,897.81 "," $11,940.41 "," $10,811.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,309.54 "," $11,940.41 ", Not Applicable
,204-4,Diagnosis Related Group,SYNCOPE & COLLAPSE,Inpatient,APR-DRG,, Not Applicable ," $11,243.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,637.53 "," $21,277.35 "," $19,266.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,243.35 "," $21,277.35 ", Not Applicable
,205-1,Diagnosis Related Group,CARDIOMYOPATHY,Inpatient,APR-DRG,, Not Applicable ," $3,822.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,996.22 "," $7,233.65 "," $6,549.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,822.40 "," $7,233.65 ", Not Applicable
,205-2,Diagnosis Related Group,CARDIOMYOPATHY,Inpatient,APR-DRG,, Not Applicable ," $5,003.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,849.11 "," $9,468.91 "," $8,573.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,003.55 "," $9,468.91 ", Not Applicable
,205-3,Diagnosis Related Group,CARDIOMYOPATHY,Inpatient,APR-DRG,, Not Applicable ," $7,441.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,673.72 "," $14,082.80 "," $12,751.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,441.62 "," $14,082.80 ", Not Applicable
,205-4,Diagnosis Related Group,CARDIOMYOPATHY,Inpatient,APR-DRG,, Not Applicable ," $17,132.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,876.30 "," $32,422.71 "," $29,357.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,132.77 "," $32,422.71 ", Not Applicable
,206-1,Diagnosis Related Group,"MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $3,840.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,024.58 "," $7,267.86 "," $6,580.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,840.47 "," $7,267.86 ", Not Applicable
,206-2,Diagnosis Related Group,"MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $5,014.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,866.66 "," $9,490.09 "," $8,593.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,014.74 "," $9,490.09 ", Not Applicable
,206-3,Diagnosis Related Group,"MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $8,035.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,605.57 "," $15,206.95 "," $13,769.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,035.64 "," $15,206.95 ", Not Applicable
,206-4,Diagnosis Related Group,"MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $16,038.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,159.82 "," $30,352.00 "," $27,482.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,038.57 "," $30,352.00 ", Not Applicable
,207-1,Diagnosis Related Group,OTHER CIRCULATORY SYSTEM DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $4,225.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,628.25 "," $7,996.11 "," $7,240.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,225.30 "," $7,996.11 ", Not Applicable
,207-2,Diagnosis Related Group,OTHER CIRCULATORY SYSTEM DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $5,517.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,655.35 "," $10,441.54 "," $9,454.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,517.51 "," $10,441.54 ", Not Applicable
,207-3,Diagnosis Related Group,OTHER CIRCULATORY SYSTEM DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $7,848.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,312.51 "," $14,853.42 "," $13,449.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,848.83 "," $14,853.42 ", Not Applicable
,207-4,Diagnosis Related Group,OTHER CIRCULATORY SYSTEM DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $14,463.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,688.40 "," $27,370.56 "," $24,783.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,463.12 "," $27,370.56 ", Not Applicable
,220-1,Diagnosis Related Group,"MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $11,257.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,659.14 "," $21,303.42 "," $19,289.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,257.13 "," $21,303.42 ", Not Applicable
,220-2,Diagnosis Related Group,"MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $16,018.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,128.75 "," $30,314.52 "," $27,449.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,018.77 "," $30,314.52 ", Not Applicable
,220-3,Diagnosis Related Group,"MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $26,067.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,891.79 "," $49,330.55 "," $44,667.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,067.19 "," $49,330.55 ", Not Applicable
,220-4,Diagnosis Related Group,"MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $48,738.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $76,457.21 "," $92,235.53 "," $83,516.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,738.99 "," $92,235.53 ", Not Applicable
,221-1,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $12,257.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,228.42 "," $23,196.55 "," $21,003.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,257.49 "," $23,196.55 ", Not Applicable
,221-2,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $15,650.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,550.74 "," $29,617.23 "," $26,817.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,650.30 "," $29,617.23 ", Not Applicable
,221-3,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $24,390.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,261.02 "," $46,156.87 "," $41,793.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,390.16 "," $46,156.87 ", Not Applicable
,221-4,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $45,751.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $71,770.97 "," $86,582.20 "," $78,398.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,751.67 "," $86,582.20 ", Not Applicable
,222-1,Diagnosis Related Group,"OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $8,619.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,521.21 "," $16,311.55 "," $14,769.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,619.33 "," $16,311.55 ", Not Applicable
,222-2,Diagnosis Related Group,"OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $10,311.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,174.94 "," $19,512.93 "," $17,668.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,311.00 "," $19,512.93 ", Not Applicable
,222-3,Diagnosis Related Group,"OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $16,189.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,396.15 "," $30,637.11 "," $27,741.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,189.22 "," $30,637.11 ", Not Applicable
,222-4,Diagnosis Related Group,"OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $37,432.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $58,721.09 "," $70,839.25 "," $64,143.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,432.79 "," $70,839.25 ", Not Applicable
,223-1,Diagnosis Related Group,OTHER SMALL & LARGE BOWEL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $9,306.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,598.91 "," $17,611.65 "," $15,946.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,306.33 "," $17,611.65 ", Not Applicable
,223-2,Diagnosis Related Group,OTHER SMALL & LARGE BOWEL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $12,225.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,178.45 "," $23,136.27 "," $20,949.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,225.64 "," $23,136.27 ", Not Applicable
,223-3,Diagnosis Related Group,OTHER SMALL & LARGE BOWEL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $19,433.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,484.84 "," $36,775.93 "," $33,299.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,433.10 "," $36,775.93 ", Not Applicable
,223-4,Diagnosis Related Group,OTHER SMALL & LARGE BOWEL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $39,708.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $62,290.46 "," $75,145.22 "," $68,042.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,708.15 "," $75,145.22 ", Not Applicable
,224-1,Diagnosis Related Group,PERITONEAL ADHESIOLYSIS,Inpatient,APR-DRG,, Not Applicable ," $10,655.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,715.14 "," $20,164.61 "," $18,258.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,655.36 "," $20,164.61 ", Not Applicable
,224-2,Diagnosis Related Group,PERITONEAL ADHESIOLYSIS,Inpatient,APR-DRG,, Not Applicable ," $13,870.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,759.26 "," $26,249.67 "," $23,768.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,870.82 "," $26,249.67 ", Not Applicable
,224-3,Diagnosis Related Group,PERITONEAL ADHESIOLYSIS,Inpatient,APR-DRG,, Not Applicable ," $20,889.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,769.88 "," $39,532.54 "," $35,795.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,889.74 "," $39,532.54 ", Not Applicable
,224-4,Diagnosis Related Group,PERITONEAL ADHESIOLYSIS,Inpatient,APR-DRG,, Not Applicable ," $36,728.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $57,616.38 "," $69,506.56 "," $62,936.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,728.58 "," $69,506.56 ", Not Applicable
,225-1,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $6,773.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,625.73 "," $12,818.55 "," $11,606.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,773.56 "," $12,818.55 ", Not Applicable
,225-2,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $9,504.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,909.52 "," $17,986.37 "," $16,286.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,504.34 "," $17,986.37 ", Not Applicable
,225-3,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $15,851.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,866.76 "," $29,998.46 "," $27,162.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,851.75 "," $29,998.46 ", Not Applicable
,225-4,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $29,507.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $46,288.39 "," $55,840.83 "," $50,562.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,507.35 "," $55,840.83 ", Not Applicable
,226-1,Diagnosis Related Group,ANAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $5,514.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,649.95 "," $10,435.03 "," $9,448.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,514.06 "," $10,435.03 ", Not Applicable
,226-2,Diagnosis Related Group,ANAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $7,290.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,436.03 "," $13,796.07 "," $12,491.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,290.10 "," $13,796.07 ", Not Applicable
,226-3,Diagnosis Related Group,ANAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $11,603.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,202.04 "," $21,958.36 "," $19,882.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,603.21 "," $21,958.36 ", Not Applicable
,226-4,Diagnosis Related Group,ANAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $23,034.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,133.98 "," $43,590.88 "," $39,470.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,034.24 "," $43,590.88 ", Not Applicable
,227-1,Diagnosis Related Group,"HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL",Inpatient,APR-DRG,, Not Applicable ," $8,867.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,910.15 "," $16,780.76 "," $15,194.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,867.27 "," $16,780.76 ", Not Applicable
,227-2,Diagnosis Related Group,"HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL",Inpatient,APR-DRG,, Not Applicable ," $11,455.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,969.75 "," $21,678.14 "," $19,629.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,455.14 "," $21,678.14 ", Not Applicable
,227-3,Diagnosis Related Group,"HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL",Inpatient,APR-DRG,, Not Applicable ," $18,088.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,375.36 "," $34,231.12 "," $30,995.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,088.37 "," $34,231.12 ", Not Applicable
,227-4,Diagnosis Related Group,"HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL",Inpatient,APR-DRG,, Not Applicable ," $34,125.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $53,532.47 "," $64,579.86 "," $58,475.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,125.22 "," $64,579.86 ", Not Applicable
,228-1,Diagnosis Related Group,"INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $6,573.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,312.42 "," $12,440.57 "," $11,264.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,573.83 "," $12,440.57 ", Not Applicable
,228-2,Diagnosis Related Group,"INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $8,627.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,534.71 "," $16,327.84 "," $14,784.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,627.94 "," $16,327.84 ", Not Applicable
,228-3,Diagnosis Related Group,"INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $12,937.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,295.31 "," $24,483.62 "," $22,169.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,937.61 "," $24,483.62 ", Not Applicable
,228-4,Diagnosis Related Group,"INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $26,940.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,261.20 "," $50,982.56 "," $46,163.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,940.14 "," $50,982.56 ", Not Applicable
,229-1,Diagnosis Related Group,OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $9,125.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,315.30 "," $17,269.52 "," $15,637.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,125.54 "," $17,269.52 ", Not Applicable
,229-2,Diagnosis Related Group,OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $12,189.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,121.73 "," $23,067.84 "," $20,887.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,189.48 "," $23,067.84 ", Not Applicable
,229-3,Diagnosis Related Group,OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $19,211.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,137.76 "," $36,357.23 "," $32,920.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,211.84 "," $36,357.23 ", Not Applicable
,229-4,Diagnosis Related Group,OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $37,827.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $59,339.62 "," $71,585.42 "," $64,818.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,827.09 "," $71,585.42 ", Not Applicable
,240-1,Diagnosis Related Group,DIGESTIVE MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $5,006.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,853.16 "," $9,473.80 "," $8,578.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,006.13 "," $9,473.80 ", Not Applicable
,240-2,Diagnosis Related Group,DIGESTIVE MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $6,665.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,455.57 "," $12,613.27 "," $11,421.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,665.09 "," $12,613.27 ", Not Applicable
,240-3,Diagnosis Related Group,DIGESTIVE MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $9,603.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,064.83 "," $18,173.73 "," $16,455.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,603.34 "," $18,173.73 ", Not Applicable
,240-4,Diagnosis Related Group,DIGESTIVE MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $15,974.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,059.88 "," $30,231.44 "," $27,373.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,974.86 "," $30,231.44 ", Not Applicable
,241-1,Diagnosis Related Group,PEPTIC ULCER & GASTRITIS,Inpatient,APR-DRG,, Not Applicable ," $4,759.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,466.91 "," $9,007.85 "," $8,156.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,759.92 "," $9,007.85 ", Not Applicable
,241-2,Diagnosis Related Group,PEPTIC ULCER & GASTRITIS,Inpatient,APR-DRG,, Not Applicable ," $6,067.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,518.32 "," $11,482.60 "," $10,397.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,067.62 "," $11,482.60 ", Not Applicable
,241-3,Diagnosis Related Group,PEPTIC ULCER & GASTRITIS,Inpatient,APR-DRG,, Not Applicable ," $8,945.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,033.05 "," $16,929.02 "," $15,328.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,945.61 "," $16,929.02 ", Not Applicable
,241-4,Diagnosis Related Group,PEPTIC ULCER & GASTRITIS,Inpatient,APR-DRG,, Not Applicable ," $19,521.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,623.94 "," $36,943.74 "," $33,451.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,521.77 "," $36,943.74 ", Not Applicable
,242-1,Diagnosis Related Group,MAJOR ESOPHAGEAL DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $4,470.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,013.15 "," $8,460.44 "," $7,660.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,470.65 "," $8,460.44 ", Not Applicable
,242-2,Diagnosis Related Group,MAJOR ESOPHAGEAL DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $5,857.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,188.80 "," $11,085.08 "," $10,037.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,857.56 "," $11,085.08 ", Not Applicable
,242-3,Diagnosis Related Group,MAJOR ESOPHAGEAL DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $8,692.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,636.00 "," $16,450.03 "," $14,895.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,692.51 "," $16,450.03 ", Not Applicable
,242-4,Diagnosis Related Group,MAJOR ESOPHAGEAL DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $19,109.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,977.05 "," $36,163.35 "," $32,745.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,109.40 "," $36,163.35 ", Not Applicable
,243-1,Diagnosis Related Group,OTHER ESOPHAGEAL DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $4,312.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,764.65 "," $8,160.66 "," $7,389.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,312.25 "," $8,160.66 ", Not Applicable
,243-2,Diagnosis Related Group,OTHER ESOPHAGEAL DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $5,356.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,402.81 "," $10,136.88 "," $9,178.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,356.52 "," $10,136.88 ", Not Applicable
,243-3,Diagnosis Related Group,OTHER ESOPHAGEAL DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $7,712.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,099.13 "," $14,596.00 "," $13,216.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,712.80 "," $14,596.00 ", Not Applicable
,243-4,Diagnosis Related Group,OTHER ESOPHAGEAL DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $15,825.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,824.89 "," $29,947.95 "," $27,117.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,825.06 "," $29,947.95 ", Not Applicable
,244-1,Diagnosis Related Group,DIVERTICULITIS & DIVERTICULOSIS,Inpatient,APR-DRG,, Not Applicable ," $4,314.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,768.71 "," $8,165.55 "," $7,393.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,314.83 "," $8,165.55 ", Not Applicable
,244-2,Diagnosis Related Group,DIVERTICULITIS & DIVERTICULOSIS,Inpatient,APR-DRG,, Not Applicable ," $5,545.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,699.92 "," $10,495.31 "," $9,503.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,545.92 "," $10,495.31 ", Not Applicable
,244-3,Diagnosis Related Group,DIVERTICULITIS & DIVERTICULOSIS,Inpatient,APR-DRG,, Not Applicable ," $8,259.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,956.70 "," $15,630.54 "," $14,153.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,259.47 "," $15,630.54 ", Not Applicable
,244-4,Diagnosis Related Group,DIVERTICULITIS & DIVERTICULOSIS,Inpatient,APR-DRG,, Not Applicable ," $17,496.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,446.21 "," $33,110.23 "," $29,980.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,496.07 "," $33,110.23 ", Not Applicable
,245-1,Diagnosis Related Group,INFLAMMATORY BOWEL DISEASE,Inpatient,APR-DRG,, Not Applicable ," $4,833.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,583.06 "," $9,147.96 "," $8,283.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,833.95 "," $9,147.96 ", Not Applicable
,245-2,Diagnosis Related Group,INFLAMMATORY BOWEL DISEASE,Inpatient,APR-DRG,, Not Applicable ," $5,856.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,187.45 "," $11,083.45 "," $10,035.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,856.70 "," $11,083.45 ", Not Applicable
,245-3,Diagnosis Related Group,INFLAMMATORY BOWEL DISEASE,Inpatient,APR-DRG,, Not Applicable ," $8,525.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,374.00 "," $16,133.97 "," $14,608.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,525.49 "," $16,133.97 ", Not Applicable
,245-4,Diagnosis Related Group,INFLAMMATORY BOWEL DISEASE,Inpatient,APR-DRG,, Not Applicable ," $15,300.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,002.44 "," $28,955.77 "," $26,218.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,300.78 "," $28,955.77 ", Not Applicable
,246-1,Diagnosis Related Group,GASTROINTESTINAL VASCULAR INSUFFICIENCY,Inpatient,APR-DRG,, Not Applicable ," $5,384.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,446.03 "," $10,189.02 "," $9,225.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,384.07 "," $10,189.02 ", Not Applicable
,246-2,Diagnosis Related Group,GASTROINTESTINAL VASCULAR INSUFFICIENCY,Inpatient,APR-DRG,, Not Applicable ," $6,505.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,205.73 "," $12,311.86 "," $11,148.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,505.82 "," $12,311.86 ", Not Applicable
,246-3,Diagnosis Related Group,GASTROINTESTINAL VASCULAR INSUFFICIENCY,Inpatient,APR-DRG,, Not Applicable ," $9,560.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,997.30 "," $18,092.27 "," $16,382.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,560.29 "," $18,092.27 ", Not Applicable
,246-4,Diagnosis Related Group,GASTROINTESTINAL VASCULAR INSUFFICIENCY,Inpatient,APR-DRG,, Not Applicable ," $18,076.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,356.45 "," $34,208.31 "," $30,974.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,076.32 "," $34,208.31 ", Not Applicable
,247-1,Diagnosis Related Group,INTESTINAL OBSTRUCTION,Inpatient,APR-DRG,, Not Applicable ," $4,110.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,448.64 "," $7,779.43 "," $7,044.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,110.80 "," $7,779.43 ", Not Applicable
,247-2,Diagnosis Related Group,INTESTINAL OBSTRUCTION,Inpatient,APR-DRG,, Not Applicable ," $5,210.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,173.23 "," $9,859.92 "," $8,927.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,210.17 "," $9,859.92 ", Not Applicable
,247-3,Diagnosis Related Group,INTESTINAL OBSTRUCTION,Inpatient,APR-DRG,, Not Applicable ," $7,866.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,339.52 "," $14,886.00 "," $13,478.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,866.04 "," $14,886.00 ", Not Applicable
,247-4,Diagnosis Related Group,INTESTINAL OBSTRUCTION,Inpatient,APR-DRG,, Not Applicable ," $16,503.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,889.09 "," $31,231.76 "," $28,279.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,503.45 "," $31,231.76 ", Not Applicable
,248-1,Diagnosis Related Group,MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $4,442.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,968.58 "," $8,406.67 "," $7,612.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,442.24 "," $8,406.67 ", Not Applicable
,248-2,Diagnosis Related Group,MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $5,955.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,342.76 "," $11,270.81 "," $10,205.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,955.71 "," $11,270.81 ", Not Applicable
,248-3,Diagnosis Related Group,MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $8,588.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,472.59 "," $16,252.90 "," $14,716.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,588.34 "," $16,252.90 ", Not Applicable
,248-4,Diagnosis Related Group,MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $16,745.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,268.58 "," $31,689.57 "," $28,694.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,745.37 "," $31,689.57 ", Not Applicable
,249-1,Diagnosis Related Group,"OTHER GASTROENTERITIS, NAUSEA & VOMITING",Inpatient,APR-DRG,, Not Applicable ," $3,408.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,346.63 "," $6,450.00 "," $5,840.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,408.30 "," $6,450.00 ", Not Applicable
,249-2,Diagnosis Related Group,"OTHER GASTROENTERITIS, NAUSEA & VOMITING",Inpatient,APR-DRG,, Not Applicable ," $4,355.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,832.18 "," $8,242.12 "," $7,463.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,355.29 "," $8,242.12 ", Not Applicable
,249-3,Diagnosis Related Group,"OTHER GASTROENTERITIS, NAUSEA & VOMITING",Inpatient,APR-DRG,, Not Applicable ," $6,042.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,479.16 "," $11,435.35 "," $10,354.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,042.66 "," $11,435.35 ", Not Applicable
,249-4,Diagnosis Related Group,"OTHER GASTROENTERITIS, NAUSEA & VOMITING",Inpatient,APR-DRG,, Not Applicable ," $12,325.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,335.11 "," $23,325.26 "," $21,120.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,325.51 "," $23,325.26 ", Not Applicable
,251-1,Diagnosis Related Group,ABDOMINAL PAIN,Inpatient,APR-DRG,, Not Applicable ," $3,868.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,069.15 "," $7,321.62 "," $6,629.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,868.88 "," $7,321.62 ", Not Applicable
,251-2,Diagnosis Related Group,ABDOMINAL PAIN,Inpatient,APR-DRG,, Not Applicable ," $4,913.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,707.30 "," $9,297.84 "," $8,418.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,913.16 "," $9,297.84 ", Not Applicable
,251-3,Diagnosis Related Group,ABDOMINAL PAIN,Inpatient,APR-DRG,, Not Applicable ," $6,499.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,196.28 "," $12,300.46 "," $11,137.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,499.80 "," $12,300.46 ", Not Applicable
,251-4,Diagnosis Related Group,ABDOMINAL PAIN,Inpatient,APR-DRG,, Not Applicable ," $11,043.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,324.21 "," $20,899.38 "," $18,923.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,043.63 "," $20,899.38 ", Not Applicable
,252-1,Diagnosis Related Group,"MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $4,219.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,618.80 "," $7,984.71 "," $7,229.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,219.27 "," $7,984.71 ", Not Applicable
,252-2,Diagnosis Related Group,"MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $5,569.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,736.38 "," $10,539.29 "," $9,543.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,569.16 "," $10,539.29 ", Not Applicable
,252-3,Diagnosis Related Group,"MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $8,178.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,829.75 "," $15,477.40 "," $14,014.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,178.55 "," $15,477.40 ", Not Applicable
,252-4,Diagnosis Related Group,"MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $16,060.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,194.93 "," $30,394.36 "," $27,521.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,060.95 "," $30,394.36 ", Not Applicable
,253-1,Diagnosis Related Group,OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE,Inpatient,APR-DRG,, Not Applicable ," $4,563.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,159.00 "," $8,636.39 "," $7,820.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,563.63 "," $8,636.39 ", Not Applicable
,253-2,Diagnosis Related Group,OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE,Inpatient,APR-DRG,, Not Applicable ," $5,848.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,173.95 "," $11,067.16 "," $10,021.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,848.09 "," $11,067.16 ", Not Applicable
,253-3,Diagnosis Related Group,OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE,Inpatient,APR-DRG,, Not Applicable ," $8,548.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,410.47 "," $16,177.96 "," $14,648.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,548.74 "," $16,177.96 ", Not Applicable
,253-4,Diagnosis Related Group,OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE,Inpatient,APR-DRG,, Not Applicable ," $16,358.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,662.20 "," $30,958.06 "," $28,031.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,358.82 "," $30,958.06 ", Not Applicable
,254-1,Diagnosis Related Group,OTHER DIGESTIVE SYSTEM DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $3,913.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,139.37 "," $7,406.34 "," $6,706.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,913.65 "," $7,406.34 ", Not Applicable
,254-2,Diagnosis Related Group,OTHER DIGESTIVE SYSTEM DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $5,431.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,520.30 "," $10,278.62 "," $9,307.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,431.42 "," $10,278.62 ", Not Applicable
,254-3,Diagnosis Related Group,OTHER DIGESTIVE SYSTEM DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $7,751.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,159.90 "," $14,669.32 "," $13,282.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,751.54 "," $14,669.32 ", Not Applicable
,254-4,Diagnosis Related Group,OTHER DIGESTIVE SYSTEM DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $14,717.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,088.15 "," $27,852.80 "," $25,220.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,717.95 "," $27,852.80 ", Not Applicable
,260-1,Diagnosis Related Group,"MAJOR PANCREAS, LIVER & SHUNT PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $12,478.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,575.50 "," $23,615.25 "," $21,383.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,478.75 "," $23,615.25 ", Not Applicable
,260-2,Diagnosis Related Group,"MAJOR PANCREAS, LIVER & SHUNT PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $16,464.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,828.31 "," $31,158.45 "," $28,213.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,464.71 "," $31,158.45 ", Not Applicable
,260-3,Diagnosis Related Group,"MAJOR PANCREAS, LIVER & SHUNT PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $25,939.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,691.92 "," $49,089.43 "," $44,449.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,939.78 "," $49,089.43 ", Not Applicable
,260-4,Diagnosis Related Group,"MAJOR PANCREAS, LIVER & SHUNT PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $49,410.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $77,510.60 "," $93,506.30 "," $84,667.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,410.49 "," $93,506.30 ", Not Applicable
,261-1,Diagnosis Related Group,MAJOR BILIARY TRACT PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $11,368.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,833.35 "," $21,513.59 "," $19,480.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,368.18 "," $21,513.59 ", Not Applicable
,261-2,Diagnosis Related Group,MAJOR BILIARY TRACT PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $15,202.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,848.48 "," $28,770.04 "," $26,050.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,202.63 "," $28,770.04 ", Not Applicable
,261-3,Diagnosis Related Group,MAJOR BILIARY TRACT PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $22,025.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,551.19 "," $41,681.45 "," $37,741.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,025.27 "," $41,681.45 ", Not Applicable
,261-4,Diagnosis Related Group,MAJOR BILIARY TRACT PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $39,150.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $61,415.34 "," $74,089.50 "," $67,086.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,150.29 "," $74,089.50 ", Not Applicable
,262-1,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $10,299.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,157.38 "," $19,491.75 "," $17,649.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,299.81 "," $19,491.75 ", Not Applicable
,262-2,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $13,470.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,131.27 "," $25,492.09 "," $23,082.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,470.50 "," $25,492.09 ", Not Applicable
,262-3,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $19,416.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,459.18 "," $36,744.98 "," $33,271.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,416.74 "," $36,744.98 ", Not Applicable
,262-4,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $35,229.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,265.16 "," $66,670.12 "," $60,368.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,229.75 "," $66,670.12 ", Not Applicable
,263-1,Diagnosis Related Group,CHOLECYSTECTOMY,Inpatient,APR-DRG,, Not Applicable ," $8,194.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,854.06 "," $15,506.73 "," $14,040.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,194.05 "," $15,506.73 ", Not Applicable
,263-2,Diagnosis Related Group,CHOLECYSTECTOMY,Inpatient,APR-DRG,, Not Applicable ," $10,664.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,729.99 "," $20,182.53 "," $18,274.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,664.83 "," $20,182.53 ", Not Applicable
,263-3,Diagnosis Related Group,CHOLECYSTECTOMY,Inpatient,APR-DRG,, Not Applicable ," $14,496.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,741.07 "," $27,434.10 "," $24,840.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,496.70 "," $27,434.10 ", Not Applicable
,263-4,Diagnosis Related Group,CHOLECYSTECTOMY,Inpatient,APR-DRG,, Not Applicable ," $28,517.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $44,735.31 "," $53,967.25 "," $48,866.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,517.31 "," $53,967.25 ", Not Applicable
,264-1,Diagnosis Related Group,"OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $10,662.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,725.94 "," $20,177.64 "," $18,270.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,662.25 "," $20,177.64 ", Not Applicable
,264-2,Diagnosis Related Group,"OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $12,060.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,919.15 "," $22,823.46 "," $20,666.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,060.35 "," $22,823.46 ", Not Applicable
,264-3,Diagnosis Related Group,"OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $18,785.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,469.26 "," $35,550.77 "," $32,190.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,785.70 "," $35,550.77 ", Not Applicable
,264-4,Diagnosis Related Group,"OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $38,879.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $60,991.28 "," $73,577.93 "," $66,622.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,879.97 "," $73,577.93 ", Not Applicable
,279-1,Diagnosis Related Group,HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $3,990.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,259.57 "," $7,551.34 "," $6,837.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,990.27 "," $7,551.34 ", Not Applicable
,279-2,Diagnosis Related Group,HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $4,949.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,764.02 "," $9,366.27 "," $8,480.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,949.31 "," $9,366.27 ", Not Applicable
,279-3,Diagnosis Related Group,HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $7,786.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,215.27 "," $14,736.11 "," $13,343.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,786.84 "," $14,736.11 ", Not Applicable
,279-4,Diagnosis Related Group,HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $18,460.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,958.77 "," $34,934.94 "," $31,632.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,460.28 "," $34,934.94 ", Not Applicable
,280-1,Diagnosis Related Group,ALCOHOLIC LIVER DISEASE,Inpatient,APR-DRG,, Not Applicable ," $4,123.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,468.90 "," $7,803.87 "," $7,066.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,123.71 "," $7,803.87 ", Not Applicable
,280-2,Diagnosis Related Group,ALCOHOLIC LIVER DISEASE,Inpatient,APR-DRG,, Not Applicable ," $5,216.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,182.68 "," $9,871.32 "," $8,938.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,216.19 "," $9,871.32 ", Not Applicable
,280-3,Diagnosis Related Group,ALCOHOLIC LIVER DISEASE,Inpatient,APR-DRG,, Not Applicable ," $8,091.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,693.35 "," $15,312.85 "," $13,865.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,091.60 "," $15,312.85 ", Not Applicable
,280-4,Diagnosis Related Group,ALCOHOLIC LIVER DISEASE,Inpatient,APR-DRG,, Not Applicable ," $17,142.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,891.16 "," $32,440.63 "," $29,374.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,142.24 "," $32,440.63 ", Not Applicable
,281-1,Diagnosis Related Group,MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS,Inpatient,APR-DRG,, Not Applicable ," $5,178.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,123.26 "," $9,799.64 "," $8,873.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,178.31 "," $9,799.64 ", Not Applicable
,281-2,Diagnosis Related Group,MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS,Inpatient,APR-DRG,, Not Applicable ," $6,820.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,700.01 "," $12,908.15 "," $11,688.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,820.91 "," $12,908.15 ", Not Applicable
,281-3,Diagnosis Related Group,MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS,Inpatient,APR-DRG,, Not Applicable ," $9,347.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,663.73 "," $17,689.85 "," $16,017.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,347.65 "," $17,689.85 ", Not Applicable
,281-4,Diagnosis Related Group,MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS,Inpatient,APR-DRG,, Not Applicable ," $14,618.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,932.84 "," $27,665.45 "," $25,050.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,618.94 "," $27,665.45 ", Not Applicable
,282-1,Diagnosis Related Group,DISORDERS OF PANCREAS EXCEPT MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $4,556.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,148.20 "," $8,623.36 "," $7,808.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,556.74 "," $8,623.36 ", Not Applicable
,282-2,Diagnosis Related Group,DISORDERS OF PANCREAS EXCEPT MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $5,794.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,090.22 "," $10,966.15 "," $9,929.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,794.72 "," $10,966.15 ", Not Applicable
,282-3,Diagnosis Related Group,DISORDERS OF PANCREAS EXCEPT MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $9,039.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,180.25 "," $17,106.60 "," $15,489.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,039.45 "," $17,106.60 ", Not Applicable
,282-4,Diagnosis Related Group,DISORDERS OF PANCREAS EXCEPT MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $22,638.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,512.75 "," $42,841.44 "," $38,791.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,638.23 "," $42,841.44 ", Not Applicable
,283-1,Diagnosis Related Group,OTHER DISORDERS OF THE LIVER,Inpatient,APR-DRG,, Not Applicable ," $4,444.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,972.63 "," $8,411.56 "," $7,616.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,444.83 "," $8,411.56 ", Not Applicable
,283-2,Diagnosis Related Group,OTHER DISORDERS OF THE LIVER,Inpatient,APR-DRG,, Not Applicable ," $5,265.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,259.66 "," $9,964.19 "," $9,022.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,265.26 "," $9,964.19 ", Not Applicable
,283-3,Diagnosis Related Group,OTHER DISORDERS OF THE LIVER,Inpatient,APR-DRG,, Not Applicable ," $7,802.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,239.58 "," $14,765.44 "," $13,369.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,802.34 "," $14,765.44 ", Not Applicable
,283-4,Diagnosis Related Group,OTHER DISORDERS OF THE LIVER,Inpatient,APR-DRG,, Not Applicable ," $14,363.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,531.74 "," $27,181.57 "," $24,612.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,363.26 "," $27,181.57 ", Not Applicable
,284-1,Diagnosis Related Group,DISORDERS OF GALLBLADDER & BILIARY TRACT,Inpatient,APR-DRG,, Not Applicable ," $4,763.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,472.32 "," $9,014.36 "," $8,162.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,763.36 "," $9,014.36 ", Not Applicable
,284-2,Diagnosis Related Group,DISORDERS OF GALLBLADDER & BILIARY TRACT,Inpatient,APR-DRG,, Not Applicable ," $6,587.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,334.03 "," $12,466.64 "," $11,288.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,587.61 "," $12,466.64 ", Not Applicable
,284-3,Diagnosis Related Group,DISORDERS OF GALLBLADDER & BILIARY TRACT,Inpatient,APR-DRG,, Not Applicable ," $9,341.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,654.28 "," $17,678.45 "," $16,007.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,341.63 "," $17,678.45 ", Not Applicable
,284-4,Diagnosis Related Group,DISORDERS OF GALLBLADDER & BILIARY TRACT,Inpatient,APR-DRG,, Not Applicable ," $17,741.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,831.10 "," $33,574.55 "," $30,400.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,741.43 "," $33,574.55 ", Not Applicable
,301-1,Diagnosis Related Group,HIP JOINT REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $14,985.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,508.15 "," $28,359.48 "," $25,678.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,985.69 "," $28,359.48 ", Not Applicable
,301-2,Diagnosis Related Group,HIP JOINT REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $16,169.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,365.09 "," $30,599.63 "," $27,707.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,169.42 "," $30,599.63 ", Not Applicable
,301-3,Diagnosis Related Group,HIP JOINT REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $20,452.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,083.83 "," $38,704.90 "," $35,046.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,452.40 "," $38,704.90 ", Not Applicable
,301-4,Diagnosis Related Group,HIP JOINT REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $32,446.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $50,898.99 "," $61,402.92 "," $55,598.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,446.46 "," $61,402.92 ", Not Applicable
,302-1,Diagnosis Related Group,KNEE JOINT REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $14,626.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,945.00 "," $27,680.11 "," $25,063.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,626.69 "," $27,680.11 ", Not Applicable
,302-2,Diagnosis Related Group,KNEE JOINT REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $16,054.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,185.47 "," $30,382.95 "," $27,511.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,054.92 "," $30,382.95 ", Not Applicable
,302-3,Diagnosis Related Group,KNEE JOINT REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $19,674.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,862.98 "," $37,232.11 "," $33,712.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,674.15 "," $37,232.11 ", Not Applicable
,302-4,Diagnosis Related Group,KNEE JOINT REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $32,812.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,472.96 "," $62,095.33 "," $56,225.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,812.34 "," $62,095.33 ", Not Applicable
,303-1,Diagnosis Related Group,DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK,Inpatient,APR-DRG,, Not Applicable ," $37,413.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $58,691.38 "," $70,803.40 "," $64,110.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,413.85 "," $70,803.40 ", Not Applicable
,303-2,Diagnosis Related Group,DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK,Inpatient,APR-DRG,, Not Applicable ," $44,528.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $69,851.91 "," $84,267.11 "," $76,301.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $44,528.33 "," $84,267.11 ", Not Applicable
,303-3,Diagnosis Related Group,DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK,Inpatient,APR-DRG,, Not Applicable ," $61,963.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $97,202.24 "," $117,261.67 "," $106,177.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $61,963.28 "," $117,261.67 ", Not Applicable
,303-4,Diagnosis Related Group,DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK,Inpatient,APR-DRG,, Not Applicable ," $82,790.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $129,873.53 "," $156,675.28 "," $141,865.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $82,790.17 "," $156,675.28 ", Not Applicable
,304-1,Diagnosis Related Group,DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK,Inpatient,APR-DRG,, Not Applicable ," $24,314.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,142.17 "," $46,013.50 "," $41,664.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,314.40 "," $46,013.50 ", Not Applicable
,304-2,Diagnosis Related Group,DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK,Inpatient,APR-DRG,, Not Applicable ," $28,644.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $44,935.19 "," $54,208.37 "," $49,084.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,644.73 "," $54,208.37 ", Not Applicable
,304-3,Diagnosis Related Group,DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK,Inpatient,APR-DRG,, Not Applicable ," $40,703.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $63,851.64 "," $77,028.58 "," $69,747.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,703.35 "," $77,028.58 ", Not Applicable
,304-4,Diagnosis Related Group,DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK,Inpatient,APR-DRG,, Not Applicable ," $65,092.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $102,111.31 "," $123,183.81 "," $111,539.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $65,092.65 "," $123,183.81 ", Not Applicable
,305-1,Diagnosis Related Group,AMPUTATION OF LOWER LIMB EXCEPT TOES,Inpatient,APR-DRG,, Not Applicable ," $9,167.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,381.47 "," $17,349.35 "," $15,709.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,167.72 "," $17,349.35 ", Not Applicable
,305-2,Diagnosis Related Group,AMPUTATION OF LOWER LIMB EXCEPT TOES,Inpatient,APR-DRG,, Not Applicable ," $11,892.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,655.81 "," $22,505.77 "," $20,378.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,892.47 "," $22,505.77 ", Not Applicable
,305-3,Diagnosis Related Group,AMPUTATION OF LOWER LIMB EXCEPT TOES,Inpatient,APR-DRG,, Not Applicable ," $19,032.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,856.85 "," $36,018.35 "," $32,613.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,032.78 "," $36,018.35 ", Not Applicable
,305-4,Diagnosis Related Group,AMPUTATION OF LOWER LIMB EXCEPT TOES,Inpatient,APR-DRG,, Not Applicable ," $37,778.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $59,263.99 "," $71,494.18 "," $64,736.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,778.87 "," $71,494.18 ", Not Applicable
,308-1,Diagnosis Related Group,HIP & FEMUR FRACTURE REPAIR,Inpatient,APR-DRG,, Not Applicable ," $11,468.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,990.01 "," $21,702.57 "," $19,651.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,468.05 "," $21,702.57 ", Not Applicable
,308-2,Diagnosis Related Group,HIP & FEMUR FRACTURE REPAIR,Inpatient,APR-DRG,, Not Applicable ," $13,744.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,560.73 "," $26,010.18 "," $23,551.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,744.27 "," $26,010.18 ", Not Applicable
,308-3,Diagnosis Related Group,HIP & FEMUR FRACTURE REPAIR,Inpatient,APR-DRG,, Not Applicable ," $17,935.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,134.97 "," $33,941.12 "," $30,732.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,935.13 "," $33,941.12 ", Not Applicable
,308-4,Diagnosis Related Group,HIP & FEMUR FRACTURE REPAIR,Inpatient,APR-DRG,, Not Applicable ," $29,277.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,927.80 "," $55,405.83 "," $50,168.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,277.49 "," $55,405.83 ", Not Applicable
,309-1,Diagnosis Related Group,OTHER SIGNIFICANT HIP & FEMUR SURGERY,Inpatient,APR-DRG,, Not Applicable ," $10,301.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,160.08 "," $19,495.01 "," $17,652.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,301.53 "," $19,495.01 ", Not Applicable
,309-2,Diagnosis Related Group,OTHER SIGNIFICANT HIP & FEMUR SURGERY,Inpatient,APR-DRG,, Not Applicable ," $15,002.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,533.81 "," $28,390.44 "," $25,706.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,002.04 "," $28,390.44 ", Not Applicable
,309-3,Diagnosis Related Group,OTHER SIGNIFICANT HIP & FEMUR SURGERY,Inpatient,APR-DRG,, Not Applicable ," $21,518.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,755.75 "," $40,721.85 "," $36,872.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,518.20 "," $40,721.85 ", Not Applicable
,309-4,Diagnosis Related Group,OTHER SIGNIFICANT HIP & FEMUR SURGERY,Inpatient,APR-DRG,, Not Applicable ," $38,686.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $60,687.42 "," $73,211.36 "," $66,291.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,686.26 "," $73,211.36 ", Not Applicable
,310-1,Diagnosis Related Group,INTERVERTEBRAL DISC EXCISION & DECOMPRESSION,Inpatient,APR-DRG,, Not Applicable ," $7,805.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,244.98 "," $14,771.96 "," $13,375.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,805.78 "," $14,771.96 ", Not Applicable
,310-2,Diagnosis Related Group,INTERVERTEBRAL DISC EXCISION & DECOMPRESSION,Inpatient,APR-DRG,, Not Applicable ," $10,397.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,311.34 "," $19,677.48 "," $17,817.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,397.95 "," $19,677.48 ", Not Applicable
,310-3,Diagnosis Related Group,INTERVERTEBRAL DISC EXCISION & DECOMPRESSION,Inpatient,APR-DRG,, Not Applicable ," $15,413.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,179.35 "," $29,169.20 "," $26,411.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,413.55 "," $29,169.20 ", Not Applicable
,310-4,Diagnosis Related Group,INTERVERTEBRAL DISC EXCISION & DECOMPRESSION,Inpatient,APR-DRG,, Not Applicable ," $30,907.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,484.30 "," $58,489.91 "," $52,961.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,907.17 "," $58,489.91 ", Not Applicable
,312-1,Diagnosis Related Group,"SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $10,403.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,319.44 "," $19,687.25 "," $17,826.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,403.12 "," $19,687.25 ", Not Applicable
,312-2,Diagnosis Related Group,"SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $15,845.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,857.30 "," $29,987.06 "," $27,152.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,845.73 "," $29,987.06 ", Not Applicable
,312-3,Diagnosis Related Group,"SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $27,126.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,552.90 "," $51,334.46 "," $46,482.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,126.10 "," $51,334.46 ", Not Applicable
,312-4,Diagnosis Related Group,"SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $63,079.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $98,953.84 "," $119,374.74 "," $108,090.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $63,079.86 "," $119,374.74 ", Not Applicable
,313-1,Diagnosis Related Group,KNEE & LOWER LEG PROCEDURES EXCEPT FOOT,Inpatient,APR-DRG,, Not Applicable ," $9,581.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,031.07 "," $18,133.00 "," $16,418.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,581.82 "," $18,133.00 ", Not Applicable
,313-2,Diagnosis Related Group,KNEE & LOWER LEG PROCEDURES EXCEPT FOOT,Inpatient,APR-DRG,, Not Applicable ," $13,044.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,462.78 "," $24,685.64 "," $22,352.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,044.36 "," $24,685.64 ", Not Applicable
,313-3,Diagnosis Related Group,KNEE & LOWER LEG PROCEDURES EXCEPT FOOT,Inpatient,APR-DRG,, Not Applicable ," $19,025.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,844.70 "," $36,003.69 "," $32,600.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,025.03 "," $36,003.69 ", Not Applicable
,313-4,Diagnosis Related Group,KNEE & LOWER LEG PROCEDURES EXCEPT FOOT,Inpatient,APR-DRG,, Not Applicable ," $36,003.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $56,479.26 "," $68,134.77 "," $61,694.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,003.70 "," $68,134.77 ", Not Applicable
,314-1,Diagnosis Related Group,FOOT & TOE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $8,266.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,967.50 "," $15,643.58 "," $14,164.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,266.36 "," $15,643.58 ", Not Applicable
,314-2,Diagnosis Related Group,FOOT & TOE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $9,698.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,213.38 "," $18,352.94 "," $16,618.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,698.04 "," $18,352.94 ", Not Applicable
,314-3,Diagnosis Related Group,FOOT & TOE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $13,136.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,607.28 "," $24,859.96 "," $22,510.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,136.47 "," $24,859.96 ", Not Applicable
,314-4,Diagnosis Related Group,FOOT & TOE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $27,234.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,723.07 "," $51,539.74 "," $46,667.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,234.57 "," $51,539.74 ", Not Applicable
,315-1,Diagnosis Related Group,"SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT",Inpatient,APR-DRG,, Not Applicable ," $7,262.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,392.82 "," $13,743.93 "," $12,444.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,262.55 "," $13,743.93 ", Not Applicable
,315-2,Diagnosis Related Group,"SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT",Inpatient,APR-DRG,, Not Applicable ," $13,510.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,194.75 "," $25,568.66 "," $23,151.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,510.96 "," $25,568.66 ", Not Applicable
,315-3,Diagnosis Related Group,"SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT",Inpatient,APR-DRG,, Not Applicable ," $19,060.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,900.07 "," $36,070.49 "," $32,660.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,060.33 "," $36,070.49 ", Not Applicable
,315-4,Diagnosis Related Group,"SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT",Inpatient,APR-DRG,, Not Applicable ," $34,262.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $53,748.55 "," $64,840.53 "," $58,711.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,262.96 "," $64,840.53 ", Not Applicable
,316-1,Diagnosis Related Group,HAND & WRIST PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $6,251.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,807.33 "," $11,831.25 "," $10,712.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,251.86 "," $11,831.25 ", Not Applicable
,316-2,Diagnosis Related Group,HAND & WRIST PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $8,829.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,850.73 "," $16,709.08 "," $15,129.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,829.39 "," $16,709.08 ", Not Applicable
,316-3,Diagnosis Related Group,HAND & WRIST PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $14,098.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,115.79 "," $26,679.78 "," $24,157.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,098.10 "," $26,679.78 ", Not Applicable
,316-4,Diagnosis Related Group,HAND & WRIST PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $27,429.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $43,028.28 "," $51,907.94 "," $47,001.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,429.13 "," $51,907.94 ", Not Applicable
,317-1,Diagnosis Related Group,"TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $7,303.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,456.29 "," $13,820.50 "," $12,514.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,303.01 "," $13,820.50 ", Not Applicable
,317-2,Diagnosis Related Group,"TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $10,037.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,745.48 "," $18,994.84 "," $17,199.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,037.23 "," $18,994.84 ", Not Applicable
,317-3,Diagnosis Related Group,"TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $16,442.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,793.20 "," $31,116.09 "," $28,174.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,442.33 "," $31,116.09 ", Not Applicable
,317-4,Diagnosis Related Group,"TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $36,774.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $57,687.96 "," $69,592.91 "," $63,014.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,774.20 "," $69,592.91 ", Not Applicable
,320-1,Diagnosis Related Group,OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $8,003.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,555.60 "," $15,146.67 "," $13,714.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,003.79 "," $15,146.67 ", Not Applicable
,320-2,Diagnosis Related Group,OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $12,477.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,574.15 "," $23,613.62 "," $21,381.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,477.88 "," $23,613.62 ", Not Applicable
,320-3,Diagnosis Related Group,OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $17,450.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,374.64 "," $33,023.88 "," $29,902.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,450.44 "," $33,023.88 ", Not Applicable
,320-4,Diagnosis Related Group,OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $31,048.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,705.78 "," $58,757.10 "," $53,203.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,048.36 "," $58,757.10 ", Not Applicable
,321-1,Diagnosis Related Group,CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP,Inpatient,APR-DRG,, Not Applicable ," $14,265.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,377.79 "," $26,995.84 "," $24,444.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,265.11 "," $26,995.84 ", Not Applicable
,321-2,Diagnosis Related Group,CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP,Inpatient,APR-DRG,, Not Applicable ," $17,864.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,024.23 "," $33,807.53 "," $30,611.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,864.54 "," $33,807.53 ", Not Applicable
,321-3,Diagnosis Related Group,CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP,Inpatient,APR-DRG,, Not Applicable ," $28,630.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $44,913.58 "," $54,182.30 "," $49,060.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,630.95 "," $54,182.30 ", Not Applicable
,321-4,Diagnosis Related Group,CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP,Inpatient,APR-DRG,, Not Applicable ," $53,168.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $83,405.53 "," $100,617.76 "," $91,106.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $53,168.32 "," $100,617.76 ", Not Applicable
,322-1,Diagnosis Related Group,SHOULDER & ELBOW JOINT REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $14,752.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,142.17 "," $27,917.97 "," $25,279.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,752.38 "," $27,917.97 ", Not Applicable
,322-2,Diagnosis Related Group,SHOULDER & ELBOW JOINT REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $15,827.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,828.94 "," $29,952.84 "," $27,121.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,827.65 "," $29,952.84 ", Not Applicable
,322-3,Diagnosis Related Group,SHOULDER & ELBOW JOINT REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $20,514.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,181.06 "," $38,822.21 "," $35,152.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,514.39 "," $38,822.21 ", Not Applicable
,322-4,Diagnosis Related Group,SHOULDER & ELBOW JOINT REPLACEMENT,Inpatient,APR-DRG,, Not Applicable ," $32,932.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,662.03 "," $62,323.42 "," $56,432.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,932.87 "," $62,323.42 ", Not Applicable
,340-1,Diagnosis Related Group,FRACTURE OF FEMUR,Inpatient,APR-DRG,, Not Applicable ," $3,795.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,954.35 "," $7,183.14 "," $6,504.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,795.71 "," $7,183.14 ", Not Applicable
,340-2,Diagnosis Related Group,FRACTURE OF FEMUR,Inpatient,APR-DRG,, Not Applicable ," $4,652.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,298.10 "," $8,804.20 "," $7,971.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,652.30 "," $8,804.20 ", Not Applicable
,340-3,Diagnosis Related Group,FRACTURE OF FEMUR,Inpatient,APR-DRG,, Not Applicable ," $6,653.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,436.66 "," $12,590.46 "," $11,400.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,653.04 "," $12,590.46 ", Not Applicable
,340-4,Diagnosis Related Group,FRACTURE OF FEMUR,Inpatient,APR-DRG,, Not Applicable ," $12,873.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,195.38 "," $24,363.06 "," $22,060.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,873.90 "," $24,363.06 ", Not Applicable
,341-1,Diagnosis Related Group,FRACTURE OF PELVIS OR DISLOCATION OF HIP,Inpatient,APR-DRG,, Not Applicable ," $4,006.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,285.23 "," $7,582.30 "," $6,865.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,006.63 "," $7,582.30 ", Not Applicable
,341-2,Diagnosis Related Group,FRACTURE OF PELVIS OR DISLOCATION OF HIP,Inpatient,APR-DRG,, Not Applicable ," $4,920.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,718.11 "," $9,310.88 "," $8,430.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,920.04 "," $9,310.88 ", Not Applicable
,341-3,Diagnosis Related Group,FRACTURE OF PELVIS OR DISLOCATION OF HIP,Inpatient,APR-DRG,, Not Applicable ," $6,477.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,161.16 "," $12,258.10 "," $11,099.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,477.41 "," $12,258.10 ", Not Applicable
,341-4,Diagnosis Related Group,FRACTURE OF PELVIS OR DISLOCATION OF HIP,Inpatient,APR-DRG,, Not Applicable ," $15,039.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,593.24 "," $28,462.12 "," $25,771.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,039.92 "," $28,462.12 ", Not Applicable
,342-1,Diagnosis Related Group,"FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK",Inpatient,APR-DRG,, Not Applicable ," $3,737.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,862.52 "," $7,072.36 "," $6,403.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,737.17 "," $7,072.36 ", Not Applicable
,342-2,Diagnosis Related Group,"FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK",Inpatient,APR-DRG,, Not Applicable ," $5,223.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,193.48 "," $9,884.36 "," $8,950.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,223.08 "," $9,884.36 ", Not Applicable
,342-3,Diagnosis Related Group,"FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK",Inpatient,APR-DRG,, Not Applicable ," $7,289.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,434.68 "," $13,794.44 "," $12,490.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,289.24 "," $13,794.44 ", Not Applicable
,342-4,Diagnosis Related Group,"FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK",Inpatient,APR-DRG,, Not Applicable ," $16,080.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,225.99 "," $30,431.83 "," $27,555.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,080.75 "," $30,431.83 ", Not Applicable
,343-1,Diagnosis Related Group,MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG,Inpatient,APR-DRG,, Not Applicable ," $5,686.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,920.05 "," $10,760.87 "," $9,743.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,686.24 "," $10,760.87 ", Not Applicable
,343-2,Diagnosis Related Group,MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG,Inpatient,APR-DRG,, Not Applicable ," $6,949.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,901.24 "," $13,150.90 "," $11,907.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,949.18 "," $13,150.90 ", Not Applicable
,343-3,Diagnosis Related Group,MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG,Inpatient,APR-DRG,, Not Applicable ," $11,115.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,436.31 "," $21,034.60 "," $19,046.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,115.08 "," $21,034.60 ", Not Applicable
,343-4,Diagnosis Related Group,MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG,Inpatient,APR-DRG,, Not Applicable ," $18,145.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,464.49 "," $34,338.65 "," $31,092.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,145.19 "," $34,338.65 ", Not Applicable
,344-1,Diagnosis Related Group,"OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS",Inpatient,APR-DRG,, Not Applicable ," $5,370.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,424.42 "," $10,162.95 "," $9,202.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,370.29 "," $10,162.95 ", Not Applicable
,344-2,Diagnosis Related Group,"OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS",Inpatient,APR-DRG,, Not Applicable ," $7,052.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,063.30 "," $13,346.41 "," $12,084.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,052.49 "," $13,346.41 ", Not Applicable
,344-3,Diagnosis Related Group,"OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS",Inpatient,APR-DRG,, Not Applicable ," $10,574.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,588.19 "," $20,011.46 "," $18,119.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,574.43 "," $20,011.46 ", Not Applicable
,344-4,Diagnosis Related Group,"OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS",Inpatient,APR-DRG,, Not Applicable ," $18,624.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,216.72 "," $35,246.11 "," $31,914.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,624.71 "," $35,246.11 ", Not Applicable
,346-1,Diagnosis Related Group,CONNECTIVE TISSUE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $4,598.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,214.37 "," $8,703.19 "," $7,880.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,598.93 "," $8,703.19 ", Not Applicable
,346-2,Diagnosis Related Group,CONNECTIVE TISSUE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $6,247.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,800.58 "," $11,823.10 "," $10,705.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,247.55 "," $11,823.10 ", Not Applicable
,346-3,Diagnosis Related Group,CONNECTIVE TISSUE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $10,082.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,817.06 "," $19,081.19 "," $17,277.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,082.86 "," $19,081.19 ", Not Applicable
,346-4,Diagnosis Related Group,CONNECTIVE TISSUE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $24,075.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,766.73 "," $45,560.58 "," $41,253.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,075.07 "," $45,560.58 ", Not Applicable
,347-1,Diagnosis Related Group,"OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES",Inpatient,APR-DRG,, Not Applicable ," $4,602.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,219.77 "," $8,709.70 "," $7,886.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,602.37 "," $8,709.70 ", Not Applicable
,347-2,Diagnosis Related Group,"OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES",Inpatient,APR-DRG,, Not Applicable ," $5,955.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,342.76 "," $11,270.81 "," $10,205.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,955.71 "," $11,270.81 ", Not Applicable
,347-3,Diagnosis Related Group,"OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES",Inpatient,APR-DRG,, Not Applicable ," $8,150.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,785.18 "," $15,423.64 "," $13,965.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,150.14 "," $15,423.64 ", Not Applicable
,347-4,Diagnosis Related Group,"OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES",Inpatient,APR-DRG,, Not Applicable ," $18,304.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,714.33 "," $34,640.05 "," $31,365.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,304.46 "," $34,640.05 ", Not Applicable
,349-1,Diagnosis Related Group,"MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $3,903.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,123.17 "," $7,386.79 "," $6,688.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,903.32 "," $7,386.79 ", Not Applicable
,349-2,Diagnosis Related Group,"MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $5,535.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,683.72 "," $10,475.76 "," $9,485.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,535.59 "," $10,475.76 ", Not Applicable
,349-3,Diagnosis Related Group,"MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $8,621.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,525.26 "," $16,316.44 "," $14,774.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,621.91 "," $16,316.44 ", Not Applicable
,349-4,Diagnosis Related Group,"MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $17,622.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,644.74 "," $33,349.72 "," $30,197.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,622.62 "," $33,349.72 ", Not Applicable
,351-1,Diagnosis Related Group,OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $3,732.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,855.77 "," $7,064.21 "," $6,396.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,732.86 "," $7,064.21 ", Not Applicable
,351-2,Diagnosis Related Group,OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $4,826.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,570.90 "," $9,133.30 "," $8,269.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,826.21 "," $9,133.30 ", Not Applicable
,351-3,Diagnosis Related Group,OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $7,422.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,644.01 "," $14,046.96 "," $12,719.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,422.68 "," $14,046.96 ", Not Applicable
,351-4,Diagnosis Related Group,OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $15,935.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,997.76 "," $30,156.49 "," $27,305.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,935.26 "," $30,156.49 ", Not Applicable
,361-1,Diagnosis Related Group,SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $9,651.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,140.46 "," $18,264.96 "," $16,538.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,651.55 "," $18,264.96 ", Not Applicable
,361-2,Diagnosis Related Group,SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $12,477.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,574.15 "," $23,613.62 "," $21,381.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,477.88 "," $23,613.62 ", Not Applicable
,361-3,Diagnosis Related Group,SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $18,285.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,684.62 "," $34,604.21 "," $31,333.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,285.52 "," $34,604.21 ", Not Applicable
,361-4,Diagnosis Related Group,SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $36,838.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $57,789.25 "," $69,715.10 "," $63,125.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,838.77 "," $69,715.10 ", Not Applicable
,362-1,Diagnosis Related Group,MASTECTOMY PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $9,827.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,415.96 "," $18,597.32 "," $16,839.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,827.17 "," $18,597.32 ", Not Applicable
,362-2,Diagnosis Related Group,MASTECTOMY PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $12,574.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,725.40 "," $23,796.10 "," $21,546.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,574.31 "," $23,796.10 ", Not Applicable
,362-3,Diagnosis Related Group,MASTECTOMY PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $15,458.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,249.58 "," $29,253.92 "," $26,488.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,458.32 "," $29,253.92 ", Not Applicable
,362-4,Diagnosis Related Group,MASTECTOMY PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $28,911.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,353.84 "," $54,713.42 "," $49,541.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,911.60 "," $54,713.42 ", Not Applicable
,363-1,Diagnosis Related Group,BREAST PROCEDURES EXCEPT MASTECTOMY,Inpatient,APR-DRG,, Not Applicable ," $7,716.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,104.53 "," $14,602.52 "," $13,222.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,716.25 "," $14,602.52 ", Not Applicable
,363-2,Diagnosis Related Group,BREAST PROCEDURES EXCEPT MASTECTOMY,Inpatient,APR-DRG,, Not Applicable ," $13,319.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,894.94 "," $25,206.98 "," $22,824.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,319.84 "," $25,206.98 ", Not Applicable
,363-3,Diagnosis Related Group,BREAST PROCEDURES EXCEPT MASTECTOMY,Inpatient,APR-DRG,, Not Applicable ," $17,583.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,582.61 "," $33,274.78 "," $30,129.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,583.02 "," $33,274.78 ", Not Applicable
,363-4,Diagnosis Related Group,BREAST PROCEDURES EXCEPT MASTECTOMY,Inpatient,APR-DRG,, Not Applicable ," $35,113.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,082.84 "," $66,450.18 "," $60,168.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,113.53 "," $66,450.18 ", Not Applicable
,364-1,Diagnosis Related Group,"OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $6,474.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,157.11 "," $12,253.21 "," $11,094.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,474.83 "," $12,253.21 ", Not Applicable
,364-2,Diagnosis Related Group,"OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $9,039.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,180.25 "," $17,106.60 "," $15,489.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,039.45 "," $17,106.60 ", Not Applicable
,364-3,Diagnosis Related Group,"OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $13,795.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,641.76 "," $26,107.93 "," $23,640.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,795.92 "," $26,107.93 ", Not Applicable
,364-4,Diagnosis Related Group,"OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $25,000.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,218.52 "," $47,311.97 "," $42,839.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,000.54 "," $47,311.97 ", Not Applicable
,380-1,Diagnosis Related Group,SKIN ULCERS,Inpatient,APR-DRG,, Not Applicable ," $4,629.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,261.64 "," $8,760.21 "," $7,932.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,629.06 "," $8,760.21 ", Not Applicable
,380-2,Diagnosis Related Group,SKIN ULCERS,Inpatient,APR-DRG,, Not Applicable ," $5,506.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,637.80 "," $10,420.36 "," $9,435.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,506.32 "," $10,420.36 ", Not Applicable
,380-3,Diagnosis Related Group,SKIN ULCERS,Inpatient,APR-DRG,, Not Applicable ," $7,578.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,888.45 "," $14,341.85 "," $12,986.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,578.50 "," $14,341.85 ", Not Applicable
,380-4,Diagnosis Related Group,SKIN ULCERS,Inpatient,APR-DRG,, Not Applicable ," $13,752.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,572.89 "," $26,024.84 "," $23,564.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,752.02 "," $26,024.84 ", Not Applicable
,381-1,Diagnosis Related Group,MAJOR SKIN DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $3,144.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,932.03 "," $5,949.84 "," $5,387.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,144.01 "," $5,949.84 ", Not Applicable
,381-2,Diagnosis Related Group,MAJOR SKIN DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $5,215.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,181.33 "," $9,869.69 "," $8,936.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,215.33 "," $9,869.69 ", Not Applicable
,381-3,Diagnosis Related Group,MAJOR SKIN DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $9,316.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,615.11 "," $17,631.20 "," $15,964.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,316.66 "," $17,631.20 ", Not Applicable
,381-4,Diagnosis Related Group,MAJOR SKIN DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $23,360.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,645.82 "," $44,208.34 "," $40,029.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,360.52 "," $44,208.34 ", Not Applicable
,382-1,Diagnosis Related Group,MALIGNANT BREAST DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $3,640.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,711.26 "," $6,889.89 "," $6,238.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,640.75 "," $6,889.89 ", Not Applicable
,382-2,Diagnosis Related Group,MALIGNANT BREAST DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $5,249.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,235.35 "," $9,934.86 "," $8,995.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,249.77 "," $9,934.86 ", Not Applicable
,382-3,Diagnosis Related Group,MALIGNANT BREAST DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $8,519.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,364.55 "," $16,122.56 "," $14,598.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,519.47 "," $16,122.56 ", Not Applicable
,382-4,Diagnosis Related Group,MALIGNANT BREAST DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $13,816.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,674.17 "," $26,147.03 "," $23,675.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,816.58 "," $26,147.03 ", Not Applicable
,383-1,Diagnosis Related Group,CELLULITIS & OTHER SKIN INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $3,571.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,603.22 "," $6,759.55 "," $6,120.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,571.87 "," $6,759.55 ", Not Applicable
,383-2,Diagnosis Related Group,CELLULITIS & OTHER SKIN INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $4,866.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,634.38 "," $9,209.87 "," $8,339.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,866.67 "," $9,209.87 ", Not Applicable
,383-3,Diagnosis Related Group,CELLULITIS & OTHER SKIN INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $7,335.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,507.61 "," $13,882.41 "," $12,570.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,335.73 "," $13,882.41 ", Not Applicable
,383-4,Diagnosis Related Group,CELLULITIS & OTHER SKIN INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $15,472.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,271.19 "," $29,279.98 "," $26,512.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,472.09 "," $29,279.98 ", Not Applicable
,384-1,Diagnosis Related Group,"CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE",Inpatient,APR-DRG,, Not Applicable ," $4,128.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,477.00 "," $7,813.64 "," $7,075.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,128.88 "," $7,813.64 ", Not Applicable
,384-2,Diagnosis Related Group,"CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE",Inpatient,APR-DRG,, Not Applicable ," $5,223.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,193.48 "," $9,884.36 "," $8,950.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,223.08 "," $9,884.36 ", Not Applicable
,384-3,Diagnosis Related Group,"CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE",Inpatient,APR-DRG,, Not Applicable ," $7,675.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,041.06 "," $14,525.95 "," $13,152.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,675.78 "," $14,525.95 ", Not Applicable
,384-4,Diagnosis Related Group,"CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE",Inpatient,APR-DRG,, Not Applicable ," $16,944.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,580.54 "," $32,065.91 "," $29,034.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,944.23 "," $32,065.91 ", Not Applicable
,385-1,Diagnosis Related Group,"OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $3,130.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,910.42 "," $5,923.77 "," $5,363.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,130.23 "," $5,923.77 ", Not Applicable
,385-2,Diagnosis Related Group,"OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $4,338.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,805.17 "," $8,209.54 "," $7,433.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,338.08 "," $8,209.54 ", Not Applicable
,385-3,Diagnosis Related Group,"OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $6,591.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,340.78 "," $12,474.78 "," $11,295.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,591.91 "," $12,474.78 ", Not Applicable
,385-4,Diagnosis Related Group,"OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $12,949.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,314.22 "," $24,506.43 "," $22,189.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,949.66 "," $24,506.43 ", Not Applicable
,401-1,Diagnosis Related Group,ADRENAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $11,636.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,254.71 "," $22,021.90 "," $19,940.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,636.79 "," $22,021.90 ", Not Applicable
,401-2,Diagnosis Related Group,ADRENAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $15,652.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,553.44 "," $29,620.49 "," $26,820.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,652.02 "," $29,620.49 ", Not Applicable
,401-3,Diagnosis Related Group,ADRENAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $24,972.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,173.95 "," $47,258.20 "," $42,791.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,972.13 "," $47,258.20 ", Not Applicable
,401-4,Diagnosis Related Group,ADRENAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $52,819.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $82,858.58 "," $99,957.94 "," $90,509.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $52,819.66 "," $99,957.94 ", Not Applicable
,403-1,Diagnosis Related Group,PROCEDURES FOR OBESITY,Inpatient,APR-DRG,, Not Applicable ," $10,687.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,765.11 "," $20,224.89 "," $18,313.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,687.21 "," $20,224.89 ", Not Applicable
,403-2,Diagnosis Related Group,PROCEDURES FOR OBESITY,Inpatient,APR-DRG,, Not Applicable ," $12,101.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,983.98 "," $22,901.66 "," $20,736.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,101.67 "," $22,901.66 ", Not Applicable
,403-3,Diagnosis Related Group,PROCEDURES FOR OBESITY,Inpatient,APR-DRG,, Not Applicable ," $17,580.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,578.56 "," $33,269.89 "," $30,125.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,580.44 "," $33,269.89 ", Not Applicable
,403-4,Diagnosis Related Group,PROCEDURES FOR OBESITY,Inpatient,APR-DRG,, Not Applicable ," $44,816.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $70,304.33 "," $84,812.89 "," $76,795.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $44,816.73 "," $84,812.89 ", Not Applicable
,404-1,Diagnosis Related Group,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $6,566.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,301.61 "," $12,427.54 "," $11,252.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,566.95 "," $12,427.54 ", Not Applicable
,404-2,Diagnosis Related Group,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $8,560.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,429.37 "," $16,200.76 "," $14,669.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,560.79 "," $16,200.76 ", Not Applicable
,404-3,Diagnosis Related Group,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $16,611.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,059.25 "," $31,437.04 "," $28,465.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,611.93 "," $31,437.04 ", Not Applicable
,404-4,Diagnosis Related Group,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $38,812.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $60,885.94 "," $73,450.85 "," $66,507.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,812.82 "," $73,450.85 ", Not Applicable
,405-1,Diagnosis Related Group,"OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $9,742.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,283.61 "," $18,437.66 "," $16,694.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,742.81 "," $18,437.66 ", Not Applicable
,405-2,Diagnosis Related Group,"OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $12,181.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,109.58 "," $23,053.18 "," $20,874.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,181.74 "," $23,053.18 ", Not Applicable
,405-3,Diagnosis Related Group,"OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $18,135.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,449.63 "," $34,320.73 "," $31,076.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,135.72 "," $34,320.73 ", Not Applicable
,405-4,Diagnosis Related Group,"OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $38,705.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $60,717.13 "," $73,247.20 "," $66,323.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,705.20 "," $73,247.20 ", Not Applicable
,420-1,Diagnosis Related Group,DIABETES,Inpatient,APR-DRG,, Not Applicable ," $3,298.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,175.12 "," $6,243.09 "," $5,652.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,298.97 "," $6,243.09 ", Not Applicable
,420-2,Diagnosis Related Group,DIABETES,Inpatient,APR-DRG,, Not Applicable ," $4,498.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,056.36 "," $8,512.57 "," $7,707.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,498.20 "," $8,512.57 ", Not Applicable
,420-3,Diagnosis Related Group,DIABETES,Inpatient,APR-DRG,, Not Applicable ," $6,523.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,234.09 "," $12,346.08 "," $11,179.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,523.90 "," $12,346.08 ", Not Applicable
,420-4,Diagnosis Related Group,DIABETES,Inpatient,APR-DRG,, Not Applicable ," $15,508.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,327.91 "," $29,348.41 "," $26,574.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,508.25 "," $29,348.41 ", Not Applicable
,421-1,Diagnosis Related Group,"MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $4,078.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,398.67 "," $7,719.15 "," $6,989.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,078.94 "," $7,719.15 ", Not Applicable
,421-2,Diagnosis Related Group,"MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $4,719.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,403.44 "," $8,931.27 "," $8,087.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,719.45 "," $8,931.27 ", Not Applicable
,421-3,Diagnosis Related Group,"MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $7,121.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,171.34 "," $13,476.74 "," $12,202.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,121.36 "," $13,476.74 ", Not Applicable
,421-4,Diagnosis Related Group,"MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS",Inpatient,APR-DRG,, Not Applicable ," $13,777.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,613.40 "," $26,073.72 "," $23,609.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,777.84 "," $26,073.72 ", Not Applicable
,422-1,Diagnosis Related Group,HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $2,626.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,120.38 "," $4,970.69 "," $4,500.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,626.61 "," $4,970.69 ", Not Applicable
,422-2,Diagnosis Related Group,HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $3,953.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,201.50 "," $7,481.29 "," $6,774.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,953.25 "," $7,481.29 ", Not Applicable
,422-3,Diagnosis Related Group,HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $5,642.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,851.18 "," $10,677.78 "," $9,668.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,642.34 "," $10,677.78 ", Not Applicable
,422-4,Diagnosis Related Group,HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $10,705.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,793.47 "," $20,259.10 "," $18,344.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,705.29 "," $20,259.10 ", Not Applicable
,423-1,Diagnosis Related Group,INBORN ERRORS OF METABOLISM,Inpatient,APR-DRG,, Not Applicable ," $3,926.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,159.63 "," $7,430.78 "," $6,728.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,926.56 "," $7,430.78 ", Not Applicable
,423-2,Diagnosis Related Group,INBORN ERRORS OF METABOLISM,Inpatient,APR-DRG,, Not Applicable ," $5,063.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,943.64 "," $9,582.95 "," $8,677.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,063.81 "," $9,582.95 ", Not Applicable
,423-3,Diagnosis Related Group,INBORN ERRORS OF METABOLISM,Inpatient,APR-DRG,, Not Applicable ," $8,164.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,808.14 "," $15,451.33 "," $13,990.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,164.78 "," $15,451.33 ", Not Applicable
,423-4,Diagnosis Related Group,INBORN ERRORS OF METABOLISM,Inpatient,APR-DRG,, Not Applicable ," $13,601.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,336.55 "," $25,739.73 "," $23,306.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,601.36 "," $25,739.73 ", Not Applicable
,424-1,Diagnosis Related Group,OTHER ENDOCRINE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $3,811.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,978.66 "," $7,212.47 "," $6,530.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,811.20 "," $7,212.47 ", Not Applicable
,424-2,Diagnosis Related Group,OTHER ENDOCRINE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $5,468.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,578.38 "," $10,348.68 "," $9,370.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,468.44 "," $10,348.68 ", Not Applicable
,424-3,Diagnosis Related Group,OTHER ENDOCRINE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $8,152.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,789.24 "," $15,428.52 "," $13,970.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,152.72 "," $15,428.52 ", Not Applicable
,424-4,Diagnosis Related Group,OTHER ENDOCRINE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $15,953.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,026.12 "," $30,190.71 "," $27,336.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,953.34 "," $30,190.71 ", Not Applicable
,425-1,Diagnosis Related Group,OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $3,449.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,411.45 "," $6,528.20 "," $5,911.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,449.63 "," $6,528.20 ", Not Applicable
,425-2,Diagnosis Related Group,OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $4,342.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,811.92 "," $8,217.68 "," $7,440.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,342.38 "," $8,217.68 ", Not Applicable
,425-3,Diagnosis Related Group,OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $6,292.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,870.80 "," $11,907.82 "," $10,782.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,292.32 "," $11,907.82 ", Not Applicable
,425-4,Diagnosis Related Group,OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $13,041.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,458.72 "," $24,680.75 "," $22,347.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,041.77 "," $24,680.75 ", Not Applicable
,440-1,Diagnosis Related Group,KIDNEY TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $36,915.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $57,909.44 "," $69,860.10 "," $63,256.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,915.39 "," $69,860.10 ", Not Applicable
,440-2,Diagnosis Related Group,KIDNEY TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $41,968.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $65,836.88 "," $79,423.50 "," $71,916.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,968.88 "," $79,423.50 ", Not Applicable
,440-3,Diagnosis Related Group,KIDNEY TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $49,368.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $77,444.42 "," $93,426.47 "," $84,595.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,368.31 "," $93,426.47 ", Not Applicable
,440-4,Diagnosis Related Group,KIDNEY TRANSPLANT,Inpatient,APR-DRG,, Not Applicable ," $73,859.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $115,863.45 "," $139,773.96 "," $126,561.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $73,859.19 "," $139,773.96 ", Not Applicable
,441-1,Diagnosis Related Group,MAJOR BLADDER PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $12,243.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,206.81 "," $23,170.48 "," $20,980.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,243.72 "," $23,170.48 ", Not Applicable
,441-2,Diagnosis Related Group,MAJOR BLADDER PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $18,777.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,457.11 "," $35,536.11 "," $32,177.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,777.95 "," $35,536.11 ", Not Applicable
,441-3,Diagnosis Related Group,MAJOR BLADDER PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $25,809.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,487.99 "," $48,843.42 "," $44,226.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,809.78 "," $48,843.42 ", Not Applicable
,441-4,Diagnosis Related Group,MAJOR BLADDER PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $49,976.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $78,397.88 "," $94,576.69 "," $85,636.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,976.11 "," $94,576.69 ", Not Applicable
,442-1,Diagnosis Related Group,KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $11,613.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,218.25 "," $21,977.91 "," $19,900.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,613.54 "," $21,977.91 ", Not Applicable
,442-2,Diagnosis Related Group,KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $13,586.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,313.59 "," $25,712.03 "," $23,281.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,586.72 "," $25,712.03 ", Not Applicable
,442-3,Diagnosis Related Group,KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $19,709.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,918.35 "," $37,298.90 "," $33,773.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,709.44 "," $37,298.90 ", Not Applicable
,442-4,Diagnosis Related Group,KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $38,124.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $59,805.54 "," $72,147.49 "," $65,327.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,124.10 "," $72,147.49 ", Not Applicable
,443-1,Diagnosis Related Group,KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $9,885.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,507.79 "," $18,708.10 "," $16,939.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,885.71 "," $18,708.10 ", Not Applicable
,443-2,Diagnosis Related Group,KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $11,053.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,339.07 "," $20,917.30 "," $18,940.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,053.10 "," $20,917.30 ", Not Applicable
,443-3,Diagnosis Related Group,KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $15,777.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,750.61 "," $29,858.35 "," $27,035.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,777.71 "," $29,858.35 ", Not Applicable
,443-4,Diagnosis Related Group,KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $30,378.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $47,655.09 "," $57,489.58 "," $52,055.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,378.58 "," $57,489.58 ", Not Applicable
,444-1,Diagnosis Related Group,RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR,Inpatient,APR-DRG,, Not Applicable ," $7,986.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,528.59 "," $15,114.09 "," $13,685.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,986.57 "," $15,114.09 ", Not Applicable
,444-2,Diagnosis Related Group,RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR,Inpatient,APR-DRG,, Not Applicable ," $10,947.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,172.96 "," $20,716.91 "," $18,758.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,947.20 "," $20,716.91 ", Not Applicable
,444-3,Diagnosis Related Group,RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR,Inpatient,APR-DRG,, Not Applicable ," $17,501.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,454.31 "," $33,120.01 "," $29,989.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,501.24 "," $33,120.01 ", Not Applicable
,444-4,Diagnosis Related Group,RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR,Inpatient,APR-DRG,, Not Applicable ," $32,358.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $50,761.24 "," $61,236.74 "," $55,448.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,358.65 "," $61,236.74 ", Not Applicable
,445-1,Diagnosis Related Group,OTHER BLADDER PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $7,505.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,773.66 "," $14,203.37 "," $12,860.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,505.33 "," $14,203.37 ", Not Applicable
,445-2,Diagnosis Related Group,OTHER BLADDER PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $10,074.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,803.55 "," $19,064.90 "," $17,262.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,074.25 "," $19,064.90 ", Not Applicable
,445-3,Diagnosis Related Group,OTHER BLADDER PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $13,250.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,786.90 "," $25,076.65 "," $22,706.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,250.97 "," $25,076.65 ", Not Applicable
,445-4,Diagnosis Related Group,OTHER BLADDER PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $24,230.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,009.82 "," $45,853.83 "," $41,519.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,230.03 "," $45,853.83 ", Not Applicable
,446-1,Diagnosis Related Group,URETHRAL & TRANSURETHRAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $6,060.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,507.52 "," $11,469.57 "," $10,385.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,060.74 "," $11,469.57 ", Not Applicable
,446-2,Diagnosis Related Group,URETHRAL & TRANSURETHRAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $7,433.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,661.57 "," $14,068.14 "," $12,738.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,433.87 "," $14,068.14 ", Not Applicable
,446-3,Diagnosis Related Group,URETHRAL & TRANSURETHRAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $11,729.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,400.56 "," $22,197.85 "," $20,099.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,729.76 "," $22,197.85 ", Not Applicable
,446-4,Diagnosis Related Group,URETHRAL & TRANSURETHRAL PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $23,168.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,344.66 "," $43,845.03 "," $39,700.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,168.54 "," $43,845.03 ", Not Applicable
,447-1,Diagnosis Related Group,"OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $9,868.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,480.78 "," $18,675.52 "," $16,910.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,868.50 "," $18,675.52 ", Not Applicable
,447-2,Diagnosis Related Group,"OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $11,376.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,846.86 "," $21,529.88 "," $19,494.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,376.79 "," $21,529.88 ", Not Applicable
,447-3,Diagnosis Related Group,"OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $16,450.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,805.35 "," $31,130.75 "," $28,188.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,450.08 "," $31,130.75 ", Not Applicable
,447-4,Diagnosis Related Group,"OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $34,956.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $54,837.05 "," $66,153.67 "," $59,900.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,956.84 "," $66,153.67 ", Not Applicable
,461-1,Diagnosis Related Group,KIDNEY & URINARY TRACT MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $3,837.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,020.53 "," $7,262.97 "," $6,576.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,837.89 "," $7,262.97 ", Not Applicable
,461-2,Diagnosis Related Group,KIDNEY & URINARY TRACT MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $5,410.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,487.89 "," $10,239.52 "," $9,271.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,410.76 "," $10,239.52 ", Not Applicable
,461-3,Diagnosis Related Group,KIDNEY & URINARY TRACT MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $8,417.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,205.19 "," $15,930.32 "," $14,424.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,417.88 "," $15,930.32 ", Not Applicable
,461-4,Diagnosis Related Group,KIDNEY & URINARY TRACT MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $14,711.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,078.69 "," $27,841.40 "," $25,209.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,711.92 "," $27,841.40 ", Not Applicable
,462-1,Diagnosis Related Group,NEPHRITIS & NEPHROSIS,Inpatient,APR-DRG,, Not Applicable ," $3,246.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,092.74 "," $6,143.71 "," $5,562.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,246.45 "," $6,143.71 ", Not Applicable
,462-2,Diagnosis Related Group,NEPHRITIS & NEPHROSIS,Inpatient,APR-DRG,, Not Applicable ," $4,628.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,260.29 "," $8,758.58 "," $7,930.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,628.20 "," $8,758.58 ", Not Applicable
,462-3,Diagnosis Related Group,NEPHRITIS & NEPHROSIS,Inpatient,APR-DRG,, Not Applicable ," $8,601.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,492.85 "," $16,277.34 "," $14,738.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,601.25 "," $16,277.34 ", Not Applicable
,462-4,Diagnosis Related Group,NEPHRITIS & NEPHROSIS,Inpatient,APR-DRG,, Not Applicable ," $16,066.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,204.38 "," $30,405.76 "," $27,531.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,066.98 "," $30,405.76 ", Not Applicable
,463-1,Diagnosis Related Group,KIDNEY & URINARY TRACT INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $3,687.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,784.19 "," $6,977.86 "," $6,318.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,687.23 "," $6,977.86 ", Not Applicable
,463-2,Diagnosis Related Group,KIDNEY & URINARY TRACT INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $4,754.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,458.81 "," $8,998.07 "," $8,147.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,754.75 "," $8,998.07 ", Not Applicable
,463-3,Diagnosis Related Group,KIDNEY & URINARY TRACT INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $6,463.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,139.55 "," $12,232.03 "," $11,075.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,463.64 "," $12,232.03 ", Not Applicable
,463-4,Diagnosis Related Group,KIDNEY & URINARY TRACT INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $11,417.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,910.33 "," $21,606.45 "," $19,564.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,417.26 "," $21,606.45 ", Not Applicable
,465-1,Diagnosis Related Group,URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION,Inpatient,APR-DRG,, Not Applicable ," $3,918.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,147.48 "," $7,416.12 "," $6,715.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,918.82 "," $7,416.12 ", Not Applicable
,465-2,Diagnosis Related Group,URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION,Inpatient,APR-DRG,, Not Applicable ," $4,716.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,399.39 "," $8,926.39 "," $8,082.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,716.87 "," $8,926.39 ", Not Applicable
,465-3,Diagnosis Related Group,URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION,Inpatient,APR-DRG,, Not Applicable ," $7,348.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,527.87 "," $13,906.85 "," $12,592.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,348.64 "," $13,906.85 ", Not Applicable
,465-4,Diagnosis Related Group,URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION,Inpatient,APR-DRG,, Not Applicable ," $14,962.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,471.69 "," $28,315.50 "," $25,638.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,962.44 "," $28,315.50 ", Not Applicable
,466-1,Diagnosis Related Group,"MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC",Inpatient,APR-DRG,, Not Applicable ," $3,340.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,239.94 "," $6,321.30 "," $5,723.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,340.29 "," $6,321.30 ", Not Applicable
,466-2,Diagnosis Related Group,"MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC",Inpatient,APR-DRG,, Not Applicable ," $4,994.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,835.60 "," $9,452.62 "," $8,559.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,994.94 "," $9,452.62 ", Not Applicable
,466-3,Diagnosis Related Group,"MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC",Inpatient,APR-DRG,, Not Applicable ," $7,283.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,425.23 "," $13,783.03 "," $12,480.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,283.21 "," $13,783.03 ", Not Applicable
,466-4,Diagnosis Related Group,"MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC",Inpatient,APR-DRG,, Not Applicable ," $13,346.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,936.80 "," $25,257.49 "," $22,870.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,346.53 "," $25,257.49 ", Not Applicable
,468-1,Diagnosis Related Group,"OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS",Inpatient,APR-DRG,, Not Applicable ," $3,679.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,772.04 "," $6,963.20 "," $6,305.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,679.49 "," $6,963.20 ", Not Applicable
,468-2,Diagnosis Related Group,"OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS",Inpatient,APR-DRG,, Not Applicable ," $5,096.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,994.96 "," $9,644.86 "," $8,733.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,096.53 "," $9,644.86 ", Not Applicable
,468-3,Diagnosis Related Group,"OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS",Inpatient,APR-DRG,, Not Applicable ," $7,475.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,726.39 "," $14,146.34 "," $12,809.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,475.19 "," $14,146.34 ", Not Applicable
,468-4,Diagnosis Related Group,"OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS",Inpatient,APR-DRG,, Not Applicable ," $14,395.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,581.71 "," $27,241.85 "," $24,666.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,395.11 "," $27,241.85 ", Not Applicable
,469-1,Diagnosis Related Group,ACUTE KIDNEY INJURY,Inpatient,APR-DRG,, Not Applicable ," $3,812.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,981.36 "," $7,215.73 "," $6,533.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,812.93 "," $7,215.73 ", Not Applicable
,469-2,Diagnosis Related Group,ACUTE KIDNEY INJURY,Inpatient,APR-DRG,, Not Applicable ," $5,054.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,928.79 "," $9,565.03 "," $8,660.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,054.34 "," $9,565.03 ", Not Applicable
,469-3,Diagnosis Related Group,ACUTE KIDNEY INJURY,Inpatient,APR-DRG,, Not Applicable ," $7,909.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,407.04 "," $14,967.46 "," $13,552.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,909.09 "," $14,967.46 ", Not Applicable
,469-4,Diagnosis Related Group,ACUTE KIDNEY INJURY,Inpatient,APR-DRG,, Not Applicable ," $16,907.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,522.47 "," $31,995.86 "," $28,971.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,907.22 "," $31,995.86 ", Not Applicable
,470-1,Diagnosis Related Group,CHRONIC KIDNEY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $3,882.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,090.76 "," $7,347.69 "," $6,653.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,882.66 "," $7,347.69 ", Not Applicable
,470-2,Diagnosis Related Group,CHRONIC KIDNEY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $4,757.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,462.86 "," $9,002.96 "," $8,151.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,757.33 "," $9,002.96 ", Not Applicable
,470-3,Diagnosis Related Group,CHRONIC KIDNEY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $7,024.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,020.08 "," $13,294.27 "," $12,037.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,024.94 "," $13,294.27 ", Not Applicable
,470-4,Diagnosis Related Group,CHRONIC KIDNEY DISEASE,Inpatient,APR-DRG,, Not Applicable ," $14,306.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,442.61 "," $27,074.05 "," $24,514.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,306.44 "," $27,074.05 ", Not Applicable
,480-1,Diagnosis Related Group,MAJOR MALE PELVIC PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $10,781.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,912.31 "," $20,402.47 "," $18,473.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,781.05 "," $20,402.47 ", Not Applicable
,480-2,Diagnosis Related Group,MAJOR MALE PELVIC PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $11,979.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,792.21 "," $22,670.32 "," $20,527.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,979.42 "," $22,670.32 ", Not Applicable
,480-3,Diagnosis Related Group,MAJOR MALE PELVIC PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $19,078.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,928.43 "," $36,104.70 "," $32,691.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,078.40 "," $36,104.70 ", Not Applicable
,480-4,Diagnosis Related Group,MAJOR MALE PELVIC PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $39,682.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $62,249.95 "," $75,096.34 "," $67,997.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,682.32 "," $75,096.34 ", Not Applicable
,481-1,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $5,920.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,287.39 "," $11,204.01 "," $10,144.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,920.41 "," $11,204.01 ", Not Applicable
,481-2,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $9,557.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,993.25 "," $18,087.38 "," $16,377.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,557.71 "," $18,087.38 ", Not Applicable
,481-3,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $13,515.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,201.50 "," $25,576.81 "," $23,159.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,515.27 "," $25,576.81 ", Not Applicable
,481-4,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $31,166.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,890.80 "," $58,980.30 "," $53,405.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,166.30 "," $58,980.30 ", Not Applicable
,482-1,Diagnosis Related Group,TRANSURETHRAL PROSTATECTOMY,Inpatient,APR-DRG,, Not Applicable ," $5,422.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,506.80 "," $10,262.33 "," $9,292.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,422.81 "," $10,262.33 ", Not Applicable
,482-2,Diagnosis Related Group,TRANSURETHRAL PROSTATECTOMY,Inpatient,APR-DRG,, Not Applicable ," $6,999.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,980.92 "," $13,247.03 "," $11,994.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,999.98 "," $13,247.03 ", Not Applicable
,482-3,Diagnosis Related Group,TRANSURETHRAL PROSTATECTOMY,Inpatient,APR-DRG,, Not Applicable ," $12,856.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,168.37 "," $24,330.47 "," $22,030.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,856.68 "," $24,330.47 ", Not Applicable
,482-4,Diagnosis Related Group,TRANSURETHRAL PROSTATECTOMY,Inpatient,APR-DRG,, Not Applicable ," $24,576.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,554.07 "," $46,510.40 "," $42,114.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,576.97 "," $46,510.40 ", Not Applicable
,483-1,Diagnosis Related Group,"PENIS, TESTES & SCROTAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $5,418.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,500.05 "," $10,254.18 "," $9,284.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,418.50 "," $10,254.18 ", Not Applicable
,483-2,Diagnosis Related Group,"PENIS, TESTES & SCROTAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $9,673.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,174.22 "," $18,305.69 "," $16,575.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,673.07 "," $18,305.69 ", Not Applicable
,483-3,Diagnosis Related Group,"PENIS, TESTES & SCROTAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $17,102.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,829.03 "," $32,365.69 "," $29,306.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,102.64 "," $32,365.69 ", Not Applicable
,483-4,Diagnosis Related Group,"PENIS, TESTES & SCROTAL PROCEDURES",Inpatient,APR-DRG,, Not Applicable ," $35,171.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,173.33 "," $66,559.34 "," $60,267.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,171.21 "," $66,559.34 ", Not Applicable
,484-1,Diagnosis Related Group,OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $6,982.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,953.91 "," $13,214.44 "," $11,965.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,982.76 "," $13,214.44 ", Not Applicable
,484-2,Diagnosis Related Group,OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $10,891.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,085.18 "," $20,611.01 "," $18,662.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,891.25 "," $20,611.01 ", Not Applicable
,484-3,Diagnosis Related Group,OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $13,572.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,291.98 "," $25,685.97 "," $23,258.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,572.95 "," $25,685.97 ", Not Applicable
,484-4,Diagnosis Related Group,OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $34,074.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $53,452.79 "," $64,483.74 "," $58,388.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,074.42 "," $64,483.74 ", Not Applicable
,500-1,Diagnosis Related Group,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM",Inpatient,APR-DRG,, Not Applicable ," $3,401.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,335.83 "," $6,436.97 "," $5,828.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,401.42 "," $6,436.97 ", Not Applicable
,500-2,Diagnosis Related Group,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM",Inpatient,APR-DRG,, Not Applicable ," $5,516.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,654.00 "," $10,439.91 "," $9,453.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,516.65 "," $10,439.91 ", Not Applicable
,500-3,Diagnosis Related Group,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM",Inpatient,APR-DRG,, Not Applicable ," $8,728.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,692.72 "," $16,518.46 "," $14,957.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,728.67 "," $16,518.46 ", Not Applicable
,500-4,Diagnosis Related Group,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM",Inpatient,APR-DRG,, Not Applicable ," $13,008.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,406.06 "," $24,617.21 "," $22,290.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,008.20 "," $24,617.21 ", Not Applicable
,501-1,Diagnosis Related Group,MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $3,500.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,491.13 "," $6,624.33 "," $5,998.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,500.42 "," $6,624.33 ", Not Applicable
,501-2,Diagnosis Related Group,MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $4,868.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,637.08 "," $9,213.13 "," $8,342.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,868.39 "," $9,213.13 ", Not Applicable
,501-3,Diagnosis Related Group,MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $7,221.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,327.99 "," $13,665.73 "," $12,373.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,221.23 "," $13,665.73 ", Not Applicable
,501-4,Diagnosis Related Group,MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $15,744.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,697.94 "," $29,794.81 "," $26,978.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,744.14 "," $29,794.81 ", Not Applicable
,510-1,Diagnosis Related Group,"PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS",Inpatient,APR-DRG,, Not Applicable ," $10,099.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,842.72 "," $19,112.15 "," $17,305.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,099.22 "," $19,112.15 ", Not Applicable
,510-2,Diagnosis Related Group,"PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS",Inpatient,APR-DRG,, Not Applicable ," $12,437.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,510.67 "," $23,537.05 "," $21,312.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,437.42 "," $23,537.05 ", Not Applicable
,510-3,Diagnosis Related Group,"PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS",Inpatient,APR-DRG,, Not Applicable ," $21,833.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,250.03 "," $41,318.14 "," $37,412.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,833.28 "," $41,318.14 ", Not Applicable
,510-4,Diagnosis Related Group,"PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS",Inpatient,APR-DRG,, Not Applicable ," $44,539.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $69,869.47 "," $84,288.29 "," $76,320.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $44,539.52 "," $84,288.29 ", Not Applicable
,511-1,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $10,719.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,815.08 "," $20,285.17 "," $18,367.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,719.07 "," $20,285.17 ", Not Applicable
,511-2,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $13,083.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,523.55 "," $24,758.95 "," $22,418.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,083.10 "," $24,758.95 ", Not Applicable
,511-3,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $19,615.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,771.14 "," $37,121.32 "," $33,612.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,615.61 "," $37,121.32 ", Not Applicable
,511-4,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $40,452.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $63,458.64 "," $76,554.48 "," $69,318.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,452.83 "," $76,554.48 ", Not Applicable
,512-1,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG,Inpatient,APR-DRG,, Not Applicable ," $9,320.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,620.51 "," $17,637.72 "," $15,970.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,320.10 "," $17,637.72 ", Not Applicable
,512-2,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG,Inpatient,APR-DRG,, Not Applicable ," $11,134.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,467.37 "," $21,072.07 "," $19,080.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,134.88 "," $21,072.07 ", Not Applicable
,512-3,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG,Inpatient,APR-DRG,, Not Applicable ," $16,589.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,024.14 "," $31,394.68 "," $28,427.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,589.54 "," $31,394.68 ", Not Applicable
,512-4,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG,Inpatient,APR-DRG,, Not Applicable ," $33,504.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $52,558.76 "," $63,405.21 "," $57,411.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,504.51 "," $63,405.21 ", Not Applicable
,513-1,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA,Inpatient,APR-DRG,, Not Applicable ," $7,534.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,819.58 "," $14,258.76 "," $12,910.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,534.60 "," $14,258.76 ", Not Applicable
,513-2,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA,Inpatient,APR-DRG,, Not Applicable ," $8,892.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,949.31 "," $16,828.01 "," $15,237.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,892.24 "," $16,828.01 ", Not Applicable
,513-3,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA,Inpatient,APR-DRG,, Not Applicable ," $14,181.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,246.79 "," $26,837.81 "," $24,300.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,181.61 "," $26,837.81 ", Not Applicable
,513-4,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA,Inpatient,APR-DRG,, Not Applicable ," $32,241.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $50,577.58 "," $61,015.17 "," $55,247.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,241.57 "," $61,015.17 ", Not Applicable
,514-1,Diagnosis Related Group,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $6,015.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,435.94 "," $11,383.22 "," $10,307.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,015.11 "," $11,383.22 ", Not Applicable
,514-2,Diagnosis Related Group,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $8,733.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,700.82 "," $16,528.23 "," $14,965.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,733.83 "," $16,528.23 ", Not Applicable
,514-3,Diagnosis Related Group,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $14,674.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,020.62 "," $27,771.34 "," $25,146.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,674.90 "," $27,771.34 ", Not Applicable
,514-4,Diagnosis Related Group,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $41,132.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $64,525.54 "," $77,841.55 "," $70,483.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,132.94 "," $77,841.55 ", Not Applicable
,517-1,Diagnosis Related Group,DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $5,322.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,350.14 "," $10,073.34 "," $9,121.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,322.94 "," $10,073.34 ", Not Applicable
,517-2,Diagnosis Related Group,DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $7,020.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,013.33 "," $13,286.13 "," $12,030.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,020.64 "," $13,286.13 ", Not Applicable
,517-3,Diagnosis Related Group,DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $12,137.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,040.70 "," $22,970.09 "," $20,798.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,137.83 "," $22,970.09 ", Not Applicable
,517-4,Diagnosis Related Group,DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $26,116.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,968.77 "," $49,423.41 "," $44,751.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,116.26 "," $49,423.41 ", Not Applicable
,518-1,Diagnosis Related Group,OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $6,153.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,653.37 "," $11,645.52 "," $10,544.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,153.71 "," $11,645.52 ", Not Applicable
,518-2,Diagnosis Related Group,OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $8,770.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,758.89 "," $16,598.29 "," $15,029.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,770.85 "," $16,598.29 ", Not Applicable
,518-3,Diagnosis Related Group,OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $15,268.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,952.47 "," $28,895.49 "," $26,164.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,268.92 "," $28,895.49 ", Not Applicable
,518-4,Diagnosis Related Group,OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES,Inpatient,APR-DRG,, Not Applicable ," $34,929.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $54,793.84 "," $66,101.53 "," $59,853.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,929.30 "," $66,101.53 ", Not Applicable
,519-1,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA,Inpatient,APR-DRG,, Not Applicable ," $7,322.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,487.35 "," $13,857.98 "," $12,548.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,322.82 "," $13,857.98 ", Not Applicable
,519-2,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA,Inpatient,APR-DRG,, Not Applicable ," $9,059.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,211.31 "," $17,144.07 "," $15,523.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,059.25 "," $17,144.07 ", Not Applicable
,519-3,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA,Inpatient,APR-DRG,, Not Applicable ," $15,631.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,521.03 "," $29,581.38 "," $26,785.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,631.36 "," $29,581.38 ", Not Applicable
,519-4,Diagnosis Related Group,UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA,Inpatient,APR-DRG,, Not Applicable ," $35,689.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,986.33 "," $67,540.12 "," $61,155.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,689.47 "," $67,540.12 ", Not Applicable
,530-1,Diagnosis Related Group,FEMALE REPRODUCTIVE SYSTEM MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $3,758.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,896.28 "," $7,113.09 "," $6,440.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,758.69 "," $7,113.09 ", Not Applicable
,530-2,Diagnosis Related Group,FEMALE REPRODUCTIVE SYSTEM MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $5,267.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,263.71 "," $9,969.07 "," $9,026.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,267.85 "," $9,969.07 ", Not Applicable
,530-3,Diagnosis Related Group,FEMALE REPRODUCTIVE SYSTEM MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $8,678.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,614.39 "," $16,423.97 "," $14,871.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,678.73 "," $16,423.97 ", Not Applicable
,530-4,Diagnosis Related Group,FEMALE REPRODUCTIVE SYSTEM MALIGNANCY,Inpatient,APR-DRG,, Not Applicable ," $15,263.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,944.37 "," $28,885.72 "," $26,155.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,263.76 "," $28,885.72 ", Not Applicable
,531-1,Diagnosis Related Group,FEMALE REPRODUCTIVE SYSTEM INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $3,961.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,213.65 "," $7,495.95 "," $6,787.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,961.00 "," $7,495.95 ", Not Applicable
,531-2,Diagnosis Related Group,FEMALE REPRODUCTIVE SYSTEM INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $5,344.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,383.90 "," $10,114.07 "," $9,158.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,344.47 "," $10,114.07 ", Not Applicable
,531-3,Diagnosis Related Group,FEMALE REPRODUCTIVE SYSTEM INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $8,228.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,908.08 "," $15,571.89 "," $14,099.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,228.48 "," $15,571.89 ", Not Applicable
,531-4,Diagnosis Related Group,FEMALE REPRODUCTIVE SYSTEM INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $14,647.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,977.41 "," $27,719.21 "," $25,099.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,647.35 "," $27,719.21 ", Not Applicable
,532-1,Diagnosis Related Group,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $3,251.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,100.84 "," $6,153.49 "," $5,571.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,251.62 "," $6,153.49 ", Not Applicable
,532-2,Diagnosis Related Group,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $4,097.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,428.38 "," $7,754.99 "," $7,021.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,097.88 "," $7,754.99 ", Not Applicable
,532-3,Diagnosis Related Group,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $6,616.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,378.59 "," $12,520.40 "," $11,336.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.02 "," $12,520.40 ", Not Applicable
,532-4,Diagnosis Related Group,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $13,463.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,120.47 "," $25,479.06 "," $23,070.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,463.62 "," $25,479.06 ", Not Applicable
,540-1,Diagnosis Related Group,CESAREAN DELIVERY,Inpatient,APR-DRG,, Not Applicable ," $5,715.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,965.97 "," $10,816.26 "," $9,793.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,715.52 "," $10,816.26 ", Not Applicable
,540-2,Diagnosis Related Group,CESAREAN DELIVERY,Inpatient,APR-DRG,, Not Applicable ," $6,820.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,700.01 "," $12,908.15 "," $11,688.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,820.91 "," $12,908.15 ", Not Applicable
,540-3,Diagnosis Related Group,CESAREAN DELIVERY,Inpatient,APR-DRG,, Not Applicable ," $9,085.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,253.18 "," $17,194.58 "," $15,569.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,085.94 "," $17,194.58 ", Not Applicable
,540-4,Diagnosis Related Group,CESAREAN DELIVERY,Inpatient,APR-DRG,, Not Applicable ," $21,957.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,444.50 "," $41,552.75 "," $37,624.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,957.25 "," $41,552.75 ", Not Applicable
,541-1,Diagnosis Related Group,VAGINAL DELIVERY W STERILIZATION &/OR D&C,Inpatient,APR-DRG,, Not Applicable ," $5,731.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,991.63 "," $10,847.21 "," $9,821.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,731.87 "," $10,847.21 ", Not Applicable
,541-2,Diagnosis Related Group,VAGINAL DELIVERY W STERILIZATION &/OR D&C,Inpatient,APR-DRG,, Not Applicable ," $6,156.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,657.43 "," $11,650.41 "," $10,549.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,156.30 "," $11,650.41 ", Not Applicable
,541-3,Diagnosis Related Group,VAGINAL DELIVERY W STERILIZATION &/OR D&C,Inpatient,APR-DRG,, Not Applicable ," $8,287.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,999.91 "," $15,682.68 "," $14,200.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,287.02 "," $15,682.68 ", Not Applicable
,541-4,Diagnosis Related Group,VAGINAL DELIVERY W STERILIZATION &/OR D&C,Inpatient,APR-DRG,, Not Applicable ," $25,549.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,080.14 "," $48,351.40 "," $43,780.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,549.79 "," $48,351.40 ", Not Applicable
,542-1,Diagnosis Related Group,VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/OR D&C,Inpatient,APR-DRG,, Not Applicable ," $3,871.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,073.20 "," $7,326.51 "," $6,633.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,871.47 "," $7,326.51 ", Not Applicable
,542-2,Diagnosis Related Group,VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/OR D&C,Inpatient,APR-DRG,, Not Applicable ," $4,765.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,475.02 "," $9,017.62 "," $8,165.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,765.08 "," $9,017.62 ", Not Applicable
,542-3,Diagnosis Related Group,VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/OR D&C,Inpatient,APR-DRG,, Not Applicable ," $8,693.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,637.35 "," $16,451.66 "," $14,896.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,693.37 "," $16,451.66 ", Not Applicable
,542-4,Diagnosis Related Group,VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/OR D&C,Inpatient,APR-DRG,, Not Applicable ," $30,328.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $47,576.76 "," $57,395.09 "," $51,969.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,328.65 "," $57,395.09 ", Not Applicable
,544-1,Diagnosis Related Group,"D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $4,864.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,630.33 "," $9,204.98 "," $8,334.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,864.09 "," $9,204.98 ", Not Applicable
,544-2,Diagnosis Related Group,"D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $6,026.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,453.50 "," $11,404.40 "," $10,326.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,026.30 "," $11,404.40 ", Not Applicable
,544-3,Diagnosis Related Group,"D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $9,097.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,272.08 "," $17,217.39 "," $15,589.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,097.99 "," $17,217.39 ", Not Applicable
,544-4,Diagnosis Related Group,"D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $24,809.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,918.71 "," $46,950.29 "," $42,512.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,809.42 "," $46,950.29 ", Not Applicable
,545-1,Diagnosis Related Group,ECTOPIC PREGNANCY PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $7,365.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,553.53 "," $13,937.81 "," $12,620.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,365.00 "," $13,937.81 ", Not Applicable
,545-2,Diagnosis Related Group,ECTOPIC PREGNANCY PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $8,292.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,008.02 "," $15,692.45 "," $14,209.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,292.19 "," $15,692.45 ", Not Applicable
,545-3,Diagnosis Related Group,ECTOPIC PREGNANCY PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $10,694.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,777.26 "," $20,239.55 "," $18,326.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,694.96 "," $20,239.55 ", Not Applicable
,545-4,Diagnosis Related Group,ECTOPIC PREGNANCY PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $17,792.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,910.78 "," $33,670.68 "," $30,487.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,792.22 "," $33,670.68 ", Not Applicable
,546-1,Diagnosis Related Group,OTHER O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $5,111.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,017.92 "," $9,672.56 "," $8,758.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,111.16 "," $9,672.56 ", Not Applicable
,546-2,Diagnosis Related Group,OTHER O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $7,408.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,622.40 "," $14,020.90 "," $12,695.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,408.91 "," $14,020.90 ", Not Applicable
,546-3,Diagnosis Related Group,OTHER O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $13,462.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,119.12 "," $25,477.43 "," $23,069.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,462.75 "," $25,477.43 ", Not Applicable
,546-4,Diagnosis Related Group,OTHER O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $38,287.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $60,062.14 "," $72,457.04 "," $65,608.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,287.67 "," $72,457.04 ", Not Applicable
,560-1,Diagnosis Related Group,VAGINAL DELIVERY,Inpatient,APR-DRG,, Not Applicable ," $3,379.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,300.71 "," $6,394.61 "," $5,790.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,379.03 "," $6,394.61 ", Not Applicable
,560-2,Diagnosis Related Group,VAGINAL DELIVERY,Inpatient,APR-DRG,, Not Applicable ," $3,902.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,121.82 "," $7,385.16 "," $6,687.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,902.46 "," $7,385.16 ", Not Applicable
,560-3,Diagnosis Related Group,VAGINAL DELIVERY,Inpatient,APR-DRG,, Not Applicable ," $5,318.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,343.39 "," $10,065.20 "," $9,113.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,318.64 "," $10,065.20 ", Not Applicable
,560-4,Diagnosis Related Group,VAGINAL DELIVERY,Inpatient,APR-DRG,, Not Applicable ," $12,887.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,216.99 "," $24,389.12 "," $22,083.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,887.67 "," $24,389.12 ", Not Applicable
,561-1,Diagnosis Related Group,POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $2,308.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,620.69 "," $4,367.89 "," $3,955.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,308.07 "," $4,367.89 ", Not Applicable
,561-2,Diagnosis Related Group,POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $3,717.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,831.46 "," $7,034.89 "," $6,369.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,717.37 "," $7,034.89 ", Not Applicable
,561-3,Diagnosis Related Group,POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $5,763.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,041.60 "," $10,907.49 "," $9,876.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,763.73 "," $10,907.49 ", Not Applicable
,561-4,Diagnosis Related Group,POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $14,340.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,496.63 "," $27,139.21 "," $24,573.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,340.87 "," $27,139.21 ", Not Applicable
,563-1,Diagnosis Related Group,PRETERM LABOR,Inpatient,APR-DRG,, Not Applicable ," $2,509.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,936.71 "," $4,749.12 "," $4,300.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,509.52 "," $4,749.12 ", Not Applicable
,563-2,Diagnosis Related Group,PRETERM LABOR,Inpatient,APR-DRG,, Not Applicable ," $3,239.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,081.93 "," $6,130.68 "," $5,551.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,239.57 "," $6,130.68 ", Not Applicable
,563-3,Diagnosis Related Group,PRETERM LABOR,Inpatient,APR-DRG,, Not Applicable ," $4,752.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,454.76 "," $8,993.18 "," $8,143.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,752.17 "," $8,993.18 ", Not Applicable
,563-4,Diagnosis Related Group,PRETERM LABOR,Inpatient,APR-DRG,, Not Applicable ," $8,886.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,939.86 "," $16,816.60 "," $15,227.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,886.21 "," $16,816.60 ", Not Applicable
,564-1,Diagnosis Related Group,"ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",Inpatient,APR-DRG,, Not Applicable ," $2,891.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,536.33 "," $5,472.48 "," $4,955.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,891.76 "," $5,472.48 ", Not Applicable
,564-2,Diagnosis Related Group,"ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",Inpatient,APR-DRG,, Not Applicable ," $3,426.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,374.99 "," $6,484.22 "," $5,871.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,426.38 "," $6,484.22 ", Not Applicable
,564-3,Diagnosis Related Group,"ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",Inpatient,APR-DRG,, Not Applicable ," $4,853.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,614.12 "," $9,185.43 "," $8,317.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,853.75 "," $9,185.43 ", Not Applicable
,564-4,Diagnosis Related Group,"ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",Inpatient,APR-DRG,, Not Applicable ," $17,454.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,381.39 "," $33,032.03 "," $29,909.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,454.75 "," $33,032.03 ", Not Applicable
,565-1,Diagnosis Related Group,FALSE LABOR,Inpatient,APR-DRG,, Not Applicable ," $1,244.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,951.47 "," $2,354.19 "," $2,131.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,244.00 "," $2,354.19 ", Not Applicable
,565-2,Diagnosis Related Group,FALSE LABOR,Inpatient,APR-DRG,, Not Applicable ," $1,726.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,707.75 "," $3,266.55 "," $2,957.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,726.10 "," $3,266.55 ", Not Applicable
,565-3,Diagnosis Related Group,FALSE LABOR,Inpatient,APR-DRG,, Not Applicable ," $4,010.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,291.98 "," $7,590.44 "," $6,872.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,010.93 "," $7,590.44 ", Not Applicable
,565-4,Diagnosis Related Group,FALSE LABOR,Inpatient,APR-DRG,, Not Applicable ," $4,456.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,990.19 "," $8,432.74 "," $7,635.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,456.02 "," $8,432.74 ", Not Applicable
,566-1,Diagnosis Related Group,OTHER ANTEPARTUM DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $2,432.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,815.16 "," $4,602.49 "," $4,167.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,432.04 "," $4,602.49 ", Not Applicable
,566-2,Diagnosis Related Group,OTHER ANTEPARTUM DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $3,280.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,145.41 "," $6,207.25 "," $5,620.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,280.03 "," $6,207.25 ", Not Applicable
,566-3,Diagnosis Related Group,OTHER ANTEPARTUM DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $4,783.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,503.38 "," $9,051.84 "," $8,196.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,783.16 "," $9,051.84 ", Not Applicable
,566-4,Diagnosis Related Group,OTHER ANTEPARTUM DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $14,488.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,727.56 "," $27,417.81 "," $24,826.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,488.09 "," $27,417.81 ", Not Applicable
,580-1,Diagnosis Related Group,"NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE",Inpatient,APR-DRG,, Not Applicable ," $1,937.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,038.63 "," $3,665.70 "," $3,319.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,937.03 "," $3,665.70 ", Not Applicable
,580-2,Diagnosis Related Group,"NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE",Inpatient,APR-DRG,, Not Applicable ," $2,476.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,885.39 "," $4,687.21 "," $4,244.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,476.81 "," $4,687.21 ", Not Applicable
,580-3,Diagnosis Related Group,"NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE",Inpatient,APR-DRG,, Not Applicable ," $3,771.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,916.54 "," $7,137.53 "," $6,462.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,771.60 "," $7,137.53 ", Not Applicable
,580-4,Diagnosis Related Group,"NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE",Inpatient,APR-DRG,, Not Applicable ," $6,680.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,479.88 "," $12,642.59 "," $11,447.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,680.58 "," $12,642.59 ", Not Applicable
,581-1,Diagnosis Related Group,"NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE",Inpatient,APR-DRG,, Not Applicable , $791.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,241.11 "," $1,497.23 "," $1,355.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $791.17 ," $1,497.23 ", Not Applicable
,581-2,Diagnosis Related Group,"NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE",Inpatient,APR-DRG,, Not Applicable ," $1,194.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,874.49 "," $2,261.33 "," $2,047.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,194.93 "," $2,261.33 ", Not Applicable
,581-3,Diagnosis Related Group,"NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE",Inpatient,APR-DRG,, Not Applicable ," $1,961.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,077.79 "," $3,712.95 "," $3,361.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,961.99 "," $3,712.95 ", Not Applicable
,581-4,Diagnosis Related Group,"NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE",Inpatient,APR-DRG,, Not Applicable ," $3,417.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,361.49 "," $6,467.92 "," $5,856.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,417.77 "," $6,467.92 ", Not Applicable
,583-1,Diagnosis Related Group,NEONATE W ECMO,Inpatient,APR-DRG,, Not Applicable ," $35,232.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,269.21 "," $66,675.01 "," $60,372.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,232.33 "," $66,675.01 ", Not Applicable
,583-2,Diagnosis Related Group,NEONATE W ECMO,Inpatient,APR-DRG,, Not Applicable ," $55,633.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $87,273.36 "," $105,283.79 "," $95,331.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,633.94 "," $105,283.79 ", Not Applicable
,583-3,Diagnosis Related Group,NEONATE W ECMO,Inpatient,APR-DRG,, Not Applicable ," $136,668.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $214,393.23 "," $258,637.13 "," $234,189.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $136,668.74 "," $258,637.13 ", Not Applicable
,583-4,Diagnosis Related Group,NEONATE W ECMO,Inpatient,APR-DRG,, Not Applicable ," $224,325.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $351,901.14 "," $424,522.27 "," $384,394.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $224,325.57 "," $424,522.27 ", Not Applicable
,588-1,Diagnosis Related Group,NEONATE BWT <1500G W MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $42,414.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $66,536.43 "," $80,267.43 "," $72,680.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,414.82 "," $80,267.43 ", Not Applicable
,588-2,Diagnosis Related Group,NEONATE BWT <1500G W MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $61,361.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $96,258.24 "," $116,122.86 "," $105,146.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $61,361.51 "," $116,122.86 ", Not Applicable
,588-3,Diagnosis Related Group,NEONATE BWT <1500G W MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $137,449.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $215,618.13 "," $260,114.81 "," $235,527.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $137,449.57 "," $260,114.81 ", Not Applicable
,588-4,Diagnosis Related Group,NEONATE BWT <1500G W MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $204,669.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $321,066.52 "," $387,324.38 "," $350,712.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $204,669.51 "," $387,324.38 ", Not Applicable
,589-1,Diagnosis Related Group,"NEONATE BWT < 500G, OR BWT 500-999G & GESTATIONAL AGE <24 WKS, OR BWT 500-749G W MAJOR ANOMALY OR W/O LIFE SUSTAINING INTERVENTION",Inpatient,APR-DRG,, Not Applicable ," $197,902.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $310,451.59 "," $374,518.87 "," $339,117.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $197,902.83 "," $374,518.87 ", Not Applicable
,589-2,Diagnosis Related Group,"NEONATE BWT < 500G, OR BWT 500-999G & GESTATIONAL AGE <24 WKS, OR BWT 500-749G W MAJOR ANOMALY OR W/O LIFE SUSTAINING INTERVENTION",Inpatient,APR-DRG,, Not Applicable ," $179,911.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $282,228.84 "," $340,471.85 "," $308,288.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $179,911.74 "," $340,471.85 ", Not Applicable
,589-3,Diagnosis Related Group,"NEONATE BWT < 500G, OR BWT 500-999G & GESTATIONAL AGE <24 WKS, OR BWT 500-749G W MAJOR ANOMALY OR W/O LIFE SUSTAINING INTERVENTION",Inpatient,APR-DRG,, Not Applicable ," $163,556.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $256,572.04 "," $309,520.30 "," $280,262.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $163,556.36 "," $309,520.30 ", Not Applicable
,589-4,Diagnosis Related Group,"NEONATE BWT < 500G, OR BWT 500-999G & GESTATIONAL AGE <24 WKS, OR BWT 500-749G W MAJOR ANOMALY OR W/O LIFE SUSTAINING INTERVENTION",Inpatient,APR-DRG,, Not Applicable ," $2,740.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,298.64 "," $5,185.74 "," $4,695.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,740.24 "," $5,185.74 ", Not Applicable
,591-1,Diagnosis Related Group,NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable , $488.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $767.08 , $925.39 , $837.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $488.99 , $925.39 , Not Applicable
,591-2,Diagnosis Related Group,NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $65,474.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $102,709.58 "," $123,905.55 "," $112,193.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $65,474.03 "," $123,905.55 ", Not Applicable
,591-3,Diagnosis Related Group,NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $111,663.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $175,167.95 "," $211,317.02 "," $191,342.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $111,663.90 "," $211,317.02 ", Not Applicable
,591-4,Diagnosis Related Group,NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $179,516.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $281,608.96 "," $339,724.04 "," $307,611.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $179,516.59 "," $339,724.04 ", Not Applicable
,593-1,Diagnosis Related Group,NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $5,202.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,161.07 "," $9,845.26 "," $8,914.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,202.42 "," $9,845.26 ", Not Applicable
,593-2,Diagnosis Related Group,NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $56,374.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $88,434.79 "," $106,684.90 "," $96,600.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $56,374.31 "," $106,684.90 ", Not Applicable
,593-3,Diagnosis Related Group,NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $92,043.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $144,390.06 "," $174,187.55 "," $157,722.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $92,043.98 "," $174,187.55 ", Not Applicable
,593-4,Diagnosis Related Group,NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $142,256.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $223,159.32 "," $269,212.27 "," $243,765.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $142,256.84 "," $269,212.27 ", Not Applicable
,602-1,Diagnosis Related Group,NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM,Inpatient,APR-DRG,, Not Applicable ," $24,044.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,718.11 "," $45,501.93 "," $41,200.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,044.08 "," $45,501.93 ", Not Applicable
,602-2,Diagnosis Related Group,NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM,Inpatient,APR-DRG,, Not Applicable ," $56,237.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $88,220.06 "," $106,425.86 "," $96,365.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $56,237.43 "," $106,425.86 ", Not Applicable
,602-3,Diagnosis Related Group,NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM,Inpatient,APR-DRG,, Not Applicable ," $77,845.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $122,116.26 "," $147,317.15 "," $133,392.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $77,845.16 "," $147,317.15 ", Not Applicable
,602-4,Diagnosis Related Group,NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM,Inpatient,APR-DRG,, Not Applicable ," $109,630.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $171,978.07 "," $207,468.84 "," $187,857.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $109,630.45 "," $207,468.84 ", Not Applicable
,603-1,Diagnosis Related Group,NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $8,851.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,885.84 "," $16,751.43 "," $15,168.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,851.77 "," $16,751.43 ", Not Applicable
,603-2,Diagnosis Related Group,NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $32,696.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,291.99 "," $61,877.02 "," $56,028.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,696.98 "," $61,877.02 ", Not Applicable
,603-3,Diagnosis Related Group,NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $54,758.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $85,899.90 "," $103,626.90 "," $93,831.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $54,758.41 "," $103,626.90 ", Not Applicable
,603-4,Diagnosis Related Group,NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $94,475.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $148,203.87 "," $178,788.41 "," $161,888.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $94,475.17 "," $178,788.41 ", Not Applicable
,607-1,Diagnosis Related Group,NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM,Inpatient,APR-DRG,, Not Applicable ," $23,883.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,465.57 "," $45,197.27 "," $40,925.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,883.09 "," $45,197.27 ", Not Applicable
,607-2,Diagnosis Related Group,NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM,Inpatient,APR-DRG,, Not Applicable ," $43,470.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $68,192.15 "," $82,264.82 "," $74,488.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $43,470.28 "," $82,264.82 ", Not Applicable
,607-3,Diagnosis Related Group,NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM,Inpatient,APR-DRG,, Not Applicable ," $60,403.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $94,755.13 "," $114,309.56 "," $103,504.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $60,403.33 "," $114,309.56 ", Not Applicable
,607-4,Diagnosis Related Group,NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM,Inpatient,APR-DRG,, Not Applicable ," $86,914.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $136,343.78 "," $164,480.77 "," $148,933.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $86,914.74 "," $164,480.77 ", Not Applicable
,608-1,Diagnosis Related Group,NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $15,520.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,346.81 "," $29,371.22 "," $26,594.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,520.31 "," $29,371.22 ", Not Applicable
,608-2,Diagnosis Related Group,NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $33,722.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $52,900.44 "," $63,817.39 "," $57,785.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,722.31 "," $63,817.39 ", Not Applicable
,608-3,Diagnosis Related Group,NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $50,077.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $78,557.23 "," $94,768.93 "," $85,810.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $50,077.69 "," $94,768.93 ", Not Applicable
,608-4,Diagnosis Related Group,NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $70,734.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $110,962.48 "," $133,861.59 "," $121,208.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $70,734.99 "," $133,861.59 ", Not Applicable
,609-1,Diagnosis Related Group,NEONATE BWT 1500-2499G W MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $10,398.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,312.69 "," $19,679.11 "," $17,818.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,398.81 "," $19,679.11 ", Not Applicable
,609-2,Diagnosis Related Group,NEONATE BWT 1500-2499G W MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $31,398.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,255.44 "," $59,420.18 "," $53,803.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,398.74 "," $59,420.18 ", Not Applicable
,609-3,Diagnosis Related Group,NEONATE BWT 1500-2499G W MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $59,785.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $93,785.47 "," $113,139.79 "," $102,445.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $59,785.20 "," $113,139.79 ", Not Applicable
,609-4,Diagnosis Related Group,NEONATE BWT 1500-2499G W MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $105,954.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $166,211.44 "," $200,512.16 "," $181,558.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $105,954.41 "," $200,512.16 ", Not Applicable
,611-1,Diagnosis Related Group,NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $13,461.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,116.42 "," $25,474.17 "," $23,066.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,461.03 "," $25,474.17 ", Not Applicable
,611-2,Diagnosis Related Group,NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $24,106.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,816.70 "," $45,620.86 "," $41,308.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,106.92 "," $45,620.86 ", Not Applicable
,611-3,Diagnosis Related Group,NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $41,633.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $65,311.53 "," $78,789.74 "," $71,342.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,633.98 "," $78,789.74 ", Not Applicable
,611-4,Diagnosis Related Group,NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $65,244.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $102,348.99 "," $123,470.55 "," $111,799.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $65,244.17 "," $123,470.55 ", Not Applicable
,612-1,Diagnosis Related Group,NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND,Inpatient,APR-DRG,, Not Applicable ," $19,569.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,698.22 "," $37,033.35 "," $33,532.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,569.12 "," $37,033.35 ", Not Applicable
,612-2,Diagnosis Related Group,NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND,Inpatient,APR-DRG,, Not Applicable ," $29,843.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $46,815.08 "," $56,476.22 "," $51,137.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,843.10 "," $56,476.22 ", Not Applicable
,612-3,Diagnosis Related Group,NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND,Inpatient,APR-DRG,, Not Applicable ," $42,418.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $66,541.84 "," $80,273.94 "," $72,686.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,418.26 "," $80,273.94 ", Not Applicable
,612-4,Diagnosis Related Group,NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND,Inpatient,APR-DRG,, Not Applicable ," $62,420.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $97,919.35 "," $118,126.78 "," $106,960.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $62,420.42 "," $118,126.78 ", Not Applicable
,613-1,Diagnosis Related Group,NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION,Inpatient,APR-DRG,, Not Applicable ," $15,553.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,398.13 "," $29,433.13 "," $26,650.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,553.02 "," $29,433.13 ", Not Applicable
,613-2,Diagnosis Related Group,NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION,Inpatient,APR-DRG,, Not Applicable ," $22,889.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,907.09 "," $43,317.17 "," $39,222.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,889.61 "," $43,317.17 ", Not Applicable
,613-3,Diagnosis Related Group,NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION,Inpatient,APR-DRG,, Not Applicable ," $40,456.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $63,464.05 "," $76,561.00 "," $69,324.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,456.27 "," $76,561.00 ", Not Applicable
,613-4,Diagnosis Related Group,NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION,Inpatient,APR-DRG,, Not Applicable ," $52,999.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $83,140.83 "," $100,298.44 "," $90,817.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $52,999.59 "," $100,298.44 ", Not Applicable
,614-1,Diagnosis Related Group,NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $7,999.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,548.85 "," $15,138.53 "," $13,707.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,999.48 "," $15,138.53 ", Not Applicable
,614-2,Diagnosis Related Group,NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $19,675.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,865.68 "," $37,235.37 "," $33,715.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,675.87 "," $37,235.37 ", Not Applicable
,614-3,Diagnosis Related Group,NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $32,857.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,544.53 "," $62,181.68 "," $56,303.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,857.97 "," $62,181.68 ", Not Applicable
,614-4,Diagnosis Related Group,NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $39,740.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $62,340.43 "," $75,205.50 "," $68,096.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,740.00 "," $75,205.50 ", Not Applicable
,621-1,Diagnosis Related Group,NEONATE BWT 2000-2499G W MAJOR ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $4,880.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,655.98 "," $9,235.93 "," $8,362.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,880.44 "," $9,235.93 ", Not Applicable
,621-2,Diagnosis Related Group,NEONATE BWT 2000-2499G W MAJOR ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $13,981.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,933.47 "," $26,459.84 "," $23,958.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,981.88 "," $26,459.84 ", Not Applicable
,621-3,Diagnosis Related Group,NEONATE BWT 2000-2499G W MAJOR ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $26,354.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,342.86 "," $49,874.70 "," $45,160.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,354.73 "," $49,874.70 ", Not Applicable
,621-4,Diagnosis Related Group,NEONATE BWT 2000-2499G W MAJOR ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $51,083.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $80,134.62 "," $96,671.84 "," $87,533.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,083.22 "," $96,671.84 ", Not Applicable
,622-1,Diagnosis Related Group,NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND,Inpatient,APR-DRG,, Not Applicable ," $12,026.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,866.49 "," $22,759.92 "," $20,608.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,026.77 "," $22,759.92 ", Not Applicable
,622-2,Diagnosis Related Group,NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND,Inpatient,APR-DRG,, Not Applicable ," $18,281.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,677.87 "," $34,596.06 "," $31,325.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,281.21 "," $34,596.06 ", Not Applicable
,622-3,Diagnosis Related Group,NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND,Inpatient,APR-DRG,, Not Applicable ," $26,990.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,339.53 "," $51,077.05 "," $46,249.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,990.08 "," $51,077.05 ", Not Applicable
,622-4,Diagnosis Related Group,NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND,Inpatient,APR-DRG,, Not Applicable ," $40,656.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $63,778.71 "," $76,940.60 "," $69,667.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,656.86 "," $76,940.60 ", Not Applicable
,623-1,Diagnosis Related Group,NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION,Inpatient,APR-DRG,, Not Applicable ," $8,330.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,068.79 "," $15,765.77 "," $14,275.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,330.93 "," $15,765.77 ", Not Applicable
,623-2,Diagnosis Related Group,NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION,Inpatient,APR-DRG,, Not Applicable ," $14,557.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,836.96 "," $27,549.77 "," $24,945.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,557.82 "," $27,549.77 ", Not Applicable
,623-3,Diagnosis Related Group,NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION,Inpatient,APR-DRG,, Not Applicable ," $23,961.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,588.47 "," $45,345.52 "," $41,059.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,961.43 "," $45,345.52 ", Not Applicable
,623-4,Diagnosis Related Group,NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION,Inpatient,APR-DRG,, Not Applicable ," $35,041.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $54,969.40 "," $66,313.33 "," $60,045.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,041.21 "," $66,313.33 ", Not Applicable
,625-1,Diagnosis Related Group,NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $9,710.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,232.29 "," $18,375.75 "," $16,638.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,710.09 "," $18,375.75 ", Not Applicable
,625-2,Diagnosis Related Group,NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $16,294.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,560.91 "," $30,835.87 "," $27,921.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,294.25 "," $30,835.87 ", Not Applicable
,625-3,Diagnosis Related Group,NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $22,532.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,346.64 "," $42,641.05 "," $38,610.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,532.34 "," $42,641.05 ", Not Applicable
,625-4,Diagnosis Related Group,NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $33,686.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $52,843.71 "," $63,748.97 "," $57,723.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,686.16 "," $63,748.97 ", Not Applicable
,626-1,Diagnosis Related Group,"NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM",Inpatient,APR-DRG,, Not Applicable ," $1,154.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,811.02 "," $2,184.76 "," $1,978.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,154.47 "," $2,184.76 ", Not Applicable
,626-2,Diagnosis Related Group,"NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM",Inpatient,APR-DRG,, Not Applicable ," $2,054.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,222.29 "," $3,887.27 "," $3,519.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,054.11 "," $3,887.27 ", Not Applicable
,626-3,Diagnosis Related Group,"NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM",Inpatient,APR-DRG,, Not Applicable ," $6,514.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,219.23 "," $12,328.16 "," $11,162.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,514.43 "," $12,328.16 ", Not Applicable
,626-4,Diagnosis Related Group,"NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM",Inpatient,APR-DRG,, Not Applicable ," $21,614.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,907.00 "," $40,904.32 "," $37,037.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,614.62 "," $40,904.32 ", Not Applicable
,630-1,Diagnosis Related Group,NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $15,740.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,692.54 "," $29,788.29 "," $26,972.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,740.70 "," $29,788.29 ", Not Applicable
,630-2,Diagnosis Related Group,NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $22,124.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,706.50 "," $41,868.81 "," $37,911.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,124.27 "," $41,868.81 ", Not Applicable
,630-3,Diagnosis Related Group,NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $35,305.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $55,384.01 "," $66,813.49 "," $60,497.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,305.51 "," $66,813.49 ", Not Applicable
,630-4,Diagnosis Related Group,NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $75,102.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $117,813.57 "," $142,126.52 "," $128,692.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $75,102.33 "," $142,126.52 ", Not Applicable
,631-1,Diagnosis Related Group,NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $8,571.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,445.58 "," $16,220.32 "," $14,687.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,571.12 "," $16,220.32 ", Not Applicable
,631-2,Diagnosis Related Group,NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $10,833.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,994.69 "," $20,501.85 "," $18,563.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,833.57 "," $20,501.85 ", Not Applicable
,631-3,Diagnosis Related Group,NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $22,100.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,668.69 "," $41,823.19 "," $37,869.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,100.16 "," $41,823.19 ", Not Applicable
,631-4,Diagnosis Related Group,NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $65,294.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $102,427.32 "," $123,565.04 "," $111,885.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $65,294.10 "," $123,565.04 ", Not Applicable
,633-1,Diagnosis Related Group,NEONATE BIRTHWT >2499G W MAJOR ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $1,735.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,722.61 "," $3,284.47 "," $2,974.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,735.57 "," $3,284.47 ", Not Applicable
,633-2,Diagnosis Related Group,NEONATE BIRTHWT >2499G W MAJOR ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $4,561.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,156.30 "," $8,633.13 "," $7,817.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,561.91 "," $8,633.13 ", Not Applicable
,633-3,Diagnosis Related Group,NEONATE BIRTHWT >2499G W MAJOR ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $9,531.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,952.74 "," $18,038.50 "," $16,333.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,531.88 "," $18,038.50 ", Not Applicable
,633-4,Diagnosis Related Group,NEONATE BIRTHWT >2499G W MAJOR ANOMALY,Inpatient,APR-DRG,, Not Applicable ," $26,133.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,995.78 "," $49,456.00 "," $44,781.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,133.48 "," $49,456.00 ", Not Applicable
,634-1,Diagnosis Related Group,"NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND",Inpatient,APR-DRG,, Not Applicable ," $3,581.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,618.08 "," $6,777.47 "," $6,136.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,581.34 "," $6,777.47 ", Not Applicable
,634-2,Diagnosis Related Group,"NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND",Inpatient,APR-DRG,, Not Applicable ," $6,346.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,955.89 "," $12,010.46 "," $10,875.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,346.55 "," $12,010.46 ", Not Applicable
,634-3,Diagnosis Related Group,"NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND",Inpatient,APR-DRG,, Not Applicable ," $15,715.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,653.38 "," $29,741.05 "," $26,929.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,715.73 "," $29,741.05 ", Not Applicable
,634-4,Diagnosis Related Group,"NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND",Inpatient,APR-DRG,, Not Applicable ," $39,197.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $61,489.62 "," $74,179.11 "," $67,167.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,197.64 "," $74,179.11 ", Not Applicable
,636-1,Diagnosis Related Group,NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION,Inpatient,APR-DRG,, Not Applicable ," $4,536.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,117.14 "," $8,585.88 "," $7,774.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,536.94 "," $8,585.88 ", Not Applicable
,636-2,Diagnosis Related Group,NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION,Inpatient,APR-DRG,, Not Applicable ," $6,946.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,897.18 "," $13,146.01 "," $11,903.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,946.60 "," $13,146.01 ", Not Applicable
,636-3,Diagnosis Related Group,NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION,Inpatient,APR-DRG,, Not Applicable ," $13,739.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,553.98 "," $26,002.03 "," $23,544.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,739.96 "," $26,002.03 ", Not Applicable
,636-4,Diagnosis Related Group,NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION,Inpatient,APR-DRG,, Not Applicable ," $28,938.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,395.71 "," $54,763.93 "," $49,587.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,938.29 "," $54,763.93 ", Not Applicable
,639-1,Diagnosis Related Group,NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $2,718.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,264.88 "," $5,145.01 "," $4,658.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,718.72 "," $5,145.01 ", Not Applicable
,639-2,Diagnosis Related Group,NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $4,239.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,651.21 "," $8,023.81 "," $7,265.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,239.93 "," $8,023.81 ", Not Applicable
,639-3,Diagnosis Related Group,NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $8,112.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,725.76 "," $15,351.95 "," $13,900.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,112.26 "," $15,351.95 ", Not Applicable
,639-4,Diagnosis Related Group,NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION,Inpatient,APR-DRG,, Not Applicable ," $23,033.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,132.63 "," $43,589.25 "," $39,468.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,033.38 "," $43,589.25 ", Not Applicable
,640-1,Diagnosis Related Group,"NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM",Inpatient,APR-DRG,, Not Applicable , $872.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,368.06 "," $1,650.38 "," $1,494.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $872.09 ," $1,650.38 ", Not Applicable
,640-2,Diagnosis Related Group,"NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM",Inpatient,APR-DRG,, Not Applicable ," $1,180.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,851.54 "," $2,233.63 "," $2,022.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,180.29 "," $2,233.63 ", Not Applicable
,640-3,Diagnosis Related Group,"NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM",Inpatient,APR-DRG,, Not Applicable ," $2,419.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,796.26 "," $4,579.68 "," $4,146.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,419.99 "," $4,579.68 ", Not Applicable
,640-4,Diagnosis Related Group,"NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM",Inpatient,APR-DRG,, Not Applicable ," $14,042.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,028.01 "," $26,573.88 "," $24,061.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,042.14 "," $26,573.88 ", Not Applicable
,650-1,Diagnosis Related Group,SPLENECTOMY,Inpatient,APR-DRG,, Not Applicable ," $11,176.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,532.19 "," $21,150.27 "," $19,151.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,176.20 "," $21,150.27 ", Not Applicable
,650-2,Diagnosis Related Group,SPLENECTOMY,Inpatient,APR-DRG,, Not Applicable ," $15,017.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,558.12 "," $28,419.76 "," $25,733.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,017.54 "," $28,419.76 ", Not Applicable
,650-3,Diagnosis Related Group,SPLENECTOMY,Inpatient,APR-DRG,, Not Applicable ," $20,734.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,526.79 "," $39,239.28 "," $35,530.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,734.78 "," $39,239.28 ", Not Applicable
,650-4,Diagnosis Related Group,SPLENECTOMY,Inpatient,APR-DRG,, Not Applicable ," $39,850.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $62,513.29 "," $75,414.04 "," $68,285.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,850.20 "," $75,414.04 ", Not Applicable
,651-1,Diagnosis Related Group,OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS,Inpatient,APR-DRG,, Not Applicable ," $8,305.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,029.62 "," $15,718.52 "," $14,232.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,305.96 "," $15,718.52 ", Not Applicable
,651-2,Diagnosis Related Group,OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS,Inpatient,APR-DRG,, Not Applicable ," $11,868.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,617.99 "," $22,460.15 "," $20,337.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,868.37 "," $22,460.15 ", Not Applicable
,651-3,Diagnosis Related Group,OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS,Inpatient,APR-DRG,, Not Applicable ," $19,119.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,993.25 "," $36,182.90 "," $32,762.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,119.73 "," $36,182.90 ", Not Applicable
,651-4,Diagnosis Related Group,OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS,Inpatient,APR-DRG,, Not Applicable ," $40,195.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $63,054.85 "," $76,067.35 "," $68,877.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,195.42 "," $76,067.35 ", Not Applicable
,660-1,Diagnosis Related Group,MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL,Inpatient,APR-DRG,, Not Applicable ," $4,992.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,831.55 "," $9,447.73 "," $8,554.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,992.36 "," $9,447.73 ", Not Applicable
,660-2,Diagnosis Related Group,MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL,Inpatient,APR-DRG,, Not Applicable ," $6,016.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,438.64 "," $11,386.48 "," $10,310.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,016.83 "," $11,386.48 ", Not Applicable
,660-3,Diagnosis Related Group,MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL,Inpatient,APR-DRG,, Not Applicable ," $9,627.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,102.64 "," $18,219.34 "," $16,497.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,627.44 "," $18,219.34 ", Not Applicable
,660-4,Diagnosis Related Group,MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL,Inpatient,APR-DRG,, Not Applicable ," $21,578.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,850.28 "," $40,835.90 "," $36,975.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,578.46 "," $40,835.90 ", Not Applicable
,661-1,Diagnosis Related Group,COAGULATION & PLATELET DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $5,660.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,879.54 "," $10,711.99 "," $9,699.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,660.42 "," $10,711.99 ", Not Applicable
,661-2,Diagnosis Related Group,COAGULATION & PLATELET DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $7,051.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,061.95 "," $13,344.78 "," $12,083.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,051.63 "," $13,344.78 ", Not Applicable
,661-3,Diagnosis Related Group,COAGULATION & PLATELET DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $10,766.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,889.35 "," $20,374.78 "," $18,448.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,766.42 "," $20,374.78 ", Not Applicable
,661-4,Diagnosis Related Group,COAGULATION & PLATELET DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $23,265.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,497.26 "," $44,029.13 "," $39,867.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,265.82 "," $44,029.13 ", Not Applicable
,662-1,Diagnosis Related Group,SICKLE CELL ANEMIA CRISIS,Inpatient,APR-DRG,, Not Applicable ," $4,324.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,783.56 "," $8,183.47 "," $7,409.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,324.30 "," $8,183.47 ", Not Applicable
,662-2,Diagnosis Related Group,SICKLE CELL ANEMIA CRISIS,Inpatient,APR-DRG,, Not Applicable ," $5,978.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,377.87 "," $11,313.16 "," $10,243.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,978.09 "," $11,313.16 ", Not Applicable
,662-3,Diagnosis Related Group,SICKLE CELL ANEMIA CRISIS,Inpatient,APR-DRG,, Not Applicable ," $9,171.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,386.88 "," $17,355.87 "," $15,715.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,171.17 "," $17,355.87 ", Not Applicable
,662-4,Diagnosis Related Group,SICKLE CELL ANEMIA CRISIS,Inpatient,APR-DRG,, Not Applicable ," $20,706.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,482.23 "," $39,185.52 "," $35,481.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,706.37 "," $39,185.52 ", Not Applicable
,663-1,Diagnosis Related Group,OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS,Inpatient,APR-DRG,, Not Applicable ," $3,868.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,067.80 "," $7,320.00 "," $6,628.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,868.02 "," $7,320.00 ", Not Applicable
,663-2,Diagnosis Related Group,OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS,Inpatient,APR-DRG,, Not Applicable ," $5,019.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,873.42 "," $9,498.24 "," $8,600.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,019.05 "," $9,498.24 ", Not Applicable
,663-3,Diagnosis Related Group,OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS,Inpatient,APR-DRG,, Not Applicable ," $7,048.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,056.54 "," $13,338.26 "," $12,077.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,048.19 "," $13,338.26 ", Not Applicable
,663-4,Diagnosis Related Group,OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS,Inpatient,APR-DRG,, Not Applicable ," $12,025.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,865.13 "," $22,758.29 "," $20,607.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,025.91 "," $22,758.29 ", Not Applicable
,680-1,Diagnosis Related Group,MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS,Inpatient,APR-DRG,, Not Applicable ," $11,748.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,430.27 "," $22,233.69 "," $20,132.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,748.70 "," $22,233.69 ", Not Applicable
,680-2,Diagnosis Related Group,MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS,Inpatient,APR-DRG,, Not Applicable ," $16,332.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,620.34 "," $30,907.55 "," $27,986.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,332.13 "," $30,907.55 ", Not Applicable
,680-3,Diagnosis Related Group,MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS,Inpatient,APR-DRG,, Not Applicable ," $27,498.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $43,137.67 "," $52,039.91 "," $47,120.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,498.87 "," $52,039.91 ", Not Applicable
,680-4,Diagnosis Related Group,MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS,Inpatient,APR-DRG,, Not Applicable ," $51,765.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $81,204.21 "," $97,962.17 "," $88,702.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $51,765.06 "," $97,962.17 ", Not Applicable
,681-1,Diagnosis Related Group,OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS,Inpatient,APR-DRG,, Not Applicable ," $8,688.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,629.25 "," $16,441.89 "," $14,887.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,688.20 "," $16,441.89 ", Not Applicable
,681-2,Diagnosis Related Group,OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS,Inpatient,APR-DRG,, Not Applicable ," $11,570.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,150.72 "," $21,896.45 "," $19,826.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,570.50 "," $21,896.45 ", Not Applicable
,681-3,Diagnosis Related Group,OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS,Inpatient,APR-DRG,, Not Applicable ," $21,158.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,191.24 "," $40,040.85 "," $36,255.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,158.34 "," $40,040.85 ", Not Applicable
,681-4,Diagnosis Related Group,OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS,Inpatient,APR-DRG,, Not Applicable ," $47,393.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $74,346.38 "," $89,689.09 "," $81,211.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $47,393.41 "," $89,689.09 ", Not Applicable
,690-1,Diagnosis Related Group,ACUTE LEUKEMIA,Inpatient,APR-DRG,, Not Applicable ," $6,476.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,159.81 "," $12,256.47 "," $11,097.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,476.55 "," $12,256.47 ", Not Applicable
,690-2,Diagnosis Related Group,ACUTE LEUKEMIA,Inpatient,APR-DRG,, Not Applicable ," $11,520.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,072.39 "," $21,801.95 "," $19,741.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,520.56 "," $21,801.95 ", Not Applicable
,690-3,Diagnosis Related Group,ACUTE LEUKEMIA,Inpatient,APR-DRG,, Not Applicable ," $23,741.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,242.74 "," $44,928.45 "," $40,681.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,741.04 "," $44,928.45 ", Not Applicable
,690-4,Diagnosis Related Group,ACUTE LEUKEMIA,Inpatient,APR-DRG,, Not Applicable ," $53,448.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $83,844.44 "," $101,147.25 "," $91,586.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $53,448.12 "," $101,147.25 ", Not Applicable
,691-1,Diagnosis Related Group,"LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA",Inpatient,APR-DRG,, Not Applicable ," $6,897.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,820.21 "," $13,053.15 "," $11,819.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,897.53 "," $13,053.15 ", Not Applicable
,691-2,Diagnosis Related Group,"LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA",Inpatient,APR-DRG,, Not Applicable ," $8,696.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,642.75 "," $16,458.18 "," $14,902.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,696.81 "," $16,458.18 ", Not Applicable
,691-3,Diagnosis Related Group,"LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA",Inpatient,APR-DRG,, Not Applicable ," $13,760.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,586.39 "," $26,041.13 "," $23,579.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,760.63 "," $26,041.13 ", Not Applicable
,691-4,Diagnosis Related Group,"LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA",Inpatient,APR-DRG,, Not Applicable ," $26,821.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,074.83 "," $50,757.73 "," $45,959.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,821.34 "," $50,757.73 ", Not Applicable
,692-1,Diagnosis Related Group,RADIOTHERAPY,Inpatient,APR-DRG,, Not Applicable ," $4,715.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,396.69 "," $8,923.13 "," $8,079.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,715.15 "," $8,923.13 ", Not Applicable
,692-2,Diagnosis Related Group,RADIOTHERAPY,Inpatient,APR-DRG,, Not Applicable ," $9,756.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,305.22 "," $18,463.72 "," $16,718.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,756.58 "," $18,463.72 ", Not Applicable
,692-3,Diagnosis Related Group,RADIOTHERAPY,Inpatient,APR-DRG,, Not Applicable ," $14,932.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,424.42 "," $28,258.47 "," $25,587.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,932.31 "," $28,258.47 ", Not Applicable
,692-4,Diagnosis Related Group,RADIOTHERAPY,Inpatient,APR-DRG,, Not Applicable ," $28,248.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $44,313.96 "," $53,458.94 "," $48,405.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,248.71 "," $53,458.94 ", Not Applicable
,694-1,Diagnosis Related Group,LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR,Inpatient,APR-DRG,, Not Applicable ," $4,480.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,029.35 "," $8,479.99 "," $7,678.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,480.98 "," $8,479.99 ", Not Applicable
,694-2,Diagnosis Related Group,LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR,Inpatient,APR-DRG,, Not Applicable ," $5,963.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,354.91 "," $11,285.47 "," $10,218.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,963.45 "," $11,285.47 ", Not Applicable
,694-3,Diagnosis Related Group,LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR,Inpatient,APR-DRG,, Not Applicable ," $9,386.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,724.50 "," $17,763.17 "," $16,084.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,386.39 "," $17,763.17 ", Not Applicable
,694-4,Diagnosis Related Group,LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR,Inpatient,APR-DRG,, Not Applicable ," $16,997.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,664.27 "," $32,166.92 "," $29,126.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,997.61 "," $32,166.92 ", Not Applicable
,695-1,Diagnosis Related Group,CHEMOTHERAPY FOR ACUTE LEUKEMIA,Inpatient,APR-DRG,, Not Applicable ," $5,198.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,154.32 "," $9,837.11 "," $8,907.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,198.11 "," $9,837.11 ", Not Applicable
,695-2,Diagnosis Related Group,CHEMOTHERAPY FOR ACUTE LEUKEMIA,Inpatient,APR-DRG,, Not Applicable ," $6,399.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,039.62 "," $12,111.47 "," $10,966.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,399.93 "," $12,111.47 ", Not Applicable
,695-3,Diagnosis Related Group,CHEMOTHERAPY FOR ACUTE LEUKEMIA,Inpatient,APR-DRG,, Not Applicable ," $13,708.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,504.01 "," $25,941.75 "," $23,489.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,708.11 "," $25,941.75 ", Not Applicable
,695-4,Diagnosis Related Group,CHEMOTHERAPY FOR ACUTE LEUKEMIA,Inpatient,APR-DRG,, Not Applicable ," $44,186.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $69,315.76 "," $83,620.32 "," $75,716.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $44,186.55 "," $83,620.32 ", Not Applicable
,696-1,Diagnosis Related Group,OTHER CHEMOTHERAPY,Inpatient,APR-DRG,, Not Applicable ," $5,414.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,493.29 "," $10,246.04 "," $9,277.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,414.20 "," $10,246.04 ", Not Applicable
,696-2,Diagnosis Related Group,OTHER CHEMOTHERAPY,Inpatient,APR-DRG,, Not Applicable ," $6,852.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,749.98 "," $12,968.43 "," $11,742.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,852.76 "," $12,968.43 ", Not Applicable
,696-3,Diagnosis Related Group,OTHER CHEMOTHERAPY,Inpatient,APR-DRG,, Not Applicable ," $10,362.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,255.97 "," $19,610.68 "," $17,756.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,362.65 "," $19,610.68 ", Not Applicable
,696-4,Diagnosis Related Group,OTHER CHEMOTHERAPY,Inpatient,APR-DRG,, Not Applicable ," $23,114.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,259.57 "," $43,742.39 "," $39,607.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,114.30 "," $43,742.39 ", Not Applicable
,710-1,Diagnosis Related Group,INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $8,649.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,568.47 "," $16,368.57 "," $14,821.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,649.46 "," $16,368.57 ", Not Applicable
,710-2,Diagnosis Related Group,INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $12,712.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,942.83 "," $24,058.40 "," $21,784.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,712.91 "," $24,058.40 ", Not Applicable
,710-3,Diagnosis Related Group,INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $21,145.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,170.98 "," $40,016.41 "," $36,233.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,145.43 "," $40,016.41 ", Not Applicable
,710-4,Diagnosis Related Group,INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $40,501.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $63,534.27 "," $76,645.71 "," $69,400.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,501.04 "," $76,645.71 ", Not Applicable
,711-1,Diagnosis Related Group,"POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $8,409.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,191.68 "," $15,914.03 "," $14,409.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,409.27 "," $15,914.03 ", Not Applicable
,711-2,Diagnosis Related Group,"POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $11,301.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,729.36 "," $21,388.14 "," $19,366.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,301.90 "," $21,388.14 ", Not Applicable
,711-3,Diagnosis Related Group,"POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $19,792.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,049.35 "," $37,456.94 "," $33,916.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,792.95 "," $37,456.94 ", Not Applicable
,711-4,Diagnosis Related Group,"POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE",Inpatient,APR-DRG,, Not Applicable ," $38,970.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $61,133.08 "," $73,749.00 "," $66,777.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,970.36 "," $73,749.00 ", Not Applicable
,720-1,Diagnosis Related Group,SEPTICEMIA & DISSEMINATED INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $4,644.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,285.95 "," $8,789.53 "," $7,958.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,644.56 "," $8,789.53 ", Not Applicable
,720-2,Diagnosis Related Group,SEPTICEMIA & DISSEMINATED INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $6,241.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,791.13 "," $11,811.70 "," $10,695.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,241.53 "," $11,811.70 ", Not Applicable
,720-3,Diagnosis Related Group,SEPTICEMIA & DISSEMINATED INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $9,716.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,241.74 "," $18,387.15 "," $16,649.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,716.12 "," $18,387.15 ", Not Applicable
,720-4,Diagnosis Related Group,SEPTICEMIA & DISSEMINATED INFECTIONS,Inpatient,APR-DRG,, Not Applicable ," $19,560.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,684.71 "," $37,017.05 "," $33,518.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,560.51 "," $37,017.05 ", Not Applicable
,721-1,Diagnosis Related Group,"POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS",Inpatient,APR-DRG,, Not Applicable ," $4,447.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,976.68 "," $8,416.45 "," $7,620.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,447.41 "," $8,416.45 ", Not Applicable
,721-2,Diagnosis Related Group,"POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS",Inpatient,APR-DRG,, Not Applicable ," $5,902.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,259.03 "," $11,169.80 "," $10,113.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,902.33 "," $11,169.80 ", Not Applicable
,721-3,Diagnosis Related Group,"POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS",Inpatient,APR-DRG,, Not Applicable ," $9,695.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,209.33 "," $18,348.05 "," $16,613.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,695.46 "," $18,348.05 ", Not Applicable
,721-4,Diagnosis Related Group,"POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS",Inpatient,APR-DRG,, Not Applicable ," $18,123.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,430.73 "," $34,297.92 "," $31,055.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,123.67 "," $34,297.92 ", Not Applicable
,722-1,Diagnosis Related Group,FEVER,Inpatient,APR-DRG,, Not Applicable ," $3,377.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,298.01 "," $6,391.35 "," $5,787.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,377.31 "," $6,391.35 ", Not Applicable
,722-2,Diagnosis Related Group,FEVER,Inpatient,APR-DRG,, Not Applicable ," $4,578.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,181.96 "," $8,664.09 "," $7,845.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,578.27 "," $8,664.09 ", Not Applicable
,722-3,Diagnosis Related Group,FEVER,Inpatient,APR-DRG,, Not Applicable ," $6,207.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,737.11 "," $11,746.53 "," $10,636.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,207.09 "," $11,746.53 ", Not Applicable
,722-4,Diagnosis Related Group,FEVER,Inpatient,APR-DRG,, Not Applicable ," $9,786.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,352.48 "," $18,520.75 "," $16,770.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,786.71 "," $18,520.75 ", Not Applicable
,723-1,Diagnosis Related Group,VIRAL ILLNESS,Inpatient,APR-DRG,, Not Applicable ," $2,907.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,560.64 "," $5,501.81 "," $4,981.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,907.26 "," $5,501.81 ", Not Applicable
,723-2,Diagnosis Related Group,VIRAL ILLNESS,Inpatient,APR-DRG,, Not Applicable ," $4,103.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,437.83 "," $7,766.40 "," $7,032.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,103.91 "," $7,766.40 ", Not Applicable
,723-3,Diagnosis Related Group,VIRAL ILLNESS,Inpatient,APR-DRG,, Not Applicable ," $6,394.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,031.51 "," $12,101.70 "," $10,957.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,394.77 "," $12,101.70 ", Not Applicable
,723-4,Diagnosis Related Group,VIRAL ILLNESS,Inpatient,APR-DRG,, Not Applicable ," $16,607.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,052.50 "," $31,428.90 "," $28,458.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,607.62 "," $31,428.90 ", Not Applicable
,724-1,Diagnosis Related Group,OTHER INFECTIOUS & PARASITIC DISEASES,Inpatient,APR-DRG,, Not Applicable ," $5,081.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,970.65 "," $9,615.54 "," $8,706.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,081.03 "," $9,615.54 ", Not Applicable
,724-2,Diagnosis Related Group,OTHER INFECTIOUS & PARASITIC DISEASES,Inpatient,APR-DRG,, Not Applicable ," $6,184.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,701.99 "," $11,704.17 "," $10,597.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,184.71 "," $11,704.17 ", Not Applicable
,724-3,Diagnosis Related Group,OTHER INFECTIOUS & PARASITIC DISEASES,Inpatient,APR-DRG,, Not Applicable ," $9,582.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,032.42 "," $18,134.63 "," $16,420.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,582.68 "," $18,134.63 ", Not Applicable
,724-4,Diagnosis Related Group,OTHER INFECTIOUS & PARASITIC DISEASES,Inpatient,APR-DRG,, Not Applicable ," $20,005.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,382.92 "," $37,859.35 "," $34,280.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,005.59 "," $37,859.35 ", Not Applicable
,740-1,Diagnosis Related Group,MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $14,922.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,409.57 "," $28,240.55 "," $25,571.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,922.84 "," $28,240.55 ", Not Applicable
,740-2,Diagnosis Related Group,MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $20,213.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,709.74 "," $38,253.62 "," $34,637.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,213.93 "," $38,253.62 ", Not Applicable
,740-3,Diagnosis Related Group,MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $36,504.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $57,265.25 "," $69,082.97 "," $62,552.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,504.74 "," $69,082.97 ", Not Applicable
,740-4,Diagnosis Related Group,MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $76,492.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $119,994.63 "," $144,757.68 "," $131,074.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $76,492.69 "," $144,757.68 ", Not Applicable
,750-1,Diagnosis Related Group,SCHIZOPHRENIA,Inpatient,APR-DRG,, Not Applicable ," $7,831.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,285.50 "," $14,820.83 "," $13,419.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,831.61 "," $14,820.83 ", Not Applicable
,750-2,Diagnosis Related Group,SCHIZOPHRENIA,Inpatient,APR-DRG,, Not Applicable ," $9,580.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,029.71 "," $18,131.37 "," $16,417.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,580.96 "," $18,131.37 ", Not Applicable
,750-3,Diagnosis Related Group,SCHIZOPHRENIA,Inpatient,APR-DRG,, Not Applicable ," $13,453.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,104.26 "," $25,459.51 "," $23,052.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,453.28 "," $25,459.51 ", Not Applicable
,750-4,Diagnosis Related Group,SCHIZOPHRENIA,Inpatient,APR-DRG,, Not Applicable ," $29,862.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $46,844.79 "," $56,512.06 "," $51,170.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,862.04 "," $56,512.06 ", Not Applicable
,751-1,Diagnosis Related Group,MAJOR DEPRESSIVE DISORDERS & OTHER/UNSPECIFIED PSYCHOSES,Inpatient,APR-DRG,, Not Applicable ," $5,369.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,423.07 "," $10,161.32 "," $9,200.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,369.43 "," $10,161.32 ", Not Applicable
,751-2,Diagnosis Related Group,MAJOR DEPRESSIVE DISORDERS & OTHER/UNSPECIFIED PSYCHOSES,Inpatient,APR-DRG,, Not Applicable ," $7,226.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,336.10 "," $13,675.50 "," $12,382.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,226.39 "," $13,675.50 ", Not Applicable
,751-3,Diagnosis Related Group,MAJOR DEPRESSIVE DISORDERS & OTHER/UNSPECIFIED PSYCHOSES,Inpatient,APR-DRG,, Not Applicable ," $12,037.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,884.04 "," $22,781.10 "," $20,627.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,037.96 "," $22,781.10 ", Not Applicable
,751-4,Diagnosis Related Group,MAJOR DEPRESSIVE DISORDERS & OTHER/UNSPECIFIED PSYCHOSES,Inpatient,APR-DRG,, Not Applicable ," $25,088.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,356.27 "," $47,478.15 "," $42,990.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,088.35 "," $47,478.15 ", Not Applicable
,752-1,Diagnosis Related Group,DISORDERS OF PERSONALITY & IMPULSE CONTROL,Inpatient,APR-DRG,, Not Applicable ," $4,793.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,519.58 "," $9,071.39 "," $8,213.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,793.49 "," $9,071.39 ", Not Applicable
,752-2,Diagnosis Related Group,DISORDERS OF PERSONALITY & IMPULSE CONTROL,Inpatient,APR-DRG,, Not Applicable ," $6,344.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,953.19 "," $12,007.20 "," $10,872.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,344.83 "," $12,007.20 ", Not Applicable
,752-3,Diagnosis Related Group,DISORDERS OF PERSONALITY & IMPULSE CONTROL,Inpatient,APR-DRG,, Not Applicable ," $10,861.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,039.26 "," $20,555.62 "," $18,612.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,861.98 "," $20,555.62 ", Not Applicable
,752-4,Diagnosis Related Group,DISORDERS OF PERSONALITY & IMPULSE CONTROL,Inpatient,APR-DRG,, Not Applicable ," $17,903.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,085.00 "," $33,880.84 "," $30,678.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,903.28 "," $33,880.84 ", Not Applicable
,753-1,Diagnosis Related Group,BIPOLAR DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $5,810.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,114.52 "," $10,995.47 "," $9,956.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,810.21 "," $10,995.47 ", Not Applicable
,753-2,Diagnosis Related Group,BIPOLAR DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $7,678.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,045.11 "," $14,530.83 "," $13,157.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,678.37 "," $14,530.83 ", Not Applicable
,753-3,Diagnosis Related Group,BIPOLAR DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $11,778.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,477.54 "," $22,290.71 "," $20,183.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,778.83 "," $22,290.71 ", Not Applicable
,753-4,Diagnosis Related Group,BIPOLAR DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $25,338.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,747.92 "," $47,950.61 "," $43,418.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,338.01 "," $47,950.61 ", Not Applicable
,754-1,Diagnosis Related Group,DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER,Inpatient,APR-DRG,, Not Applicable ," $4,395.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,895.65 "," $8,318.70 "," $7,532.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,395.76 "," $8,318.70 ", Not Applicable
,754-2,Diagnosis Related Group,DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER,Inpatient,APR-DRG,, Not Applicable ," $5,833.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,150.99 "," $11,039.46 "," $9,995.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,833.46 "," $11,039.46 ", Not Applicable
,754-3,Diagnosis Related Group,DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER,Inpatient,APR-DRG,, Not Applicable ," $8,982.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,091.12 "," $16,999.07 "," $15,392.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,982.63 "," $16,999.07 ", Not Applicable
,754-4,Diagnosis Related Group,DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER,Inpatient,APR-DRG,, Not Applicable ," $16,666.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,144.33 "," $31,539.68 "," $28,558.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,666.16 "," $31,539.68 ", Not Applicable
,755-1,Diagnosis Related Group,ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $4,051.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,355.45 "," $7,667.02 "," $6,942.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,051.40 "," $7,667.02 ", Not Applicable
,755-2,Diagnosis Related Group,ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $6,285.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,860.00 "," $11,894.79 "," $10,770.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,285.43 "," $11,894.79 ", Not Applicable
,755-3,Diagnosis Related Group,ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $8,505.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,342.94 "," $16,096.50 "," $14,574.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,505.69 "," $16,096.50 ", Not Applicable
,755-4,Diagnosis Related Group,ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES,Inpatient,APR-DRG,, Not Applicable ," $11,977.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,789.51 "," $22,667.06 "," $20,524.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,977.70 "," $22,667.06 ", Not Applicable
,756-1,Diagnosis Related Group,ACUTE ANXIETY & DELIRIUM STATES,Inpatient,APR-DRG,, Not Applicable ," $5,990.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,396.78 "," $11,335.97 "," $10,264.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,990.14 "," $11,335.97 ", Not Applicable
,756-2,Diagnosis Related Group,ACUTE ANXIETY & DELIRIUM STATES,Inpatient,APR-DRG,, Not Applicable ," $7,730.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,127.49 "," $14,630.22 "," $13,247.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,730.88 "," $14,630.22 ", Not Applicable
,756-3,Diagnosis Related Group,ACUTE ANXIETY & DELIRIUM STATES,Inpatient,APR-DRG,, Not Applicable ," $8,702.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,652.20 "," $16,469.58 "," $14,912.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,702.84 "," $16,469.58 ", Not Applicable
,756-4,Diagnosis Related Group,ACUTE ANXIETY & DELIRIUM STATES,Inpatient,APR-DRG,, Not Applicable ," $19,865.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,162.79 "," $37,593.79 "," $34,040.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,865.27 "," $37,593.79 ", Not Applicable
,757-1,Diagnosis Related Group,ORGANIC MENTAL HEALTH DISTURBANCES,Inpatient,APR-DRG,, Not Applicable ," $9,130.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,323.40 "," $17,279.30 "," $15,645.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,130.71 "," $17,279.30 ", Not Applicable
,757-2,Diagnosis Related Group,ORGANIC MENTAL HEALTH DISTURBANCES,Inpatient,APR-DRG,, Not Applicable ," $10,837.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,001.44 "," $20,510.00 "," $18,571.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,837.87 "," $20,510.00 ", Not Applicable
,757-3,Diagnosis Related Group,ORGANIC MENTAL HEALTH DISTURBANCES,Inpatient,APR-DRG,, Not Applicable ," $13,549.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,255.52 "," $25,641.98 "," $23,218.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,549.71 "," $25,641.98 ", Not Applicable
,757-4,Diagnosis Related Group,ORGANIC MENTAL HEALTH DISTURBANCES,Inpatient,APR-DRG,, Not Applicable ," $23,605.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,030.71 "," $44,672.66 "," $40,449.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,605.88 "," $44,672.66 ", Not Applicable
,758-1,Diagnosis Related Group,BEHAVIORAL DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $5,477.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,591.88 "," $10,364.97 "," $9,385.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,477.05 "," $10,364.97 ", Not Applicable
,758-2,Diagnosis Related Group,BEHAVIORAL DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $6,838.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,727.02 "," $12,940.74 "," $11,717.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,838.13 "," $12,940.74 ", Not Applicable
,758-3,Diagnosis Related Group,BEHAVIORAL DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $9,604.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,066.18 "," $18,175.36 "," $16,457.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,604.20 "," $18,175.36 ", Not Applicable
,758-4,Diagnosis Related Group,BEHAVIORAL DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $14,471.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,701.91 "," $27,386.85 "," $24,798.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,471.73 "," $27,386.85 ", Not Applicable
,759-1,Diagnosis Related Group,EATING DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $10,401.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,316.74 "," $19,683.99 "," $17,823.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,401.39 "," $19,683.99 ", Not Applicable
,759-2,Diagnosis Related Group,EATING DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $12,279.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,262.18 "," $23,237.28 "," $21,040.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,279.02 "," $23,237.28 ", Not Applicable
,759-3,Diagnosis Related Group,EATING DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $16,153.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,340.78 "," $30,570.31 "," $27,680.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,153.93 "," $30,570.31 ", Not Applicable
,759-4,Diagnosis Related Group,EATING DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $31,860.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,979.30 "," $60,293.43 "," $54,594.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,860.19 "," $60,293.43 ", Not Applicable
,760-1,Diagnosis Related Group,OTHER MENTAL HEALTH DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $6,673.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,469.08 "," $12,629.56 "," $11,435.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,673.70 "," $12,629.56 ", Not Applicable
,760-2,Diagnosis Related Group,OTHER MENTAL HEALTH DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $8,862.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,902.05 "," $16,770.98 "," $15,185.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,862.10 "," $16,770.98 ", Not Applicable
,760-3,Diagnosis Related Group,OTHER MENTAL HEALTH DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $11,863.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,609.89 "," $22,450.38 "," $20,328.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,863.20 "," $22,450.38 ", Not Applicable
,760-4,Diagnosis Related Group,OTHER MENTAL HEALTH DISORDERS,Inpatient,APR-DRG,, Not Applicable ," $26,580.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,696.69 "," $50,301.55 "," $45,546.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,580.29 "," $50,301.55 ", Not Applicable
,770-1,Diagnosis Related Group,"DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE",Inpatient,APR-DRG,, Not Applicable ," $2,593.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,067.71 "," $4,907.15 "," $4,443.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,593.03 "," $4,907.15 ", Not Applicable
,770-2,Diagnosis Related Group,"DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE",Inpatient,APR-DRG,, Not Applicable ," $3,249.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,096.79 "," $6,148.60 "," $5,567.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,249.04 "," $6,148.60 ", Not Applicable
,770-3,Diagnosis Related Group,"DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE",Inpatient,APR-DRG,, Not Applicable ," $6,362.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,981.55 "," $12,041.42 "," $10,903.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,362.91 "," $12,041.42 ", Not Applicable
,770-4,Diagnosis Related Group,"DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE",Inpatient,APR-DRG,, Not Applicable ," $18,468.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,972.28 "," $34,951.23 "," $31,647.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,468.89 "," $34,951.23 ", Not Applicable
,772-1,Diagnosis Related Group,ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY,Inpatient,APR-DRG,, Not Applicable ," $6,122.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,604.76 "," $11,586.87 "," $10,491.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,122.72 "," $11,586.87 ", Not Applicable
,772-2,Diagnosis Related Group,ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY,Inpatient,APR-DRG,, Not Applicable ," $7,070.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,091.66 "," $13,380.62 "," $12,115.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,070.57 "," $13,380.62 ", Not Applicable
,772-3,Diagnosis Related Group,ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY,Inpatient,APR-DRG,, Not Applicable ," $8,576.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,453.68 "," $16,230.09 "," $14,695.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,576.29 "," $16,230.09 ", Not Applicable
,772-4,Diagnosis Related Group,ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY,Inpatient,APR-DRG,, Not Applicable ," $30,017.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $47,089.23 "," $56,806.95 "," $51,437.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,017.86 "," $56,806.95 ", Not Applicable
,773-1,Diagnosis Related Group,OPIOID ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $3,250.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,099.49 "," $6,151.86 "," $5,570.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,250.76 "," $6,151.86 ", Not Applicable
,773-2,Diagnosis Related Group,OPIOID ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $4,153.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,516.16 "," $7,860.89 "," $7,117.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,153.84 "," $7,860.89 ", Not Applicable
,773-3,Diagnosis Related Group,OPIOID ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $7,493.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,754.75 "," $14,180.56 "," $12,840.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,493.27 "," $14,180.56 ", Not Applicable
,773-4,Diagnosis Related Group,OPIOID ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $22,658.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,543.81 "," $42,878.91 "," $38,825.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,658.03 "," $42,878.91 ", Not Applicable
,774-1,Diagnosis Related Group,COCAINE ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $3,602.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,650.49 "," $6,816.57 "," $6,172.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,602.01 "," $6,816.57 ", Not Applicable
,774-2,Diagnosis Related Group,COCAINE ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $4,111.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,449.99 "," $7,781.06 "," $7,045.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,111.66 "," $7,781.06 ", Not Applicable
,774-3,Diagnosis Related Group,COCAINE ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $7,470.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,718.29 "," $14,136.57 "," $12,800.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,470.03 "," $14,136.57 ", Not Applicable
,774-4,Diagnosis Related Group,COCAINE ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $26,757.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,974.89 "," $50,637.17 "," $45,850.69 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,757.63 "," $50,637.17 ", Not Applicable
,775-1,Diagnosis Related Group,ALCOHOL ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $3,831.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,011.08 "," $7,251.57 "," $6,566.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,831.87 "," $7,251.57 ", Not Applicable
,775-2,Diagnosis Related Group,ALCOHOL ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $5,304.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,321.78 "," $10,039.13 "," $9,090.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,304.87 "," $10,039.13 ", Not Applicable
,775-3,Diagnosis Related Group,ALCOHOL ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $9,727.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,259.30 "," $18,408.33 "," $16,668.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,727.31 "," $18,408.33 ", Not Applicable
,775-4,Diagnosis Related Group,ALCOHOL ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $27,129.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,558.31 "," $51,340.98 "," $46,487.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,129.54 "," $51,340.98 ", Not Applicable
,776-1,Diagnosis Related Group,OTHER DRUG ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $3,533.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,542.45 "," $6,686.24 "," $6,054.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,533.13 "," $6,686.24 ", Not Applicable
,776-2,Diagnosis Related Group,OTHER DRUG ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $4,926.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,728.91 "," $9,323.91 "," $8,442.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,926.93 "," $9,323.91 ", Not Applicable
,776-3,Diagnosis Related Group,OTHER DRUG ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $8,725.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,687.32 "," $16,511.94 "," $14,951.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,725.22 "," $16,511.94 ", Not Applicable
,776-4,Diagnosis Related Group,OTHER DRUG ABUSE & DEPENDENCE,Inpatient,APR-DRG,, Not Applicable ," $17,372.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,251.74 "," $32,875.63 "," $29,768.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,372.10 "," $32,875.63 ", Not Applicable
,791-1,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $7,435.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,664.27 "," $14,071.40 "," $12,741.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,435.59 "," $14,071.40 ", Not Applicable
,791-2,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $10,909.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,113.54 "," $20,645.22 "," $18,693.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,909.32 "," $20,645.22 ", Not Applicable
,791-3,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $17,614.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,632.58 "," $33,335.06 "," $30,184.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,614.87 "," $33,335.06 ", Not Applicable
,791-4,Diagnosis Related Group,#N/A,Inpatient,APR-DRG,, Not Applicable ," $38,099.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $59,766.38 "," $72,100.25 "," $65,284.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $38,099.13 "," $72,100.25 ", Not Applicable
,811-1,Diagnosis Related Group,ALLERGIC REACTIONS,Inpatient,APR-DRG,, Not Applicable ," $2,342.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,674.71 "," $4,433.05 "," $4,014.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,342.51 "," $4,433.05 ", Not Applicable
,811-2,Diagnosis Related Group,ALLERGIC REACTIONS,Inpatient,APR-DRG,, Not Applicable ," $3,376.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,296.66 "," $6,389.72 "," $5,785.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,376.45 "," $6,389.72 ", Not Applicable
,811-3,Diagnosis Related Group,ALLERGIC REACTIONS,Inpatient,APR-DRG,, Not Applicable ," $7,299.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,450.89 "," $13,813.99 "," $12,508.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,299.57 "," $13,813.99 ", Not Applicable
,811-4,Diagnosis Related Group,ALLERGIC REACTIONS,Inpatient,APR-DRG,, Not Applicable ," $16,409.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,741.88 "," $31,054.18 "," $28,118.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,409.61 "," $31,054.18 ", Not Applicable
,812-1,Diagnosis Related Group,POISONING OF MEDICINAL AGENTS,Inpatient,APR-DRG,, Not Applicable ," $2,906.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,559.29 "," $5,500.18 "," $4,980.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,906.40 "," $5,500.18 ", Not Applicable
,812-2,Diagnosis Related Group,POISONING OF MEDICINAL AGENTS,Inpatient,APR-DRG,, Not Applicable ," $3,662.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,745.03 "," $6,930.62 "," $6,275.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,662.27 "," $6,930.62 ", Not Applicable
,812-3,Diagnosis Related Group,POISONING OF MEDICINAL AGENTS,Inpatient,APR-DRG,, Not Applicable ," $6,387.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,019.36 "," $12,087.03 "," $10,944.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,387.02 "," $12,087.03 ", Not Applicable
,812-4,Diagnosis Related Group,POISONING OF MEDICINAL AGENTS,Inpatient,APR-DRG,, Not Applicable ," $13,923.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,841.64 "," $26,349.05 "," $23,858.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,923.34 "," $26,349.05 ", Not Applicable
,813-1,Diagnosis Related Group,OTHER COMPLICATIONS OF TREATMENT,Inpatient,APR-DRG,, Not Applicable ," $3,847.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,035.38 "," $7,280.89 "," $6,592.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,847.36 "," $7,280.89 ", Not Applicable
,813-2,Diagnosis Related Group,OTHER COMPLICATIONS OF TREATMENT,Inpatient,APR-DRG,, Not Applicable ," $5,118.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,030.07 "," $9,687.22 "," $8,771.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,118.91 "," $9,687.22 ", Not Applicable
,813-3,Diagnosis Related Group,OTHER COMPLICATIONS OF TREATMENT,Inpatient,APR-DRG,, Not Applicable ," $7,760.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,173.41 "," $14,685.61 "," $13,297.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,760.15 "," $14,685.61 ", Not Applicable
,813-4,Diagnosis Related Group,OTHER COMPLICATIONS OF TREATMENT,Inpatient,APR-DRG,, Not Applicable ," $16,153.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,340.78 "," $30,570.31 "," $27,680.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,153.93 "," $30,570.31 ", Not Applicable
,815-1,Diagnosis Related Group,"OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $3,404.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,339.88 "," $6,441.86 "," $5,832.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,404.00 "," $6,441.86 ", Not Applicable
,815-2,Diagnosis Related Group,"OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $4,097.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,428.38 "," $7,754.99 "," $7,021.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,097.88 "," $7,754.99 ", Not Applicable
,815-3,Diagnosis Related Group,"OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $6,646.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,425.86 "," $12,577.42 "," $11,388.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,646.15 "," $12,577.42 ", Not Applicable
,815-4,Diagnosis Related Group,"OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES",Inpatient,APR-DRG,, Not Applicable ," $18,182.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,522.56 "," $34,408.70 "," $31,156.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,182.21 "," $34,408.70 ", Not Applicable
,816-1,Diagnosis Related Group,TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES,Inpatient,APR-DRG,, Not Applicable ," $3,772.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,917.89 "," $7,139.15 "," $6,464.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,772.46 "," $7,139.15 ", Not Applicable
,816-2,Diagnosis Related Group,TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES,Inpatient,APR-DRG,, Not Applicable ," $4,220.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,620.15 "," $7,986.34 "," $7,231.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,220.13 "," $7,986.34 ", Not Applicable
,816-3,Diagnosis Related Group,TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES,Inpatient,APR-DRG,, Not Applicable ," $6,524.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,235.44 "," $12,347.71 "," $11,180.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,524.76 "," $12,347.71 ", Not Applicable
,816-4,Diagnosis Related Group,TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES,Inpatient,APR-DRG,, Not Applicable ," $13,770.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,601.25 "," $26,059.05 "," $23,595.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,770.10 "," $26,059.05 ", Not Applicable
,841-1,Diagnosis Related Group,EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT,Inpatient,APR-DRG,, Not Applicable ," $26,086.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,921.50 "," $49,366.39 "," $44,700.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,086.13 "," $49,366.39 ", Not Applicable
,841-2,Diagnosis Related Group,EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT,Inpatient,APR-DRG,, Not Applicable ," $28,695.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $45,014.87 "," $54,304.49 "," $49,171.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,695.52 "," $54,304.49 ", Not Applicable
,841-3,Diagnosis Related Group,EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT,Inpatient,APR-DRG,, Not Applicable ," $53,656.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $84,171.26 "," $101,541.52 "," $91,943.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $53,656.45 "," $101,541.52 ", Not Applicable
,841-4,Diagnosis Related Group,EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT,Inpatient,APR-DRG,, Not Applicable ," $144,313.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $226,385.67 "," $273,104.43 "," $247,289.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $144,313.53 "," $273,104.43 ", Not Applicable
,842-1,Diagnosis Related Group,BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS,Inpatient,APR-DRG,, Not Applicable ," $10,180.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,969.66 "," $19,265.29 "," $17,444.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,180.14 "," $19,265.29 ", Not Applicable
,842-2,Diagnosis Related Group,BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS,Inpatient,APR-DRG,, Not Applicable ," $15,115.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,712.08 "," $28,605.49 "," $25,901.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,115.68 "," $28,605.49 ", Not Applicable
,842-3,Diagnosis Related Group,BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS,Inpatient,APR-DRG,, Not Applicable ," $27,987.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $43,904.76 "," $52,965.29 "," $47,958.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,987.86 "," $52,965.29 ", Not Applicable
,842-4,Diagnosis Related Group,BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS,Inpatient,APR-DRG,, Not Applicable ," $74,921.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $117,529.96 "," $141,784.39 "," $128,382.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $74,921.54 "," $141,784.39 ", Not Applicable
,843-1,Diagnosis Related Group,EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT,Inpatient,APR-DRG,, Not Applicable ," $2,587.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,058.25 "," $4,895.75 "," $4,432.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,587.00 "," $4,895.75 ", Not Applicable
,843-2,Diagnosis Related Group,EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT,Inpatient,APR-DRG,, Not Applicable ," $4,779.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,497.98 "," $9,045.32 "," $8,190.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,779.72 "," $9,045.32 ", Not Applicable
,843-3,Diagnosis Related Group,EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT,Inpatient,APR-DRG,, Not Applicable ," $8,337.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,079.59 "," $15,778.80 "," $14,287.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,337.82 "," $15,778.80 ", Not Applicable
,843-4,Diagnosis Related Group,EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT,Inpatient,APR-DRG,, Not Applicable ," $23,409.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,722.80 "," $44,301.21 "," $40,113.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,409.59 "," $44,301.21 ", Not Applicable
,844-1,Diagnosis Related Group,PARTIAL THICKNESS BURNS W/O SKIN GRAFT,Inpatient,APR-DRG,, Not Applicable ," $3,017.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,733.50 "," $5,710.35 "," $5,170.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,017.45 "," $5,710.35 ", Not Applicable
,844-2,Diagnosis Related Group,PARTIAL THICKNESS BURNS W/O SKIN GRAFT,Inpatient,APR-DRG,, Not Applicable ," $4,917.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,714.06 "," $9,305.99 "," $8,426.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,917.46 "," $9,305.99 ", Not Applicable
,844-3,Diagnosis Related Group,PARTIAL THICKNESS BURNS W/O SKIN GRAFT,Inpatient,APR-DRG,, Not Applicable ," $9,279.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,557.04 "," $17,561.15 "," $15,901.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,279.64 "," $17,561.15 ", Not Applicable
,844-4,Diagnosis Related Group,PARTIAL THICKNESS BURNS W/O SKIN GRAFT,Inpatient,APR-DRG,, Not Applicable ," $30,914.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,496.46 "," $58,504.57 "," $52,974.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,914.92 "," $58,504.57 ", Not Applicable
,850-1,Diagnosis Related Group,"PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE",Inpatient,APR-DRG,, Not Applicable ," $11,164.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,513.28 "," $21,127.47 "," $19,130.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,164.15 "," $21,127.47 ", Not Applicable
,850-2,Diagnosis Related Group,"PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE",Inpatient,APR-DRG,, Not Applicable ," $14,748.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,136.77 "," $27,911.45 "," $25,273.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,748.94 "," $27,911.45 ", Not Applicable
,850-3,Diagnosis Related Group,"PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE",Inpatient,APR-DRG,, Not Applicable ," $20,786.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,607.82 "," $39,337.03 "," $35,618.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,786.43 "," $39,337.03 ", Not Applicable
,850-4,Diagnosis Related Group,"PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE",Inpatient,APR-DRG,, Not Applicable ," $36,367.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $57,049.17 "," $68,822.30 "," $62,316.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,367.00 "," $68,822.30 ", Not Applicable
,860-1,Diagnosis Related Group,REHABILITATION,Inpatient,APR-DRG,, Not Applicable ," $6,993.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,970.11 "," $13,233.99 "," $11,983.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,993.09 "," $13,233.99 ", Not Applicable
,860-2,Diagnosis Related Group,REHABILITATION,Inpatient,APR-DRG,, Not Applicable ," $9,624.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,097.24 "," $18,212.83 "," $16,491.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,624.00 "," $18,212.83 ", Not Applicable
,860-3,Diagnosis Related Group,REHABILITATION,Inpatient,APR-DRG,, Not Applicable ," $12,848.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,156.21 "," $24,315.81 "," $22,017.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,848.93 "," $24,315.81 ", Not Applicable
,860-4,Diagnosis Related Group,REHABILITATION,Inpatient,APR-DRG,, Not Applicable ," $16,235.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,469.08 "," $30,725.08 "," $27,820.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,235.71 "," $30,725.08 ", Not Applicable
,861-1,Diagnosis Related Group,"SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS",Inpatient,APR-DRG,, Not Applicable ," $2,742.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,302.69 "," $5,190.63 "," $4,699.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,742.83 "," $5,190.63 ", Not Applicable
,861-2,Diagnosis Related Group,"SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS",Inpatient,APR-DRG,, Not Applicable ," $4,595.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,208.97 "," $8,696.67 "," $7,874.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,595.48 "," $8,696.67 ", Not Applicable
,861-3,Diagnosis Related Group,"SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS",Inpatient,APR-DRG,, Not Applicable ," $6,428.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,084.18 "," $12,165.24 "," $11,015.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,428.34 "," $12,165.24 ", Not Applicable
,861-4,Diagnosis Related Group,"SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS",Inpatient,APR-DRG,, Not Applicable ," $11,644.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,266.86 "," $22,036.56 "," $19,953.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,644.53 "," $22,036.56 ", Not Applicable
,862-1,Diagnosis Related Group,OTHER AFTERCARE & CONVALESCENCE,Inpatient,APR-DRG,, Not Applicable ," $3,064.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,807.78 "," $5,799.95 "," $5,251.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,064.80 "," $5,799.95 ", Not Applicable
,862-2,Diagnosis Related Group,OTHER AFTERCARE & CONVALESCENCE,Inpatient,APR-DRG,, Not Applicable ," $5,020.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,876.12 "," $9,501.49 "," $8,603.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,020.77 "," $9,501.49 ", Not Applicable
,862-3,Diagnosis Related Group,OTHER AFTERCARE & CONVALESCENCE,Inpatient,APR-DRG,, Not Applicable ," $6,972.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,937.70 "," $13,194.89 "," $11,947.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,972.43 "," $13,194.89 ", Not Applicable
,862-4,Diagnosis Related Group,OTHER AFTERCARE & CONVALESCENCE,Inpatient,APR-DRG,, Not Applicable ," $9,573.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,017.56 "," $18,116.70 "," $16,404.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,573.21 "," $18,116.70 ", Not Applicable
,863-1,Diagnosis Related Group,NEONATAL AFTERCARE,Inpatient,APR-DRG,, Not Applicable ," $5,718.96 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,971.37 "," $10,822.78 "," $9,799.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,718.96 "," $10,822.78 ", Not Applicable
,863-2,Diagnosis Related Group,NEONATAL AFTERCARE,Inpatient,APR-DRG,, Not Applicable ," $14,126.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,160.35 "," $26,733.54 "," $24,206.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,126.51 "," $26,733.54 ", Not Applicable
,863-3,Diagnosis Related Group,NEONATAL AFTERCARE,Inpatient,APR-DRG,, Not Applicable ," $25,609.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $40,173.32 "," $48,463.81 "," $43,882.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,609.19 "," $48,463.81 ", Not Applicable
,863-4,Diagnosis Related Group,NEONATAL AFTERCARE,Inpatient,APR-DRG,, Not Applicable ," $49,353.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $77,421.46 "," $93,398.78 "," $84,570.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,353.68 "," $93,398.78 ", Not Applicable
,890-1,Diagnosis Related Group,HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS,Inpatient,APR-DRG,, Not Applicable ," $4,521.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,092.83 "," $8,556.56 "," $7,747.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,521.45 "," $8,556.56 ", Not Applicable
,890-2,Diagnosis Related Group,HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS,Inpatient,APR-DRG,, Not Applicable ," $7,688.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,061.32 "," $14,550.39 "," $13,175.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,688.70 "," $14,550.39 ", Not Applicable
,890-3,Diagnosis Related Group,HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS,Inpatient,APR-DRG,, Not Applicable ," $11,727.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,396.51 "," $22,192.96 "," $20,095.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,727.18 "," $22,192.96 ", Not Applicable
,890-4,Diagnosis Related Group,HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS,Inpatient,APR-DRG,, Not Applicable ," $23,397.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,703.89 "," $44,278.40 "," $40,092.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,397.54 "," $44,278.40 ", Not Applicable
,892-1,Diagnosis Related Group,HIV W MAJOR HIV RELATED CONDITION,Inpatient,APR-DRG,, Not Applicable ," $5,146.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,073.29 "," $9,739.36 "," $8,818.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,146.46 "," $9,739.36 ", Not Applicable
,892-2,Diagnosis Related Group,HIV W MAJOR HIV RELATED CONDITION,Inpatient,APR-DRG,, Not Applicable ," $6,678.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,475.83 "," $12,637.70 "," $11,443.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,678.00 "," $12,637.70 ", Not Applicable
,892-3,Diagnosis Related Group,HIV W MAJOR HIV RELATED CONDITION,Inpatient,APR-DRG,, Not Applicable ," $8,844.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,875.04 "," $16,738.40 "," $15,156.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,844.89 "," $16,738.40 ", Not Applicable
,892-4,Diagnosis Related Group,HIV W MAJOR HIV RELATED CONDITION,Inpatient,APR-DRG,, Not Applicable ," $16,520.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,916.10 "," $31,264.35 "," $28,309.09 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,520.67 "," $31,264.35 ", Not Applicable
,893-1,Diagnosis Related Group,HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS,Inpatient,APR-DRG,, Not Applicable ," $5,365.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,417.67 "," $10,154.80 "," $9,194.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,365.99 "," $10,154.80 ", Not Applicable
,893-2,Diagnosis Related Group,HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS,Inpatient,APR-DRG,, Not Applicable ," $7,055.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,067.35 "," $13,351.29 "," $12,089.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,055.08 "," $13,351.29 ", Not Applicable
,893-3,Diagnosis Related Group,HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS,Inpatient,APR-DRG,, Not Applicable ," $10,327.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,200.60 "," $19,543.88 "," $17,696.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,327.36 "," $19,543.88 ", Not Applicable
,893-4,Diagnosis Related Group,HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS,Inpatient,APR-DRG,, Not Applicable ," $17,834.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,976.96 "," $33,750.51 "," $30,560.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,834.40 "," $33,750.51 ", Not Applicable
,894-1,Diagnosis Related Group,HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND,Inpatient,APR-DRG,, Not Applicable ," $4,616.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,241.38 "," $8,735.77 "," $7,910.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,616.15 "," $8,735.77 ", Not Applicable
,894-2,Diagnosis Related Group,HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND,Inpatient,APR-DRG,, Not Applicable ," $5,768.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,048.35 "," $10,915.64 "," $9,883.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,768.03 "," $10,915.64 ", Not Applicable
,894-3,Diagnosis Related Group,HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND,Inpatient,APR-DRG,, Not Applicable ," $8,095.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,698.75 "," $15,319.37 "," $13,871.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,095.04 "," $15,319.37 ", Not Applicable
,894-4,Diagnosis Related Group,HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND,Inpatient,APR-DRG,, Not Applicable ," $13,729.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,537.77 "," $25,982.48 "," $23,526.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,729.63 "," $25,982.48 ", Not Applicable
,910-1,Diagnosis Related Group,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $23,694.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,169.81 "," $44,840.47 "," $40,601.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,694.55 "," $44,840.47 ", Not Applicable
,910-2,Diagnosis Related Group,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $27,707.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $43,464.49 "," $52,434.17 "," $47,477.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,707.21 "," $52,434.17 ", Not Applicable
,910-3,Diagnosis Related Group,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $36,565.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $57,361.14 "," $69,198.64 "," $62,657.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,565.87 "," $69,198.64 ", Not Applicable
,910-4,Diagnosis Related Group,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $72,631.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $113,937.63 "," $137,450.72 "," $124,458.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $72,631.55 "," $137,450.72 ", Not Applicable
,911-1,Diagnosis Related Group,EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $13,448.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,096.16 "," $25,449.73 "," $23,044.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,448.12 "," $25,449.73 ", Not Applicable
,911-2,Diagnosis Related Group,EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $17,909.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,094.45 "," $33,892.25 "," $30,688.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,909.30 "," $33,892.25 ", Not Applicable
,911-3,Diagnosis Related Group,EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $23,614.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $37,044.22 "," $44,688.96 "," $40,464.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $23,614.49 "," $44,688.96 ", Not Applicable
,911-4,Diagnosis Related Group,EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $52,878.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $82,950.41 "," $100,068.72 "," $90,609.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $52,878.20 "," $100,068.72 ", Not Applicable
,912-1,Diagnosis Related Group,MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $17,200.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,982.99 "," $32,551.42 "," $29,474.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,200.78 "," $32,551.42 ", Not Applicable
,912-2,Diagnosis Related Group,MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $19,001.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $29,808.24 "," $35,959.70 "," $32,560.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,001.78 "," $35,959.70 ", Not Applicable
,912-3,Diagnosis Related Group,MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $30,099.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $47,217.53 "," $56,961.72 "," $51,577.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,099.65 "," $56,961.72 ", Not Applicable
,912-4,Diagnosis Related Group,MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,Inpatient,APR-DRG,, Not Applicable ," $56,958.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $89,350.43 "," $107,789.50 "," $97,600.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $56,958.00 "," $107,789.50 ", Not Applicable
,930-1,Diagnosis Related Group,MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $6,228.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,770.87 "," $11,787.26 "," $10,673.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,228.61 "," $11,787.26 ", Not Applicable
,930-2,Diagnosis Related Group,MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $8,225.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,904.03 "," $15,567.01 "," $14,095.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,225.90 "," $15,567.01 ", Not Applicable
,930-3,Diagnosis Related Group,MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $13,293.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,853.07 "," $25,156.48 "," $22,778.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,293.16 "," $25,156.48 ", Not Applicable
,930-4,Diagnosis Related Group,MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE,Inpatient,APR-DRG,, Not Applicable ," $33,963.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $53,278.58 "," $64,273.57 "," $58,198.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $33,963.37 "," $64,273.57 ", Not Applicable
,950-1,Diagnosis Related Group,EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,Inpatient,APR-DRG,, Not Applicable ," $11,856.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,599.09 "," $22,437.34 "," $20,316.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,856.31 "," $22,437.34 ", Not Applicable
,950-2,Diagnosis Related Group,EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,Inpatient,APR-DRG,, Not Applicable ," $17,061.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,764.21 "," $32,287.49 "," $29,235.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,061.32 "," $32,287.49 ", Not Applicable
,950-3,Diagnosis Related Group,EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,Inpatient,APR-DRG,, Not Applicable ," $26,969.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $42,307.11 "," $51,037.95 "," $46,213.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,969.41 "," $51,037.95 ", Not Applicable
,950-4,Diagnosis Related Group,EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,Inpatient,APR-DRG,, Not Applicable ," $49,292.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $77,325.58 "," $93,283.10 "," $84,465.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $49,292.55 "," $93,283.10 ", Not Applicable
,951-1,Diagnosis Related Group,MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,Inpatient,APR-DRG,, Not Applicable ," $8,134.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,760.87 "," $15,394.31 "," $13,939.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,134.64 "," $15,394.31 ", Not Applicable
,951-2,Diagnosis Related Group,MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,Inpatient,APR-DRG,, Not Applicable ," $11,803.80 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $18,516.71 "," $22,337.96 "," $20,226.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $11,803.80 "," $22,337.96 ", Not Applicable
,951-3,Diagnosis Related Group,MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,Inpatient,APR-DRG,, Not Applicable ," $19,495.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $30,583.42 "," $36,894.86 "," $33,407.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,495.94 "," $36,894.86 ", Not Applicable
,951-4,Diagnosis Related Group,MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,Inpatient,APR-DRG,, Not Applicable ," $36,289.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $56,927.63 "," $68,675.67 "," $62,184.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $36,289.52 "," $68,675.67 ", Not Applicable
,952-1,Diagnosis Related Group,NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,Inpatient,APR-DRG,, Not Applicable ," $6,862.23 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,764.84 "," $12,986.35 "," $11,758.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,862.23 "," $12,986.35 ", Not Applicable
,952-2,Diagnosis Related Group,NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,Inpatient,APR-DRG,, Not Applicable ," $9,927.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $15,572.62 "," $18,786.31 "," $17,010.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,927.04 "," $18,786.31 ", Not Applicable
,952-3,Diagnosis Related Group,NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,Inpatient,APR-DRG,, Not Applicable ," $16,657.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $26,130.82 "," $31,523.39 "," $28,543.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $16,657.55 "," $31,523.39 ", Not Applicable
,952-4,Diagnosis Related Group,NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,Inpatient,APR-DRG,, Not Applicable ," $31,154.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,871.89 "," $58,957.49 "," $53,384.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $31,154.25 "," $58,957.49 ", Not Applicable
,0001A,HCPCS,Adm sarscov2 30mcg/0.3ml 1st,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , $46.82 , Not Applicable , Not Applicable , $49.16 , $47.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , $46.82 , $49.16 , Not Applicable
,0002A,HCPCS,Adm sarscov2 30mcg/0.3ml 2nd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , $46.82 , Not Applicable , Not Applicable , $49.16 , $47.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , $46.82 , $49.16 , Not Applicable
,0003A,HCPCS,Adm sarscov2 30mcg/0.3ml 3rd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , $46.82 , Not Applicable , Not Applicable , $49.16 , $47.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , $46.82 , $49.16 , Not Applicable
,0004A,HCPCS,Adm sarscov2 30mcg/0.3ml bst ,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , $46.82 , Not Applicable , Not Applicable , $49.16 , $47.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , $46.82 , $49.16 , Not Applicable
,0011A,HCPCS,Adm sarscov2 100mcg/0.5ml1st,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , $46.82 , Not Applicable , Not Applicable , $49.16 , $47.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , $46.82 , $49.16 , Not Applicable
,0012A,HCPCS,Adm sarscov2 100mcg/0.5ml2nd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , $46.82 , Not Applicable , Not Applicable , $49.16 , $47.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , $46.82 , $49.16 , Not Applicable
,0013A,HCPCS,Adm sarscov2 100mcg/0.5ml3rd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , $46.82 , Not Applicable , Not Applicable , $49.16 , $47.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , $46.82 , $49.16 , Not Applicable
,0031A,HCPCS,Adm sarscov2 vac ad26 .5ml,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , $46.82 , Not Applicable , Not Applicable , $49.16 , $47.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , $46.82 , $49.16 , Not Applicable
,0034A,HCPCS,Adm sarscov2 vac ad26 .5ml b,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , $46.82 , Not Applicable , Not Applicable , $49.16 , $47.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , $46.82 , $49.16 , Not Applicable
,0064A,HCPCS,Adm sarscov2 50mcg/0.25mlbst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , $46.82 , Not Applicable , Not Applicable , $49.16 , $47.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , $46.82 , $49.16 , Not Applicable
,0071A,HCPCS,Adm sarscv2 10mcg trs-sucr 1,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , $46.82 , Not Applicable , Not Applicable , $49.16 , $47.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , $46.82 , $49.16 , Not Applicable
,0071T,HCPCS,Us leiomyomata ablate <200,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,0072A,HCPCS,Adm sarscv2 10mcg trs-sucr 2,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , $46.82 , Not Applicable , Not Applicable , $49.16 , $47.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.82 , Not Applicable , Not Applicable , $46.82 , $49.16 , Not Applicable
,0072T,HCPCS,Us leiomyomata ablate >200,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,0100T,HCPCS,Prosth retina receive&gen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $178,514.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $178,514.04 "," $178,514.04 ", Not Applicable , Not Applicable ," $187,439.74 "," $182,084.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $178,514.04 ", Not Applicable , Not Applicable ," $178,514.04 "," $187,439.74 ", Not Applicable
,0101T,HCPCS,Esw muscskel sys nos,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,0102T,HCPCS,Esw phy anes lat hmrl epcndl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,0106T,HCPCS,Touch quant sensory test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,0107T,HCPCS,Vibrate quant sensory test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,0108T,HCPCS,Cool quant sensory test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,0109T,HCPCS,Heat quant sensory test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,0110T,HCPCS,Nos quant sensory test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,0184T,HCPCS,Exc rectal tumor endoscopic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 "," $6,017.78 ", Not Applicable , Not Applicable ," $6,318.67 "," $6,138.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable ," $6,017.78 "," $6,318.67 ", Not Applicable
,0198T,HCPCS,Ocular blood flow measure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,0200T,HCPCS,Perq sacral augmt unilat inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,0201T,HCPCS,Perq sacral augmt bilat inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,0207T,HCPCS,Clear eyelid gland w/heat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,0208T,HCPCS,Audiometry air only,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,0209T,HCPCS,Audiometry air & bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,0210T,HCPCS,Speech audiometry threshold,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,0211T,HCPCS,Speech audiom thresh & recog,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,0212T,HCPCS,Compre audiometry evaluation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,0213T,HCPCS,Njx paravert w/us cer/thor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,0216T,HCPCS,Njx paravert w/us lumb/sac,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,0221T,HCPCS,Plmt post facet implt lumb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,0232T,HCPCS,Njx platelet plasma,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,0234T,HCPCS,Trluml perip athrc renal art,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,0236T,HCPCS,Trluml perip athrc abd aorta,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,0237T,HCPCS,Trluml perip athrc brchiocph,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,0238T,HCPCS,Trluml perip athrc iliac art,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,0253T,HCPCS,Insert aqueous drain device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,0263T,HCPCS,Im b1 mrw cel ther cmpl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,835.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,835.03 "," $4,835.03 ", Not Applicable , Not Applicable ," $5,076.79 "," $4,931.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,835.03 ", Not Applicable , Not Applicable ," $4,835.03 "," $5,076.79 ", Not Applicable
,0264T,HCPCS,Im b1 mrw cel ther xcl hrvst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,835.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,835.03 "," $4,835.03 ", Not Applicable , Not Applicable ," $5,076.79 "," $4,931.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,835.03 ", Not Applicable , Not Applicable ," $4,835.03 "," $5,076.79 ", Not Applicable
,0265T,HCPCS,Im b1 mrw cel ther hrvst onl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,835.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,835.03 "," $4,835.03 ", Not Applicable , Not Applicable ," $5,076.79 "," $4,931.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,835.03 ", Not Applicable , Not Applicable ," $4,835.03 "," $5,076.79 ", Not Applicable
,0266T,HCPCS,Implt/rpl crtd sns dev total,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 "," $35,191.71 ", Not Applicable , Not Applicable ," $36,951.29 "," $35,895.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable ," $35,191.71 "," $36,951.29 ", Not Applicable
,0267T,HCPCS,Implt/rpl crtd sns dev lead,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,0268T,HCPCS,Implt/rpl crtd sns dev gen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 "," $35,191.71 ", Not Applicable , Not Applicable ," $36,951.29 "," $35,895.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable ," $35,191.71 "," $36,951.29 ", Not Applicable
,0269T,HCPCS,Rev/remvl crtd sns dev total,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,0270T,HCPCS,Rev/remvl crtd sns dev lead,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,0271T,HCPCS,Rev/remvl crtd sns dev gen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,0272T,HCPCS,Interrogate crtd sns dev,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,0273T,HCPCS,Interrogate crtd sns w/pgrmg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,0274T,HCPCS,Perq lamot/lam crv/thrc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,0275T,HCPCS,Perq lamot/lam lumbar,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,0278T,HCPCS,Tempr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,0308T,HCPCS,Insj ocular telescope prosth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $28,288.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,288.58 "," $28,288.58 ", Not Applicable , Not Applicable ," $29,703.00 "," $28,854.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $28,288.58 ", Not Applicable , Not Applicable ," $28,288.58 "," $29,703.00 ", Not Applicable
,0312T,HCPCS,Laps impltj nstim vagus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 "," $35,191.71 ", Not Applicable , Not Applicable ," $36,951.29 "," $35,895.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable ," $35,191.71 "," $36,951.29 ", Not Applicable
,0313T,HCPCS,Laps rmvl nstim array vagus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,0314T,HCPCS,Laps rmvl vgl arry&pls gen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,0315T,HCPCS,Rmvl vagus nerve pls gen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,0316T,HCPCS,Replc vagus nerve pls gen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 "," $35,191.71 ", Not Applicable , Not Applicable ," $36,951.29 "," $35,895.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable ," $35,191.71 "," $36,951.29 ", Not Applicable
,0317T,HCPCS,Elec alys vagus nrv pls gen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0330T,HCPCS,Tear film img uni/bi w/i&r,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,0331T,HCPCS,Heart symp image plnr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,0332T,HCPCS,Heart symp image plnr spect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,0335T,HCPCS,Insj sinus tarsi implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,0338T,HCPCS,Trnscth renal symp denrv unl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 "," $5,925.35 ", Not Applicable , Not Applicable ," $6,221.61 "," $6,043.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable ," $5,925.35 "," $6,221.61 ", Not Applicable
,0339T,HCPCS,Trnscth renal symp denrv bil,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 "," $5,925.35 ", Not Applicable , Not Applicable ," $6,221.61 "," $6,043.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable ," $5,925.35 "," $6,221.61 ", Not Applicable
,0342T,HCPCS,Thxp apheresis w/hdl delip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,835.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,835.03 "," $4,835.03 ", Not Applicable , Not Applicable ," $5,076.79 "," $4,931.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,835.03 ", Not Applicable , Not Applicable ," $4,835.03 "," $5,076.79 ", Not Applicable
,0347T,HCPCS,Ins bone device for rsa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,0348T,HCPCS,Rsa spine exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,0349T,HCPCS,Rsa upper extr exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,0350T,HCPCS,Rsa lower extr exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,0358T,HCPCS,Bia whole body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,0362T,HCPCS,Bhv id suprt assmt ea 15 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,0373T,HCPCS,Adapt bhv tx ea 15 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,0379T,HCPCS,Vis field assmnt tech suppt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,0394T,HCPCS,Hdr elctrnc skn surf brchytx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.98 , $288.98 , Not Applicable , Not Applicable , $303.43 , $294.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.98 , Not Applicable , Not Applicable , $288.98 , $303.43 , Not Applicable
,0395T,HCPCS,Hdr elctr ntrst/ntrcv brchtx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $848.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $848.09 , $848.09 , Not Applicable , Not Applicable , $890.49 , $865.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $848.09 , Not Applicable , Not Applicable , $848.09 , $890.49 , Not Applicable
,0398T,HCPCS,Mrgfus strtctc les abltj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 "," $13,442.21 ", Not Applicable , Not Applicable ," $14,114.33 "," $13,711.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable ," $13,442.21 "," $14,114.33 ", Not Applicable
,0402T,HCPCS,Colgn cross-link crn med sep,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,0404T,HCPCS,Trnscrv uterin fibroid abltj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 "," $8,115.89 ", Not Applicable , Not Applicable ," $8,521.68 "," $8,278.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable ," $8,115.89 "," $8,521.68 ", Not Applicable
,0408T,HCPCS,Insj/rplc cardiac modulj sys,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 "," $27,568.15 ", Not Applicable , Not Applicable ," $28,946.56 "," $28,119.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable ," $27,568.15 "," $28,946.56 ", Not Applicable
,0409T,HCPCS,Insj/rplc car modulj pls gn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 "," $27,568.15 ", Not Applicable , Not Applicable ," $28,946.56 "," $28,119.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable ," $27,568.15 "," $28,946.56 ", Not Applicable
,0410T,HCPCS,Insj/rplc car modulj atr elt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,0411T,HCPCS,Insj/rplc car modulj vnt elt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,0412T,HCPCS,Rmvl cardiac modulj pls gen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,0413T,HCPCS,Rmvl car modulj tranvns elt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,0414T,HCPCS,Rmvl & rpl car modulj pls gn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 "," $27,568.15 ", Not Applicable , Not Applicable ," $28,946.56 "," $28,119.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable ," $27,568.15 "," $28,946.56 ", Not Applicable
,0415T,HCPCS,Repos car modulj tranvns elt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,0416T,HCPCS,Reloc skin pocket pls gen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,0417T,HCPCS,Prgrmg eval cardiac modulj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0418T,HCPCS,Interro eval cardiac modulj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0419T,HCPCS,Dstrj neurofibroma xtnsv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,0420T,HCPCS,Dstrj neurofibroma xtnsv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,0421T,HCPCS,Waterjet prostate abltj cmpl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 "," $9,866.61 ", Not Applicable , Not Applicable ," $10,359.94 "," $10,063.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable ," $9,866.61 "," $10,359.94 ", Not Applicable
,0422T,HCPCS,Tactile breast img uni/bi,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,0424T,HCPCS,Insj/rplc nstim apnea compl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 "," $35,191.71 ", Not Applicable , Not Applicable ," $36,951.29 "," $35,895.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable ," $35,191.71 "," $36,951.29 ", Not Applicable
,0425T,HCPCS,Insj/rplc nstim apnea sen ld,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 "," $13,442.21 ", Not Applicable , Not Applicable ," $14,114.33 "," $13,711.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable ," $13,442.21 "," $14,114.33 ", Not Applicable
,0426T,HCPCS,Insj/rplc nstim apnea stm ld,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 "," $13,442.21 ", Not Applicable , Not Applicable ," $14,114.33 "," $13,711.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable ," $13,442.21 "," $14,114.33 ", Not Applicable
,0427T,HCPCS,Insj/rplc nstim apnea pls gn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 "," $35,191.71 ", Not Applicable , Not Applicable ," $36,951.29 "," $35,895.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable ," $35,191.71 "," $36,951.29 ", Not Applicable
,0428T,HCPCS,Rmvl nstim apnea pls gen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,0429T,HCPCS,Rmvl nstim apnea sen ld,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,0430T,HCPCS,Rmvl nstim apnea stimj ld,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,0431T,HCPCS,Rmvl/rplc nstim apnea pls gn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 "," $35,191.71 ", Not Applicable , Not Applicable ," $36,951.29 "," $35,895.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable ," $35,191.71 "," $36,951.29 ", Not Applicable
,0432T,HCPCS,Repos nstim apnea stimj ld,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,0433T,HCPCS,Repos nstim apnea sensing ld,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,0434T,HCPCS,Interro eval npgs apnea,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , $120.02 , Not Applicable , Not Applicable , $126.02 , $122.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , $120.02 , $126.02 , Not Applicable
,0435T,HCPCS,Prgrmg eval npgs apnea 1 ses,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , $120.02 , Not Applicable , Not Applicable , $126.02 , $122.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , $120.02 , $126.02 , Not Applicable
,0436T,HCPCS,Prgrmg eval npgs apnea study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,0440T,HCPCS,Abltj perc uxtr/perph nrv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,0441T,HCPCS,Abltj perc lxtr/perph nrv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,0442T,HCPCS,Abltj perc plex/trncl nrv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,0446T,HCPCS,Insj impltbl glucose sensor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,0447T,HCPCS,Rmvl impltbl glucose sensor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,0448T,HCPCS,Remvl insj impltbl gluc sens,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,0449T,HCPCS,Insj aqueous drain dev 1st,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,0464T,HCPCS,Visual ep test for glaucoma,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,0465T,HCPCS,Supchrdl njx rx w/o supply,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,0472T,HCPCS,Prgrmg io rta eltrd ra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , $326.43 , Not Applicable , Not Applicable , $342.75 , $332.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , $326.43 , $342.75 , Not Applicable
,0473T,HCPCS,Reprgrmg io rta eltrd ra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , $120.02 , Not Applicable , Not Applicable , $126.02 , $122.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , $120.02 , $126.02 , Not Applicable
,0476T,HCPCS,Rec ftl car sgl elec tr data,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,0477T,HCPCS,Rec ftl car sgl xrtj alys,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,0479T,HCPCS,Fxjl abl lsr 1st 100 sq cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,0481T,HCPCS,Njx autol wbc concentrate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,0485T,HCPCS,Oct mid ear i&r unilateral,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,0486T,HCPCS,Oct mid ear i&r bilateral,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,0487T,HCPCS,Trvg biomchn mapg w/reprt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,0491T,HCPCS,Abl lsr opn wnd 1st 20 sqcm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,0497T,HCPCS,Xtrnl pt act ecg in-off conn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0499T,HCPCS,Cysto f/urtl strix/stenosis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,0503T,HCPCS,Cor ffr alys gnrj ffr mdl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,112.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,112.64 "," $1,112.64 ", Not Applicable , Not Applicable ," $1,168.27 "," $1,134.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,112.64 ", Not Applicable , Not Applicable ," $1,112.64 "," $1,168.27 ", Not Applicable
,0505T,HCPCS,Ev fempop artl revsc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,0506T,HCPCS,Mac pgmt opt dns meas hfp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,0507T,HCPCS,Near ifr 2img mibmn glnd i&r,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,0508T,HCPCS,Pls echo us b1 dns meas tib,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,0509T,HCPCS,Pattern erg w/i&r,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,0510T,HCPCS,Rmvl sinus tarsi implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,0511T,HCPCS,Rmvl&rinsj sinus tarsi implt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,0512T,HCPCS,Esw integ wnd hlg 1st wnd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,0515T,HCPCS,Insj wcs lv compl sys,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 "," $27,568.15 ", Not Applicable , Not Applicable ," $28,946.56 "," $28,119.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable ," $27,568.15 "," $28,946.56 ", Not Applicable
,0516T,HCPCS,Insj wcs lv eltrd only,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,0517T,HCPCS,Insj wcs lv pg compnt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,0518T,HCPCS,Rmvl pg compnt wcs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,0519T,HCPCS,Rmvl & rplcmt pg compnt wcs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,0520T,HCPCS,Rmvl&rplcmt pg wcs new eltrd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 "," $27,568.15 ", Not Applicable , Not Applicable ," $28,946.56 "," $28,119.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable ," $27,568.15 "," $28,946.56 ", Not Applicable
,0521T,HCPCS,Interrog dev eval wcs ip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,0522T,HCPCS,Prgrmg dev eval wcs ip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0524T,HCPCS,Ev cath dir chem abltj w/img,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,0525T,HCPCS,Insj/rplcmt compl iims,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 "," $12,430.76 ", Not Applicable , Not Applicable ," $13,052.30 "," $12,679.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable ," $12,430.76 "," $13,052.30 ", Not Applicable
,0526T,HCPCS,Insj/rplcmt iims eltrd only,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,0527T,HCPCS,Insj/rplcmt iims implt mntr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,0528T,HCPCS,Prgrmg dev eval iims ip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0529T,HCPCS,Interrog dev eval iims ip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0530T,HCPCS,Removal complete iims,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,0531T,HCPCS,Removal iims electrode only,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,0532T,HCPCS,Removal iims implt mntr only,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,0534T,HCPCS,Cont rec mvmt do setup&train,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0535T,HCPCS,Cont rec mvmt do reprt cnfig,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0540T,HCPCS,Car-t cll admn autologous,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,0541T,HCPCS,Myocardial imaging mcg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,0555T,HCPCS,B1 str&fx rsk transmis data,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,0556T,HCPCS,B1 str & fx rsk assessment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,0558T,HCPCS,Ct scan f/biomchn ct alys,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,0559T,HCPCS,Antmc mdl 3d print 1st cmpnt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,0561T,HCPCS,Antmc guide 3d print 1st gd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,0563T,HCPCS,Evac meibomian glnd heat bi,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,0564T,HCPCS,Onc chemo rx cytotox csc 14,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,0571T,HCPCS,Insj/rplcmt icds ss eltrd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $39,269.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,269.48 "," $39,269.48 ", Not Applicable , Not Applicable ," $41,232.96 "," $40,054.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,269.48 ", Not Applicable , Not Applicable ," $39,269.48 "," $41,232.96 ", Not Applicable
,0572T,HCPCS,Insertion ss dfb electrode,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,0573T,HCPCS,Removal ss dfb electrode,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,0574T,HCPCS,Repos prev ss impl dfb eltrd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,0575T,HCPCS,Prgrmg dev eval icds ss ip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0576T,HCPCS,Interrog dev eval icds ss ip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0577T,HCPCS,Ephys eval icds ss,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,331.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,331.56 "," $1,331.56 ", Not Applicable , Not Applicable ," $1,398.14 "," $1,358.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,331.56 ", Not Applicable , Not Applicable ," $1,331.56 "," $1,398.14 ", Not Applicable
,0579T,HCPCS,Rem interrog dev icds tech,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0580T,HCPCS,Rmvl ss impl dfb pg only,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,0583T,HCPCS,Tmpst auto tube dlvr sys,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,0587T,HCPCS,Perq impltj/rplcmt isdns ptn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,369.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,369.33 "," $7,369.33 ", Not Applicable , Not Applicable ," $7,737.79 "," $7,516.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,369.33 ", Not Applicable , Not Applicable ," $7,369.33 "," $7,737.79 ", Not Applicable
,0588T,HCPCS,Revision/removal isdns ptn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,0589T,HCPCS,Elec alys smpl prgrmg iins,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , $120.02 , Not Applicable , Not Applicable , $126.02 , $122.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , $120.02 , $126.02 , Not Applicable
,0590T,HCPCS,Elec alys cplx prgrmg iins,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , $120.02 , Not Applicable , Not Applicable , $126.02 , $122.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , $120.02 , $126.02 , Not Applicable
,0594T,HCPCS,Osteot hum xtrnl lngth dev,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,0596T,HCPCS,Temp fml iu vlv-pmp 1st insj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,0597T,HCPCS,Temp fml iu valve-pmp rplcmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,0598T,HCPCS,Ncntc r-t fluor wnd img 1st,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,0600T,HCPCS,Ire abltj 1+tum organ perq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,0601T,HCPCS,Ire abltj 1+tumors open,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,0604T,HCPCS,Rem oct rta dev setup&educaj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,0605T,HCPCS,Rem oct rta techl sprt min 8,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0607T,HCPCS,Rem mntr pulm flu mntr setup,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,0608T,HCPCS,Rem mntr pulm flu mntr alys,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0609T,HCPCS,Mrs disc pain acquisj data,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,0611T,HCPCS,Mrs disc pain alg alys data,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,0614T,HCPCS,Rmvl&rplcmt ss impl dfb pg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 "," $27,568.15 ", Not Applicable , Not Applicable ," $28,946.56 "," $28,119.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable ," $27,568.15 "," $28,946.56 ", Not Applicable
,0615T,HCPCS,Eye mvmt alys w/o calbrj i&r,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,0616T,HCPCS,Insertion of iris prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,0617T,HCPCS,Insj iris prosth w/rmvl&insj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,0618T,HCPCS,Insj iris prosth sec io lens,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,0619T,HCPCS,Cysto w/prst8 commissurotomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,0620T,HCPCS,Evasc ven artlz tibl/prnl vn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,0627T,HCPCS,Perq njx algc fluor lmbr 1st,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,0629T,HCPCS,Perq njx algc ct lmbr 1st,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,0631T,HCPCS,Tc vis lit hyperspectral img,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,0632T,HCPCS,Perq tcat us abltj nrv p-art,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,0633T,HCPCS,Ct breast w/3d uni c-,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,0634T,HCPCS,Ct breast w/3d uni c+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,0635T,HCPCS,Ct breast w/3d uni c-/c+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,0636T,HCPCS,Ct breast w/3d bi c-,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,0637T,HCPCS,Ct breast w/3d bi c+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,0638T,HCPCS,Ct breast w/3d bi c-/c+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,0641T,HCPCS,Ncntc nr ifr spctrsc wnd img,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,0644T,HCPCS,Tcat rmvl/dblk icar mas perq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 "," $5,925.35 ", Not Applicable , Not Applicable ," $6,221.61 "," $6,043.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable ," $5,925.35 "," $6,221.61 ", Not Applicable
,0647T,HCPCS,Insj gtube perq mag gastrpxy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,0648T,HCPCS,Quan mr tis wo mri 1orgn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,112.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,112.64 "," $1,112.64 ", Not Applicable , Not Applicable ," $1,168.27 "," $1,134.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,112.64 ", Not Applicable , Not Applicable ," $1,112.64 "," $1,168.27 ", Not Applicable
,0650T,HCPCS,Prgrmg dev eval scrms remote,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0651T,HCPCS,Mag ctrld capsule endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,0652T,HCPCS,Egd flx transnasal dx br/wa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,0653T,HCPCS,Egd flx transnasal bx 1/mlt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,0654T,HCPCS,Egd flx transnasal tube/cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,0655T,HCPCS,Tprnl focal abltj mal prst8,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,0658T,HCPCS,Elec impd spectrsc 1+skn les,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,0662T,HCPCS,Scalp cool 1st meas&calbrj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,166.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,166.16 "," $2,166.16 ", Not Applicable , Not Applicable ," $2,274.47 "," $2,209.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,166.16 ", Not Applicable , Not Applicable ," $2,166.16 "," $2,274.47 ", Not Applicable
,0671T,HCPCS,Insj ant sgm aq drg dev 1+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,0673T,HCPCS,Abltj b9 thyr ndul perq lasr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,0686T,HCPCS,Histotripsy mal hepatcel tis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,632.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,632.84 "," $14,632.84 ", Not Applicable , Not Applicable ," $15,364.48 "," $14,925.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,632.84 ", Not Applicable , Not Applicable ," $14,632.84 "," $15,364.48 ", Not Applicable
,0689T,HCPCS,Quan us tis charac w/o dx us,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,0692T,HCPCS,Therapeutic ultrafiltration,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,0693T,HCPCS,Compre ful bdy 3d mtn alys,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $410.29 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $410.29 , $410.29 , Not Applicable , Not Applicable , $430.80 , $418.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $410.29 , Not Applicable , Not Applicable , $410.29 , $430.80 , Not Applicable
,0696T,HCPCS,Bdy surf mapg pm/cvdfb f/up,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0697T,HCPCS,Quan mr tis wo mri mlt orgn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,0699T,HCPCS,Njx pst chmbr eye medication,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,0702T,HCPCS,Rem ther mntr ol tech sprt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,0707T,HCPCS,Njx b1 sub mtrl sbchdrl dfct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,0712T,HCPCS,N-nvs artl plaq alys quan,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,10005,HCPCS,Fna bx w/us gdn 1st les,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,10007,HCPCS,Fna bx w/fluor gdn 1st les,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,10009,HCPCS,Fna bx w/ct gdn 1st les,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,10011,HCPCS,Fna bx w/mr gdn 1st les,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,10021,HCPCS,Fna bx w/o img gdn 1st les,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,10030,HCPCS,Guide cathet fluid drainage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,10035,HCPCS,Perq dev soft tiss 1st imag,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,10040,HCPCS,Acne surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,10060,HCPCS,Drainage of skin abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,10061,HCPCS,Drainage of skin abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,10080,HCPCS,Drainage of pilonidal cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,10081,HCPCS,Drainage of pilonidal cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,10120,HCPCS,Remove foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,10121,HCPCS,Remove foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,10140,HCPCS,Drainage of hematoma/fluid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,10160,HCPCS,Puncture drainage of lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,10180,HCPCS,Complex drainage wound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11000,HCPCS,Debride infected skin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,11010,HCPCS,Debride skin at fx site,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11011,HCPCS,Debride skin musc at fx site,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11012,HCPCS,Deb skin bone at fx site,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11042,HCPCS,Deb subq tissue 20 sq cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,11043,HCPCS,Deb musc/fascia 20 sq cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,11044,HCPCS,Deb bone 20 sq cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,11055,HCPCS,Trim skin lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,11056,HCPCS,Trim skin lesions 2 to 4,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,11057,HCPCS,Trim skin lesions over 4,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,11102,HCPCS,Tangntl bx skin single les,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,11104,HCPCS,Punch bx skin single lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,11106,HCPCS,Incal bx skn single les,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,11200,HCPCS,Removal of skin tags 2.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,11305,HCPCS,Shave skin lesion 0.5 cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,11306,HCPCS,Shave skin lesion 0.6-1.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,11307,HCPCS,Shave skin lesion 1.1-2.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,11308,HCPCS,Shave skin lesion >2.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,11310,HCPCS,Shave skin lesion 0.5 cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,11311,HCPCS,Shave skin lesion 0.6-1.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,11312,HCPCS,Shave skin lesion 1.1-2.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,11313,HCPCS,Shave skin lesion >2.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,11400,HCPCS,Exc tr-ext b9+marg 0.5 cm<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11401,HCPCS,Exc tr-ext b9+marg 0.6-1 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,11402,HCPCS,Exc tr-ext b9+marg 1.1-2 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11403,HCPCS,Exc tr-ext b9+marg 2.1-3cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11404,HCPCS,Exc tr-ext b9+marg 3.1-4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,11406,HCPCS,Exc tr-ext b9+marg >4.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,11420,HCPCS,Exc h-f-nk-sp b9+marg 0.5/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,11421,HCPCS,Exc h-f-nk-sp b9+marg 0.6-1,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11422,HCPCS,Exc h-f-nk-sp b9+marg 1.1-2,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,11423,HCPCS,Exc h-f-nk-sp b9+marg 2.1-3,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,11424,HCPCS,Exc h-f-nk-sp b9+marg 3.1-4,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,11426,HCPCS,Exc h-f-nk-sp b9+marg >4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11440,HCPCS,Exc face-mm b9+marg 0.5 cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11441,HCPCS,Exc face-mm b9+marg 0.6-1 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11442,HCPCS,Exc face-mm b9+marg 1.1-2 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11443,HCPCS,Exc face-mm b9+marg 2.1-3 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,11444,HCPCS,Exc face-mm b9+marg 3.1-4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,11446,HCPCS,Exc face-mm b9+marg >4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11450,HCPCS,Removal sweat gland lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11451,HCPCS,Removal sweat gland lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11462,HCPCS,Removal sweat gland lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11463,HCPCS,Removal sweat gland lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11470,HCPCS,Removal sweat gland lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11471,HCPCS,Removal sweat gland lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11600,HCPCS,Exc tr-ext mal+marg 0.5 cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11601,HCPCS,Exc tr-ext mal+marg 0.6-1 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11602,HCPCS,Exc tr-ext mal+marg 1.1-2 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,11603,HCPCS,Exc tr-ext mal+marg 2.1-3 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11604,HCPCS,Exc tr-ext mal+marg 3.1-4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11606,HCPCS,Exc tr-ext mal+marg >4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,11620,HCPCS,Exc h-f-nk-sp mal+marg 0.5/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,11621,HCPCS,Exc s/n/h/f/g mal+mrg 0.6-1,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11622,HCPCS,Exc s/n/h/f/g mal+mrg 1.1-2,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11623,HCPCS,Exc s/n/h/f/g mal+mrg 2.1-3,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,11624,HCPCS,Exc s/n/h/f/g mal+mrg 3.1-4,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,11626,HCPCS,Exc s/n/h/f/g mal+mrg >4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11640,HCPCS,Exc f/e/e/n/l mal+mrg 0.5cm<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11641,HCPCS,Exc f/e/e/n/l mal+mrg 0.6-1,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11642,HCPCS,Exc f/e/e/n/l mal+mrg 1.1-2,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11643,HCPCS,Exc f/e/e/n/l mal+mrg 2.1-3,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,11644,HCPCS,Exc f/e/e/n/l mal+mrg 3.1-4,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,11646,HCPCS,Exc f/e/e/n/l mal+mrg >4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11719,HCPCS,Trim nail(s) any number,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,11720,HCPCS,Debride nail 1-5,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,11721,HCPCS,Debride nail 6 or more,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,11730,HCPCS,Removal of nail plate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,11740,HCPCS,Drain blood from under nail,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,11750,HCPCS,Removal of nail bed,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,11755,HCPCS,Biopsy nail unit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11760,HCPCS,Repair of nail bed,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,11762,HCPCS,Reconstruction of nail bed,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,11765,HCPCS,Excision of nail fold toe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,11770,HCPCS,Remove pilonidal cyst simple,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11771,HCPCS,Remove pilonidal cyst exten,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11772,HCPCS,Remove pilonidal cyst compl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11900,HCPCS,Inject skin lesions 7,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,11920,HCPCS,Correct skin color 6.0 cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,11921,HCPCS,Correct skn color 6.1-20.0cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,11950,HCPCS,Tx contour defects 1 cc/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,11951,HCPCS,Tx contour defects 1.1-5.0cc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,11952,HCPCS,Tx contour defects 5.1-10cc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,11954,HCPCS,Tx contour defects >10.0 cc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,11960,HCPCS,Insert tissue expander(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,11970,HCPCS,Rplcmt tiss xpndr perm implt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,11971,HCPCS,Rmvl tis xpndr wo insj implt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,11976,HCPCS,Remove contraceptive capsule,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,11980,HCPCS,Implant hormone pellet(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,11981,HCPCS,Insertion drug dlvr implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,11982,HCPCS,Remove drug implant device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,11983,HCPCS,Remove/insert drug implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,12001,HCPCS,Rpr s/n/ax/gen/trnk 2.5cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,12002,HCPCS,Rpr s/n/ax/gen/trnk2.6-7.5cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,12004,HCPCS,Rpr s/n/ax/gen/trk7.6-12.5cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,12005,HCPCS,Rpr s/n/a/gen/trk12.6-20.0cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12006,HCPCS,Rpr s/n/a/gen/trk20.1-30.0cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12007,HCPCS,Rpr s/n/ax/gen/trnk >30.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,12011,HCPCS,Rpr f/e/e/n/l/m 2.5 cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,12013,HCPCS,Rpr f/e/e/n/l/m 2.6-5.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,12014,HCPCS,Rpr f/e/e/n/l/m 5.1-7.5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,12015,HCPCS,Rpr f/e/e/n/l/m 7.6-12.5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,12016,HCPCS,Rpr fe/e/en/l/m 12.6-20.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12017,HCPCS,Rpr fe/e/en/l/m 20.1-30.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12018,HCPCS,Rpr f/e/e/n/l/m >30.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,12020,HCPCS,Closure of split wound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,12021,HCPCS,Closure of split wound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12031,HCPCS,Intmd rpr s/a/t/ext 2.5 cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12032,HCPCS,Intmd rpr s/a/t/ext 2.6-7.5,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12034,HCPCS,Intmd rpr s/tr/ext 7.6-12.5,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12035,HCPCS,Intmd rpr s/a/t/ext 12.6-20,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12036,HCPCS,Intmd rpr s/a/t/ext 20.1-30,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,12037,HCPCS,Intmd rpr s/tr/ext >30.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,12041,HCPCS,Intmd rpr n-hf/genit 2.5cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12042,HCPCS,Intmd rpr n-hf/genit2.6-7.5,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12044,HCPCS,Intmd rpr n-hf/genit7.6-12.5,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,12045,HCPCS,Intmd rpr n-hf/genit12.6-20,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,12046,HCPCS,Intmd rpr n-hf/genit20.1-30,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,12047,HCPCS,Intmd rpr n-hf/genit >30.0cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,12051,HCPCS,Intmd rpr face/mm 2.5 cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12052,HCPCS,Intmd rpr face/mm 2.6-5.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12053,HCPCS,Intmd rpr face/mm 5.1-7.5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12054,HCPCS,Intmd rpr face/mm 7.6-12.5cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12055,HCPCS,Intmd rpr face/mm 12.6-20 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12056,HCPCS,Intmd rpr face/mm 20.1-30.0,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,12057,HCPCS,Intmd rpr face/mm >30.0 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,13100,HCPCS,Cmplx rpr trunk 1.1-2.5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,13101,HCPCS,Cmplx rpr trunk 2.6-7.5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,13120,HCPCS,Cmplx rpr s/a/l 1.1-2.5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,13121,HCPCS,Cmplx rpr s/a/l 2.6-7.5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,13131,HCPCS,Cmplx rpr f/c/c/m/n/ax/g/h/f,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,13132,HCPCS,Cmplx rpr f/c/c/m/n/ax/g/h/f,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,13151,HCPCS,Cmplx rpr e/n/e/l 1.1-2.5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,13152,HCPCS,Cmplx rpr e/n/e/l 2.6-7.5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,13160,HCPCS,Late closure of wound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,14000,HCPCS,Tis trnfr trunk 10 sq cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,14001,HCPCS,Tis trnfr trunk 10.1-30sqcm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,14020,HCPCS,Tis trnfr s/a/l 10 sq cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,14021,HCPCS,Tis trnfr s/a/l 10.1-30 sqcm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,14040,HCPCS,Tis trnfr f/c/c/m/n/a/g/h/f,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,14041,HCPCS,Tis trnfr f/c/c/m/n/a/g/h/f,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,14060,HCPCS,Tis trnfr e/n/e/l 10 sq cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,14061,HCPCS,Tis trnfr e/n/e/l10.1-30sqcm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,14301,HCPCS,Tis trnfr any 30.1-60 sq cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,14350,HCPCS,Filleted finger/toe flap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15002,HCPCS,Wound prep trk/arm/leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15004,HCPCS,Wound prep f/n/hf/g,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,15040,HCPCS,Harvest cultured skin graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15050,HCPCS,Skin pinch graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,15100,HCPCS,Skin splt grft trnk/arm/leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15110,HCPCS,Epidrm autogrft trnk/arm/leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15115,HCPCS,Epidrm a-grft face/nck/hf/g,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15120,HCPCS,Skn splt a-grft fac/nck/hf/g,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15130,HCPCS,Derm autograft trnk/arm/leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15135,HCPCS,Derm autograft face/nck/hf/g,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15150,HCPCS,Cult skin grft t/arm/leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15155,HCPCS,Cult skin graft f/n/hf/g,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15200,HCPCS,Skin full graft trunk,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15220,HCPCS,Skin full graft sclp/arm/leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15240,HCPCS,Skin full grft face/genit/hf,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15260,HCPCS,Skin full graft een & lips,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15271,HCPCS,Skin sub graft trnk/arm/leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15273,HCPCS,Skin sub grft t/arm/lg child,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15275,HCPCS,Skin sub graft face/nk/hf/g,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15277,HCPCS,Skn sub grft f/n/hf/g child,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15570,HCPCS,Skin pedicle flap trunk,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15572,HCPCS,Skin pedicle flap arms/legs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15574,HCPCS,Pedcle fh/ch/ch/m/n/ax/g/h/f,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15576,HCPCS,Pedicle e/n/e/l/ntroral,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15600,HCPCS,Delay flap trunk,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15610,HCPCS,Delay flap arms/legs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15620,HCPCS,Delay flap f/c/c/n/ax/g/h/f,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15630,HCPCS,Delay flap eye/nos/ear/lip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15650,HCPCS,Transfer skin pedicle flap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15730,HCPCS,Mdfc flap w/prsrv vasc pedcl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15731,HCPCS,Forehead flap w/vasc pedicle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15733,HCPCS,Musc myoq/fscq flp h&n pedcl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15734,HCPCS,Muscle-skin graft trunk,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15736,HCPCS,Muscle-skin graft arm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15738,HCPCS,Muscle-skin graft leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15740,HCPCS,Island pedicle flap graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15750,HCPCS,Neurovascular pedicle flap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15760,HCPCS,Composite skin graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15769,HCPCS,Grfg autol soft tiss dir exc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15770,HCPCS,Derma-fat-fascia graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15771,HCPCS,Grfg autol fat lipo 50 cc/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15773,HCPCS,Grfg autol fat lipo 25 cc/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15775,HCPCS,Hair trnspl 1-15 punch grfts,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,15776,HCPCS,Hair trnspl >15 punch grafts,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,15780,HCPCS,Dermabrasion total face,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15781,HCPCS,Dermabrasion segmental face,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,15782,HCPCS,Dermabrasion other than face,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15783,HCPCS,Dermabrasion suprfl any site,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,15786,HCPCS,Abrasion lesion single,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,15788,HCPCS,Chemical peel face epiderm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,15789,HCPCS,Chemical peel face dermal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,15792,HCPCS,Chemical peel nonfacial,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,15793,HCPCS,Chemical peel nonfacial,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,15819,HCPCS,Plastic surgery neck,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15820,HCPCS,Revision of lower eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15821,HCPCS,Revision of lower eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15822,HCPCS,Revision of upper eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15823,HCPCS,Revision of upper eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15824,HCPCS,Removal of forehead wrinkles,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15825,HCPCS,Removal of neck wrinkles,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15826,HCPCS,Removal of brow wrinkles,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15828,HCPCS,Removal of face wrinkles,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15829,HCPCS,Removal of skin wrinkles,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15830,HCPCS,Exc skin abd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 "," $6,616.24 ", Not Applicable , Not Applicable ," $6,947.05 "," $6,748.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable ," $6,616.24 "," $6,947.05 ", Not Applicable
,15832,HCPCS,Excise excessive skin thigh,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15833,HCPCS,Excise excessive skin leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15834,HCPCS,Excise excessive skin hip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15835,HCPCS,Excise excessive skin buttck,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15836,HCPCS,Excise excessive skin arm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15837,HCPCS,Excise excess skin arm/hand,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15838,HCPCS,Excise excess skin fat pad,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15839,HCPCS,Excise excess skin & tissue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15840,HCPCS,Nerve palsy fascial graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15841,HCPCS,Nerve palsy muscle graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15842,HCPCS,Nerve palsy microsurg graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15845,HCPCS,Skin and muscle repair face,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15850,HCPCS,Remove sutures same surgeon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,15851,HCPCS,Remove sutures diff surgeon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15852,HCPCS,Dressing change not for burn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,15860,HCPCS,Test for blood flow in graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,15876,HCPCS,Suction lipectomy head&neck,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15877,HCPCS,Suction lipectomy trunk,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15878,HCPCS,Suction lipectomy upr extrem,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15879,HCPCS,Suction lipectomy lwr extrem,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15920,HCPCS,Removal of tail bone ulcer,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15922,HCPCS,Removal of tail bone ulcer,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15931,HCPCS,Remove sacrum pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15933,HCPCS,Remove sacrum pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15934,HCPCS,Remove sacrum pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15935,HCPCS,Remove sacrum pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15936,HCPCS,Remove sacrum pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15937,HCPCS,Remove sacrum pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15940,HCPCS,Remove hip pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15941,HCPCS,Remove hip pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15944,HCPCS,Remove hip pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15945,HCPCS,Remove hip pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15946,HCPCS,Remove hip pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15950,HCPCS,Remove thigh pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,15951,HCPCS,Remove thigh pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,15952,HCPCS,Remove thigh pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15953,HCPCS,Remove thigh pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15956,HCPCS,Remove thigh pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,15958,HCPCS,Remove thigh pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,15999,HCPCS,Removal of pressure sore,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,16000,HCPCS,Initial treatment of burn(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,16020,HCPCS,Dress/debrid p-thick burn s,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,16025,HCPCS,Dress/debrid p-thick burn m,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,16030,HCPCS,Dress/debrid p-thick burn l,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,16035,HCPCS,Incision of burn scab initi,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,17000,HCPCS,Destruct premalg lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,17004,HCPCS,Destroy premal lesions 15/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,17106,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,17107,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,17108,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,17110,HCPCS,Destruct b9 lesion 1-14,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,17111,HCPCS,Destruct lesion 15 or more,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,17250,HCPCS,Chem caut of granltj tissue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,17260,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,17261,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,17262,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,17263,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,17264,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,17266,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,17270,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,17271,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,17272,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,17273,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,17274,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,17276,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,17280,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,17281,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,17282,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,17283,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,17284,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,17286,HCPCS,Destruction of skin lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,17311,HCPCS,Mohs 1 stage h/n/hf/g,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,17313,HCPCS,Mohs 1 stage t/a/l,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,17340,HCPCS,Cryotherapy of skin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,17360,HCPCS,Skin peel therapy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,17380,HCPCS,Hair removal by electrolysis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,17999,HCPCS,Skin tissue procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,19000,HCPCS,Drainage of breast lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,19020,HCPCS,Incision of breast lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,19081,HCPCS,Bx breast 1st lesion strtctc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,19083,HCPCS,Bx breast 1st lesion us imag,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,19085,HCPCS,Bx breast 1st lesion mr imag,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,19100,HCPCS,Bx breast percut w/o image,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,19101,HCPCS,Biopsy of breast open,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,19105,HCPCS,Cryosurg ablate fa each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,19110,HCPCS,Nipple exploration,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,19112,HCPCS,Excise breast duct fistula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,19120,HCPCS,Removal of breast lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,19125,HCPCS,Excision breast lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,19281,HCPCS,Perq device breast 1st imag,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,19283,HCPCS,Perq dev breast 1st strtctc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,19285,HCPCS,Perq dev breast 1st us imag,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,19287,HCPCS,Perq dev breast 1st mr guide,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,19296,HCPCS,Place po breast cath for rad,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,659.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,659.78 "," $10,659.78 ", Not Applicable , Not Applicable ," $11,192.77 "," $10,872.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,659.78 ", Not Applicable , Not Applicable ," $10,659.78 "," $11,192.77 ", Not Applicable
,19298,HCPCS,Place breast rad tube/caths,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 "," $6,616.24 ", Not Applicable , Not Applicable ," $6,947.05 "," $6,748.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable ," $6,616.24 "," $6,947.05 ", Not Applicable
,19300,HCPCS,Removal of breast tissue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,19301,HCPCS,Partial mastectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,19302,HCPCS,P-mastectomy w/ln removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 "," $6,616.24 ", Not Applicable , Not Applicable ," $6,947.05 "," $6,748.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable ," $6,616.24 "," $6,947.05 ", Not Applicable
,19303,HCPCS,Mast simple complete,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 "," $6,616.24 ", Not Applicable , Not Applicable ," $6,947.05 "," $6,748.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable ," $6,616.24 "," $6,947.05 ", Not Applicable
,19307,HCPCS,Mast mod rad,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 "," $6,616.24 ", Not Applicable , Not Applicable ," $6,947.05 "," $6,748.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable ," $6,616.24 "," $6,947.05 ", Not Applicable
,19316,HCPCS,Suspension of breast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 "," $6,616.24 ", Not Applicable , Not Applicable ," $6,947.05 "," $6,748.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable ," $6,616.24 "," $6,947.05 ", Not Applicable
,19318,HCPCS,Breast reduction,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 "," $6,616.24 ", Not Applicable , Not Applicable ," $6,947.05 "," $6,748.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable ," $6,616.24 "," $6,947.05 ", Not Applicable
,19325,HCPCS,Breast augmentation w/implt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,659.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,659.78 "," $10,659.78 ", Not Applicable , Not Applicable ," $11,192.77 "," $10,872.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,659.78 ", Not Applicable , Not Applicable ," $10,659.78 "," $11,192.77 ", Not Applicable
,19328,HCPCS,Rmvl intact breast implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,19330,HCPCS,Rmvl ruptured breast implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,19340,HCPCS,Insj breast implt sm d mast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 "," $6,616.24 ", Not Applicable , Not Applicable ," $6,947.05 "," $6,748.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable ," $6,616.24 "," $6,947.05 ", Not Applicable
,19342,HCPCS,Insj/rplcmt brst implt sep d,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,659.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,659.78 "," $10,659.78 ", Not Applicable , Not Applicable ," $11,192.77 "," $10,872.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,659.78 ", Not Applicable , Not Applicable ," $10,659.78 "," $11,192.77 ", Not Applicable
,19350,HCPCS,Breast reconstruction,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,19355,HCPCS,Correct inverted nipple(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,19357,HCPCS,Tiss xpndr plmt brst rcnstj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $17,836.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,836.97 "," $17,836.97 ", Not Applicable , Not Applicable ," $18,728.82 "," $18,193.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $17,836.97 ", Not Applicable , Not Applicable ," $17,836.97 "," $18,728.82 ", Not Applicable
,19370,HCPCS,Revj peri-implt capsule brst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,19371,HCPCS,Peri-implt capslc brst compl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,19380,HCPCS,Revj reconstructed breast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 "," $6,616.24 ", Not Applicable , Not Applicable ," $6,947.05 "," $6,748.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable ," $6,616.24 "," $6,947.05 ", Not Applicable
,19396,HCPCS,Design custom breast implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,19499,HCPCS,Breast surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,20100,HCPCS,Explore wound neck,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,20101,HCPCS,Explore wound chest,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,20102,HCPCS,Explore wound abdomen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,20103,HCPCS,Explore wound extremity,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,20150,HCPCS,Excise epiphyseal bar,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,20200,HCPCS,Muscle biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,20205,HCPCS,Deep muscle biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,20206,HCPCS,Needle biopsy muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,20220,HCPCS,Bone biopsy trocar/needle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,20225,HCPCS,Bone biopsy trocar/needle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,20240,HCPCS,Bone biopsy open superficial,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,20245,HCPCS,Bone biopsy open deep,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,20250,HCPCS,Open bone biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,20251,HCPCS,Open bone biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,20500,HCPCS,Injection of sinus tract,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,20520,HCPCS,Removal of foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,20525,HCPCS,Removal of foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,20526,HCPCS,Ther injection carp tunnel,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,20527,HCPCS,Inj dupuytren cord w/enzyme,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,20550,HCPCS,Inj tendon sheath/ligament,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,20551,HCPCS,Inj tendon origin/insertion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,20552,HCPCS,Inj trigger point 1/2 muscl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,20553,HCPCS,Inject trigger points 3/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,20555,HCPCS,Place ndl musc/tis for rt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,20560,HCPCS,Ndl insj w/o njx 1 or 2 musc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,20561,HCPCS,Ndl insj w/o njx 3+ musc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,20600,HCPCS,Drain/inj joint/bursa w/o us,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,20604,HCPCS,Drain/inj joint/bursa w/us,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,20605,HCPCS,Drain/inj joint/bursa w/o us,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,20606,HCPCS,Drain/inj joint/bursa w/us,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,20610,HCPCS,Drain/inj joint/bursa w/o us,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,20611,HCPCS,Drain/inj joint/bursa w/us,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,20612,HCPCS,Aspirate/inj ganglion cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,20615,HCPCS,Treatment of bone cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,20650,HCPCS,Insert and remove bone pin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,20660,HCPCS,Apply rem fixation device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,20662,HCPCS,Application of pelvis brace,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,20663,HCPCS,Application of thigh brace,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,20665,HCPCS,Removal of fixation device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,20670,HCPCS,Removal of support implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,20680,HCPCS,Removal of support implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,20690,HCPCS,Apply bone fixation device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,20692,HCPCS,Apply bone fixation device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,20693,HCPCS,Adjust bone fixation device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,20694,HCPCS,Remove bone fixation device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,20696,HCPCS,Comp multiplane ext fixation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 "," $19,330.21 ", Not Applicable , Not Applicable ," $20,296.72 "," $19,716.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable ," $19,330.21 "," $20,296.72 ", Not Applicable
,20697,HCPCS,Comp ext fixate strut change,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,20822,HCPCS,Replantation digit complete,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,20900,HCPCS,Removal of bone for graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,20902,HCPCS,Removal of bone for graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,20910,HCPCS,Remove cartilage for graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,20912,HCPCS,Remove cartilage for graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,20920,HCPCS,Removal of fascia for graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,20922,HCPCS,Removal of fascia for graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,20924,HCPCS,Removal of tendon for graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,20950,HCPCS,Fluid pressure muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,20972,HCPCS,Bone/skin graft metatarsal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,20973,HCPCS,Bone/skin graft great toe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,20979,HCPCS,Us bone stimulation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,20982,HCPCS,Ablate bone tumor(s) perq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,20983,HCPCS,Ablate bone tumor(s) perq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,20999,HCPCS,Musculoskeletal surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,21010,HCPCS,Incision of jaw joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21011,HCPCS,Exc face les sc <2 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,21012,HCPCS,Exc face les sbq 2 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,21013,HCPCS,Exc face tum deep < 2 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,21014,HCPCS,Exc face tum deep 2 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,21015,HCPCS,Resect face/scalp tum < 2 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,21016,HCPCS,Resect face/scalp tum 2 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,21025,HCPCS,Excision of bone lower jaw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21026,HCPCS,Excision of facial bone(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21029,HCPCS,Contour of face bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21030,HCPCS,Excise max/zygoma b9 tumor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21031,HCPCS,Remove exostosis mandible,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21032,HCPCS,Remove exostosis maxilla,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21034,HCPCS,Excise max/zygoma mal tumor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21040,HCPCS,Excise mandible lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21044,HCPCS,Removal of jaw bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21046,HCPCS,Remove mandible cyst complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21047,HCPCS,Excise lwr jaw cyst w/repair,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21048,HCPCS,Remove maxilla cyst complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21049,HCPCS,Excis uppr jaw cyst w/repair,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21050,HCPCS,Removal of jaw joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21060,HCPCS,Remove jaw joint cartilage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21070,HCPCS,Remove coronoid process,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21073,HCPCS,Mnpj of tmj w/anesth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,21076,HCPCS,Prepare face/oral prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,21077,HCPCS,Prepare face/oral prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21079,HCPCS,Prepare face/oral prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21080,HCPCS,Prepare face/oral prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21081,HCPCS,Prepare face/oral prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21082,HCPCS,Prepare face/oral prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21083,HCPCS,Prepare face/oral prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21084,HCPCS,Prepare face/oral prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21085,HCPCS,Prepare face/oral prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,21086,HCPCS,Prepare face/oral prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21087,HCPCS,Prepare face/oral prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21088,HCPCS,Prepare face/oral prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21089,HCPCS,Prepare face/oral prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,21100,HCPCS,Maxillofacial fixation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21110,HCPCS,Interdental fixation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,21120,HCPCS,Reconstruction of chin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21121,HCPCS,Reconstruction of chin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21122,HCPCS,Reconstruction of chin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21123,HCPCS,Reconstruction of chin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21125,HCPCS,Augmentation lower jaw bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21127,HCPCS,Augmentation lower jaw bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21137,HCPCS,Reduction of forehead,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21138,HCPCS,Reduction of forehead,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21139,HCPCS,Reduction of forehead,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21150,HCPCS,Lefort ii anterior intrusion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21172,HCPCS,Reconstruct orbit/forehead,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21175,HCPCS,Reconstruct orbit/forehead,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21181,HCPCS,Contour cranial bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21193,HCPCS,Reconst lwr jaw w/o graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21195,HCPCS,Reconst lwr jaw w/o fixation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21198,HCPCS,Reconstr lwr jaw segment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21199,HCPCS,Reconstr lwr jaw w/advance,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21206,HCPCS,Reconstruct upper jaw bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21208,HCPCS,Augmentation of facial bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21209,HCPCS,Reduction of facial bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21210,HCPCS,Face bone graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21215,HCPCS,Lower jaw bone graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21230,HCPCS,Rib cartilage graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21235,HCPCS,Ear cartilage graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21240,HCPCS,Reconstruction of jaw joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21242,HCPCS,Reconstruction of jaw joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21243,HCPCS,Reconstruction of jaw joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 "," $19,330.21 ", Not Applicable , Not Applicable ," $20,296.72 "," $19,716.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable ," $19,330.21 "," $20,296.72 ", Not Applicable
,21244,HCPCS,Reconstruction of lower jaw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21245,HCPCS,Reconstruction of jaw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21246,HCPCS,Reconstruction of jaw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21248,HCPCS,Reconstruction of jaw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21249,HCPCS,Reconstruction of jaw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21256,HCPCS,Reconstruction of orbit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21260,HCPCS,Revise eye sockets,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21261,HCPCS,Revise eye sockets,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21263,HCPCS,Revise eye sockets,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21267,HCPCS,Revise eye sockets,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21270,HCPCS,Augmentation cheek bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21275,HCPCS,Revision orbitofacial bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21280,HCPCS,Revision of eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21282,HCPCS,Revision of eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21295,HCPCS,Revision of jaw muscle/bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,21296,HCPCS,Revision of jaw muscle/bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21299,HCPCS,Cranio/maxillofacial surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,21315,HCPCS,Clsd tx nsl fx mnpj wo stblj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,21320,HCPCS,Clsd tx nsl fx w/mnpj&stablj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21325,HCPCS,Open tx nose fx uncomplicatd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21330,HCPCS,Open tx nose fx w/skele fixj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21335,HCPCS,Open tx nose & septal fx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21336,HCPCS,Open tx septal fx w/wo stabj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,21337,HCPCS,Closed tx septal&nose fx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21338,HCPCS,Open nasoethmoid fx w/o fixj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21339,HCPCS,Open nasoethmoid fx w/ fixj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21340,HCPCS,Perq tx nasoethmoid fx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21345,HCPCS,Closed tx nose/jaw fx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,21346,HCPCS,Opn tx nasomax fx w/fixj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21355,HCPCS,Perq tx malar fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21356,HCPCS,Opn tx dprsd zygomatic arch,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21360,HCPCS,Opn tx dprsd malar fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21365,HCPCS,Opn tx complx malar fx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21385,HCPCS,Opn tx orbit fx transantral,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21386,HCPCS,Opn tx orbit fx periorbital,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21387,HCPCS,Opn tx orbit fx combined,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21390,HCPCS,Opn tx orbit periorbtl implt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21395,HCPCS,Opn tx orbit periorbt w/grft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21400,HCPCS,Closed tx orbit w/o manipulj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,21401,HCPCS,Closed tx orbit w/manipulj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,21406,HCPCS,Opn tx orbit fx w/o implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21407,HCPCS,Opn tx orbit fx w/implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21408,HCPCS,Opn tx orbit fx w/bone grft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21421,HCPCS,Treat mouth roof fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21440,HCPCS,Treat dental ridge fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21445,HCPCS,Treat dental ridge fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21450,HCPCS,Treat lower jaw fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,21451,HCPCS,Treat lower jaw fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,21452,HCPCS,Treat lower jaw fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21453,HCPCS,Treat lower jaw fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21454,HCPCS,Treat lower jaw fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21461,HCPCS,Treat lower jaw fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21462,HCPCS,Treat lower jaw fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21465,HCPCS,Treat lower jaw fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21470,HCPCS,Treat lower jaw fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21480,HCPCS,Reset dislocated jaw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,21485,HCPCS,Reset dislocated jaw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,21490,HCPCS,Repair dislocated jaw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,21497,HCPCS,Interdental wiring,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,21499,HCPCS,Head surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,21501,HCPCS,Drain neck/chest lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,21502,HCPCS,Drain chest lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,21550,HCPCS,Biopsy of neck/chest,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,21552,HCPCS,Exc neck les sc 3 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,21554,HCPCS,Exc neck tum deep 5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,21555,HCPCS,Exc neck les sc < 3 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,21556,HCPCS,Exc neck tum deep < 5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,21557,HCPCS,Resect neck thorax tumor<5cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,21558,HCPCS,Resect neck tumor 5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,21600,HCPCS,Partial removal of rib,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,21601,HCPCS,Exc chest wall tumor w/ribs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,21610,HCPCS,Partial removal of rib,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,21685,HCPCS,Hyoid myotomy & suspension,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,21700,HCPCS,Revision of neck muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,21720,HCPCS,Revision of neck muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,21725,HCPCS,Revision of neck muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,21742,HCPCS,Repair stern/nuss w/o scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,21743,HCPCS,Repair sternum/nuss w/scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,21811,HCPCS,Optx of rib fx w/fixj scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,21812,HCPCS,Treatment of rib fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,21813,HCPCS,Treatment of rib fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,21820,HCPCS,Treat sternum fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,21899,HCPCS,Neck/chest surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,21920,HCPCS,Biopsy soft tissue of back,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,21925,HCPCS,Biopsy soft tissue of back,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,21930,HCPCS,Exc back les sc < 3 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,21931,HCPCS,Exc back les sc 3 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,21932,HCPCS,Exc back tum deep < 5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,21933,HCPCS,Exc back tum deep 5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,21935,HCPCS,Resect back tum < 5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,21936,HCPCS,Resect back tum 5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,22100,HCPCS,Remove part of neck vertebra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,22101,HCPCS,Remove part thorax vertebra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,22102,HCPCS,Remove part lumbar vertebra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,22310,HCPCS,Closed tx vert fx w/o manj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,22315,HCPCS,Closed tx vert fx w/manj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,22505,HCPCS,Manipulation of spine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,22510,HCPCS,Perq cervicothoracic inject,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,22511,HCPCS,Perq lumbosacral injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,22513,HCPCS,Perq vertebral augmentation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,22514,HCPCS,Perq vertebral augmentation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,22551,HCPCS,Arthrd ant ntrbdy cervical,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,22554,HCPCS,Arthrd ant ntrbd min dsc crv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,22612,HCPCS,Arthrd pst tq 1ntrspc lumbar,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,22630,HCPCS,Arthrd pst tq 1ntrspc lum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 "," $19,330.21 ", Not Applicable , Not Applicable ," $20,296.72 "," $19,716.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable ," $19,330.21 "," $20,296.72 ", Not Applicable
,22633,HCPCS,Arthrd cmbn 1ntrspc lumbar,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,22856,HCPCS,Tot disc arthrp ant 1ntrspc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 "," $19,330.21 ", Not Applicable , Not Applicable ," $20,296.72 "," $19,716.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable ," $19,330.21 "," $20,296.72 ", Not Applicable
,22867,HCPCS,Insj stablj dev w/dcmprn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 "," $19,330.21 ", Not Applicable , Not Applicable ," $20,296.72 "," $19,716.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable ," $19,330.21 "," $20,296.72 ", Not Applicable
,22869,HCPCS,Insj stablj dev w/o dcmprn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,22899,HCPCS,Spine surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,22900,HCPCS,Exc abdl tum deep < 5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,22901,HCPCS,Exc abdl tum deep 5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,22902,HCPCS,Exc abd les sc < 3 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,22903,HCPCS,Exc abd les sc 3 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,22904,HCPCS,Radical resect abd tumor<5cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,22905,HCPCS,Rad resect abd tumor 5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,22999,HCPCS,Abdomen surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,23000,HCPCS,Removal of calcium deposits,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,23020,HCPCS,Release shoulder joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,23030,HCPCS,Drain shoulder lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,23031,HCPCS,Drain shoulder bursa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,23035,HCPCS,Drain shoulder bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,23040,HCPCS,Exploratory shoulder surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,23044,HCPCS,Exploratory shoulder surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,23065,HCPCS,Biopsy shoulder tissues,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,23066,HCPCS,Biopsy shoulder tissues,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,23071,HCPCS,Exc shoulder les sc 3 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,23073,HCPCS,Exc shoulder tum deep 5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,23075,HCPCS,Exc shoulder les sc < 3 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,23076,HCPCS,Exc shoulder tum deep < 5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,23077,HCPCS,Resect shoulder tumor < 5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,23078,HCPCS,Resect shoulder tumor 5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,23100,HCPCS,Biopsy of shoulder joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,23101,HCPCS,Shoulder joint surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,23105,HCPCS,Remove shoulder joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23106,HCPCS,Incision of collarbone joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,23107,HCPCS,Explore treat shoulder joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23120,HCPCS,Partial removal collar bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,23125,HCPCS,Removal of collar bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,23130,HCPCS,Remove shoulder bone part,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,23140,HCPCS,Removal of bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,23145,HCPCS,Removal of bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,23146,HCPCS,Removal of bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23150,HCPCS,Removal of humerus lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,23155,HCPCS,Removal of humerus lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23156,HCPCS,Removal of humerus lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23170,HCPCS,Remove collar bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,23172,HCPCS,Remove shoulder blade lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,23174,HCPCS,Remove humerus lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23180,HCPCS,Remove collar bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23182,HCPCS,Remove shoulder blade lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23184,HCPCS,Remove humerus lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23190,HCPCS,Partial removal of scapula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,23195,HCPCS,Removal of head of humerus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23330,HCPCS,Remove shoulder foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,23333,HCPCS,Remove shoulder fb deep,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,23334,HCPCS,Shoulder prosthesis removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,23395,HCPCS,Muscle transfer shoulder/arm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23397,HCPCS,Muscle transfers,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23400,HCPCS,Fixation of shoulder blade,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23405,HCPCS,Incision of tendon & muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23406,HCPCS,Incise tendon(s) & muscle(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23410,HCPCS,Repair rotator cuff acute,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23412,HCPCS,Repair rotator cuff chronic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23415,HCPCS,Release of shoulder ligament,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23420,HCPCS,Repair of shoulder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23430,HCPCS,Repair biceps tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23440,HCPCS,Remove/transplant tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23450,HCPCS,Repair shoulder capsule,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23455,HCPCS,Repair shoulder capsule,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23460,HCPCS,Repair shoulder capsule,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23462,HCPCS,Repair shoulder capsule,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23465,HCPCS,Repair shoulder capsule,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23466,HCPCS,Repair shoulder capsule,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23470,HCPCS,Reconstruct shoulder joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,23472,HCPCS,Reconstruct shoulder joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,23473,HCPCS,Revis reconst shoulder joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,23480,HCPCS,Revision of collar bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23485,HCPCS,Revision of collar bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,23490,HCPCS,Reinforce clavicle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23491,HCPCS,Reinforce shoulder bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,23500,HCPCS,Treat clavicle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,23505,HCPCS,Treat clavicle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,23515,HCPCS,Treat clavicle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23520,HCPCS,Treat clavicle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,23525,HCPCS,Treat clavicle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,23530,HCPCS,Treat clavicle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23532,HCPCS,Treat clavicle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23540,HCPCS,Treat clavicle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,23545,HCPCS,Treat clavicle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,23550,HCPCS,Treat clavicle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23552,HCPCS,Treat clavicle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23570,HCPCS,Treat shoulder blade fx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,23575,HCPCS,Treat shoulder blade fx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,23585,HCPCS,Treat scapula fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23600,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,23605,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,23615,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,23616,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 "," $19,330.21 ", Not Applicable , Not Applicable ," $20,296.72 "," $19,716.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable ," $19,330.21 "," $20,296.72 ", Not Applicable
,23620,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,23625,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,23630,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23650,HCPCS,Treat shoulder dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,23655,HCPCS,Treat shoulder dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,23660,HCPCS,Treat shoulder dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23665,HCPCS,Treat dislocation/fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,23670,HCPCS,Treat dislocation/fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23675,HCPCS,Treat dislocation/fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,23680,HCPCS,Treat dislocation/fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,23700,HCPCS,Fixation of shoulder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,23800,HCPCS,Fusion of shoulder joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,23802,HCPCS,Fusion of shoulder joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,23921,HCPCS,Amputation follow-up surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,23929,HCPCS,Shoulder surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,23930,HCPCS,Drainage of arm lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,23931,HCPCS,Drainage of arm bursa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,23935,HCPCS,Drain arm/elbow bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24000,HCPCS,Exploratory elbow surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24006,HCPCS,Release elbow joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24065,HCPCS,Biopsy arm/elbow soft tissue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,24066,HCPCS,Biopsy arm/elbow soft tissue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,24071,HCPCS,Exc arm/elbow les sc 3 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,24073,HCPCS,Ex arm/elbow tum deep 5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,24075,HCPCS,Exc arm/elbow les sc < 3 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,24076,HCPCS,Ex arm/elbow tum deep < 5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,24077,HCPCS,Resect arm/elbow tum < 5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,24079,HCPCS,Resect arm/elbow tum 5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,24100,HCPCS,Biopsy elbow joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24101,HCPCS,Explore/treat elbow joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24102,HCPCS,Remove elbow joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24105,HCPCS,Removal of elbow bursa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24110,HCPCS,Remove humerus lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24115,HCPCS,Remove/graft bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24116,HCPCS,Remove/graft bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24120,HCPCS,Remove elbow lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24125,HCPCS,Remove/graft bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24126,HCPCS,Remove/graft bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24130,HCPCS,Removal of head of radius,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24134,HCPCS,Removal of arm bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24136,HCPCS,Remove radius bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24138,HCPCS,Remove elbow bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24140,HCPCS,Partial removal of arm bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24145,HCPCS,Partial removal of radius,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24147,HCPCS,Partial removal of elbow,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24149,HCPCS,Radical resection of elbow,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24150,HCPCS,Resect distal humerus tumor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24152,HCPCS,Resect radius tumor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24155,HCPCS,Removal of elbow joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24160,HCPCS,Remove elbow joint implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24164,HCPCS,Remove radius head implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24200,HCPCS,Removal of arm foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,24201,HCPCS,Removal of arm foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,24300,HCPCS,Manipulate elbow w/anesth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,24301,HCPCS,Muscle/tendon transfer,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24305,HCPCS,Arm tendon lengthening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24310,HCPCS,Revision of arm tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24320,HCPCS,Repair of arm tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24330,HCPCS,Revision of arm muscles,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24331,HCPCS,Revision of arm muscles,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24332,HCPCS,Tenolysis triceps,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24340,HCPCS,Repair of biceps tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24341,HCPCS,Repair arm tendon/muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24342,HCPCS,Repair of ruptured tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24343,HCPCS,Repr elbow lat ligmnt w/tiss,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24344,HCPCS,Reconstruct elbow lat ligmnt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24345,HCPCS,Repr elbw med ligmnt w/tissu,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24346,HCPCS,Reconstruct elbow med ligmnt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24357,HCPCS,Repair elbow perc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24358,HCPCS,Repair elbow w/deb open,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24359,HCPCS,Repair elbow deb/attch open,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24360,HCPCS,Reconstruct elbow joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24361,HCPCS,Reconstruct elbow joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 "," $19,330.21 ", Not Applicable , Not Applicable ," $20,296.72 "," $19,716.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable ," $19,330.21 "," $20,296.72 ", Not Applicable
,24362,HCPCS,Reconstruct elbow joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24363,HCPCS,Replace elbow joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 "," $19,330.21 ", Not Applicable , Not Applicable ," $20,296.72 "," $19,716.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable ," $19,330.21 "," $20,296.72 ", Not Applicable
,24365,HCPCS,Reconstruct head of radius,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24366,HCPCS,Reconstruct head of radius,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24370,HCPCS,Revise reconst elbow joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24371,HCPCS,Revise reconst elbow joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 "," $19,330.21 ", Not Applicable , Not Applicable ," $20,296.72 "," $19,716.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable ," $19,330.21 "," $20,296.72 ", Not Applicable
,24400,HCPCS,Revision of humerus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24410,HCPCS,Revision of humerus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24420,HCPCS,Revision of humerus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24430,HCPCS,Repair of humerus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24435,HCPCS,Repair humerus with graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24470,HCPCS,Revision of elbow joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24495,HCPCS,Decompression of forearm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24498,HCPCS,Reinforce humerus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24500,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,24505,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,24515,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24516,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24530,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,24535,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,24538,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24545,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24546,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 "," $19,330.21 ", Not Applicable , Not Applicable ," $20,296.72 "," $19,716.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable ," $19,330.21 "," $20,296.72 ", Not Applicable
,24560,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,24565,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,24566,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,24575,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24576,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,24577,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,24579,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24582,HCPCS,Treat humerus fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24586,HCPCS,Treat elbow fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24587,HCPCS,Treat elbow fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24600,HCPCS,Treat elbow dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,24605,HCPCS,Treat elbow dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,24615,HCPCS,Treat elbow dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24620,HCPCS,Treat elbow fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,24635,HCPCS,Treat elbow fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24640,HCPCS,Treat elbow dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,24650,HCPCS,Treat radius fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,24655,HCPCS,Treat radius fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,24665,HCPCS,Treat radius fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24666,HCPCS,Treat radius fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24670,HCPCS,Treat ulnar fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,24675,HCPCS,Treat ulnar fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,24685,HCPCS,Treat ulnar fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24800,HCPCS,Fusion of elbow joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24802,HCPCS,Fusion/graft of elbow joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,24925,HCPCS,Amputation follow-up surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,24935,HCPCS,Revision of amputation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,24999,HCPCS,Upper arm/elbow surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,25000,HCPCS,Incision of tendon sheath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25001,HCPCS,Incise flexor carpi radialis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25020,HCPCS,Decompress forearm 1 space,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25023,HCPCS,Decompress forearm 1 space,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25024,HCPCS,Decompress forearm 2 spaces,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25025,HCPCS,Decompress forearm 2 spaces,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25028,HCPCS,Drainage of forearm lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25031,HCPCS,Drainage of forearm bursa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25035,HCPCS,Treat forearm bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25040,HCPCS,Explore/treat wrist joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25065,HCPCS,Biopsy forearm soft tissues,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,25066,HCPCS,Biopsy forearm soft tissues,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,25071,HCPCS,Exc forearm les sc 3 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,25073,HCPCS,Exc forearm tum deep 3 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,25075,HCPCS,Exc forearm les sc < 3 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,25076,HCPCS,Exc forearm tum deep < 3 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,25077,HCPCS,Resect forearm/wrist tum<3cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,25078,HCPCS,Resect forarm/wrist tum 3cm>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,25085,HCPCS,Incision of wrist capsule,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25100,HCPCS,Biopsy of wrist joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25101,HCPCS,Explore/treat wrist joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25105,HCPCS,Remove wrist joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25107,HCPCS,Remove wrist joint cartilage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25109,HCPCS,Excise tendon forearm/wrist,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25110,HCPCS,Remove wrist tendon lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25111,HCPCS,Remove wrist tendon lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25112,HCPCS,Reremove wrist tendon lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25115,HCPCS,Remove wrist/forearm lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25116,HCPCS,Remove wrist/forearm lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25118,HCPCS,Excise wrist tendon sheath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25119,HCPCS,Partial removal of ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25120,HCPCS,Removal of forearm lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25125,HCPCS,Remove/graft forearm lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25126,HCPCS,Remove/graft forearm lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25130,HCPCS,Removal of wrist lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25135,HCPCS,Remove & graft wrist lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25136,HCPCS,Remove & graft wrist lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25145,HCPCS,Remove forearm bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25150,HCPCS,Partial removal of ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25151,HCPCS,Partial removal of radius,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25170,HCPCS,Resect radius/ulnar tumor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25210,HCPCS,Removal of wrist bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25215,HCPCS,Removal of wrist bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25230,HCPCS,Partial removal of radius,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25240,HCPCS,Partial removal of ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25248,HCPCS,Remove forearm foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25250,HCPCS,Removal of wrist prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25251,HCPCS,Removal of wrist prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25259,HCPCS,Manipulate wrist w/anesthes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25260,HCPCS,Repair forearm tendon/muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25263,HCPCS,Repair forearm tendon/muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25265,HCPCS,Repair forearm tendon/muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25270,HCPCS,Repair forearm tendon/muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25272,HCPCS,Repair forearm tendon/muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25274,HCPCS,Repair forearm tendon/muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25275,HCPCS,Repair forearm tendon sheath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25280,HCPCS,Revise wrist/forearm tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25290,HCPCS,Incise wrist/forearm tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25295,HCPCS,Release wrist/forearm tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25300,HCPCS,Fusion of tendons at wrist,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25301,HCPCS,Fusion of tendons at wrist,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25310,HCPCS,Transplant forearm tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25312,HCPCS,Transplant forearm tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25315,HCPCS,Revise palsy hand tendon(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25316,HCPCS,Revise palsy hand tendon(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25320,HCPCS,Repair/revise wrist joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25332,HCPCS,Revise wrist joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25335,HCPCS,Realignment of hand,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25337,HCPCS,Reconstruct ulna/radioulnar,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25350,HCPCS,Revision of radius,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25355,HCPCS,Revision of radius,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25360,HCPCS,Revision of ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25365,HCPCS,Revise radius & ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,25370,HCPCS,Revise radius or ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25375,HCPCS,Revise radius & ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25390,HCPCS,Shorten radius or ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25391,HCPCS,Lengthen radius or ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,25392,HCPCS,Shorten radius & ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25393,HCPCS,Lengthen radius & ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25394,HCPCS,Repair carpal bone shorten,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25400,HCPCS,Repair radius or ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25405,HCPCS,Repair/graft radius or ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25415,HCPCS,Repair radius & ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25420,HCPCS,Repair/graft radius & ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25425,HCPCS,Repair/graft radius or ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25426,HCPCS,Repair/graft radius & ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25430,HCPCS,Vasc graft into carpal bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25431,HCPCS,Repair nonunion carpal bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25440,HCPCS,Repair/graft wrist bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25441,HCPCS,Reconstruct wrist joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,25442,HCPCS,Reconstruct wrist joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 "," $19,330.21 ", Not Applicable , Not Applicable ," $20,296.72 "," $19,716.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable ," $19,330.21 "," $20,296.72 ", Not Applicable
,25443,HCPCS,Reconstruct wrist joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25444,HCPCS,Reconstruct wrist joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,25445,HCPCS,Reconstruct wrist joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25446,HCPCS,Wrist replacement,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 "," $19,330.21 ", Not Applicable , Not Applicable ," $20,296.72 "," $19,716.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable ," $19,330.21 "," $20,296.72 ", Not Applicable
,25447,HCPCS,Repair wrist joints,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25449,HCPCS,Remove wrist joint implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25450,HCPCS,Revision of wrist joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25455,HCPCS,Revision of wrist joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25490,HCPCS,Reinforce radius,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25491,HCPCS,Reinforce ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,25492,HCPCS,Reinforce radius and ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25500,HCPCS,Treat fracture of radius,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,25505,HCPCS,Treat fracture of radius,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25515,HCPCS,Treat fracture of radius,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25520,HCPCS,Treat fracture of radius,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25525,HCPCS,Treat fracture of radius,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25526,HCPCS,Treat fracture of radius,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25530,HCPCS,Treat fracture of ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,25535,HCPCS,Treat fracture of ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,25545,HCPCS,Treat fracture of ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25560,HCPCS,Treat fracture radius & ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,25565,HCPCS,Treat fracture radius & ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25574,HCPCS,Treat fracture radius & ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25575,HCPCS,Treat fracture radius/ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25600,HCPCS,Treat fracture radius/ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,25605,HCPCS,Treat fracture radius/ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25606,HCPCS,Treat fx distal radial,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25607,HCPCS,Treat fx rad extra-articul,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25608,HCPCS,Treat fx rad intra-articul,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25609,HCPCS,Treat fx radial 3+ frag,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25622,HCPCS,Treat wrist bone fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,25624,HCPCS,Treat wrist bone fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25628,HCPCS,Treat wrist bone fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25630,HCPCS,Treat wrist bone fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,25635,HCPCS,Treat wrist bone fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25645,HCPCS,Treat wrist bone fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25650,HCPCS,Treat wrist bone fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,25651,HCPCS,Pin ulnar styloid fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25652,HCPCS,Treat fracture ulnar styloid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25660,HCPCS,Treat wrist dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,25670,HCPCS,Treat wrist dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25671,HCPCS,Pin radioulnar dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25675,HCPCS,Treat wrist dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,25676,HCPCS,Treat wrist dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25680,HCPCS,Treat wrist fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,25685,HCPCS,Treat wrist fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25690,HCPCS,Treat wrist dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25695,HCPCS,Treat wrist dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25800,HCPCS,Fusion of wrist joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25805,HCPCS,Fusion/graft of wrist joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25810,HCPCS,Fusion/graft of wrist joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,25820,HCPCS,Fusion of hand bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25825,HCPCS,Fuse hand bones with graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25830,HCPCS,Fusion radioulnar jnt/ulna,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25907,HCPCS,Amputation follow-up surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25909,HCPCS,Amputation follow-up surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,25922,HCPCS,Amputate hand at wrist,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,25929,HCPCS,Amputation follow-up surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,25931,HCPCS,Amputation follow-up surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,25999,HCPCS,Forearm or wrist surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,26010,HCPCS,Drainage of finger abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,26011,HCPCS,Drainage of finger abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,26020,HCPCS,Drain hand tendon sheath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26025,HCPCS,Drainage of palm bursa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26030,HCPCS,Drainage of palm bursas,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26034,HCPCS,Treat hand bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26035,HCPCS,Decompress fingers/hand,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26037,HCPCS,Decompress fingers/hand,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26040,HCPCS,Release palm contracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26045,HCPCS,Release palm contracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26055,HCPCS,Incise finger tendon sheath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26060,HCPCS,Incision of finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26070,HCPCS,Explore/treat hand joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26075,HCPCS,Explore/treat finger joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26080,HCPCS,Explore/treat finger joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26100,HCPCS,Biopsy hand joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26105,HCPCS,Biopsy finger joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26110,HCPCS,Biopsy finger joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26111,HCPCS,Exc hand les sc 1.5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,26113,HCPCS,Exc hand tum deep 1.5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,26115,HCPCS,Exc hand les sc < 1.5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,26116,HCPCS,Exc hand tum deep < 1.5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,26117,HCPCS,Rad resect hand tumor < 3 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,26118,HCPCS,Rad resect hand tumor 3 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,26121,HCPCS,Release palm contracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26123,HCPCS,Release palm contracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26130,HCPCS,Remove wrist joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26135,HCPCS,Revise finger joint each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26140,HCPCS,Revise finger joint each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26145,HCPCS,Tendon excision palm/finger,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26160,HCPCS,Remove tendon sheath lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26170,HCPCS,Removal of palm tendon each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26180,HCPCS,Removal of finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26185,HCPCS,Remove finger bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26200,HCPCS,Remove hand bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26205,HCPCS,Remove/graft bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26210,HCPCS,Removal of finger lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26215,HCPCS,Remove/graft finger lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26230,HCPCS,Partial removal of hand bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26235,HCPCS,Partial removal finger bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26236,HCPCS,Partial removal finger bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26250,HCPCS,Extensive hand surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26260,HCPCS,Resect prox finger tumor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26262,HCPCS,Resect distal finger tumor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26320,HCPCS,Removal of implant from hand,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,26340,HCPCS,Manipulate finger w/anesth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26341,HCPCS,Manipulat palm cord post inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,26350,HCPCS,Repair finger/hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26352,HCPCS,Repair/graft hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26356,HCPCS,Repair finger/hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26357,HCPCS,Repair finger/hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26358,HCPCS,Repair/graft hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26370,HCPCS,Repair finger/hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26372,HCPCS,Repair/graft hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26373,HCPCS,Repair finger/hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26390,HCPCS,Revise hand/finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26392,HCPCS,Repair/graft hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26410,HCPCS,Repair hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26412,HCPCS,Repair/graft hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26415,HCPCS,Excision hand/finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26416,HCPCS,Graft hand or finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26418,HCPCS,Repair finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26420,HCPCS,Repair/graft finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26426,HCPCS,Repair finger/hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26428,HCPCS,Repair/graft finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26432,HCPCS,Repair finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26433,HCPCS,Repair finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26434,HCPCS,Repair/graft finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26437,HCPCS,Realignment of tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26440,HCPCS,Release palm/finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26442,HCPCS,Release palm & finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26445,HCPCS,Release hand/finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26449,HCPCS,Release forearm/hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26450,HCPCS,Incision of palm tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26455,HCPCS,Incision of finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26460,HCPCS,Incise hand/finger tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26471,HCPCS,Fusion of finger tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26474,HCPCS,Fusion of finger tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26476,HCPCS,Tendon lengthening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26477,HCPCS,Tendon shortening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26478,HCPCS,Lengthening of hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26479,HCPCS,Shortening of hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26480,HCPCS,Transplant hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26483,HCPCS,Transplant/graft hand tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26485,HCPCS,Transplant palm tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26489,HCPCS,Transplant/graft palm tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26490,HCPCS,Revise thumb tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26492,HCPCS,Tendon transfer with graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26494,HCPCS,Hand tendon/muscle transfer,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26496,HCPCS,Revise thumb tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26497,HCPCS,Finger tendon transfer,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26498,HCPCS,Finger tendon transfer,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26499,HCPCS,Revision of finger,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26500,HCPCS,Hand tendon reconstruction,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26502,HCPCS,Hand tendon reconstruction,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26508,HCPCS,Release thumb contracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26510,HCPCS,Thumb tendon transfer,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26516,HCPCS,Fusion of knuckle joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26517,HCPCS,Fusion of knuckle joints,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26518,HCPCS,Fusion of knuckle joints,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26520,HCPCS,Release knuckle contracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26525,HCPCS,Release finger contracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26530,HCPCS,Revise knuckle joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26531,HCPCS,Revise knuckle with implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26535,HCPCS,Revise finger joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26536,HCPCS,Revise/implant finger joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26540,HCPCS,Repair hand joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26541,HCPCS,Repair hand joint with graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26542,HCPCS,Repair hand joint with graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26545,HCPCS,Reconstruct finger joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26546,HCPCS,Repair nonunion hand,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26548,HCPCS,Reconstruct finger joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26550,HCPCS,Construct thumb replacement,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26555,HCPCS,Positional change of finger,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26560,HCPCS,Repair of web finger,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26561,HCPCS,Repair of web finger,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26562,HCPCS,Repair of web finger,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26565,HCPCS,Correct metacarpal flaw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26567,HCPCS,Correct finger deformity,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26568,HCPCS,Lengthen metacarpal/finger,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26580,HCPCS,Repair hand deformity,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26587,HCPCS,Reconstruct extra finger,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26590,HCPCS,Repair finger deformity,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26591,HCPCS,Repair muscles of hand,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26593,HCPCS,Release muscles of hand,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26596,HCPCS,Excision constricting tissue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26600,HCPCS,Treat metacarpal fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,26605,HCPCS,Treat metacarpal fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,26607,HCPCS,Treat metacarpal fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26608,HCPCS,Treat metacarpal fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26615,HCPCS,Treat metacarpal fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26641,HCPCS,Treat thumb dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,26645,HCPCS,Treat thumb fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26650,HCPCS,Treat thumb fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26665,HCPCS,Treat thumb fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26670,HCPCS,Treat hand dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,26675,HCPCS,Treat hand dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26676,HCPCS,Pin hand dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26685,HCPCS,Treat hand dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26686,HCPCS,Treat hand dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26700,HCPCS,Treat knuckle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,26705,HCPCS,Treat knuckle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26706,HCPCS,Pin knuckle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26715,HCPCS,Treat knuckle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26720,HCPCS,Treat finger fracture each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,26725,HCPCS,Treat finger fracture each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,26727,HCPCS,Treat finger fracture each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26735,HCPCS,Treat finger fracture each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26740,HCPCS,Treat finger fracture each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,26742,HCPCS,Treat finger fracture each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,26746,HCPCS,Treat finger fracture each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26750,HCPCS,Treat finger fracture each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,26755,HCPCS,Treat finger fracture each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,26756,HCPCS,Pin finger fracture each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26765,HCPCS,Treat finger fracture each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26770,HCPCS,Treat finger dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,26775,HCPCS,Treat finger dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,26776,HCPCS,Pin finger dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26785,HCPCS,Treat finger dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26820,HCPCS,Thumb fusion with graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26841,HCPCS,Fusion of thumb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26842,HCPCS,Thumb fusion with graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26843,HCPCS,Fusion of hand joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26844,HCPCS,Fusion/graft of hand joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26850,HCPCS,Fusion of knuckle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26852,HCPCS,Fusion of knuckle with graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,26860,HCPCS,Fusion of finger joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26862,HCPCS,Fusion/graft of finger joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26910,HCPCS,Amputate metacarpal bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26951,HCPCS,Amputation of finger/thumb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26952,HCPCS,Amputation of finger/thumb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26989,HCPCS,Hand/finger surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,26990,HCPCS,Drainage of pelvis lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,26991,HCPCS,Drainage of pelvis bursa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27000,HCPCS,Incision of hip tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27001,HCPCS,Incision of hip tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27003,HCPCS,Incision of hip tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27006,HCPCS,Incision of hip tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27027,HCPCS,Buttock fasciotomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27033,HCPCS,Exploration of hip joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27035,HCPCS,Denervation of hip joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27040,HCPCS,Biopsy of soft tissues,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,27041,HCPCS,Biopsy of soft tissues,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,27043,HCPCS,Exc hip pelvis les sc 3 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27045,HCPCS,Exc hip/pelv tum deep 5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27047,HCPCS,Exc hip/pelvis les sc < 3 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27048,HCPCS,Exc hip/pelv tum deep < 5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27049,HCPCS,Resect hip/pelv tum < 5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27050,HCPCS,Biopsy of sacroiliac joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27052,HCPCS,Biopsy of hip joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27057,HCPCS,Buttock fasciotomy w/dbrdmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27059,HCPCS,Resect hip/pelv tum 5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27060,HCPCS,Removal of ischial bursa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27062,HCPCS,Remove femur lesion/bursa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27065,HCPCS,Remove hip bone les super,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27066,HCPCS,Remove hip bone les deep,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27067,HCPCS,Remove/graft hip bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27080,HCPCS,Removal of tail bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27086,HCPCS,Remove hip foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27087,HCPCS,Remove hip foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27097,HCPCS,Revision of hip tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27098,HCPCS,Transfer tendon to pelvis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27100,HCPCS,Transfer of abdominal muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27105,HCPCS,Transfer of spinal muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27110,HCPCS,Transfer of iliopsoas muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27111,HCPCS,Transfer of iliopsoas muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27130,HCPCS,Total hip arthroplasty,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27179,HCPCS,Revise head/neck of femur,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27197,HCPCS,Clsd tx pelvic ring fx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27198,HCPCS,Clsd tx pelvic ring fx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27200,HCPCS,Treat tail bone fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27202,HCPCS,Treat tail bone fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27220,HCPCS,Treat hip socket fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27230,HCPCS,Treat thigh fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27235,HCPCS,Treat thigh fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27238,HCPCS,Treat thigh fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27246,HCPCS,Treat thigh fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27250,HCPCS,Treat hip dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27252,HCPCS,Treat hip dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27256,HCPCS,Treat hip dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27257,HCPCS,Treat hip dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27265,HCPCS,Treat hip dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27266,HCPCS,Treat hip dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27267,HCPCS,Cltx thigh fx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27275,HCPCS,Manipulation of hip joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27279,HCPCS,Arthrodesis sacroiliac joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 "," $19,330.21 ", Not Applicable , Not Applicable ," $20,296.72 "," $19,716.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable ," $19,330.21 "," $20,296.72 ", Not Applicable
,27299,HCPCS,Pelvis/hip joint surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27301,HCPCS,Drain thigh/knee lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27305,HCPCS,Incise thigh tendon & fascia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27306,HCPCS,Incision of thigh tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27307,HCPCS,Incision of thigh tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27310,HCPCS,Exploration of knee joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27323,HCPCS,Biopsy thigh soft tissues,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,27324,HCPCS,Biopsy thigh soft tissues,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27325,HCPCS,Neurectomy hamstring,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,27326,HCPCS,Neurectomy popliteal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,27327,HCPCS,Exc thigh/knee les sc < 3 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,27328,HCPCS,Exc thigh/knee tum deep <5cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27329,HCPCS,Resect thigh/knee tum < 5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27330,HCPCS,Biopsy knee joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27331,HCPCS,Explore/treat knee joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27332,HCPCS,Removal of knee cartilage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27333,HCPCS,Removal of knee cartilage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27334,HCPCS,Remove knee joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27335,HCPCS,Remove knee joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27337,HCPCS,Exc thigh/knee les sc 3 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27339,HCPCS,Exc thigh/knee tum dep 5cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27340,HCPCS,Removal of kneecap bursa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27345,HCPCS,Removal of knee cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27347,HCPCS,Remove knee cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27350,HCPCS,Removal of kneecap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27355,HCPCS,Remove femur lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27356,HCPCS,Remove femur lesion/graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27357,HCPCS,Remove femur lesion/graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27360,HCPCS,Partial removal leg bone(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27364,HCPCS,Resect thigh/knee tum 5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27372,HCPCS,Removal of foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27380,HCPCS,Repair of kneecap tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27381,HCPCS,Repair/graft kneecap tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27385,HCPCS,Repair of thigh muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27386,HCPCS,Repair/graft of thigh muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27390,HCPCS,Incision of thigh tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27391,HCPCS,Incision of thigh tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27392,HCPCS,Incision of thigh tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27393,HCPCS,Lengthening of thigh tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27394,HCPCS,Lengthening of thigh tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27395,HCPCS,Lengthening of thigh tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27396,HCPCS,Transplant of thigh tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27397,HCPCS,Transplants of thigh tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27400,HCPCS,Revise thigh muscles/tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27403,HCPCS,Repair of knee cartilage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27405,HCPCS,Repair of knee ligament,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27407,HCPCS,Repair of knee ligament,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27409,HCPCS,Repair of knee ligaments,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27412,HCPCS,Autochondrocyte implant knee,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27415,HCPCS,Osteochondral knee allograft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27416,HCPCS,Osteochondral knee autograft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27418,HCPCS,Repair degenerated kneecap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27420,HCPCS,Revision of unstable kneecap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27422,HCPCS,Revision of unstable kneecap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27424,HCPCS,Revision/removal of kneecap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27425,HCPCS,Lat retinacular release open,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27427,HCPCS,Reconstruction knee,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27428,HCPCS,Reconstruction knee,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27429,HCPCS,Reconstruction knee,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27430,HCPCS,Revision of thigh muscles,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27435,HCPCS,Incision of knee joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27437,HCPCS,Revise kneecap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27438,HCPCS,Revise kneecap with implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27440,HCPCS,Revision of knee joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27441,HCPCS,Revision of knee joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27442,HCPCS,Revision of knee joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27443,HCPCS,Revision of knee joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27446,HCPCS,Revision of knee joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27447,HCPCS,Total knee arthroplasty,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27475,HCPCS,Surgery to stop leg growth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27477,HCPCS,Surgery to stop leg growth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27479,HCPCS,Surgery to stop leg growth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27485,HCPCS,Surgery to stop leg growth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27496,HCPCS,Decompression of thigh/knee,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27497,HCPCS,Decompression of thigh/knee,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27498,HCPCS,Decompression of thigh/knee,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27499,HCPCS,Decompression of thigh/knee,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27500,HCPCS,Treatment of thigh fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27501,HCPCS,Treatment of thigh fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27502,HCPCS,Treatment of thigh fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27503,HCPCS,Treatment of thigh fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27508,HCPCS,Treatment of thigh fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27509,HCPCS,Treatment of thigh fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27510,HCPCS,Treatment of thigh fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27516,HCPCS,Treat thigh fx growth plate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27517,HCPCS,Treat thigh fx growth plate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27520,HCPCS,Treat kneecap fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27524,HCPCS,Treat kneecap fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27530,HCPCS,Treat knee fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27532,HCPCS,Treat knee fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27538,HCPCS,Treat knee fracture(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27550,HCPCS,Treat knee dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27552,HCPCS,Treat knee dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27560,HCPCS,Treat kneecap dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27562,HCPCS,Treat kneecap dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27566,HCPCS,Treat kneecap dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27570,HCPCS,Fixation of knee joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27594,HCPCS,Amputation follow-up surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27599,HCPCS,Leg surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27600,HCPCS,Decompression of lower leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27601,HCPCS,Decompression of lower leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27602,HCPCS,Decompression of lower leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27603,HCPCS,Drain lower leg lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27604,HCPCS,Drain lower leg bursa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27605,HCPCS,Incision of achilles tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27606,HCPCS,Incision of achilles tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27607,HCPCS,Treat lower leg bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27610,HCPCS,Explore/treat ankle joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27612,HCPCS,Exploration of ankle joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27613,HCPCS,Biopsy lower leg soft tissue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,27614,HCPCS,Biopsy lower leg soft tissue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27615,HCPCS,Resect leg/ankle tum < 5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27616,HCPCS,Resect leg/ankle tum 5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27618,HCPCS,Exc leg/ankle tum < 3 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,27619,HCPCS,Exc leg/ankle tum deep <5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27620,HCPCS,Explore/treat ankle joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27625,HCPCS,Remove ankle joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27626,HCPCS,Remove ankle joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27630,HCPCS,Removal of tendon lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27632,HCPCS,Exc leg/ankle les sc 3 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27634,HCPCS,Exc leg/ankle tum dep 5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,27635,HCPCS,Remove lower leg bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27637,HCPCS,Remove/graft leg bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27638,HCPCS,Remove/graft leg bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27640,HCPCS,Partial removal of tibia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27641,HCPCS,Partial removal of fibula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27647,HCPCS,Resect talus/calcaneus tum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27650,HCPCS,Repair achilles tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27652,HCPCS,Repair/graft achilles tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27654,HCPCS,Repair of achilles tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27656,HCPCS,Repair leg fascia defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27658,HCPCS,Repair of leg tendon each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27659,HCPCS,Repair of leg tendon each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27664,HCPCS,Repair of leg tendon each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27665,HCPCS,Repair of leg tendon each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27675,HCPCS,Repair lower leg tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27676,HCPCS,Repair lower leg tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27680,HCPCS,Release of lower leg tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27681,HCPCS,Release of lower leg tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27685,HCPCS,Revision of lower leg tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27686,HCPCS,Revise lower leg tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27687,HCPCS,Revision of calf tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27690,HCPCS,Revise lower leg tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27691,HCPCS,Revise lower leg tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27695,HCPCS,Repair of ankle ligament,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27696,HCPCS,Repair of ankle ligaments,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27698,HCPCS,Repair of ankle ligament,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27700,HCPCS,Revision of ankle joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27702,HCPCS,Reconstruct ankle joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27704,HCPCS,Removal of ankle implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27705,HCPCS,Incision of tibia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27707,HCPCS,Incision of fibula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27709,HCPCS,Incision of tibia & fibula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27720,HCPCS,Repair of tibia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27722,HCPCS,Repair/graft of tibia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27726,HCPCS,Repair fibula nonunion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27730,HCPCS,Repair of tibia epiphysis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27732,HCPCS,Repair of fibula epiphysis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27734,HCPCS,Repair lower leg epiphyses,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27740,HCPCS,Repair of leg epiphyses,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27742,HCPCS,Repair of leg epiphyses,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27745,HCPCS,Reinforce tibia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27750,HCPCS,Treatment of tibia fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27752,HCPCS,Treatment of tibia fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27756,HCPCS,Treatment of tibia fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27758,HCPCS,Treatment of tibia fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27759,HCPCS,Treatment of tibia fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27760,HCPCS,Cltx medial ankle fx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27762,HCPCS,Cltx med ankle fx w/mnpj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27766,HCPCS,Optx medial ankle fx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27767,HCPCS,Cltx post ankle fx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27768,HCPCS,Cltx post ankle fx w/mnpj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27769,HCPCS,Optx post ankle fx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27780,HCPCS,Treatment of fibula fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27781,HCPCS,Treatment of fibula fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27784,HCPCS,Treatment of fibula fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27786,HCPCS,Treatment of ankle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27788,HCPCS,Treatment of ankle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27792,HCPCS,Treatment of ankle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27808,HCPCS,Treatment of ankle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27810,HCPCS,Treatment of ankle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27814,HCPCS,Treatment of ankle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27816,HCPCS,Treatment of ankle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27818,HCPCS,Treatment of ankle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27822,HCPCS,Treatment of ankle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27823,HCPCS,Treatment of ankle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27824,HCPCS,Treat lower leg fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27825,HCPCS,Treat lower leg fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27826,HCPCS,Treat lower leg fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27827,HCPCS,Treat lower leg fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27828,HCPCS,Treat lower leg fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27829,HCPCS,Treat lower leg joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27830,HCPCS,Treat lower leg dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27831,HCPCS,Treat lower leg dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27832,HCPCS,Treat lower leg dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27840,HCPCS,Treat ankle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,27842,HCPCS,Treat ankle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,27846,HCPCS,Treat ankle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27848,HCPCS,Treat ankle dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27860,HCPCS,Fixation of ankle joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27870,HCPCS,Fusion of ankle joint open,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27871,HCPCS,Fusion of tibiofibular joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,27884,HCPCS,Amputation follow-up surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27889,HCPCS,Amputation of foot at ankle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27892,HCPCS,Decompression of leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27893,HCPCS,Decompression of leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,27894,HCPCS,Decompression of leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,27899,HCPCS,Leg/ankle surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28001,HCPCS,Drainage of bursa of foot,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,28002,HCPCS,Treatment of foot infection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28003,HCPCS,Treatment of foot infection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28005,HCPCS,Treat foot bone lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28008,HCPCS,Incision of foot fascia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28010,HCPCS,Incision of toe tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28011,HCPCS,Incision of toe tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28020,HCPCS,Exploration of foot joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28022,HCPCS,Exploration of foot joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28024,HCPCS,Exploration of toe joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28035,HCPCS,Decompression of tibia nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,28039,HCPCS,Exc foot/toe tum sc 1.5 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,28041,HCPCS,Exc foot/toe tum dep 1.5cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,28043,HCPCS,Exc foot/toe tum sc < 1.5 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,28045,HCPCS,Exc foot/toe tum deep <1.5cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,28046,HCPCS,Resect foot/toe tumor < 3 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,28047,HCPCS,Resect foot/toe tumor 3 cm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,28050,HCPCS,Biopsy of foot joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28052,HCPCS,Biopsy of foot joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28054,HCPCS,Biopsy of toe joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28055,HCPCS,Neurectomy foot,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,28060,HCPCS,Partial removal foot fascia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28062,HCPCS,Removal of foot fascia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28070,HCPCS,Removal of foot joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28072,HCPCS,Removal of foot joint lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28080,HCPCS,Removal of foot lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28086,HCPCS,Excise foot tendon sheath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28088,HCPCS,Excise foot tendon sheath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28090,HCPCS,Removal of foot lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28092,HCPCS,Removal of toe lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28100,HCPCS,Removal of ankle/heel lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28102,HCPCS,Remove/graft foot lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28103,HCPCS,Remove/graft foot lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28104,HCPCS,Removal of foot lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28106,HCPCS,Remove/graft foot lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28107,HCPCS,Remove/graft foot lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28108,HCPCS,Removal of toe lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28110,HCPCS,Part removal of metatarsal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28111,HCPCS,Part removal of metatarsal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28112,HCPCS,Part removal of metatarsal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28113,HCPCS,Part removal of metatarsal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28114,HCPCS,Removal of metatarsal heads,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28116,HCPCS,Revision of foot,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28118,HCPCS,Removal of heel bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28119,HCPCS,Removal of heel spur,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28120,HCPCS,Part removal of ankle/heel,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28122,HCPCS,Partial removal of foot bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28124,HCPCS,Partial removal of toe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28126,HCPCS,Partial removal of toe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28130,HCPCS,Removal of ankle bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28140,HCPCS,Removal of metatarsal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28150,HCPCS,Removal of toe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28153,HCPCS,Partial removal of toe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28160,HCPCS,Partial removal of toe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28171,HCPCS,Resect tarsal tumor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28173,HCPCS,Resect metatarsal tumor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28175,HCPCS,Resect phalanx of toe tumor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28190,HCPCS,Removal of foot foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,28192,HCPCS,Removal of foot foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,28193,HCPCS,Removal of foot foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,28200,HCPCS,Repair of foot tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28202,HCPCS,Repair/graft of foot tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28208,HCPCS,Repair of foot tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28210,HCPCS,Repair/graft of foot tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28220,HCPCS,Release of foot tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28222,HCPCS,Release of foot tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28225,HCPCS,Release of foot tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28226,HCPCS,Release of foot tendons,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28230,HCPCS,Incision of foot tendon(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28232,HCPCS,Incision of toe tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28234,HCPCS,Incision of foot tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28238,HCPCS,Revision of foot tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28240,HCPCS,Release of big toe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28250,HCPCS,Revision of foot fascia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28260,HCPCS,Release of midfoot joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28261,HCPCS,Revision of foot tendon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28262,HCPCS,Revision of foot and ankle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28264,HCPCS,Release of midfoot joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28270,HCPCS,Release of foot contracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28272,HCPCS,Release of toe joint each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28280,HCPCS,Fusion of toes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28285,HCPCS,Repair of hammertoe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28286,HCPCS,Repair of hammertoe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28288,HCPCS,Partial removal of foot bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28289,HCPCS,Corrj halux rigdus w/o implt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28291,HCPCS,Corrj halux rigdus w/implt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28292,HCPCS,Correction hallux valgus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28295,HCPCS,Correction hallux valgus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28296,HCPCS,Correction hallux valgus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28297,HCPCS,Correction hallux valgus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28298,HCPCS,Correction hallux valgus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28299,HCPCS,Correction hallux valgus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28300,HCPCS,Incision of heel bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28302,HCPCS,Incision of ankle bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28304,HCPCS,Incision of midfoot bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28305,HCPCS,Incise/graft midfoot bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28306,HCPCS,Incision of metatarsal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28307,HCPCS,Incision of metatarsal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28308,HCPCS,Incision of metatarsal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28309,HCPCS,Incision of metatarsals,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28310,HCPCS,Revision of big toe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28312,HCPCS,Revision of toe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28313,HCPCS,Repair deformity of toe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28315,HCPCS,Removal of sesamoid bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28320,HCPCS,Repair of foot bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,28322,HCPCS,Repair of metatarsals,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28340,HCPCS,Resect enlarged toe tissue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28341,HCPCS,Resect enlarged toe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28344,HCPCS,Repair extra toe(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28345,HCPCS,Repair webbed toe(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28360,HCPCS,Reconstruct cleft foot,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28400,HCPCS,Treatment of heel fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28405,HCPCS,Treatment of heel fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28406,HCPCS,Treatment of heel fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28415,HCPCS,Treat heel fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28420,HCPCS,Treat/graft heel fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,28430,HCPCS,Treatment of ankle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28435,HCPCS,Treatment of ankle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28436,HCPCS,Treatment of ankle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28445,HCPCS,Treat ankle fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28446,HCPCS,Osteochondral talus autogrft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28450,HCPCS,Treat midfoot fracture each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28455,HCPCS,Treat midfoot fracture each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28456,HCPCS,Treat midfoot fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28465,HCPCS,Treat midfoot fracture each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28470,HCPCS,Treat metatarsal fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28475,HCPCS,Treat metatarsal fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28476,HCPCS,Treat metatarsal fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28485,HCPCS,Treat metatarsal fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28490,HCPCS,Treat big toe fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28495,HCPCS,Treat big toe fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28496,HCPCS,Treat big toe fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28505,HCPCS,Treat big toe fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28510,HCPCS,Treatment of toe fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28515,HCPCS,Treatment of toe fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28525,HCPCS,Treat toe fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28530,HCPCS,Treat sesamoid bone fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28531,HCPCS,Treat sesamoid bone fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28540,HCPCS,Treat foot dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28545,HCPCS,Treat foot dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28546,HCPCS,Treat foot dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28555,HCPCS,Repair foot dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28570,HCPCS,Treat foot dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28575,HCPCS,Treat foot dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28576,HCPCS,Treat foot dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28585,HCPCS,Repair foot dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28600,HCPCS,Treat foot dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28605,HCPCS,Treat foot dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28606,HCPCS,Treat foot dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28615,HCPCS,Repair foot dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28630,HCPCS,Treat toe dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28635,HCPCS,Treat toe dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28636,HCPCS,Treat toe dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28645,HCPCS,Repair toe dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28660,HCPCS,Treat toe dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,28665,HCPCS,Treat toe dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,28666,HCPCS,Treat toe dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28675,HCPCS,Repair of toe dislocation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28705,HCPCS,Fusion of foot bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 "," $19,330.21 ", Not Applicable , Not Applicable ," $20,296.72 "," $19,716.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,330.21 ", Not Applicable , Not Applicable ," $19,330.21 "," $20,296.72 ", Not Applicable
,28715,HCPCS,Fusion of foot bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,28725,HCPCS,Fusion of foot bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,28730,HCPCS,Fusion of foot bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,28735,HCPCS,Fusion of foot bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,28737,HCPCS,Revision of foot bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,28740,HCPCS,Fusion of foot bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28750,HCPCS,Fusion of big toe joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28755,HCPCS,Fusion of big toe joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28760,HCPCS,Fusion of big toe joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,28805,HCPCS,Amputation thru metatarsal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28810,HCPCS,Amputation toe & metatarsal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28820,HCPCS,Amputation of toe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28825,HCPCS,Partial amputation of toe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,28890,HCPCS,Hi enrgy eswt plantar fascia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,28899,HCPCS,Foot/toes surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,29000,HCPCS,Application of body cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29010,HCPCS,Application of body cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29015,HCPCS,Application of body cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29035,HCPCS,Application of body cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29040,HCPCS,Application of body cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29044,HCPCS,Application of body cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29046,HCPCS,Application of body cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29049,HCPCS,Application of figure eight,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29055,HCPCS,Application of shoulder cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29058,HCPCS,Application of shoulder cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29065,HCPCS,Application of long arm cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29075,HCPCS,Application of forearm cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29085,HCPCS,Apply hand/wrist cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29086,HCPCS,Apply finger cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29105,HCPCS,Apply long arm splint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29125,HCPCS,Apply forearm splint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,29126,HCPCS,Apply forearm splint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,29130,HCPCS,Application of finger splint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,29131,HCPCS,Application of finger splint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,29200,HCPCS,Strapping of chest,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29240,HCPCS,Strapping of shoulder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,29260,HCPCS,Strapping of elbow or wrist,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,29280,HCPCS,Strapping of hand or finger,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,29305,HCPCS,Application of hip cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29325,HCPCS,Application of hip casts,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29345,HCPCS,Application of long leg cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29355,HCPCS,Application of long leg cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29358,HCPCS,Apply long leg cast brace,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29365,HCPCS,Application of long leg cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29405,HCPCS,Apply short leg cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29425,HCPCS,Apply short leg cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29435,HCPCS,Apply short leg cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29440,HCPCS,Addition of walker to cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29445,HCPCS,Apply rigid leg cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29450,HCPCS,Application of leg cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29505,HCPCS,Application long leg splint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29515,HCPCS,Application lower leg splint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29520,HCPCS,Strapping of hip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,29530,HCPCS,Strapping of knee,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,29540,HCPCS,Strapping of ankle and/or ft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29550,HCPCS,Strapping of toes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,29580,HCPCS,Application of paste boot,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29581,HCPCS,Apply multlay comprs lwr leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29584,HCPCS,Appl multlay comprs arm/hand,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29700,HCPCS,Removal/revision of cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29705,HCPCS,Removal/revision of cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29710,HCPCS,Removal/revision of cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29720,HCPCS,Repair of body cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29730,HCPCS,Windowing of cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29740,HCPCS,Wedging of cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29750,HCPCS,Wedging of clubfoot cast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , $288.41 , Not Applicable , Not Applicable , $302.83 , $294.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.41 , Not Applicable , Not Applicable , $288.41 , $302.83 , Not Applicable
,29799,HCPCS,Casting/strapping procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , $168.90 , Not Applicable , Not Applicable , $177.35 , $172.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $168.90 , Not Applicable , Not Applicable , $168.90 , $177.35 , Not Applicable
,29800,HCPCS,Jaw arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29804,HCPCS,Jaw arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29805,HCPCS,Sho arthrs dx +- synovial bx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29806,HCPCS,Sho arthrs srg capsulorraphy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29807,HCPCS,Sho arthrs srg rpr slap les,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29819,HCPCS,Sho arthrs srg rmvl loose/fb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29820,HCPCS,Sho arthrs srg prtl synvct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29821,HCPCS,Sho arthrs srg compl synvct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29822,HCPCS,Sho arthrs srg lmtd dbrdmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29823,HCPCS,Sho arthrs srg xtnsv dbrdmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29824,HCPCS,Sho arthrs srg dstl claviclc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29825,HCPCS,Sho arthrs srg lss&rescj ads,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29827,HCPCS,Sho arthrs srg rt8tr cuf rpr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29828,HCPCS,Sho arthrs srg bicp tenodsis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29830,HCPCS,Elbow arthroscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29834,HCPCS,Elbow arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29835,HCPCS,Elbow arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29836,HCPCS,Elbow arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29837,HCPCS,Elbow arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29838,HCPCS,Elbow arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29840,HCPCS,Wrist arthroscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29843,HCPCS,Wrist arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29844,HCPCS,Wrist arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29845,HCPCS,Wrist arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29846,HCPCS,Wrist arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29847,HCPCS,Wrist arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29848,HCPCS,Wrist endoscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,29850,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,29851,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,29855,HCPCS,Tibial arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29856,HCPCS,Tibial arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,29860,HCPCS,Hip arthroscopy dx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29861,HCPCS,Hip arthro w/fb removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29862,HCPCS,Hip arthr0 w/debridement,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29863,HCPCS,Hip arthr0 w/synovectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29866,HCPCS,Autgrft implnt knee w/scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29867,HCPCS,Allgrft implnt knee w/scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,29868,HCPCS,Meniscal trnspl knee w/scpe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29870,HCPCS,Knee arthroscopy dx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29871,HCPCS,Knee arthroscopy/drainage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29873,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29874,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29875,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29876,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29877,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29879,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29880,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29881,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29882,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29883,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29884,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29885,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29886,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29887,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29888,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29889,HCPCS,Knee arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,29891,HCPCS,Ankle arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29892,HCPCS,Ankle arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29893,HCPCS,Scope plantar fasciotomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29894,HCPCS,Ankle arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29895,HCPCS,Ankle arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29897,HCPCS,Ankle arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29898,HCPCS,Ankle arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29899,HCPCS,Ankle arthroscopy/surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29900,HCPCS,Mcp joint arthroscopy dx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29901,HCPCS,Mcp joint arthroscopy surg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29902,HCPCS,Mcp joint arthroscopy surg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 "," $1,665.16 ", Not Applicable , Not Applicable ," $1,748.42 "," $1,698.46 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,665.16 ", Not Applicable , Not Applicable ," $1,665.16 "," $1,748.42 ", Not Applicable
,29904,HCPCS,Subtalar arthro w/fb rmvl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29905,HCPCS,Subtalar arthro w/exc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29906,HCPCS,Subtalar arthro w/deb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,29907,HCPCS,Subtalar arthro w/fusion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,29914,HCPCS,Hip arthro w/femoroplasty,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29915,HCPCS,Hip arthro acetabuloplasty,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29916,HCPCS,Hip arthro w/labral repair,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,29999,HCPCS,Arthroscopy of joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , $246.41 , Not Applicable , Not Applicable , $258.73 , $251.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $246.41 , Not Applicable , Not Applicable , $246.41 , $258.73 , Not Applicable
,30000,HCPCS,Drainage of nose lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,30020,HCPCS,Drainage of nose lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,30100,HCPCS,Intranasal biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,30110,HCPCS,Removal of nose polyp(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,30115,HCPCS,Removal of nose polyp(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,30117,HCPCS,Removal of intranasal lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,30118,HCPCS,Removal of intranasal lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,30120,HCPCS,Revision of nose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,30124,HCPCS,Removal of nose lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,30125,HCPCS,Removal of nose lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30130,HCPCS,Excise inferior turbinate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,30140,HCPCS,Resect inferior turbinate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,30150,HCPCS,Partial removal of nose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30160,HCPCS,Removal of nose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30200,HCPCS,Injection treatment of nose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,30210,HCPCS,Nasal sinus therapy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,30220,HCPCS,Insert nasal septal button,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,30300,HCPCS,Remove nasal foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,30310,HCPCS,Remove nasal foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,30320,HCPCS,Remove nasal foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,30400,HCPCS,Reconstruction of nose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30410,HCPCS,Reconstruction of nose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30420,HCPCS,Reconstruction of nose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30430,HCPCS,Revision of nose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30435,HCPCS,Revision of nose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30450,HCPCS,Revision of nose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30460,HCPCS,Revision of nose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30462,HCPCS,Revision of nose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30465,HCPCS,Repair nasal stenosis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30468,HCPCS,Rpr nsl vlv collapse w/implt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30520,HCPCS,Repair of nasal septum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,30540,HCPCS,Repair nasal defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30545,HCPCS,Repair nasal defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30560,HCPCS,Release of nasal adhesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,30580,HCPCS,Repair upper jaw fistula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30600,HCPCS,Repair mouth/nose fistula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30620,HCPCS,Intranasal reconstruction,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,30630,HCPCS,Repair nasal septum defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,30801,HCPCS,Ablate inf turbinate superf,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,30802,HCPCS,Ablate inf turbinate submuc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,30901,HCPCS,Control of nosebleed,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,30903,HCPCS,Control of nosebleed,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,30905,HCPCS,Control of nosebleed,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,30906,HCPCS,Repeat control of nosebleed,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,30915,HCPCS,Ligation nasal sinus artery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,30920,HCPCS,Ligation upper jaw artery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,30930,HCPCS,Ther fx nasal inf turbinate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,30999,HCPCS,Nasal surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,31000,HCPCS,Irrigation maxillary sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,31002,HCPCS,Irrigation sphenoid sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,31020,HCPCS,Exploration maxillary sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,31030,HCPCS,Exploration maxillary sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31032,HCPCS,Explore sinus remove polyps,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31040,HCPCS,Exploration behind upper jaw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31050,HCPCS,Exploration sphenoid sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31051,HCPCS,Sphenoid sinus surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31070,HCPCS,Exploration of frontal sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31075,HCPCS,Exploration of frontal sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31080,HCPCS,Removal of frontal sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31081,HCPCS,Removal of frontal sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31084,HCPCS,Removal of frontal sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31085,HCPCS,Removal of frontal sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31086,HCPCS,Removal of frontal sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31087,HCPCS,Removal of frontal sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31090,HCPCS,Exploration of sinuses,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31200,HCPCS,Removal of ethmoid sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31201,HCPCS,Removal of ethmoid sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,31205,HCPCS,Removal of ethmoid sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,31231,HCPCS,Nasal endoscopy dx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $196.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $196.80 , $196.80 , Not Applicable , Not Applicable , $206.64 , $200.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $196.80 , Not Applicable , Not Applicable , $196.80 , $206.64 , Not Applicable
,31233,HCPCS,Nsl/sins ndsc dx max sinusc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , $449.36 , Not Applicable , Not Applicable , $471.83 , $458.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , $449.36 , $471.83 , Not Applicable
,31235,HCPCS,Nsl/sins ndsc dx sphn sinusc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31237,HCPCS,Nasal/sinus endoscopy surg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31238,HCPCS,Nasal/sinus endoscopy surg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31239,HCPCS,Nasal/sinus endoscopy surg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31240,HCPCS,Nasal/sinus endoscopy surg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31241,HCPCS,Nsl/sins ndsc w/artery lig,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31253,HCPCS,Nsl/sins ndsc total,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31254,HCPCS,Nsl/sins ndsc w/prtl ethmdct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31255,HCPCS,Nsl/sins ndsc w/tot ethmdct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31256,HCPCS,Exploration maxillary sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31257,HCPCS,Nsl/sins ndsc tot w/sphendt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31259,HCPCS,Nsl/sins ndsc sphn tiss rmvl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31267,HCPCS,Endoscopy maxillary sinus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31276,HCPCS,Nsl/sins ndsc frnt tiss rmvl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31287,HCPCS,Nasal/sinus endoscopy surg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31288,HCPCS,Nasal/sinus endoscopy surg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31292,HCPCS,Nsl/sins ndsc med/inf dcmprn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31293,HCPCS,Nsl/sins ndsc med&inf dcmprn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31294,HCPCS,Nsl/sins ndsc surg on dcmprn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31295,HCPCS,Nsl/sins ndsc surg max sins,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31296,HCPCS,Nsl/sins ndsc surg frnt sins,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31297,HCPCS,Nsl/sins ndsc surg sphn sins,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31298,HCPCS,Nsl/sins ndsc surg frnt&sphn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31299,HCPCS,Sinus surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,31300,HCPCS,Removal of larynx lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,31400,HCPCS,Revision of larynx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31420,HCPCS,Removal of epiglottis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31500,HCPCS,Insert emergency airway,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,31502,HCPCS,Change of windpipe airway,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,31505,HCPCS,Diagnostic laryngoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $196.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $196.80 , $196.80 , Not Applicable , Not Applicable , $206.64 , $200.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $196.80 , Not Applicable , Not Applicable , $196.80 , $206.64 , Not Applicable
,31510,HCPCS,Laryngoscopy with biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31511,HCPCS,Remove foreign body larynx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $196.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $196.80 , $196.80 , Not Applicable , Not Applicable , $206.64 , $200.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $196.80 , Not Applicable , Not Applicable , $196.80 , $206.64 , Not Applicable
,31512,HCPCS,Removal of larynx lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31513,HCPCS,Injection into vocal cord,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , $449.36 , Not Applicable , Not Applicable , $471.83 , $458.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , $449.36 , $471.83 , Not Applicable
,31515,HCPCS,Laryngoscopy for aspiration,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , $449.36 , Not Applicable , Not Applicable , $471.83 , $458.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , $449.36 , $471.83 , Not Applicable
,31520,HCPCS,Dx laryngoscopy newborn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , $449.36 , Not Applicable , Not Applicable , $471.83 , $458.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , $449.36 , $471.83 , Not Applicable
,31525,HCPCS,Dx laryngoscopy excl nb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31526,HCPCS,Dx laryngoscopy w/oper scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31527,HCPCS,Laryngoscopy for treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31528,HCPCS,Laryngoscopy and dilation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31529,HCPCS,Laryngoscopy and dilation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31530,HCPCS,Laryngoscopy w/fb removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31531,HCPCS,Laryngoscopy w/fb & op scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31535,HCPCS,Laryngoscopy w/biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31536,HCPCS,Laryngoscopy w/bx & op scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31540,HCPCS,Laryngoscopy w/exc of tumor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31541,HCPCS,Larynscop w/tumr exc + scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31545,HCPCS,Remove vc lesion w/scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31546,HCPCS,Remove vc lesion scope/graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31551,HCPCS,Laryngoplasty laryngeal sten,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31552,HCPCS,Laryngoplasty laryngeal sten,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31553,HCPCS,Laryngoplasty laryngeal sten,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31554,HCPCS,Laryngoplasty laryngeal sten,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31560,HCPCS,Laryngoscop w/arytenoidectom,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31561,HCPCS,Larynscop remve cart + scop,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31570,HCPCS,Laryngoscope w/vc inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31571,HCPCS,Laryngoscop w/vc inj + scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31572,HCPCS,Largsc w/laser dstrj les,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31573,HCPCS,Largsc w/ther injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31574,HCPCS,Largsc w/njx augmentation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31575,HCPCS,Diagnostic laryngoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $196.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $196.80 , $196.80 , Not Applicable , Not Applicable , $206.64 , $200.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $196.80 , Not Applicable , Not Applicable , $196.80 , $206.64 , Not Applicable
,31576,HCPCS,Laryngoscopy with biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31577,HCPCS,Largsc w/rmvl foreign bdy(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , $449.36 , Not Applicable , Not Applicable , $471.83 , $458.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , $449.36 , $471.83 , Not Applicable
,31578,HCPCS,Largsc w/removal lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31579,HCPCS,Laryngoscopy telescopic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , $449.36 , Not Applicable , Not Applicable , $471.83 , $458.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , $449.36 , $471.83 , Not Applicable
,31580,HCPCS,Laryngoplasty laryngeal web,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31584,HCPCS,Laryngoplasty fx rdctj fixj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31587,HCPCS,Laryngoplasty cricoid split,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31590,HCPCS,Reinnervate larynx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31591,HCPCS,Laryngoplasty medialization,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31592,HCPCS,Cricotracheal resection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31599,HCPCS,Larynx surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,31600,HCPCS,Incision of windpipe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,31601,HCPCS,Incision of windpipe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31603,HCPCS,Incision of windpipe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,31605,HCPCS,Incision of windpipe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,31610,HCPCS,Incision of windpipe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31611,HCPCS,Surgery/speech prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,31612,HCPCS,Puncture/clear windpipe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,31613,HCPCS,Repair windpipe opening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,31614,HCPCS,Repair windpipe opening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31615,HCPCS,Visualization of windpipe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,31622,HCPCS,Dx bronchoscope/wash,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31623,HCPCS,Dx bronchoscope/brush,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31624,HCPCS,Dx bronchoscope/lavage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31625,HCPCS,Bronchoscopy w/biopsy(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31626,HCPCS,Bronchoscopy w/markers,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31628,HCPCS,Bronchoscopy/lung bx each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31629,HCPCS,Bronchoscopy/needle bx each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31630,HCPCS,Bronchoscopy dilate/fx repr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31631,HCPCS,Bronchoscopy dilate w/stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31634,HCPCS,Bronch w/balloon occlusion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31635,HCPCS,Bronchoscopy w/fb removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31636,HCPCS,Bronchoscopy bronch stents,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31638,HCPCS,Bronchoscopy revise stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31640,HCPCS,Bronchoscopy w/tumor excise,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31641,HCPCS,Bronchoscopy treat blockage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31643,HCPCS,Diag bronchoscope/catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31645,HCPCS,Brnchsc w/ther aspir 1st,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31646,HCPCS,Brnchsc w/ther aspir sbsq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , $449.36 , Not Applicable , Not Applicable , $471.83 , $458.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , $449.36 , $471.83 , Not Applicable
,31647,HCPCS,Bronchial valve init insert,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31648,HCPCS,Bronchial valve remov init,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31649,HCPCS,Bronchial valve remov addl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31652,HCPCS,Bronch ebus samplng 1/2 node,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31653,HCPCS,Bronch ebus samplng 3/> node,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 "," $3,703.22 ", Not Applicable , Not Applicable ," $3,888.38 "," $3,777.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,703.22 ", Not Applicable , Not Applicable ," $3,703.22 "," $3,888.38 ", Not Applicable
,31660,HCPCS,Bronch thermoplsty 1 lobe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31661,HCPCS,Bronch thermoplsty 2/> lobes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 "," $6,962.00 ", Not Applicable , Not Applicable ," $7,310.10 "," $7,101.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,962.00 ", Not Applicable , Not Applicable ," $6,962.00 "," $7,310.10 ", Not Applicable
,31717,HCPCS,Bronchial brush biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , $449.36 , Not Applicable , Not Applicable , $471.83 , $458.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $449.36 , Not Applicable , Not Applicable , $449.36 , $471.83 , Not Applicable
,31720,HCPCS,Clearance of airways,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $224.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $224.72 , $224.72 , Not Applicable , Not Applicable , $235.95 , $229.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $224.72 , Not Applicable , Not Applicable , $224.72 , $235.95 , Not Applicable
,31730,HCPCS,Intro windpipe wire/tube,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 "," $1,788.65 ", Not Applicable , Not Applicable ," $1,878.08 "," $1,824.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,788.65 ", Not Applicable , Not Applicable ," $1,788.65 "," $1,878.08 ", Not Applicable
,31750,HCPCS,Repair of windpipe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31755,HCPCS,Repair of windpipe,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31785,HCPCS,Remove windpipe lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,31820,HCPCS,Closure of windpipe lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,31825,HCPCS,Repair of windpipe defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,31830,HCPCS,Revise windpipe scar,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,31899,HCPCS,Airways surgical procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $196.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $196.80 , $196.80 , Not Applicable , Not Applicable , $206.64 , $200.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $196.80 , Not Applicable , Not Applicable , $196.80 , $206.64 , Not Applicable
,32400,HCPCS,Needle biopsy chest lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,32408,HCPCS,Core ndl bx lng/med perq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,32550,HCPCS,Insert pleural cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,32551,HCPCS,Insertion of chest tube,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,32552,HCPCS,Remove lung catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,32553,HCPCS,Ins mark thor for rt perq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,509.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,509.66 "," $1,509.66 ", Not Applicable , Not Applicable ," $1,585.15 "," $1,539.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,509.66 ", Not Applicable , Not Applicable ," $1,509.66 "," $1,585.15 ", Not Applicable
,32554,HCPCS,Aspirate pleura w/o imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,32555,HCPCS,Aspirate pleura w/ imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,32556,HCPCS,Insert cath pleura w/o image,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,32557,HCPCS,Insert cath pleura w/ image,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,32560,HCPCS,Treat pleurodesis w/agent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,32561,HCPCS,Lyse chest fibrin init day,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,32562,HCPCS,Lyse chest fibrin subq day,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,32601,HCPCS,Thoracoscopy diagnostic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,32604,HCPCS,Thoracoscopy wbx sac,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,32606,HCPCS,Thoracoscopy w/bx med space,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,32607,HCPCS,Thoracoscopy w/bx infiltrate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,32608,HCPCS,Thoracoscopy w/bx nodule,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,32609,HCPCS,Thoracoscopy w/bx pleura,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,32960,HCPCS,Therapeutic pneumothorax,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,32994,HCPCS,Ablate pulm tumor perq crybl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,32998,HCPCS,Ablate pulm tumor perq rf,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,32999,HCPCS,Chest surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,33016,HCPCS,Pericardiocentesis w/imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,33206,HCPCS,Insert heart pm atrial,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 "," $12,430.76 ", Not Applicable , Not Applicable ," $13,052.30 "," $12,679.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable ," $12,430.76 "," $13,052.30 ", Not Applicable
,33207,HCPCS,Insert heart pm ventricular,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 "," $12,430.76 ", Not Applicable , Not Applicable ," $13,052.30 "," $12,679.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable ," $12,430.76 "," $13,052.30 ", Not Applicable
,33208,HCPCS,Insrt heart pm atrial & vent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 "," $12,430.76 ", Not Applicable , Not Applicable ," $13,052.30 "," $12,679.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable ," $12,430.76 "," $13,052.30 ", Not Applicable
,33210,HCPCS,Insert electrd/pm cath sngl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,33211,HCPCS,Insert card electrodes dual,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,33212,HCPCS,Insert pulse gen sngl lead,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,33213,HCPCS,Insert pulse gen dual leads,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 "," $12,430.76 ", Not Applicable , Not Applicable ," $13,052.30 "," $12,679.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable ," $12,430.76 "," $13,052.30 ", Not Applicable
,33214,HCPCS,Upgrade of pacemaker system,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 "," $12,430.76 ", Not Applicable , Not Applicable ," $13,052.30 "," $12,679.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable ," $12,430.76 "," $13,052.30 ", Not Applicable
,33215,HCPCS,Reposition pacing-defib lead,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,33216,HCPCS,Insert 1 electrode pm-defib,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,33217,HCPCS,Insert 2 electrode pm-defib,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,33218,HCPCS,Repair lead pace-defib one,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,33220,HCPCS,Repair lead pace-defib dual,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,33221,HCPCS,Insert pulse gen mult leads,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $22,265.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,265.36 "," $22,265.36 ", Not Applicable , Not Applicable ," $23,378.62 "," $22,710.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,265.36 ", Not Applicable , Not Applicable ," $22,265.36 "," $23,378.62 ", Not Applicable
,33222,HCPCS,Relocation pocket pacemaker,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,33223,HCPCS,Relocate pocket for defib,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,33224,HCPCS,Insert pacing lead & connect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 "," $12,430.76 ", Not Applicable , Not Applicable ," $13,052.30 "," $12,679.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable ," $12,430.76 "," $13,052.30 ", Not Applicable
,33226,HCPCS,Reposition l ventric lead,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,33227,HCPCS,Remove&replace pm gen singl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,33228,HCPCS,Remv&replc pm gen dual lead,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 "," $12,430.76 ", Not Applicable , Not Applicable ," $13,052.30 "," $12,679.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,430.76 ", Not Applicable , Not Applicable ," $12,430.76 "," $13,052.30 ", Not Applicable
,33229,HCPCS,Remv&replc pm gen mult leads,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $22,265.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,265.36 "," $22,265.36 ", Not Applicable , Not Applicable ," $23,378.62 "," $22,710.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $22,265.36 ", Not Applicable , Not Applicable ," $22,265.36 "," $23,378.62 ", Not Applicable
,33230,HCPCS,Insrt pulse gen w/dual leads,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 "," $27,568.15 ", Not Applicable , Not Applicable ," $28,946.56 "," $28,119.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable ," $27,568.15 "," $28,946.56 ", Not Applicable
,33231,HCPCS,Insrt pulse gen w/mult leads,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $39,269.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,269.48 "," $39,269.48 ", Not Applicable , Not Applicable ," $41,232.96 "," $40,054.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,269.48 ", Not Applicable , Not Applicable ," $39,269.48 "," $41,232.96 ", Not Applicable
,33233,HCPCS,Removal of pm generator,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,33234,HCPCS,Removal of pacemaker system,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,33235,HCPCS,Removal pacemaker electrode,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,33240,HCPCS,Insrt pulse gen w/singl lead,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 "," $27,568.15 ", Not Applicable , Not Applicable ," $28,946.56 "," $28,119.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable ," $27,568.15 "," $28,946.56 ", Not Applicable
,33241,HCPCS,Remove pulse generator,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,33244,HCPCS,Remove elctrd transvenously,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,33249,HCPCS,Insj/rplcmt defib w/lead(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $39,269.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,269.48 "," $39,269.48 ", Not Applicable , Not Applicable ," $41,232.96 "," $40,054.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,269.48 ", Not Applicable , Not Applicable ," $39,269.48 "," $41,232.96 ", Not Applicable
,33262,HCPCS,Rmvl& replc pulse gen 1 lead,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 "," $27,568.15 ", Not Applicable , Not Applicable ," $28,946.56 "," $28,119.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable ," $27,568.15 "," $28,946.56 ", Not Applicable
,33263,HCPCS,Rmvl & rplcmt dfb gen 2 lead,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 "," $27,568.15 ", Not Applicable , Not Applicable ," $28,946.56 "," $28,119.52 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $27,568.15 ", Not Applicable , Not Applicable ," $27,568.15 "," $28,946.56 ", Not Applicable
,33264,HCPCS,Rmvl & rplcmt dfb gen mlt ld,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $39,269.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,269.48 "," $39,269.48 ", Not Applicable , Not Applicable ," $41,232.96 "," $40,054.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,269.48 ", Not Applicable , Not Applicable ," $39,269.48 "," $41,232.96 ", Not Applicable
,33270,HCPCS,Ins/rep subq defibrillator,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $39,269.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,269.48 "," $39,269.48 ", Not Applicable , Not Applicable ," $41,232.96 "," $40,054.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $39,269.48 ", Not Applicable , Not Applicable ," $39,269.48 "," $41,232.96 ", Not Applicable
,33271,HCPCS,Insj subq impltbl dfb elctrd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,33272,HCPCS,Rmvl of subq defibrillator,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,33273,HCPCS,Repos prev impltbl subq dfb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,33274,HCPCS,Tcat insj/rpl perm ldls pm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,33275,HCPCS,Tcat rmvl perm ldls pm w/img,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,33285,HCPCS,Insj subq car rhythm mntr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 "," $9,753.71 ", Not Applicable , Not Applicable ," $10,241.39 "," $9,948.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,753.71 ", Not Applicable , Not Applicable ," $9,753.71 "," $10,241.39 ", Not Applicable
,33286,HCPCS,Rmvl subq car rhythm mntr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,33289,HCPCS,Tcat impl wrls p-art prs snr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $34,485.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,485.29 "," $34,485.29 ", Not Applicable , Not Applicable ," $36,209.55 "," $35,174.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $34,485.29 ", Not Applicable , Not Applicable ," $34,485.29 "," $36,209.55 ", Not Applicable
,33999,HCPCS,Cardiac surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,34101,HCPCS,Removal of artery clot,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,34111,HCPCS,Removal of arm artery clot,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,34201,HCPCS,Removal of artery clot,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,34203,HCPCS,Removal of leg artery clot,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,34421,HCPCS,Removal of vein clot,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,34471,HCPCS,Removal of vein clot,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,34490,HCPCS,Removal of vein clot,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,34501,HCPCS,Repair valve femoral vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,34510,HCPCS,Transposition of vein valve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,34520,HCPCS,Cross-over vein graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,34530,HCPCS,Leg vein fusion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,35011,HCPCS,Repair defect of artery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35045,HCPCS,Repair defect of arm artery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35180,HCPCS,Repair blood vessel lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,35184,HCPCS,Repair blood vessel lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,35188,HCPCS,Repair blood vessel lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35190,HCPCS,Repair blood vessel lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35201,HCPCS,Repair blood vessel lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35206,HCPCS,Repair blood vessel lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,35207,HCPCS,Repair blood vessel lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,35226,HCPCS,Repair blood vessel lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,35231,HCPCS,Repair blood vessel lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,35236,HCPCS,Repair blood vessel lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35256,HCPCS,Repair blood vessel lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35261,HCPCS,Repair blood vessel lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,35266,HCPCS,Repair blood vessel lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35286,HCPCS,Repair blood vessel lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35321,HCPCS,Rechanneling of artery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35860,HCPCS,Explore limb vessels,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,35875,HCPCS,Removal of clot in graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35876,HCPCS,Removal of clot in graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35879,HCPCS,Revise graft w/vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35881,HCPCS,Revise graft w/vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35883,HCPCS,Revise graft w/nonauto graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35884,HCPCS,Revise graft w/vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,35903,HCPCS,Excision graft extremity,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36002,HCPCS,Pseudoaneurysm injection trt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,36221,HCPCS,Place cath thoracic aorta,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36222,HCPCS,Place cath carotid/inom art,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36223,HCPCS,Place cath carotid/inom art,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36224,HCPCS,Place cath carotd art,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36225,HCPCS,Place cath subclavian art,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36226,HCPCS,Place cath vertebral art,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36251,HCPCS,Ins cath ren art 1st unilat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36252,HCPCS,Ins cath ren art 1st bilat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36253,HCPCS,Ins cath ren art 2nd+ unilat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36254,HCPCS,Ins cath ren art 2nd+ bilat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36260,HCPCS,Insertion of infusion pump,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36261,HCPCS,Revision of infusion pump,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,36262,HCPCS,Removal of infusion pump,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 "," $4,116.72 ", Not Applicable , Not Applicable ," $4,322.56 "," $4,199.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,116.72 ", Not Applicable , Not Applicable ," $4,116.72 "," $4,322.56 ", Not Applicable
,36420,HCPCS,Vein access cutdown < 1 yr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,36425,HCPCS,Vein access cutdown > 1 yr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,36430,HCPCS,Blood transfusion service,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,36440,HCPCS,Bl push transfuse 2 yr/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,36450,HCPCS,Bl exchange/transfuse nb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,36455,HCPCS,Bl exchange/transfuse non-nb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,36456,HCPCS,Prtl exchange transfuse nb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,36460,HCPCS,Transfusion service fetal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,36465,HCPCS,Njx noncmpnd sclrsnt 1 vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,36466,HCPCS,Njx noncmpnd sclrsnt mlt vn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,36468,HCPCS,Njx sclrsnt spider veins,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,36470,HCPCS,Njx sclrsnt 1 incmptnt vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,36471,HCPCS,Njx sclrsnt mlt incmptnt vn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,36473,HCPCS,Endovenous mchnchem 1st vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36475,HCPCS,Endovenous rf 1st vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36478,HCPCS,Endovenous laser 1st vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36482,HCPCS,Endoven ther chem adhes 1st,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36511,HCPCS,Apheresis wbc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 "," $1,630.64 ", Not Applicable , Not Applicable ," $1,712.17 "," $1,663.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable ," $1,630.64 "," $1,712.17 ", Not Applicable
,36512,HCPCS,Apheresis rbc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 "," $1,630.64 ", Not Applicable , Not Applicable ," $1,712.17 "," $1,663.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable ," $1,630.64 "," $1,712.17 ", Not Applicable
,36513,HCPCS,Apheresis platelets,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,36514,HCPCS,Apheresis plasma,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 "," $1,630.64 ", Not Applicable , Not Applicable ," $1,712.17 "," $1,663.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable ," $1,630.64 "," $1,712.17 ", Not Applicable
,36516,HCPCS,Apheresis immunoads slctv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,835.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,835.03 "," $4,835.03 ", Not Applicable , Not Applicable ," $5,076.79 "," $4,931.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,835.03 ", Not Applicable , Not Applicable ," $4,835.03 "," $5,076.79 ", Not Applicable
,36522,HCPCS,Photopheresis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,835.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,835.03 "," $4,835.03 ", Not Applicable , Not Applicable ," $5,076.79 "," $4,931.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,835.03 ", Not Applicable , Not Applicable ," $4,835.03 "," $5,076.79 ", Not Applicable
,36555,HCPCS,Insert non-tunnel cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36556,HCPCS,Insert non-tunnel cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36557,HCPCS,Insert tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36558,HCPCS,Insert tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36560,HCPCS,Insert tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36561,HCPCS,Insert tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36563,HCPCS,Insert tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36565,HCPCS,Insert tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36566,HCPCS,Insert tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36568,HCPCS,Insj picc <5 yr w/o imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,36569,HCPCS,Insj picc 5 yr+ w/o imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,36570,HCPCS,Insert picvad cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36571,HCPCS,Insert picvad cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36572,HCPCS,Insj picc rs&i <5 yr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,36573,HCPCS,Insj picc rs&i 5 yr+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,36575,HCPCS,Repair tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,36576,HCPCS,Repair tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,36578,HCPCS,Replace tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36580,HCPCS,Replace cvad cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,36581,HCPCS,Replace tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36582,HCPCS,Replace tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36583,HCPCS,Replace tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36584,HCPCS,Compl rplcmt picc rs&i,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,36585,HCPCS,Replace picvad cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36589,HCPCS,Removal tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,36590,HCPCS,Removal tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,36591,HCPCS,Draw blood off venous device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,36592,HCPCS,Collect blood from picc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,36593,HCPCS,Declot vascular device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,36595,HCPCS,Mech remov tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36596,HCPCS,Mech remov tunneled cv cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,36597,HCPCS,Reposition venous catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,36598,HCPCS,Inj w/fluor eval cv device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , $244.57 , Not Applicable , Not Applicable , $256.80 , $249.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , $244.57 , $256.80 , Not Applicable
,36600,HCPCS,Withdrawal of arterial blood,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,36640,HCPCS,Insertion catheter artery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36680,HCPCS,Insert needle bone cavity,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,36800,HCPCS,Insertion of cannula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36810,HCPCS,Insertion of cannula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36815,HCPCS,Insertion of cannula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36818,HCPCS,Av fuse uppr arm cephalic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36819,HCPCS,Av fuse uppr arm basilic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36820,HCPCS,Av fusion/forearm vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36821,HCPCS,Av fusion direct any site,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36825,HCPCS,Artery-vein autograft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36830,HCPCS,Artery-vein nonautograft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36831,HCPCS,Open thrombect av fistula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36832,HCPCS,Av fistula revision open,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36833,HCPCS,Av fistula revision,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36835,HCPCS,Artery to vein shunt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,36838,HCPCS,Dist revas ligation hemo,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36860,HCPCS,External cannula declotting,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,36861,HCPCS,Cannula declotting,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,36901,HCPCS,Intro cath dialysis circuit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,36902,HCPCS,Intro cath dialysis circuit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 "," $5,925.35 ", Not Applicable , Not Applicable ," $6,221.61 "," $6,043.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable ," $5,925.35 "," $6,221.61 ", Not Applicable
,36903,HCPCS,Intro cath dialysis circuit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,36904,HCPCS,Thrmbc/nfs dialysis circuit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 "," $5,925.35 ", Not Applicable , Not Applicable ," $6,221.61 "," $6,043.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable ," $5,925.35 "," $6,221.61 ", Not Applicable
,36905,HCPCS,Thrmbc/nfs dialysis circuit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,36906,HCPCS,Thrmbc/nfs dialysis circuit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,37183,HCPCS,Remove hepatic shunt (tips),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 "," $5,925.35 ", Not Applicable , Not Applicable ," $6,221.61 "," $6,043.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable ," $5,925.35 "," $6,221.61 ", Not Applicable
,37184,HCPCS,Prim art m-thrmbc 1st vsl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,37187,HCPCS,Venous mech thrombectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,37188,HCPCS,Ven mechnl thrmbc repeat tx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37191,HCPCS,Ins endovas vena cava filtr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,37192,HCPCS,Redo endovas vena cava filtr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37193,HCPCS,Rem endovas vena cava filter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37195,HCPCS,Thrombolytic therapy stroke,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,37197,HCPCS,Remove intrvas foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37200,HCPCS,Transcatheter biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,37211,HCPCS,Thrombolytic art therapy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,37212,HCPCS,Thrombolytic venous therapy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37213,HCPCS,Thromblytic art/ven therapy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37214,HCPCS,Cessj therapy cath removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37220,HCPCS,Iliac revasc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 "," $5,925.35 ", Not Applicable , Not Applicable ," $6,221.61 "," $6,043.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable ," $5,925.35 "," $6,221.61 ", Not Applicable
,37221,HCPCS,Iliac revasc w/stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,37224,HCPCS,Fem/popl revas w/tla,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 "," $5,925.35 ", Not Applicable , Not Applicable ," $6,221.61 "," $6,043.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable ," $5,925.35 "," $6,221.61 ", Not Applicable
,37225,HCPCS,Fem/popl revas w/ather,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,37226,HCPCS,Fem/popl revasc w/stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,37227,HCPCS,Fem/popl revasc stnt & ather,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,37228,HCPCS,Tib/per revasc w/tla,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,37229,HCPCS,Tib/per revasc w/ather,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,37230,HCPCS,Tib/per revasc w/stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,37231,HCPCS,Tib/per revasc stent & ather,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,37236,HCPCS,Open/perq place stent 1st,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,37238,HCPCS,Open/perq place stent same,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,37241,HCPCS,Vasc embolize/occlude venous,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,37242,HCPCS,Vasc embolize/occlude artery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,37243,HCPCS,Vasc embolize/occlude organ,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,37244,HCPCS,Vasc embolize/occlude bleed,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,37246,HCPCS,Trluml balo angiop 1st art,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 "," $5,925.35 ", Not Applicable , Not Applicable ," $6,221.61 "," $6,043.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable ," $5,925.35 "," $6,221.61 ", Not Applicable
,37248,HCPCS,Trluml balo angiop 1st vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 "," $5,925.35 ", Not Applicable , Not Applicable ," $6,221.61 "," $6,043.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable ," $5,925.35 "," $6,221.61 ", Not Applicable
,37500,HCPCS,Endoscopy ligate perf veins,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,37501,HCPCS,Vascular endoscopy procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,37565,HCPCS,Ligation of neck vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37600,HCPCS,Ligation of neck artery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37605,HCPCS,Ligation of neck artery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37606,HCPCS,Ligation of neck artery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37607,HCPCS,Ligation of a-v fistula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37609,HCPCS,Temporal artery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,37615,HCPCS,Ligation of neck artery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37619,HCPCS,Ligation of inf vena cava,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,37650,HCPCS,Revision of major vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37700,HCPCS,Revise leg vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37718,HCPCS,Ligate/strip short leg vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37722,HCPCS,Ligate/strip long leg vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37735,HCPCS,Removal of leg veins/lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37760,HCPCS,Ligate leg veins radical,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37761,HCPCS,Ligate leg veins open,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37765,HCPCS,Stab phleb veins xtr 10-20,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37766,HCPCS,Phleb veins - extrem 20+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37780,HCPCS,Revision of leg vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37785,HCPCS,Ligate/divide/excise vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,37790,HCPCS,Penile venous occlusion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,37799,HCPCS,Vascular surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,38120,HCPCS,Laparoscopy splenectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,38129,HCPCS,Laparoscope proc spleen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,38206,HCPCS,Harvest auto stem cells,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 "," $1,630.64 ", Not Applicable , Not Applicable ," $1,712.17 "," $1,663.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable ," $1,630.64 "," $1,712.17 ", Not Applicable
,38207,HCPCS,Cryopreserve stem cells,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,38208,HCPCS,Thaw preserved stem cells,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,38209,HCPCS,Wash harvest stem cells,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,38210,HCPCS,T-cell depletion of harvest,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,38211,HCPCS,Tumor cell deplete of harvst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,38212,HCPCS,Rbc depletion of harvest,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,38213,HCPCS,Platelet deplete of harvest,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,38214,HCPCS,Volume deplete of harvest,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,38215,HCPCS,Harvest stem cell concentrte,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,38220,HCPCS,Dx bone marrow aspirations,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,38221,HCPCS,Dx bone marrow biopsies,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,38222,HCPCS,Dx bone marrow bx & aspir,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,38230,HCPCS,Bone marrow harvest allogen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 "," $1,630.64 ", Not Applicable , Not Applicable ," $1,712.17 "," $1,663.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable ," $1,630.64 "," $1,712.17 ", Not Applicable
,38232,HCPCS,Bone marrow harvest autolog,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,835.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,835.03 "," $4,835.03 ", Not Applicable , Not Applicable ," $5,076.79 "," $4,931.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,835.03 ", Not Applicable , Not Applicable ," $4,835.03 "," $5,076.79 ", Not Applicable
,38240,HCPCS,Transplt allo hct/donor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $48,025.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,025.36 "," $48,025.36 ", Not Applicable , Not Applicable ," $50,426.63 "," $48,985.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $48,025.36 ", Not Applicable , Not Applicable ," $48,025.36 "," $50,426.63 ", Not Applicable
,38241,HCPCS,Transplt autol hct/donor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 "," $1,630.64 ", Not Applicable , Not Applicable ," $1,712.17 "," $1,663.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable ," $1,630.64 "," $1,712.17 ", Not Applicable
,38242,HCPCS,Transplt allo lymphocytes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 "," $1,630.64 ", Not Applicable , Not Applicable ," $1,712.17 "," $1,663.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable ," $1,630.64 "," $1,712.17 ", Not Applicable
,38243,HCPCS,Transplj hematopoietic boost,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 "," $1,630.64 ", Not Applicable , Not Applicable ," $1,712.17 "," $1,663.25 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,630.64 ", Not Applicable , Not Applicable ," $1,630.64 "," $1,712.17 ", Not Applicable
,38300,HCPCS,Drainage lymph node lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,38305,HCPCS,Drainage lymph node lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,38308,HCPCS,Incision of lymph channels,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,38500,HCPCS,Biopsy/removal lymph nodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,38505,HCPCS,Needle biopsy lymph nodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,38510,HCPCS,Biopsy/removal lymph nodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,38520,HCPCS,Biopsy/removal lymph nodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,38525,HCPCS,Biopsy/removal lymph nodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,38530,HCPCS,Biopsy/removal lymph nodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,38531,HCPCS,Open bx/exc inguinofem nodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,38542,HCPCS,Explore deep node(s) neck,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,38550,HCPCS,Removal neck/armpit lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 "," $3,775.12 ", Not Applicable , Not Applicable ," $3,963.88 "," $3,850.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,775.12 ", Not Applicable , Not Applicable ," $3,775.12 "," $3,963.88 ", Not Applicable
,38555,HCPCS,Removal neck/armpit lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 "," $6,616.24 ", Not Applicable , Not Applicable ," $6,947.05 "," $6,748.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable ," $6,616.24 "," $6,947.05 ", Not Applicable
,38570,HCPCS,Laparoscopy lymph node biop,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,38571,HCPCS,Laparoscopy lymphadenectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,38572,HCPCS,Laparoscopy lymphadenectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,38573,HCPCS,Laps pelvic lymphadec,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,38589,HCPCS,Laparoscope proc lymphatic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,38700,HCPCS,Removal of lymph nodes neck,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 "," $6,616.24 ", Not Applicable , Not Applicable ," $6,947.05 "," $6,748.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable ," $6,616.24 "," $6,947.05 ", Not Applicable
,38720,HCPCS,Removal of lymph nodes neck,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,659.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,659.78 "," $10,659.78 ", Not Applicable , Not Applicable ," $11,192.77 "," $10,872.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,659.78 ", Not Applicable , Not Applicable ," $10,659.78 "," $11,192.77 ", Not Applicable
,38740,HCPCS,Remove armpit lymph nodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,38745,HCPCS,Remove armpit lymph nodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,38760,HCPCS,Remove groin lymph nodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 "," $6,616.24 ", Not Applicable , Not Applicable ," $6,947.05 "," $6,748.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,616.24 ", Not Applicable , Not Applicable ," $6,616.24 "," $6,947.05 ", Not Applicable
,38792,HCPCS,Ra tracer id of sentinl node,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,38999,HCPCS,Blood/lymph system procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , $474.52 , Not Applicable , Not Applicable , $498.24 , $484.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $474.52 , Not Applicable , Not Applicable , $474.52 , $498.24 , Not Applicable
,39401,HCPCS,Mediastinoscpy w/medstnl bx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,39402,HCPCS,Mediastinoscpy w/lmph nod bx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,40490,HCPCS,Biopsy of lip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,40500,HCPCS,Partial excision of lip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,40510,HCPCS,Partial excision of lip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,40520,HCPCS,Partial excision of lip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,40525,HCPCS,Reconstruct lip with flap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,40527,HCPCS,Reconstruct lip with flap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,40530,HCPCS,Partial removal of lip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,40650,HCPCS,Repair lip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,40652,HCPCS,Repair lip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,40654,HCPCS,Repair lip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,40700,HCPCS,Repair cleft lip/nasal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,40701,HCPCS,Repair cleft lip/nasal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,40702,HCPCS,Repair cleft lip/nasal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,40720,HCPCS,Repair cleft lip/nasal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,40761,HCPCS,Repair cleft lip/nasal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,40799,HCPCS,Lip surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,40800,HCPCS,Drainage of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,40801,HCPCS,Drainage of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,40804,HCPCS,Removal foreign body mouth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,40805,HCPCS,Removal foreign body mouth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,40806,HCPCS,Incision of lip fold,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,40808,HCPCS,Biopsy of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,40810,HCPCS,Excision of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,40812,HCPCS,Excise/repair mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,40814,HCPCS,Excise/repair mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,40816,HCPCS,Excision of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,40818,HCPCS,Excise oral mucosa for graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,40819,HCPCS,Excise lip or cheek fold,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,40820,HCPCS,Treatment of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,40830,HCPCS,Repair mouth laceration,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,40831,HCPCS,Repair mouth laceration,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,40840,HCPCS,Reconstruction of mouth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,40842,HCPCS,Reconstruction of mouth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,40843,HCPCS,Reconstruction of mouth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,40844,HCPCS,Reconstruction of mouth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,40845,HCPCS,Reconstruction of mouth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,40899,HCPCS,Mouth surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,41000,HCPCS,Drainage of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,41005,HCPCS,Drainage of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,41006,HCPCS,Drainage of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,41007,HCPCS,Drainage of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,41008,HCPCS,Drainage of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41009,HCPCS,Drainage of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,41010,HCPCS,Incision of tongue fold,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,41015,HCPCS,Drainage of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,41016,HCPCS,Drainage of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,41017,HCPCS,Drainage of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41018,HCPCS,Drainage of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,41019,HCPCS,Place needles h&n for rt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,41100,HCPCS,Biopsy of tongue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,41105,HCPCS,Biopsy of tongue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41108,HCPCS,Biopsy of floor of mouth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,41110,HCPCS,Excision of tongue lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41112,HCPCS,Excision of tongue lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41113,HCPCS,Excision of tongue lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41114,HCPCS,Excision of tongue lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41115,HCPCS,Excision of tongue fold,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,41116,HCPCS,Excision of mouth lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41120,HCPCS,Partial removal of tongue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,41250,HCPCS,Repair tongue laceration,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,41251,HCPCS,Repair tongue laceration,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,41252,HCPCS,Repair tongue laceration,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,41510,HCPCS,Tongue to lip surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41512,HCPCS,Tongue suspension,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,41520,HCPCS,Reconstruction tongue fold,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41530,HCPCS,Tongue base vol reduction,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41599,HCPCS,Tongue and mouth surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,41800,HCPCS,Drainage of gum lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,41805,HCPCS,Removal foreign body gum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,41806,HCPCS,Removal foreign body jawbone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,41820,HCPCS,Excision gum each quadrant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41821,HCPCS,Excision of gum flap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,41822,HCPCS,Excision of gum lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,41823,HCPCS,Excision of gum lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,41825,HCPCS,Excision of gum lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41826,HCPCS,Excision of gum lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41827,HCPCS,Excision of gum lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,41828,HCPCS,Excision of gum lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,41830,HCPCS,Removal of gum tissue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41850,HCPCS,Treatment of gum lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,41870,HCPCS,Gum graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,41872,HCPCS,Repair gum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41874,HCPCS,Repair tooth socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,41899,HCPCS,Dental surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,42000,HCPCS,Drainage mouth roof lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,42100,HCPCS,Biopsy roof of mouth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,42104,HCPCS,Excision lesion mouth roof,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42106,HCPCS,Excision lesion mouth roof,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42107,HCPCS,Excision lesion mouth roof,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42120,HCPCS,Remove palate/lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42140,HCPCS,Excision of uvula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42145,HCPCS,Repair palate pharynx/uvula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42160,HCPCS,Treatment mouth roof lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42180,HCPCS,Repair palate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,42182,HCPCS,Repair palate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42200,HCPCS,Reconstruct cleft palate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42205,HCPCS,Reconstruct cleft palate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42210,HCPCS,Reconstruct cleft palate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42215,HCPCS,Reconstruct cleft palate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42220,HCPCS,Reconstruct cleft palate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42225,HCPCS,Reconstruct cleft palate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42226,HCPCS,Lengthening of palate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42227,HCPCS,Lengthening of palate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42235,HCPCS,Repair palate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42260,HCPCS,Repair nose to lip fistula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42280,HCPCS,Preparation palate mold,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,42281,HCPCS,Insertion palate prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42299,HCPCS,Palate/uvula surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,42300,HCPCS,Drainage of salivary gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,42305,HCPCS,Drainage of salivary gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42310,HCPCS,Drainage of salivary gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,42320,HCPCS,Drainage of salivary gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,42330,HCPCS,Removal of salivary stone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42335,HCPCS,Removal of salivary stone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42340,HCPCS,Removal of salivary stone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42400,HCPCS,Biopsy of salivary gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,42405,HCPCS,Biopsy of salivary gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,42408,HCPCS,Excision of salivary cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42409,HCPCS,Drainage of salivary cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42410,HCPCS,Excise parotid gland/lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42415,HCPCS,Excise parotid gland/lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42420,HCPCS,Excise parotid gland/lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42425,HCPCS,Excise parotid gland/lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42440,HCPCS,Excise submaxillary gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42450,HCPCS,Excise sublingual gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42500,HCPCS,Repair salivary duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42505,HCPCS,Repair salivary duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42507,HCPCS,Parotid duct diversion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42509,HCPCS,Parotid duct diversion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42510,HCPCS,Parotid duct diversion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42600,HCPCS,Closure of salivary fistula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42650,HCPCS,Dilation of salivary duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,42660,HCPCS,Dilation of salivary duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,42665,HCPCS,Ligation of salivary duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42699,HCPCS,Salivary surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,42700,HCPCS,Drainage of tonsil abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,42720,HCPCS,Drainage of throat abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42725,HCPCS,Drainage of throat abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42800,HCPCS,Biopsy of throat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,42804,HCPCS,Biopsy of upper nose/throat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42806,HCPCS,Biopsy of upper nose/throat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42808,HCPCS,Excise pharynx lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42809,HCPCS,Remove pharynx foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,42810,HCPCS,Excision of neck cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42815,HCPCS,Excision of neck cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42820,HCPCS,Remove tonsils and adenoids,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42821,HCPCS,Remove tonsils and adenoids,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42825,HCPCS,Removal of tonsils,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42826,HCPCS,Removal of tonsils,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42830,HCPCS,Removal of adenoids,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42831,HCPCS,Removal of adenoids,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42835,HCPCS,Removal of adenoids,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42836,HCPCS,Removal of adenoids,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42842,HCPCS,Extensive surgery of throat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42844,HCPCS,Extensive surgery of throat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42860,HCPCS,Excision of tonsil tags,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42870,HCPCS,Excision of lingual tonsil,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42890,HCPCS,Partial removal of pharynx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42892,HCPCS,Revision of pharyngeal walls,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42900,HCPCS,Repair throat wound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,42950,HCPCS,Reconstruction of throat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,42955,HCPCS,Surgical opening of throat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,42960,HCPCS,Control throat bleeding,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,42962,HCPCS,Control throat bleeding,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42970,HCPCS,Control nose/throat bleeding,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,42972,HCPCS,Control nose/throat bleeding,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,42975,HCPCS,Dise eval slp do brth flx dx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $196.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $196.80 , $196.80 , Not Applicable , Not Applicable , $206.64 , $200.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $196.80 , Not Applicable , Not Applicable , $196.80 , $206.64 , Not Applicable
,42999,HCPCS,Throat surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,43020,HCPCS,Incision of esophagus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,43030,HCPCS,Throat muscle surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,43130,HCPCS,Removal of esophagus pouch,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,43180,HCPCS,Esophagoscopy rigid trnso,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,43191,HCPCS,Esophagoscopy rigid trnso dx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43192,HCPCS,Esophagoscp rig trnso inject,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43193,HCPCS,Esophagoscp rig trnso biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43194,HCPCS,Esophagoscp rig trnso rem fb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43195,HCPCS,Esophagoscopy rigid balloon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43196,HCPCS,Esophagoscp guide wire dilat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43197,HCPCS,Esophagoscopy flex dx brush,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,43198,HCPCS,Esophagosc flex trnsn biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,43200,HCPCS,Esophagoscopy flexible brush,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,43201,HCPCS,Esoph scope w/submucous inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43202,HCPCS,Esophagoscopy flex biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43204,HCPCS,Esoph scope w/sclerosis inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43205,HCPCS,Esophagus endoscopy/ligation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43206,HCPCS,Esoph optical endomicroscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43210,HCPCS,Egd esophagogastrc fndoplsty,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,43211,HCPCS,Esophagoscop mucosal resect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43212,HCPCS,Esophagoscop stent placement,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 "," $6,017.78 ", Not Applicable , Not Applicable ," $6,318.67 "," $6,138.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable ," $6,017.78 "," $6,318.67 ", Not Applicable
,43213,HCPCS,Esophagoscopy retro balloon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43214,HCPCS,Esophagosc dilate balloon 30,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43215,HCPCS,Esophagoscopy flex remove fb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43216,HCPCS,Esophagoscopy lesion removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43217,HCPCS,Esophagoscopy snare les remv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43220,HCPCS,Esophagoscopy balloon <30mm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43226,HCPCS,Esoph endoscopy dilation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43227,HCPCS,Esophagoscopy control bleed,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43229,HCPCS,Esophagoscopy lesion ablate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43231,HCPCS,Esophagoscop ultrasound exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43232,HCPCS,Esophagoscopy w/us needle bx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43233,HCPCS,Egd balloon dil esoph30 mm/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43235,HCPCS,Egd diagnostic brush wash,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,43236,HCPCS,Uppr gi scope w/submuc inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,43237,HCPCS,Endoscopic us exam esoph,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43238,HCPCS,Egd us fine needle bx/aspir,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43239,HCPCS,Egd biopsy single/multiple,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,43240,HCPCS,Egd w/transmural drain cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 "," $6,017.78 ", Not Applicable , Not Applicable ," $6,318.67 "," $6,138.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable ," $6,017.78 "," $6,318.67 ", Not Applicable
,43241,HCPCS,Egd tube/cath insertion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43242,HCPCS,Egd us fine needle bx/aspir,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43243,HCPCS,Egd injection varices,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43244,HCPCS,Egd varices ligation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43245,HCPCS,Egd dilate stricture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43246,HCPCS,Egd place gastrostomy tube,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43247,HCPCS,Egd remove foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,43248,HCPCS,Egd guide wire insertion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,43249,HCPCS,Esoph egd dilation <30 mm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43250,HCPCS,Egd cautery tumor polyp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43251,HCPCS,Egd remove lesion snare,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43252,HCPCS,Egd optical endomicroscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43253,HCPCS,Egd us transmural injxn/mark,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43254,HCPCS,Egd endo mucosal resection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43255,HCPCS,Egd control bleeding any,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43257,HCPCS,Egd w/thrml txmnt gerd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43259,HCPCS,Egd us exam duodenum/jejunum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43260,HCPCS,Ercp w/specimen collection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43261,HCPCS,Endo cholangiopancreatograph,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43262,HCPCS,Endo cholangiopancreatograph,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43263,HCPCS,Ercp sphincter pressure meas,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43264,HCPCS,Ercp remove duct calculi,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43265,HCPCS,Ercp lithotripsy calculi,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 "," $6,017.78 ", Not Applicable , Not Applicable ," $6,318.67 "," $6,138.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable ," $6,017.78 "," $6,318.67 ", Not Applicable
,43266,HCPCS,Egd endoscopic stent place,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 "," $6,017.78 ", Not Applicable , Not Applicable ," $6,318.67 "," $6,138.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable ," $6,017.78 "," $6,318.67 ", Not Applicable
,43270,HCPCS,Egd lesion ablation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43274,HCPCS,Ercp duct stent placement,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 "," $6,017.78 ", Not Applicable , Not Applicable ," $6,318.67 "," $6,138.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable ," $6,017.78 "," $6,318.67 ", Not Applicable
,43275,HCPCS,Ercp remove forgn body duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43276,HCPCS,Ercp stent exchange w/dilate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 "," $6,017.78 ", Not Applicable , Not Applicable ," $6,318.67 "," $6,138.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable ," $6,017.78 "," $6,318.67 ", Not Applicable
,43277,HCPCS,Ercp ea duct/ampulla dilate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43278,HCPCS,Ercp lesion ablate w/dilate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43280,HCPCS,Laparoscopy fundoplasty,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,43281,HCPCS,Lap paraesophag hern repair,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,43282,HCPCS,Lap paraesoph her rpr w/mesh,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,43284,HCPCS,Laps esophgl sphnctr agmntj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,43285,HCPCS,Rmvl esophgl sphnctr dev,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,43289,HCPCS,Laparoscope proc esoph,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,43420,HCPCS,Repair esophagus opening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,43450,HCPCS,Dilate esophagus 1/mult pass,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,43453,HCPCS,Dilate esophagus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43497,HCPCS,Transorl lwr esophgl myotomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43499,HCPCS,Esophagus surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,43510,HCPCS,Surgical opening of stomach,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,43647,HCPCS,Lap impl electrode antrum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 "," $13,442.21 ", Not Applicable , Not Applicable ," $14,114.33 "," $13,711.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable ," $13,442.21 "," $14,114.33 ", Not Applicable
,43648,HCPCS,Lap revise/remv eltrd antrum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,43651,HCPCS,Laparoscopy vagus nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,43652,HCPCS,Laparoscopy vagus nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,43653,HCPCS,Laparoscopy gastrostomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,43659,HCPCS,Laparoscope proc stom,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,43752,HCPCS,Nasal/orogastric w/tube plmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,43753,HCPCS,Tx gastro intub w/asp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,43754,HCPCS,Dx gastr intub w/asp spec,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,43755,HCPCS,Dx gastr intub w/asp specs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,43756,HCPCS,Dx duod intub w/asp spec,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,43757,HCPCS,Dx duod intub w/asp specs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,43761,HCPCS,Reposition gastrostomy tube,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,43762,HCPCS,Rplc gtube no revj trc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,43763,HCPCS,Rplc gtube revj gstrst trc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,43770,HCPCS,Lap place gastr adj device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,43772,HCPCS,Lap rmvl gastr adj device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43773,HCPCS,Lap replace gastr adj device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,43774,HCPCS,Lap rmvl gastr adj all parts,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43830,HCPCS,Place gastrostomy tube,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,43831,HCPCS,Place gastrostomy tube,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,43870,HCPCS,Repair stomach opening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,43886,HCPCS,Revise gastric port open,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,43887,HCPCS,Remove gastric port open,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,43888,HCPCS,Change gastric port open,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,43999,HCPCS,Stomach surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,44100,HCPCS,Biopsy of bowel,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,44180,HCPCS,Lap enterolysis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,44186,HCPCS,Lap jejunostomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,44238,HCPCS,Laparoscope proc intestine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,44312,HCPCS,Revision of ileostomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,44340,HCPCS,Revision of colostomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 "," $4,209.66 ", Not Applicable , Not Applicable ," $4,420.15 "," $4,293.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,209.66 ", Not Applicable , Not Applicable ," $4,209.66 "," $4,420.15 ", Not Applicable
,44360,HCPCS,Small bowel endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,44361,HCPCS,Small bowel endoscopy/biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,44363,HCPCS,Small bowel endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,44364,HCPCS,Small bowel endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,44365,HCPCS,Small bowel endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,44366,HCPCS,Small bowel endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,44369,HCPCS,Small bowel endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,44370,HCPCS,Small bowel endoscopy/stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 "," $6,017.78 ", Not Applicable , Not Applicable ," $6,318.67 "," $6,138.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable ," $6,017.78 "," $6,318.67 ", Not Applicable
,44372,HCPCS,Small bowel endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,44373,HCPCS,Small bowel endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,44376,HCPCS,Small bowel endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,44377,HCPCS,Small bowel endoscopy/biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,44378,HCPCS,Small bowel endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,44379,HCPCS,S bowel endoscope w/stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 "," $6,017.78 ", Not Applicable , Not Applicable ," $6,318.67 "," $6,138.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable ," $6,017.78 "," $6,318.67 ", Not Applicable
,44380,HCPCS,Small bowel endoscopy br/wa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,44381,HCPCS,Small bowel endoscopy br/wa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,44382,HCPCS,Small bowel endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,44384,HCPCS,Small bowel endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,44385,HCPCS,Endoscopy of bowel pouch,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,44386,HCPCS,Endoscopy bowel pouch/biop,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,44388,HCPCS,Colonoscopy thru stoma spx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,44389,HCPCS,Colonoscopy with biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,44390,HCPCS,Colonoscopy for foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,44391,HCPCS,Colonoscopy for bleeding,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,44392,HCPCS,Colonoscopy & polypectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,44394,HCPCS,Colonoscopy w/snare,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,44401,HCPCS,Colonoscopy with ablation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,44402,HCPCS,Colonoscopy w/stent plcmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 "," $6,017.78 ", Not Applicable , Not Applicable ," $6,318.67 "," $6,138.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable ," $6,017.78 "," $6,318.67 ", Not Applicable
,44403,HCPCS,Colonoscopy w/resection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,44404,HCPCS,Colonoscopy w/injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,44405,HCPCS,Colonoscopy w/dilation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,44406,HCPCS,Colonoscopy w/ultrasound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,44407,HCPCS,Colonoscopy w/ndl aspir/bx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,44408,HCPCS,Colonoscopy w/decompression,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,44500,HCPCS,Intro gastrointestinal tube,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,44799,HCPCS,Unlisted px small intestine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,44950,HCPCS,Appendectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,44970,HCPCS,Laparoscopy appendectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,44979,HCPCS,Laparoscope proc app,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,45000,HCPCS,Drainage of pelvic abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45005,HCPCS,Drainage of rectal abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45020,HCPCS,Drainage of rectal abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45100,HCPCS,Biopsy of rectum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45108,HCPCS,Removal of anorectal lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45150,HCPCS,Excision of rectal stricture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45160,HCPCS,Excision of rectal lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45171,HCPCS,Exc rect tum transanal part,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45172,HCPCS,Exc rect tum transanal full,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45190,HCPCS,Destruction rectal tumor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45300,HCPCS,Proctosigmoidoscopy dx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,45303,HCPCS,Proctosigmoidoscopy dilate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45305,HCPCS,Proctosigmoidoscopy w/bx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45307,HCPCS,Proctosigmoidoscopy fb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45308,HCPCS,Proctosigmoidoscopy removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45309,HCPCS,Proctosigmoidoscopy removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45315,HCPCS,Proctosigmoidoscopy removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45317,HCPCS,Proctosigmoidoscopy bleed,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45320,HCPCS,Proctosigmoidoscopy ablate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45321,HCPCS,Proctosigmoidoscopy volvul,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45327,HCPCS,Proctosigmoidoscopy w/stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 "," $6,017.78 ", Not Applicable , Not Applicable ," $6,318.67 "," $6,138.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable ," $6,017.78 "," $6,318.67 ", Not Applicable
,45330,HCPCS,Diagnostic sigmoidoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,45331,HCPCS,Sigmoidoscopy and biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,45332,HCPCS,Sigmoidoscopy w/fb removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45333,HCPCS,Sigmoidoscopy & polypectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,45334,HCPCS,Sigmoidoscopy for bleeding,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45335,HCPCS,Sigmoidoscopy w/submuc inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,45337,HCPCS,Sigmoidoscopy & decompress,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,45338,HCPCS,Sigmoidoscopy w/tumr remove,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45340,HCPCS,Sig w/tndsc balloon dilation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45341,HCPCS,Sigmoidoscopy w/ultrasound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,45342,HCPCS,Sigmoidoscopy w/us guide bx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45346,HCPCS,Sigmoidoscopy w/ablation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45347,HCPCS,Sigmoidoscopy w/plcmt stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 "," $6,017.78 ", Not Applicable , Not Applicable ," $6,318.67 "," $6,138.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable ," $6,017.78 "," $6,318.67 ", Not Applicable
,45349,HCPCS,Sigmoidoscopy w/resection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45350,HCPCS,Sgmdsc w/band ligation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45378,HCPCS,Diagnostic colonoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,45379,HCPCS,Colonoscopy w/fb removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45380,HCPCS,Colonoscopy and biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45381,HCPCS,Colonoscopy submucous njx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45382,HCPCS,Colonoscopy w/control bleed,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45384,HCPCS,Colonoscopy w/lesion removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45385,HCPCS,Colonoscopy w/lesion removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45386,HCPCS,Colonoscopy w/balloon dilat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45388,HCPCS,Colonoscopy w/ablation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45389,HCPCS,Colonoscopy w/stent plcmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 "," $6,017.78 ", Not Applicable , Not Applicable ," $6,318.67 "," $6,138.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,017.78 ", Not Applicable , Not Applicable ," $6,017.78 "," $6,318.67 ", Not Applicable
,45390,HCPCS,Colonoscopy w/resection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45391,HCPCS,Colonoscopy w/endoscope us,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45392,HCPCS,Colonoscopy w/endoscopic fnb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45393,HCPCS,Colonoscopy w/decompression,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45398,HCPCS,Colonoscopy w/band ligation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45399,HCPCS,Unlisted procedure colon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,45499,HCPCS,Laparoscope proc rectum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,45500,HCPCS,Repair of rectum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45505,HCPCS,Repair of rectum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45520,HCPCS,Treatment of rectal prolapse,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,45541,HCPCS,Correct rectal prolapse,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45560,HCPCS,Repair of rectocele,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45900,HCPCS,Reduction of rectal prolapse,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,45905,HCPCS,Dilation of anal sphincter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45910,HCPCS,Dilation of rectal narrowing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45915,HCPCS,Remove rectal obstruction,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,45990,HCPCS,Surg dx exam anorectal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,45999,HCPCS,Rectum surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,46020,HCPCS,Placement of seton,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46030,HCPCS,Removal of rectal marker,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,46040,HCPCS,Incision of rectal abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,46045,HCPCS,Incision of rectal abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46050,HCPCS,Incision of anal abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,46060,HCPCS,Incision of rectal abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46070,HCPCS,Incision of anal septum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46080,HCPCS,Incision of anal sphincter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46083,HCPCS,Incise external hemorrhoid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,46200,HCPCS,Removal of anal fissure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46220,HCPCS,Excise anal ext tag/papilla,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,46221,HCPCS,Ligation of hemorrhoid(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,46230,HCPCS,Removal of anal tags,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46250,HCPCS,Remove ext hem groups 2+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46255,HCPCS,Remove int/ext hem 1 group,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46257,HCPCS,Remove in/ex hem grp & fiss,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46258,HCPCS,Remove in/ex hem grp w/fistu,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46260,HCPCS,Remove in/ex hem groups 2+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46261,HCPCS,Remove in/ex hem grps & fiss,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46262,HCPCS,Remove in/ex hem grps w/fist,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46270,HCPCS,Remove anal fist subq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46275,HCPCS,Remove anal fist inter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46280,HCPCS,Remove anal fist complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46285,HCPCS,Remove anal fist 2 stage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46288,HCPCS,Repair anal fistula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46320,HCPCS,Removal of hemorrhoid clot,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,46500,HCPCS,Injection into hemorrhoid(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,46505,HCPCS,Chemodenervation anal musc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,46600,HCPCS,Diagnostic anoscopy spx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,46601,HCPCS,Diagnostic anoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,46604,HCPCS,Anoscopy and dilation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,46606,HCPCS,Anoscopy and biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,46607,HCPCS,Diagnostic anoscopy & biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,46608,HCPCS,Anoscopy remove for body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,46610,HCPCS,Anoscopy remove lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46611,HCPCS,Anoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,46612,HCPCS,Anoscopy remove lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46614,HCPCS,Anoscopy control bleeding,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,46615,HCPCS,Anoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46700,HCPCS,Repair of anal stricture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46706,HCPCS,Repr of anal fistula w/glue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46707,HCPCS,Repair anorectal fist w/plug,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46750,HCPCS,Repair of anal sphincter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46753,HCPCS,Reconstruction of anus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46754,HCPCS,Removal of suture from anus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46760,HCPCS,Repair of anal sphincter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46761,HCPCS,Repair of anal sphincter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46900,HCPCS,Destruction anal lesion(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,46910,HCPCS,Destruction anal lesion(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,46916,HCPCS,Cryosurgery anal lesion(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,46917,HCPCS,Laser surgery anal lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46922,HCPCS,Excision of anal lesion(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46924,HCPCS,Destruction anal lesion(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46930,HCPCS,Destroy internal hemorrhoids,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,46940,HCPCS,Treatment of anal fissure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46942,HCPCS,Treatment of anal fissure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,46945,HCPCS,Int hrhc lig 1 hroid w/o img,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46946,HCPCS,Int hrhc lig 2+hroid w/o img,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46947,HCPCS,Hemorrhoidopexy by stapling,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46948,HCPCS,Int hrhc tranal dartlzj 2+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,46999,HCPCS,Anus surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,47000,HCPCS,Needle biopsy of liver,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,47370,HCPCS,Laparo ablate liver tumor rf,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,47371,HCPCS,Laparo ablate liver cryosurg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,47379,HCPCS,Laparoscope procedure liver,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,47382,HCPCS,Percut ablate liver rf,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,47383,HCPCS,Perq abltj lvr cryoablation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,47399,HCPCS,Liver surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,47490,HCPCS,Incision of gallbladder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,47531,HCPCS,Injection for cholangiogram,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,47532,HCPCS,Injection for cholangiogram,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,47533,HCPCS,Plmt biliary drainage cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,47534,HCPCS,Plmt biliary drainage cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,47535,HCPCS,Conversion ext bil drg cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,47536,HCPCS,Exchange biliary drg cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,47537,HCPCS,Removal biliary drg cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,47538,HCPCS,Perq plmt bile duct stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,47539,HCPCS,Perq plmt bile duct stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,47540,HCPCS,Perq plmt bile duct stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,47541,HCPCS,Plmt access bil tree sm bwl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,47552,HCPCS,Biliary endo perq dx w/speci,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,47553,HCPCS,Biliary endoscopy thru skin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,47554,HCPCS,Biliary endoscopy thru skin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,47555,HCPCS,Biliary endoscopy thru skin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,47556,HCPCS,Biliary endoscopy thru skin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,47562,HCPCS,Laparoscopic cholecystectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,47563,HCPCS,Laparo cholecystectomy/graph,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,47564,HCPCS,Laparo cholecystectomy/explr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,47579,HCPCS,Laparoscope proc biliary,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,47999,HCPCS,Bile tract surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,48102,HCPCS,Needle biopsy pancreas,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,48999,HCPCS,Pancreas surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,49082,HCPCS,Abd paracentesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,49083,HCPCS,Abd paracentesis w/imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,49084,HCPCS,Peritoneal lavage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,49180,HCPCS,Biopsy abdominal mass,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,49185,HCPCS,Sclerotx fluid collection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,49250,HCPCS,Excision of umbilicus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49320,HCPCS,Diag laparo separate proc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49321,HCPCS,Laparoscopy biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49322,HCPCS,Laparoscopy aspiration,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49323,HCPCS,Laparo drain lymphocele,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49324,HCPCS,Lap insert tunnel ip cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49325,HCPCS,Lap revision perm ip cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49329,HCPCS,Laparo proc abdm/per/oment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49402,HCPCS,Remove foreign body adbomen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49405,HCPCS,Image cath fluid colxn visc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,49406,HCPCS,Image cath fluid peri/retro,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,49407,HCPCS,Image cath fluid trns/vgnl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,49411,HCPCS,Ins mark abd/pel for rt perq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,509.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,509.66 "," $1,509.66 ", Not Applicable , Not Applicable ," $1,585.15 "," $1,539.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,509.66 ", Not Applicable , Not Applicable ," $1,509.66 "," $1,585.15 ", Not Applicable
,49418,HCPCS,Insert tun ip cath perc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49419,HCPCS,Insert tun ip cath w/port,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,49421,HCPCS,Ins tun ip cath for dial opn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49422,HCPCS,Remove tunneled ip cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,49423,HCPCS,Exchange drainage catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,49426,HCPCS,Revise abdomen-venous shunt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49429,HCPCS,Removal of shunt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,49436,HCPCS,Embedded ip cath exit-site,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,49440,HCPCS,Place gastrostomy tube perc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,49441,HCPCS,Place duod/jej tube perc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,49442,HCPCS,Place cecostomy tube perc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 "," $1,239.71 ", Not Applicable , Not Applicable ," $1,301.70 "," $1,264.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,239.71 ", Not Applicable , Not Applicable ," $1,239.71 "," $1,301.70 ", Not Applicable
,49446,HCPCS,Change g-tube to g-j perc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 "," $1,941.77 ", Not Applicable , Not Applicable ," $2,038.86 "," $1,980.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,941.77 ", Not Applicable , Not Applicable ," $1,941.77 "," $2,038.86 ", Not Applicable
,49450,HCPCS,Replace g/c tube perc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,49451,HCPCS,Replace duod/jej tube perc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,49452,HCPCS,Replace g-j tube perc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,49460,HCPCS,Fix g/colon tube w/device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,49465,HCPCS,Fluoro exam of g/colon tube,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,49491,HCPCS,Rpr hern preemie reduc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49492,HCPCS,Rpr ing hern premie blocked,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49495,HCPCS,Rpr ing hernia baby reduc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49496,HCPCS,Rpr ing hernia baby blocked,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49500,HCPCS,Rpr ing hernia init reduce,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49501,HCPCS,Rpr ing hernia init blocked,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49505,HCPCS,Prp i/hern init reduc >5 yr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49507,HCPCS,Prp i/hern init block >5 yr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49520,HCPCS,Rerepair ing hernia reduce,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49521,HCPCS,Rerepair ing hernia blocked,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49525,HCPCS,Repair ing hernia sliding,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49540,HCPCS,Repair lumbar hernia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49550,HCPCS,Rpr rem hernia init reduce,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49553,HCPCS,Rpr fem hernia init blocked,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49555,HCPCS,Rerepair fem hernia reduce,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49557,HCPCS,Rerepair fem hernia blocked,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49560,HCPCS,Rpr ventral hern init reduc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49561,HCPCS,Rpr ventral hern init block,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49565,HCPCS,Rerepair ventrl hern reduce,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49566,HCPCS,Rerepair ventrl hern block,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49570,HCPCS,Rpr epigastric hern reduce,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49572,HCPCS,Rpr epigastric hern blocked,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49580,HCPCS,Rpr umbil hern reduc < 5 yr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49582,HCPCS,Rpr umbil hern block < 5 yr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49585,HCPCS,Rpr umbil hern reduc > 5 yr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49587,HCPCS,Rpr umbil hern block > 5 yr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49590,HCPCS,Repair spigelian hernia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49600,HCPCS,Repair umbilical lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,49650,HCPCS,Lap ing hernia repair init,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49651,HCPCS,Lap ing hernia repair recur,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49652,HCPCS,Lap vent/abd hernia repair,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49653,HCPCS,Lap vent/abd hern proc comp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49654,HCPCS,Lap inc hernia repair,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,49655,HCPCS,Lap inc hern repair comp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,49656,HCPCS,Lap inc hernia repair recur,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,49657,HCPCS,Lap inc hern recur comp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,49659,HCPCS,Laparo proc hernia repair,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,49999,HCPCS,Abdomen surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,50020,HCPCS,Renal abscess open drain,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,50080,HCPCS,Removal of kidney stone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 "," $9,866.61 ", Not Applicable , Not Applicable ," $10,359.94 "," $10,063.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable ," $9,866.61 "," $10,359.94 ", Not Applicable
,50081,HCPCS,Removal of kidney stone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 "," $9,866.61 ", Not Applicable , Not Applicable ," $10,359.94 "," $10,063.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable ," $9,866.61 "," $10,359.94 ", Not Applicable
,50200,HCPCS,Renal biopsy perq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,50382,HCPCS,Change ureter stent percut,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,50384,HCPCS,Remove ureter stent percut,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,50385,HCPCS,Change stent via transureth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,50386,HCPCS,Remove stent via transureth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,50387,HCPCS,Change nephroureteral cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,50389,HCPCS,Remove renal tube w/fluoro,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,50390,HCPCS,Drainage of kidney lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,50391,HCPCS,Instll rx agnt into rnal tub,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,50396,HCPCS,Measure kidney pressure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,50430,HCPCS,Njx px nfrosgrm &/urtrgrm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,50431,HCPCS,Njx px nfrosgrm &/urtrgrm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,50432,HCPCS,Plmt nephrostomy catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,50433,HCPCS,Plmt nephroureteral catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,50434,HCPCS,Convert nephrostomy catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,50435,HCPCS,Exchange nephrostomy cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,50436,HCPCS,Dilat xst trc ndurlgc px,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,50437,HCPCS,Dilat xst trc new access rcs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,50541,HCPCS,Laparo ablate renal cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,50542,HCPCS,Laparo ablate renal mass,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,50543,HCPCS,Laparo partial nephrectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,50544,HCPCS,Laparoscopy pyeloplasty,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,50549,HCPCS,Laparoscope proc renal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,50551,HCPCS,Kidney endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,50553,HCPCS,Kidney endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,50555,HCPCS,Kidney endoscopy & biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 "," $9,866.61 ", Not Applicable , Not Applicable ," $10,359.94 "," $10,063.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable ," $9,866.61 "," $10,359.94 ", Not Applicable
,50557,HCPCS,Kidney endoscopy & treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 "," $9,866.61 ", Not Applicable , Not Applicable ," $10,359.94 "," $10,063.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable ," $9,866.61 "," $10,359.94 ", Not Applicable
,50561,HCPCS,Kidney endoscopy & treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,50562,HCPCS,Renal scope w/tumor resect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 "," $9,866.61 ", Not Applicable , Not Applicable ," $10,359.94 "," $10,063.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable ," $9,866.61 "," $10,359.94 ", Not Applicable
,50570,HCPCS,Kidney endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,50572,HCPCS,Kidney endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,50574,HCPCS,Kidney endoscopy & biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,50575,HCPCS,Kidney endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,50576,HCPCS,Kidney endoscopy & treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,50580,HCPCS,Kidney endoscopy & treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,50590,HCPCS,Fragmenting of kidney stone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,50592,HCPCS,Perc rf ablate renal tumor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,50593,HCPCS,Perc cryo ablate renal tum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,50686,HCPCS,Measure ureter pressure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,50688,HCPCS,Change of ureter tube/stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,50693,HCPCS,Plmt ureteral stent prq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,50694,HCPCS,Plmt ureteral stent prq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,50695,HCPCS,Plmt ureteral stent prq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,50727,HCPCS,Revise ureter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,50945,HCPCS,Laparoscopy ureterolithotomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,50947,HCPCS,Laparo new ureter/bladder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,50948,HCPCS,Laparo new ureter/bladder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,50949,HCPCS,Laparoscope proc ureter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,50951,HCPCS,Endoscopy of ureter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,50953,HCPCS,Endoscopy of ureter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,50955,HCPCS,Ureter endoscopy & biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,50957,HCPCS,Ureter endoscopy & treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,50961,HCPCS,Ureter endoscopy & treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,50970,HCPCS,Ureter endoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,50972,HCPCS,Ureter endoscopy & catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,50974,HCPCS,Ureter endoscopy & biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,50976,HCPCS,Ureter endoscopy & treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,50980,HCPCS,Ureter endoscopy & treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,51020,HCPCS,Incise & treat bladder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,51030,HCPCS,Incise & treat bladder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,51040,HCPCS,Incise & drain bladder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,51045,HCPCS,Incise bladder/drain ureter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,51050,HCPCS,Removal of bladder stone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,51060,HCPCS,Removal of ureter stone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,51065,HCPCS,Remove ureter calculus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,51080,HCPCS,Drainage of bladder abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,51100,HCPCS,Drain bladder by needle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,51101,HCPCS,Drain bladder by trocar/cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,51102,HCPCS,Drain bl w/cath insertion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,51500,HCPCS,Removal of bladder cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,51520,HCPCS,Removal of bladder lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,51535,HCPCS,Repair of ureter lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,51700,HCPCS,Irrigation of bladder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,51701,HCPCS,Insert bladder catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,51702,HCPCS,Insert temp bladder cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,51703,HCPCS,Insert bladder cath complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,51705,HCPCS,Change of bladder tube,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,51710,HCPCS,Change of bladder tube,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,51715,HCPCS,Endoscopic injection/implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,51720,HCPCS,Treatment of bladder lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,51725,HCPCS,Simple cystometrogram,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,51726,HCPCS,Complex cystometrogram,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,51727,HCPCS,Cystometrogram w/up,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,51728,HCPCS,Cystometrogram w/vp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,51729,HCPCS,Cystometrogram w/vp&up,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,51736,HCPCS,Urine flow measurement,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,51741,HCPCS,Electro-uroflowmetry first,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,51784,HCPCS,Anal/urinary muscle study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,51785,HCPCS,Anal/urinary muscle study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,51792,HCPCS,Urinary reflex study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,51798,HCPCS,Us urine capacity measure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,51845,HCPCS,Repair bladder neck,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,51860,HCPCS,Repair of bladder wound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,51880,HCPCS,Repair of bladder opening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,51990,HCPCS,Laparo urethral suspension,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,51992,HCPCS,Laparo sling operation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,51999,HCPCS,Laparoscope proc bla,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,52000,HCPCS,Cystoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,52001,HCPCS,Cystoscopy removal of clots,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52005,HCPCS,Cystoscopy & ureter catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,52007,HCPCS,Cystoscopy and biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52010,HCPCS,Cystoscopy & duct catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,52204,HCPCS,Cystoscopy w/biopsy(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,52214,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52224,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52234,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52235,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52240,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,52250,HCPCS,Cystoscopy and radiotracer,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52260,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,52265,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,52270,HCPCS,Cystoscopy & revise urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,52275,HCPCS,Cystoscopy & revise urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,52276,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,52277,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52281,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,52282,HCPCS,Cystoscopy implant stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52283,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,52285,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,52287,HCPCS,Cystoscopy chemodenervation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,52290,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,52300,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52301,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52305,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,52310,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,52315,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,52317,HCPCS,Remove bladder stone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52318,HCPCS,Remove bladder stone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52320,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52325,HCPCS,Cystoscopy stone removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,52327,HCPCS,Cystoscopy inject material,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,52330,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52332,HCPCS,Cystoscopy and treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52334,HCPCS,Create passage to kidney,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52341,HCPCS,Cysto w/ureter stricture tx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52342,HCPCS,Cysto w/up stricture tx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52343,HCPCS,Cysto w/renal stricture tx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52344,HCPCS,Cysto/uretero stricture tx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52345,HCPCS,Cysto/uretero w/up stricture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52346,HCPCS,Cystouretero w/renal strict,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,52351,HCPCS,Cystouretero & or pyeloscope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52352,HCPCS,Cystouretero w/stone remove,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52353,HCPCS,Cystouretero w/lithotripsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,52354,HCPCS,Cystouretero w/biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,52355,HCPCS,Cystouretero w/excise tumor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,52356,HCPCS,Cysto/uretero w/lithotripsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,52400,HCPCS,Cystouretero w/congen repr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52402,HCPCS,Cystourethro cut ejacul duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52450,HCPCS,Incision of prostate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52500,HCPCS,Revision of bladder neck,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52601,HCPCS,Prostatectomy (turp),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,52630,HCPCS,Remove prostate regrowth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,52640,HCPCS,Relieve bladder contracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,52647,HCPCS,Laser surgery of prostate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,52648,HCPCS,Laser surgery of prostate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,52649,HCPCS,Prostate laser enucleation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,52700,HCPCS,Drainage of prostate abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53000,HCPCS,Incision of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,53010,HCPCS,Incision of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53020,HCPCS,Incision of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,53025,HCPCS,Incision of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,53040,HCPCS,Drainage of urethra abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53060,HCPCS,Drainage of urethra abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,53080,HCPCS,Drainage of urinary leakage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,53085,HCPCS,Drainage of urinary leakage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,53200,HCPCS,Biopsy of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,53210,HCPCS,Removal of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53215,HCPCS,Removal of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53220,HCPCS,Treatment of urethra lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53230,HCPCS,Removal of urethra lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53235,HCPCS,Removal of urethra lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53240,HCPCS,Surgery for urethra pouch,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53250,HCPCS,Removal of urethra gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53260,HCPCS,Treatment of urethra lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53265,HCPCS,Treatment of urethra lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,53270,HCPCS,Removal of urethra gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53275,HCPCS,Repair of urethra defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53400,HCPCS,Revise urethra stage 1,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53405,HCPCS,Revise urethra stage 2,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53410,HCPCS,Reconstruction of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53420,HCPCS,Reconstruct urethra stage 1,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53425,HCPCS,Reconstruct urethra stage 2,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53430,HCPCS,Reconstruction of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53431,HCPCS,Reconstruct urethra/bladder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53440,HCPCS,Male sling procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $13,730.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,730.86 "," $13,730.86 ", Not Applicable , Not Applicable ," $14,417.40 "," $14,005.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,730.86 ", Not Applicable , Not Applicable ," $13,730.86 "," $14,417.40 ", Not Applicable
,53442,HCPCS,Remove/revise male sling,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53444,HCPCS,Insert tandem cuff,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 "," $21,834.86 ", Not Applicable , Not Applicable ," $22,926.61 "," $22,271.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable ," $21,834.86 "," $22,926.61 ", Not Applicable
,53445,HCPCS,Insert uro/ves nck sphincter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 "," $21,834.86 ", Not Applicable , Not Applicable ," $22,926.61 "," $22,271.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable ," $21,834.86 "," $22,926.61 ", Not Applicable
,53446,HCPCS,Remove uro sphincter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53447,HCPCS,Remove/replace ur sphincter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 "," $21,834.86 ", Not Applicable , Not Applicable ," $22,926.61 "," $22,271.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable ," $21,834.86 "," $22,926.61 ", Not Applicable
,53449,HCPCS,Repair uro sphincter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53450,HCPCS,Revision of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53451,HCPCS,Tprnl balo cntnc dev bi,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $13,730.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,730.86 "," $13,730.86 ", Not Applicable , Not Applicable ," $14,417.40 "," $14,005.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,730.86 ", Not Applicable , Not Applicable ," $13,730.86 "," $14,417.40 ", Not Applicable
,53452,HCPCS,Tprnl balo cntnc dev uni,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53453,HCPCS,Tprnl balo cntnc dev rmvl ea,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53454,HCPCS,Tprnl balo cntnc dev adjmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,53460,HCPCS,Revision of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53500,HCPCS,Urethrlys transvag w/ scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53502,HCPCS,Repair of urethra injury,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53505,HCPCS,Repair of urethra injury,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53510,HCPCS,Repair of urethra injury,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53515,HCPCS,Repair of urethra injury,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53520,HCPCS,Repair of urethra defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,53600,HCPCS,Dilate urethra stricture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,53601,HCPCS,Dilate urethra stricture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,53605,HCPCS,Dilate urethra stricture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53620,HCPCS,Dilate urethra stricture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,53621,HCPCS,Dilate urethra stricture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,53660,HCPCS,Dilation of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,53661,HCPCS,Dilation of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,53665,HCPCS,Dilation of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,53850,HCPCS,Prostatic microwave thermotx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53852,HCPCS,Prostatic rf thermotx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53854,HCPCS,Trurl dstrj prst8 tiss rf wv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,53855,HCPCS,Insert prost urethral stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,53860,HCPCS,Transurethral rf treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,53899,HCPCS,Urology surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,54000,HCPCS,Slitting of prepuce,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54001,HCPCS,Slitting of prepuce,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,54015,HCPCS,Drain penis lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,54050,HCPCS,Destruction penis lesion(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,54055,HCPCS,Destruction penis lesion(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,54056,HCPCS,Cryosurgery penis lesion(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,54057,HCPCS,Laser surg penis lesion(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,54060,HCPCS,Excision of penis lesion(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,54065,HCPCS,Destruction penis lesion(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,54100,HCPCS,Biopsy of penis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,54105,HCPCS,Biopsy of penis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,54110,HCPCS,Treatment of penis lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54111,HCPCS,Treat penis lesion graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,54112,HCPCS,Treat penis lesion graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 "," $9,866.61 ", Not Applicable , Not Applicable ," $10,359.94 "," $10,063.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable ," $9,866.61 "," $10,359.94 ", Not Applicable
,54115,HCPCS,Treatment of penis lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,54120,HCPCS,Partial removal of penis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54150,HCPCS,Circumcision w/regionl block,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,54160,HCPCS,Circumcision neonate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , $687.79 , Not Applicable , Not Applicable , $722.18 , $701.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $687.79 , Not Applicable , Not Applicable , $687.79 , $722.18 , Not Applicable
,54161,HCPCS,Circum 28 days or older,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,54162,HCPCS,Lysis penil circumic lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,54163,HCPCS,Repair of circumcision,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,54164,HCPCS,Frenulotomy of penis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,54200,HCPCS,Treatment of penis lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,54205,HCPCS,Treatment of penis lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,54220,HCPCS,Treatment of penis lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,54231,HCPCS,Dynamic cavernosometry,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,54235,HCPCS,Penile injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,54240,HCPCS,Penis study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,54250,HCPCS,Penis study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,54300,HCPCS,Revision of penis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54304,HCPCS,Revision of penis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54308,HCPCS,Reconstruction of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,54312,HCPCS,Reconstruction of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54316,HCPCS,Reconstruction of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,54318,HCPCS,Reconstruction of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54322,HCPCS,Reconstruction of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54324,HCPCS,Reconstruction of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54326,HCPCS,Reconstruction of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54328,HCPCS,Revise penis/urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54332,HCPCS,Revise penis/urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54336,HCPCS,Revise penis/urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54340,HCPCS,Rpr hypspad comp simple,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54344,HCPCS,Rrp hypspad comp moblj&urtp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,54348,HCPCS,Rpr hypspad comp dsj & urtp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,54352,HCPCS,Revj prior hypspad repair,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,54360,HCPCS,Penis plastic surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54380,HCPCS,Repair penis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,54385,HCPCS,Repair penis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,54400,HCPCS,Insert semi-rigid prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $13,730.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,730.86 "," $13,730.86 ", Not Applicable , Not Applicable ," $14,417.40 "," $14,005.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,730.86 ", Not Applicable , Not Applicable ," $13,730.86 "," $14,417.40 ", Not Applicable
,54401,HCPCS,Insert self-contd prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 "," $21,834.86 ", Not Applicable , Not Applicable ," $22,926.61 "," $22,271.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable ," $21,834.86 "," $22,926.61 ", Not Applicable
,54405,HCPCS,Insert multi-comp penis pros,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 "," $21,834.86 ", Not Applicable , Not Applicable ," $22,926.61 "," $22,271.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable ," $21,834.86 "," $22,926.61 ", Not Applicable
,54406,HCPCS,Remove muti-comp penis pros,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54408,HCPCS,Repair multi-comp penis pros,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,54410,HCPCS,Remove/replace penis prosth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 "," $21,834.86 ", Not Applicable , Not Applicable ," $22,926.61 "," $22,271.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable ," $21,834.86 "," $22,926.61 ", Not Applicable
,54411,HCPCS,Remov/replc penis pros comp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 "," $21,834.86 ", Not Applicable , Not Applicable ," $22,926.61 "," $22,271.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable ," $21,834.86 "," $22,926.61 ", Not Applicable
,54415,HCPCS,Remove self-contd penis pros,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54416,HCPCS,Remv/repl penis contain pros,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 "," $21,834.86 ", Not Applicable , Not Applicable ," $22,926.61 "," $22,271.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $21,834.86 ", Not Applicable , Not Applicable ," $21,834.86 "," $22,926.61 ", Not Applicable
,54417,HCPCS,Remv/replc penis pros compl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $13,730.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,730.86 "," $13,730.86 ", Not Applicable , Not Applicable ," $14,417.40 "," $14,005.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,730.86 ", Not Applicable , Not Applicable ," $13,730.86 "," $14,417.40 ", Not Applicable
,54420,HCPCS,Revision of penis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54435,HCPCS,Revision of penis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54437,HCPCS,Repair corporeal tear,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54440,HCPCS,Repair of penis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54450,HCPCS,Preputial stretching,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,54500,HCPCS,Biopsy of testis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,54505,HCPCS,Biopsy of testis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54512,HCPCS,Excise lesion testis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54520,HCPCS,Removal of testis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54522,HCPCS,Orchiectomy partial,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54530,HCPCS,Removal of testis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,54535,HCPCS,Extensive testis surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54550,HCPCS,Exploration for testis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,54560,HCPCS,Exploration for testis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,54600,HCPCS,Reduce testis torsion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54620,HCPCS,Suspension of testis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54640,HCPCS,Orchiopexy ingun/scrot appr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,54650,HCPCS,Orchiopexy (fowler-stephens),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,54660,HCPCS,Revision of testis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,54670,HCPCS,Repair testis injury,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54680,HCPCS,Relocation of testis(es),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54690,HCPCS,Laparoscopy orchiectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,54692,HCPCS,Laparoscopy orchiopexy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,54699,HCPCS,Laparoscope proc testis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,54700,HCPCS,Drainage of scrotum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,54800,HCPCS,Biopsy of epididymis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,54830,HCPCS,Remove epididymis lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54840,HCPCS,Remove epididymis lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,54860,HCPCS,Removal of epididymis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54861,HCPCS,Removal of epididymis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54865,HCPCS,Explore epididymis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,54900,HCPCS,Fusion of spermatic ducts,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,54901,HCPCS,Fusion of spermatic ducts,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,55000,HCPCS,Drainage of hydrocele,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,55040,HCPCS,Removal of hydrocele,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,55041,HCPCS,Removal of hydroceles,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,55060,HCPCS,Repair of hydrocele,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,55100,HCPCS,Drainage of scrotum abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,55110,HCPCS,Explore scrotum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,55120,HCPCS,Removal of scrotum lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,55150,HCPCS,Removal of scrotum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,55175,HCPCS,Revision of scrotum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,55180,HCPCS,Revision of scrotum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,55200,HCPCS,Incision of sperm duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,55250,HCPCS,Removal of sperm duct(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,55400,HCPCS,Repair of sperm duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,55500,HCPCS,Removal of hydrocele,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,55520,HCPCS,Removal of sperm cord lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,55530,HCPCS,Revise spermatic cord veins,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,55535,HCPCS,Revise spermatic cord veins,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,55540,HCPCS,Revise hernia & sperm veins,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 "," $3,803.62 ", Not Applicable , Not Applicable ," $3,993.81 "," $3,879.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,803.62 ", Not Applicable , Not Applicable ," $3,803.62 "," $3,993.81 ", Not Applicable
,55550,HCPCS,Laparo ligate spermatic vein,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,55559,HCPCS,Laparo proc spermatic cord,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,55600,HCPCS,Incise sperm duct pouch,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,55680,HCPCS,Remove sperm pouch lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,55700,HCPCS,Biopsy of prostate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,55705,HCPCS,Biopsy of prostate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,55706,HCPCS,Prostate saturation sampling,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,55720,HCPCS,Drainage of prostate abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,55725,HCPCS,Drainage of prostate abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,55860,HCPCS,Surgical exposure prostate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,55866,HCPCS,Laparo radical prostatectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,55870,HCPCS,Electroejaculation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , $757.92 , Not Applicable , Not Applicable , $795.81 , $773.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , $757.92 , $795.81 , Not Applicable
,55873,HCPCS,Cryoablate prostate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 "," $9,866.61 ", Not Applicable , Not Applicable ," $10,359.94 "," $10,063.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable ," $9,866.61 "," $10,359.94 ", Not Applicable
,55874,HCPCS,Tprnl plmt biodegrdabl matrl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,55875,HCPCS,Transperi needle place pros,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,55876,HCPCS,Place rt device/marker pros,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,509.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,509.66 "," $1,509.66 ", Not Applicable , Not Applicable ," $1,585.15 "," $1,539.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,509.66 ", Not Applicable , Not Applicable ," $1,509.66 "," $1,585.15 ", Not Applicable
,55880,HCPCS,Abltj mal prst8 tiss hifu,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,55899,HCPCS,Genital surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,55920,HCPCS,Place needles pelvic for rt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,55970,HCPCS,Sex transformation m to f,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,55980,HCPCS,Sex transformation f to m,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 "," $3,675.67 ", Not Applicable , Not Applicable ," $3,859.45 "," $3,749.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,675.67 ", Not Applicable , Not Applicable ," $3,675.67 "," $3,859.45 ", Not Applicable
,56405,HCPCS,I & d of vulva/perineum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,56420,HCPCS,Drainage of gland abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,56440,HCPCS,Surgery for vulva lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,56441,HCPCS,Lysis of labial lesion(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,56442,HCPCS,Hymenotomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,56501,HCPCS,Destroy vulva lesions sim,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,56515,HCPCS,Destroy vulva lesion/s compl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,56605,HCPCS,Biopsy of vulva/perineum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , $757.92 , Not Applicable , Not Applicable , $795.81 , $773.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , $757.92 , $795.81 , Not Applicable
,56620,HCPCS,Partial removal of vulva,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,56625,HCPCS,Complete removal of vulva,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,56700,HCPCS,Partial removal of hymen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,56740,HCPCS,Remove vagina gland lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,56800,HCPCS,Repair of vagina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,56805,HCPCS,Repair clitoris,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,56810,HCPCS,Repair of perineum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,56820,HCPCS,Exam of vulva w/scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,56821,HCPCS,Exam/biopsy of vulva w/scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,57000,HCPCS,Exploration of vagina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57010,HCPCS,Drainage of pelvic abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57020,HCPCS,Drainage of pelvic fluid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57022,HCPCS,I & d vaginal hematoma pp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,57023,HCPCS,I & d vag hematoma non-ob,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,57061,HCPCS,Destroy vag lesions simple,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57065,HCPCS,Destroy vag lesions complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57100,HCPCS,Biopsy of vagina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , $757.92 , Not Applicable , Not Applicable , $795.81 , $773.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , $757.92 , $795.81 , Not Applicable
,57105,HCPCS,Biopsy of vagina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57106,HCPCS,Remove vagina wall partial,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57107,HCPCS,Remove vagina tissue part,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57109,HCPCS,Vaginectomy partial w/nodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57120,HCPCS,Closure of vagina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57130,HCPCS,Remove vagina lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57135,HCPCS,Remove vagina lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57150,HCPCS,Treat vagina infection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,57155,HCPCS,Insert uteri tandem/ovoids,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57156,HCPCS,Ins vag brachytx device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,57160,HCPCS,Insert pessary/other device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,57170,HCPCS,Fitting of diaphragm/cap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,57180,HCPCS,Treat vaginal bleeding,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,57200,HCPCS,Repair of vagina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57210,HCPCS,Repair vagina/perineum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57220,HCPCS,Revision of urethra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57230,HCPCS,Repair of urethral lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57240,HCPCS,Anterior colporrhaphy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57250,HCPCS,Repair rectum & vagina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57260,HCPCS,Cmbn ant pst colprhy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57265,HCPCS,Cmbn ap colprhy w/ntrcl rpr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57268,HCPCS,Repair of bowel bulge,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57282,HCPCS,Colpopexy extraperitoneal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 "," $8,115.89 ", Not Applicable , Not Applicable ," $8,521.68 "," $8,278.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable ," $8,115.89 "," $8,521.68 ", Not Applicable
,57283,HCPCS,Colpopexy intraperitoneal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 "," $8,115.89 ", Not Applicable , Not Applicable ," $8,521.68 "," $8,278.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable ," $8,115.89 "," $8,521.68 ", Not Applicable
,57284,HCPCS,Repair paravag defect open,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57285,HCPCS,Repair paravag defect vag,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 "," $8,115.89 ", Not Applicable , Not Applicable ," $8,521.68 "," $8,278.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable ," $8,115.89 "," $8,521.68 ", Not Applicable
,57287,HCPCS,Revise/remove sling repair,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57288,HCPCS,Repair bladder defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57289,HCPCS,Repair bladder & vagina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 "," $8,115.89 ", Not Applicable , Not Applicable ," $8,521.68 "," $8,278.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable ," $8,115.89 "," $8,521.68 ", Not Applicable
,57291,HCPCS,Construction of vagina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57292,HCPCS,Construct vagina with graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57295,HCPCS,Revise vag graft via vagina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57300,HCPCS,Repair rectum-vagina fistula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57310,HCPCS,Repair urethrovaginal lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 "," $8,115.89 ", Not Applicable , Not Applicable ," $8,521.68 "," $8,278.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable ," $8,115.89 "," $8,521.68 ", Not Applicable
,57320,HCPCS,Repair bladder-vagina lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57330,HCPCS,Repair bladder-vagina lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 "," $8,115.89 ", Not Applicable , Not Applicable ," $8,521.68 "," $8,278.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable ," $8,115.89 "," $8,521.68 ", Not Applicable
,57335,HCPCS,Repair vagina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57400,HCPCS,Dilation of vagina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57410,HCPCS,Pelvic examination,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57415,HCPCS,Remove vaginal foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57420,HCPCS,Exam of vagina w/scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,57421,HCPCS,Exam/biopsy of vag w/scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , $757.92 , Not Applicable , Not Applicable , $795.81 , $773.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , $757.92 , $795.81 , Not Applicable
,57423,HCPCS,Repair paravag defect lap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,57425,HCPCS,Laparoscopy surg colpopexy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,57426,HCPCS,Revise prosth vag graft lap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 "," $8,115.89 ", Not Applicable , Not Applicable ," $8,521.68 "," $8,278.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable ," $8,115.89 "," $8,521.68 ", Not Applicable
,57452,HCPCS,Exam of cervix w/scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,57454,HCPCS,Bx/curett of cervix w/scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,57455,HCPCS,Biopsy of cervix w/scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,57456,HCPCS,Endocerv curettage w/scope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,57460,HCPCS,Bx of cervix w/scope leep,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57461,HCPCS,Conz of cervix w/scope leep,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57500,HCPCS,Biopsy of cervix,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , $757.92 , Not Applicable , Not Applicable , $795.81 , $773.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , $757.92 , $795.81 , Not Applicable
,57505,HCPCS,Endocervical curettage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , $757.92 , Not Applicable , Not Applicable , $795.81 , $773.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , $757.92 , $795.81 , Not Applicable
,57510,HCPCS,Cauterization of cervix,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57511,HCPCS,Cryocautery of cervix,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,57513,HCPCS,Laser surgery of cervix,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57520,HCPCS,Conization of cervix,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57522,HCPCS,Conization of cervix,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57530,HCPCS,Removal of cervix,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57550,HCPCS,Removal of residual cervix,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57555,HCPCS,Remove cervix/repair vagina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57556,HCPCS,Remove cervix repair bowel,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,57558,HCPCS,D&c of cervical stump,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57700,HCPCS,Revision of cervix,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57720,HCPCS,Revision of cervix,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,57800,HCPCS,Dilation of cervical canal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,58100,HCPCS,Biopsy of uterus lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,58120,HCPCS,Dilation and curettage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,58145,HCPCS,Myomectomy vag method,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,58260,HCPCS,Vaginal hysterectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58262,HCPCS,Vag hyst including t/o,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58263,HCPCS,Vag hyst w/t/o & vag repair,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58270,HCPCS,Vag hyst w/enterocele repair,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58290,HCPCS,Vag hyst complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 "," $8,115.89 ", Not Applicable , Not Applicable ," $8,521.68 "," $8,278.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable ," $8,115.89 "," $8,521.68 ", Not Applicable
,58291,HCPCS,Vag hyst incl t/o complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58292,HCPCS,Vag hyst t/o & repair compl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 "," $8,115.89 ", Not Applicable , Not Applicable ," $8,521.68 "," $8,278.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable ," $8,115.89 "," $8,521.68 ", Not Applicable
,58294,HCPCS,Vag hyst w/enterocele compl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58301,HCPCS,Remove intrauterine device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,58321,HCPCS,Artificial insemination,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,58322,HCPCS,Artificial insemination,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,58323,HCPCS,Sperm washing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,58345,HCPCS,Reopen fallopian tube,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,58346,HCPCS,Insert heyman uteri capsule,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58350,HCPCS,Reopen fallopian tube,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58353,HCPCS,Endometr ablate thermal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58356,HCPCS,Endometrial cryoablation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58541,HCPCS,Lsh uterus 250 g or less,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,58542,HCPCS,Lsh w/t/o ut 250 g or less,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,58543,HCPCS,Lsh uterus above 250 g,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,58544,HCPCS,Lsh w/t/o uterus above 250 g,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,58545,HCPCS,Laparoscopic myomectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,58546,HCPCS,Laparo-myomectomy complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,58550,HCPCS,Laparo-asst vag hysterectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,58552,HCPCS,Laparo-vag hyst incl t/o,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,58553,HCPCS,Laparo-vag hyst complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,58554,HCPCS,Laparo-vag hyst w/t/o compl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,58555,HCPCS,Hysteroscopy dx sep proc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,58558,HCPCS,Hysteroscopy biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,58559,HCPCS,Hysteroscopy lysis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58560,HCPCS,Hysteroscopy resect septum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58561,HCPCS,Hysteroscopy remove myoma,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58562,HCPCS,Hysteroscopy remove fb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,58563,HCPCS,Hysteroscopy ablation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58565,HCPCS,Hysteroscopy sterilization,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58570,HCPCS,Tlh uterus 250 g or less,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,58571,HCPCS,Tlh w/t/o 250 g or less,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,58572,HCPCS,Tlh uterus over 250 g,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,58573,HCPCS,Tlh w/t/o uterus over 250 g,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,58578,HCPCS,Laparo proc uterus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,58579,HCPCS,Hysteroscope procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,58600,HCPCS,Division of fallopian tube,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,58615,HCPCS,Occlude fallopian tube(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,58660,HCPCS,Laparoscopy lysis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,58661,HCPCS,Laparoscopy remove adnexa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,58662,HCPCS,Laparoscopy excise lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,58670,HCPCS,Laparoscopy tubal cautery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,58671,HCPCS,Laparoscopy tubal block,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,58672,HCPCS,Laparoscopy fimbrioplasty,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,58673,HCPCS,Laparoscopy salpingostomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,58674,HCPCS,Laps abltj uterine fibroids,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 "," $10,648.13 ", Not Applicable , Not Applicable ," $11,180.54 "," $10,861.10 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $10,648.13 ", Not Applicable , Not Applicable ," $10,648.13 "," $11,180.54 ", Not Applicable
,58679,HCPCS,Laparo proc oviduct-ovary,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,58770,HCPCS,Create new tubal opening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,58800,HCPCS,Drainage of ovarian cyst(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,58805,HCPCS,Drainage of ovarian cyst(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,58820,HCPCS,Drain ovary abscess open,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,58900,HCPCS,Biopsy of ovary(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,58920,HCPCS,Partial removal of ovary(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 "," $8,115.89 ", Not Applicable , Not Applicable ," $8,521.68 "," $8,278.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,115.89 ", Not Applicable , Not Applicable ," $8,115.89 "," $8,521.68 ", Not Applicable
,58925,HCPCS,Removal of ovarian cyst(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,58970,HCPCS,Retrieval of oocyte,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , $757.92 , Not Applicable , Not Applicable , $795.81 , $773.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , $757.92 , $795.81 , Not Applicable
,58974,HCPCS,Transfer of embryo,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , $757.92 , Not Applicable , Not Applicable , $795.81 , $773.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , $757.92 , $795.81 , Not Applicable
,58976,HCPCS,Transfer of embryo,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,58999,HCPCS,Genital surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,59000,HCPCS,Amniocentesis diagnostic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , $757.92 , Not Applicable , Not Applicable , $795.81 , $773.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , $757.92 , $795.81 , Not Applicable
,59001,HCPCS,Amniocentesis therapeutic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,59012,HCPCS,Fetal cord puncture prenatal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,59015,HCPCS,Chorion biopsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , $757.92 , Not Applicable , Not Applicable , $795.81 , $773.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $757.92 , Not Applicable , Not Applicable , $757.92 , $795.81 , Not Applicable
,59020,HCPCS,Fetal contract stress test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,59025,HCPCS,Fetal non-stress test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,59030,HCPCS,Fetal scalp blood sample,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,59070,HCPCS,Transabdom amnioinfus w/us,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,59072,HCPCS,Umbilical cord occlud w/us,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,59074,HCPCS,Fetal fluid drainage w/us,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,59076,HCPCS,Fetal shunt placement w/us,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,59100,HCPCS,Remove uterus lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,59150,HCPCS,Treat ectopic pregnancy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,59151,HCPCS,Treat ectopic pregnancy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,59160,HCPCS,D & c after delivery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,59200,HCPCS,Insert cervical dilator,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,59300,HCPCS,Episiotomy or vaginal repair,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,59320,HCPCS,Revision of cervix,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,59409,HCPCS,Obstetrical care,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,59412,HCPCS,Antepartum manipulation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,59414,HCPCS,Deliver placenta,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,59612,HCPCS,Vbac delivery only,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,59812,HCPCS,Treatment of miscarriage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,59820,HCPCS,Care of miscarriage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,59821,HCPCS,Treatment of miscarriage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,59840,HCPCS,Abortion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,59841,HCPCS,Abortion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,59866,HCPCS,Abortion (mpr),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , $337.17 , Not Applicable , Not Applicable , $354.03 , $343.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $337.17 , Not Applicable , Not Applicable , $337.17 , $354.03 , Not Applicable
,59870,HCPCS,Evacuate mole of uterus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,59871,HCPCS,Remove cerclage suture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 "," $3,136.64 ", Not Applicable , Not Applicable ," $3,293.47 "," $3,199.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,136.64 ", Not Applicable , Not Applicable ," $3,136.64 "," $3,293.47 ", Not Applicable
,59897,HCPCS,Fetal invas px w/us,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,59898,HCPCS,Laparo proc ob care/deliver,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,59899,HCPCS,Maternity care procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,60000,HCPCS,Drain thyroid/tongue cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,60100,HCPCS,Biopsy of thyroid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,60200,HCPCS,Remove thyroid lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,60210,HCPCS,Partial thyroid excision,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,60212,HCPCS,Partial thyroid excision,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,60220,HCPCS,Partial removal of thyroid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,60225,HCPCS,Partial removal of thyroid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,60240,HCPCS,Removal of thyroid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,60252,HCPCS,Removal of thyroid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,60260,HCPCS,Repeat thyroid surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,60271,HCPCS,Removal of thyroid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,60280,HCPCS,Remove thyroid duct lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,60281,HCPCS,Remove thyroid duct lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,60300,HCPCS,Aspir/inj thyroid cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,60500,HCPCS,Explore parathyroid glands,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,60502,HCPCS,Re-explore parathyroids,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,60520,HCPCS,Removal of thymus gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,60659,HCPCS,Laparo proc endocrine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,60699,HCPCS,Endocrine surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 "," $6,049.19 ", Not Applicable , Not Applicable ," $6,351.65 "," $6,170.18 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,049.19 ", Not Applicable , Not Applicable ," $6,049.19 "," $6,351.65 ", Not Applicable
,61000,HCPCS,Remove cranial cavity fluid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,61001,HCPCS,Remove cranial cavity fluid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,61020,HCPCS,Remove brain cavity fluid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,61026,HCPCS,Injection into brain canal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,61050,HCPCS,Remove brain canal fluid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,61055,HCPCS,Injection into brain canal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,61070,HCPCS,Brain canal shunt procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,61215,HCPCS,Insert brain-fluid device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,61330,HCPCS,Decompress eye socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,61623,HCPCS,Endovasc tempory vessel occl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,61626,HCPCS,Transcath occlusion non-cns,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,61720,HCPCS,Incise skull/brain surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,61770,HCPCS,Incise skull for treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,61790,HCPCS,Treat trigeminal nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,61791,HCPCS,Treat trigeminal tract,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,61880,HCPCS,Revise/remove neuroelectrode,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,61885,HCPCS,Insrt/redo neurostim 1 array,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $24,479.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,479.81 "," $24,479.81 ", Not Applicable , Not Applicable ," $25,703.80 "," $24,969.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,479.81 ", Not Applicable , Not Applicable ," $24,479.81 "," $25,703.80 ", Not Applicable
,61886,HCPCS,Implant neurostim arrays,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 "," $35,191.71 ", Not Applicable , Not Applicable ," $36,951.29 "," $35,895.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable ," $35,191.71 "," $36,951.29 ", Not Applicable
,61888,HCPCS,Revise/remove neuroreceiver,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 "," $13,442.21 ", Not Applicable , Not Applicable ," $14,114.33 "," $13,711.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable ," $13,442.21 "," $14,114.33 ", Not Applicable
,62000,HCPCS,Treat skull fracture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,62194,HCPCS,Replace/irrigate catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,62225,HCPCS,Replace/irrigate catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,62230,HCPCS,Replace/revise brain shunt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,62252,HCPCS,Csf shunt reprogram,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , $326.43 , Not Applicable , Not Applicable , $342.75 , $332.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , $326.43 , $342.75 , Not Applicable
,62263,HCPCS,Epidural lysis mult sessions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,62264,HCPCS,Epidural lysis on single day,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,62267,HCPCS,Interdiscal perq aspir dx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,62268,HCPCS,Drain spinal cord cyst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,62269,HCPCS,Needle biopsy spinal cord,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,62270,HCPCS,Dx lmbr spi pnxr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,62272,HCPCS,Ther spi pnxr drg csf,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,62273,HCPCS,Inject epidural patch,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,62280,HCPCS,Treat spinal cord lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,62281,HCPCS,Treat spinal cord lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,62282,HCPCS,Treat spinal canal lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,62287,HCPCS,Dcmprn px perq 1/mlt lumbar,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,62292,HCPCS,Njx chemonucleolysis lmbr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,62294,HCPCS,Injection into spinal artery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,62302,HCPCS,Myelography lumbar injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,62303,HCPCS,Myelography lumbar injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,62304,HCPCS,Myelography lumbar injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,62305,HCPCS,Myelography lumbar injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,62320,HCPCS,Njx interlaminar crv/thrc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,62321,HCPCS,Njx interlaminar crv/thrc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,62322,HCPCS,Njx interlaminar lmbr/sac,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,62323,HCPCS,Njx interlaminar lmbr/sac,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,62324,HCPCS,Njx interlaminar crv/thrc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,62325,HCPCS,Njx interlaminar crv/thrc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,62326,HCPCS,Njx interlaminar lmbr/sac,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,62327,HCPCS,Njx interlaminar lmbr/sac,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,62328,HCPCS,Dx lmbr spi pnxr w/fluor/ct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,62329,HCPCS,Ther spi pnxr csf fluor/ct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,62350,HCPCS,Implant spinal canal cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,62351,HCPCS,Implant spinal canal cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,62355,HCPCS,Remove spinal canal catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,62360,HCPCS,Insert spine infusion device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $20,374.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,374.31 "," $20,374.31 ", Not Applicable , Not Applicable ," $21,393.02 "," $20,781.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,374.31 ", Not Applicable , Not Applicable ," $20,374.31 "," $21,393.02 ", Not Applicable
,62361,HCPCS,Implant spine infusion pump,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $20,374.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,374.31 "," $20,374.31 ", Not Applicable , Not Applicable ," $21,393.02 "," $20,781.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,374.31 ", Not Applicable , Not Applicable ," $20,374.31 "," $21,393.02 ", Not Applicable
,62362,HCPCS,Implant spine infusion pump,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $20,374.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,374.31 "," $20,374.31 ", Not Applicable , Not Applicable ," $21,393.02 "," $20,781.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,374.31 ", Not Applicable , Not Applicable ," $20,374.31 "," $21,393.02 ", Not Applicable
,62365,HCPCS,Remove spine infusion device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,62367,HCPCS,Analyze spine infus pump,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , $326.43 , Not Applicable , Not Applicable , $342.75 , $332.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , $326.43 , $342.75 , Not Applicable
,62368,HCPCS,Analyze sp inf pump w/reprog,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , $326.43 , Not Applicable , Not Applicable , $342.75 , $332.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , $326.43 , $342.75 , Not Applicable
,62369,HCPCS,Anal sp inf pmp w/reprg&fill,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , $326.43 , Not Applicable , Not Applicable , $342.75 , $332.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , $326.43 , $342.75 , Not Applicable
,62370,HCPCS,Anl sp inf pmp w/mdreprg&fil,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , $326.43 , Not Applicable , Not Applicable , $342.75 , $332.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , $326.43 , $342.75 , Not Applicable
,62380,HCPCS,Ndsc dcmprn 1 ntrspc lumbar,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63001,HCPCS,Remove spine lamina 1/2 crvl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63003,HCPCS,Remove spine lamina 1/2 thrc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63005,HCPCS,Remove spine lamina 1/2 lmbr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63011,HCPCS,Remove spine lamina 1/2 scrl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63012,HCPCS,Remove lamina/facets lumbar,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63015,HCPCS,Remove spine lamina >2 crvcl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63016,HCPCS,Remove spine lamina >2 thrc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63017,HCPCS,Remove spine lamina >2 lmbr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63020,HCPCS,Neck spine disk surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63030,HCPCS,Low back disk surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63040,HCPCS,Laminotomy single cervical,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63042,HCPCS,Laminotomy single lumbar,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63045,HCPCS,Lam facetec & foramot crv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63046,HCPCS,Lam facetec & foramot thrc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63047,HCPCS,Lam facetec & foramot lumbar,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63055,HCPCS,Decompress spinal cord thrc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63056,HCPCS,Decompress spinal cord lmbr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63064,HCPCS,Decompress spinal cord thrc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63075,HCPCS,Neck spine disk surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63265,HCPCS,Excise intraspinl lesion crv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63266,HCPCS,Excise intrspinl lesion thrc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63267,HCPCS,Excise intrspinl lesion lmbr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63268,HCPCS,Excise intrspinl lesion scrl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,63600,HCPCS,Remove spinal cord lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,63610,HCPCS,Stimulation of spinal cord,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,63650,HCPCS,Implant neuroelectrodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,369.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,369.33 "," $7,369.33 ", Not Applicable , Not Applicable ," $7,737.79 "," $7,516.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,369.33 ", Not Applicable , Not Applicable ," $7,369.33 "," $7,737.79 ", Not Applicable
,63655,HCPCS,Implant neuroelectrodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $24,479.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,479.81 "," $24,479.81 ", Not Applicable , Not Applicable ," $25,703.80 "," $24,969.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,479.81 ", Not Applicable , Not Applicable ," $24,479.81 "," $25,703.80 ", Not Applicable
,63661,HCPCS,Remove spine eltrd perq aray,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,63662,HCPCS,Remove spine eltrd plate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,63663,HCPCS,Revise spine eltrd perq aray,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,369.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,369.33 "," $7,369.33 ", Not Applicable , Not Applicable ," $7,737.79 "," $7,516.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,369.33 ", Not Applicable , Not Applicable ," $7,369.33 "," $7,737.79 ", Not Applicable
,63664,HCPCS,Revise spine eltrd plate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 "," $13,442.21 ", Not Applicable , Not Applicable ," $14,114.33 "," $13,711.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable ," $13,442.21 "," $14,114.33 ", Not Applicable
,63685,HCPCS,Insrt/redo spine n generator,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 "," $35,191.71 ", Not Applicable , Not Applicable ," $36,951.29 "," $35,895.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable ," $35,191.71 "," $36,951.29 ", Not Applicable
,63688,HCPCS,Revise/remove neuroreceiver,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,63741,HCPCS,Install spinal shunt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,63744,HCPCS,Revision of spinal shunt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,63746,HCPCS,Removal of spinal shunt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64400,HCPCS,Njx aa&/strd trigeminal nrv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,64405,HCPCS,Njx aa&/strd gr ocpl nrv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,64408,HCPCS,Njx aa&/strd vagus nrv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,64415,HCPCS,Njx aa&/strd brach plexus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64416,HCPCS,Njx aa&/strd brach plex nfs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64417,HCPCS,Njx aa&/strd axillary nrv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64418,HCPCS,Njx aa&/strd sprscap nrv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,64420,HCPCS,Njx aa&/strd ntrcost nrv 1,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,64421,HCPCS,Njx aa&/strd ntrcost nrv ea,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64425,HCPCS,Njx aa&/strd ii ih nerves,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,64430,HCPCS,Njx aa&/strd pudendal nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64435,HCPCS,Njx aa&/strd paracrv nrv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,64445,HCPCS,Njx aa&/strd sciatic nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,64446,HCPCS,Njx aa&/strd sciatic nrv nfs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64447,HCPCS,Njx aa&/strd femoral nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,64448,HCPCS,Njx aa&/strd fem nerve nfs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64449,HCPCS,Njx aa&/strd lmbr plex nfs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64450,HCPCS,Njx aa&/strd other pn/branch,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,64451,HCPCS,Njx aa&/strd nrv nrvtg si jt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,64454,HCPCS,Njx aa&/strd gnclr nrv brnch,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,64455,HCPCS,Njx aa&/strd pltr com dg nrv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,64461,HCPCS,Pvb thoracic single inj site,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,64463,HCPCS,Pvb thoracic cont infusion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,64479,HCPCS,Njx aa&/strd tfrm epi c/t 1,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64483,HCPCS,Njx aa&/strd tfrm epi l/s 1,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64490,HCPCS,Inj paravert f jnt c/t 1 lev,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64493,HCPCS,Inj paravert f jnt l/s 1 lev,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64505,HCPCS,N block spenopalatine gangl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,64510,HCPCS,N block stellate ganglion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64517,HCPCS,N block inj hypogas plxs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64520,HCPCS,N block lumbar/thoracic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64530,HCPCS,N block inj celiac pelus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64553,HCPCS,Implant neuroelectrodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 "," $13,442.21 ", Not Applicable , Not Applicable ," $14,114.33 "," $13,711.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable ," $13,442.21 "," $14,114.33 ", Not Applicable
,64555,HCPCS,Implant neuroelectrodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,369.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,369.33 "," $7,369.33 ", Not Applicable , Not Applicable ," $7,737.79 "," $7,516.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,369.33 ", Not Applicable , Not Applicable ," $7,369.33 "," $7,737.79 ", Not Applicable
,64561,HCPCS,Implant neuroelectrodes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,369.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,369.33 "," $7,369.33 ", Not Applicable , Not Applicable ," $7,737.79 "," $7,516.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,369.33 ", Not Applicable , Not Applicable ," $7,369.33 "," $7,737.79 ", Not Applicable
,64566,HCPCS,Neuroeltrd stim post tibial,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,64568,HCPCS,Opn impltj crnl nrv nea&pg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 "," $35,191.71 ", Not Applicable , Not Applicable ," $36,951.29 "," $35,895.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable ," $35,191.71 "," $36,951.29 ", Not Applicable
,64569,HCPCS,Revise/repl vagus n eltrd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 "," $13,442.21 ", Not Applicable , Not Applicable ," $14,114.33 "," $13,711.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable ," $13,442.21 "," $14,114.33 ", Not Applicable
,64570,HCPCS,Remove vagus n eltrd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64575,HCPCS,Opn impltj nea perph nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 "," $13,442.21 ", Not Applicable , Not Applicable ," $14,114.33 "," $13,711.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable ," $13,442.21 "," $14,114.33 ", Not Applicable
,64580,HCPCS,Opn impltj nea neuromuscular,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $24,479.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,479.81 "," $24,479.81 ", Not Applicable , Not Applicable ," $25,703.80 "," $24,969.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,479.81 ", Not Applicable , Not Applicable ," $24,479.81 "," $25,703.80 ", Not Applicable
,64581,HCPCS,Opn impltj nea sacral nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,369.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,369.33 "," $7,369.33 ", Not Applicable , Not Applicable ," $7,737.79 "," $7,516.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,369.33 ", Not Applicable , Not Applicable ," $7,369.33 "," $7,737.79 ", Not Applicable
,64582,HCPCS,Opn mpltj hpglsl nstm ary pg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 "," $35,191.71 ", Not Applicable , Not Applicable ," $36,951.29 "," $35,895.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $35,191.71 ", Not Applicable , Not Applicable ," $35,191.71 "," $36,951.29 ", Not Applicable
,64583,HCPCS,Rev/rplct hpglsl nstm ary pg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 "," $13,442.21 ", Not Applicable , Not Applicable ," $14,114.33 "," $13,711.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $13,442.21 ", Not Applicable , Not Applicable ," $13,442.21 "," $14,114.33 ", Not Applicable
,64584,HCPCS,Rmvl hpglsl nstim ary pg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64585,HCPCS,Revise/remove neuroelectrode,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,64590,HCPCS,Insrt/redo pn/gastr stimul,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $24,479.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,479.81 "," $24,479.81 ", Not Applicable , Not Applicable ," $25,703.80 "," $24,969.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $24,479.81 ", Not Applicable , Not Applicable ," $24,479.81 "," $25,703.80 ", Not Applicable
,64595,HCPCS,Revise/rmv pn/gastr stimul,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 "," $3,916.44 ", Not Applicable , Not Applicable ," $4,112.27 "," $3,994.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,916.44 ", Not Applicable , Not Applicable ," $3,916.44 "," $4,112.27 ", Not Applicable
,64600,HCPCS,Injection treatment of nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64605,HCPCS,Injection treatment of nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64610,HCPCS,Injection treatment of nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64611,HCPCS,Chemodenerv saliv glands,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,64612,HCPCS,Destroy nerve face muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,64615,HCPCS,Chemodenerv musc migraine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,64616,HCPCS,Chemodenerv musc neck dyston,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,64617,HCPCS,Chemodener muscle larynx emg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,64620,HCPCS,Injection treatment of nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64624,HCPCS,Dstrj nulyt agt gnclr nrv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64625,HCPCS,Rf abltj nrv nrvtg si jt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64628,HCPCS,Trml dstrj ios bvn 1st 2 l/s,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,64630,HCPCS,Injection treatment of nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64632,HCPCS,N block inj common digit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,64633,HCPCS,Destroy cerv/thor facet jnt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64635,HCPCS,Destroy lumb/sac facet jnt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64640,HCPCS,Injection treatment of nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64642,HCPCS,Chemodenerv 1 extremity 1-4,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,64644,HCPCS,Chemodenerv 1 extrem 5/> mus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,64646,HCPCS,Chemodenerv trunk musc 1-5,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,64647,HCPCS,Chemodenerv trunk musc 6/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,64650,HCPCS,Chemodenerv eccrine glands,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,64653,HCPCS,Chemodenerv eccrine glands,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,64680,HCPCS,Injection treatment of nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64681,HCPCS,Injection treatment of nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , $984.14 , Not Applicable , Not Applicable ," $1,033.35 "," $1,003.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , $984.14 , Not Applicable , Not Applicable , $984.14 ," $1,033.35 ", Not Applicable
,64702,HCPCS,Revise finger/toe nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64704,HCPCS,Revise hand/foot nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64708,HCPCS,Revise arm/leg nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64712,HCPCS,Revision of sciatic nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64713,HCPCS,Revision of arm nerve(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64714,HCPCS,Revise low back nerve(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64716,HCPCS,Revision of cranial nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64718,HCPCS,Revise ulnar nerve at elbow,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64719,HCPCS,Revise ulnar nerve at wrist,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64721,HCPCS,Carpal tunnel surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64722,HCPCS,Relieve pressure on nerve(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64726,HCPCS,Release foot/toe nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64732,HCPCS,Incision of brow nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64734,HCPCS,Incision of cheek nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64736,HCPCS,Incision of chin nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64738,HCPCS,Incision of jaw nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64740,HCPCS,Incision of tongue nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64742,HCPCS,Incision of facial nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64744,HCPCS,Incise nerve back of head,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64746,HCPCS,Incise diaphragm nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64763,HCPCS,Incise hip/thigh nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64766,HCPCS,Incise hip/thigh nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64771,HCPCS,Sever cranial nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64772,HCPCS,Incision of spinal nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64774,HCPCS,Remove skin nerve lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64776,HCPCS,Remove digit nerve lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64782,HCPCS,Remove limb nerve lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64784,HCPCS,Remove nerve lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64786,HCPCS,Remove sciatic nerve lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64788,HCPCS,Remove skin nerve lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64790,HCPCS,Removal of nerve lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64792,HCPCS,Removal of nerve lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64795,HCPCS,Biopsy of nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64802,HCPCS,Sympathectomy cervical,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64804,HCPCS,Remove sympathetic nerves,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64820,HCPCS,Sympathectomy digital artery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64821,HCPCS,Remove sympathetic nerves,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,64822,HCPCS,Remove sympathetic nerves,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,64823,HCPCS,Sympathectomy supfc palmar,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,64831,HCPCS,Repair of digit nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64834,HCPCS,Repair of hand or foot nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64835,HCPCS,Repair of hand or foot nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64836,HCPCS,Repair of hand or foot nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64840,HCPCS,Repair of leg nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64856,HCPCS,Repair/transpose nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64857,HCPCS,Repair arm/leg nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64858,HCPCS,Repair sciatic nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64861,HCPCS,Repair of arm nerves,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,64862,HCPCS,Repair of low back nerves,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64864,HCPCS,Repair of facial nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64865,HCPCS,Repair of facial nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64885,HCPCS,Nerve graft head/neck 4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64886,HCPCS,Nerve graft head/neck >4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64890,HCPCS,Nerve graft hand/foot 4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64891,HCPCS,Nerve graft hand/foot >4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64892,HCPCS,Nerve graft arm/leg <4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64893,HCPCS,Nerve graft arm/leg >4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64895,HCPCS,Nerve graft hand/foot 4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64896,HCPCS,Nerve graft hand/foot >4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64897,HCPCS,Nerve graft arm/leg 4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64898,HCPCS,Nerve graft arm/leg >4 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64905,HCPCS,Nerve pedicle transfer,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64907,HCPCS,Nerve pedicle transfer,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64910,HCPCS,Nerve repair w/allograft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64911,HCPCS,Neurorraphy w/vein autograft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64912,HCPCS,Nrv rpr w/nrv algrft 1st,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 "," $6,817.40 ", Not Applicable , Not Applicable ," $7,158.27 "," $6,953.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,817.40 ", Not Applicable , Not Applicable ," $6,817.40 "," $7,158.27 ", Not Applicable
,64999,HCPCS,Nervous system surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,65091,HCPCS,Revise eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65093,HCPCS,Revise eye with implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65101,HCPCS,Removal of eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65103,HCPCS,Remove eye/insert implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65105,HCPCS,Remove eye/attach implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65110,HCPCS,Removal of eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65112,HCPCS,Remove eye/revise socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65114,HCPCS,Remove eye/revise socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65125,HCPCS,Revise ocular implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,65130,HCPCS,Insert ocular implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65135,HCPCS,Insert ocular implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65140,HCPCS,Attach ocular implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65150,HCPCS,Revise ocular implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65155,HCPCS,Reinsert ocular implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65175,HCPCS,Removal of ocular implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65205,HCPCS,Remove foreign body from eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,65210,HCPCS,Remove foreign body from eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,65220,HCPCS,Remove foreign body from eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,65222,HCPCS,Remove foreign body from eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,65235,HCPCS,Remove foreign body from eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,65260,HCPCS,Remove foreign body from eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,65265,HCPCS,Remove foreign body from eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,65270,HCPCS,Repair of eye wound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,65272,HCPCS,Repair of eye wound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,65275,HCPCS,Repair of eye wound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65280,HCPCS,Repair of eye wound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,65285,HCPCS,Repair of eye wound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,65286,HCPCS,Repair of eye wound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,65290,HCPCS,Repair of eye socket wound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65400,HCPCS,Removal of eye lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , $968.14 , Not Applicable , Not Applicable ," $1,016.55 ", $987.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , $968.14 ," $1,016.55 ", Not Applicable
,65410,HCPCS,Biopsy of cornea,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,65420,HCPCS,Removal of eye lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,65426,HCPCS,Removal of eye lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,65430,HCPCS,Corneal smear,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,65435,HCPCS,Curette/treat cornea,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , $968.14 , Not Applicable , Not Applicable ," $1,016.55 ", $987.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , $968.14 ," $1,016.55 ", Not Applicable
,65436,HCPCS,Curette/treat cornea,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,65450,HCPCS,Treatment of corneal lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,65600,HCPCS,Revision of cornea,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,65710,HCPCS,Corneal transplant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,65730,HCPCS,Corneal transplant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,65750,HCPCS,Corneal transplant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,65755,HCPCS,Corneal transplant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,65756,HCPCS,Corneal trnspl endothelial,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,65770,HCPCS,Revise cornea with implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $8,772.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,772.63 "," $8,772.63 ", Not Applicable , Not Applicable ," $9,211.26 "," $8,948.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $8,772.63 ", Not Applicable , Not Applicable ," $8,772.63 "," $9,211.26 ", Not Applicable
,65772,HCPCS,Correction of astigmatism,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , $968.14 , Not Applicable , Not Applicable ," $1,016.55 ", $987.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , $968.14 ," $1,016.55 ", Not Applicable
,65775,HCPCS,Correction of astigmatism,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,65778,HCPCS,Cover eye w/membrane,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , $968.14 , Not Applicable , Not Applicable ," $1,016.55 ", $987.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , $968.14 ," $1,016.55 ", Not Applicable
,65779,HCPCS,Cover eye w/membrane suture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65780,HCPCS,Ocular reconst transplant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65781,HCPCS,Ocular reconst transplant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,65782,HCPCS,Ocular reconst transplant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,65785,HCPCS,Impltj ntrstrml crnl rng seg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,65800,HCPCS,Drainage of eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,65810,HCPCS,Drainage of eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,65815,HCPCS,Drainage of eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,65820,HCPCS,Relieve inner eye pressure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,65850,HCPCS,Incision of eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,65855,HCPCS,Trabeculoplasty laser surg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , $601.65 , Not Applicable , Not Applicable , $631.74 , $613.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , $601.65 , $631.74 , Not Applicable
,65860,HCPCS,Incise inner eye adhesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , $601.65 , Not Applicable , Not Applicable , $631.74 , $613.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , $601.65 , $631.74 , Not Applicable
,65865,HCPCS,Incise inner eye adhesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,65870,HCPCS,Incise inner eye adhesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,65875,HCPCS,Incise inner eye adhesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,65880,HCPCS,Incise inner eye adhesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,65900,HCPCS,Remove eye lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,65920,HCPCS,Remove implant of eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,65930,HCPCS,Remove blood clot from eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66020,HCPCS,Injection treatment of eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66030,HCPCS,Injection treatment of eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66130,HCPCS,Remove eye lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,66150,HCPCS,Glaucoma surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,66155,HCPCS,Glaucoma surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,66160,HCPCS,Glaucoma surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66170,HCPCS,Glaucoma surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66172,HCPCS,Incision of eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66174,HCPCS,Translum dil eye canal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,66175,HCPCS,Trnslum dil eye canal w/stnt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,66179,HCPCS,Aqueous shunt eye w/o graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,66180,HCPCS,Aqueous shunt eye w/graft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,66183,HCPCS,Insert ant drainage device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,66184,HCPCS,Revision of aqueous shunt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66185,HCPCS,Revise aqueous shunt eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66225,HCPCS,Repair/graft eye lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,66250,HCPCS,Follow-up surgery of eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,66500,HCPCS,Incision of iris,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66505,HCPCS,Incision of iris,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66600,HCPCS,Remove iris and lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,66605,HCPCS,Removal of iris,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66625,HCPCS,Removal of iris,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66630,HCPCS,Removal of iris,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66635,HCPCS,Removal of iris,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66680,HCPCS,Repair iris & ciliary body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66682,HCPCS,Repair iris & ciliary body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66700,HCPCS,Destruction ciliary body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66710,HCPCS,Ciliary transsleral therapy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,66711,HCPCS,Ecp ciliary body destruction,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66720,HCPCS,Destruction ciliary body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,66740,HCPCS,Destruction ciliary body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,66761,HCPCS,Revision of iris,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , $601.65 , Not Applicable , Not Applicable , $631.74 , $613.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , $601.65 , $631.74 , Not Applicable
,66762,HCPCS,Revision of iris,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , $601.65 , Not Applicable , Not Applicable , $631.74 , $613.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , $601.65 , $631.74 , Not Applicable
,66770,HCPCS,Removal of inner eye lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , $601.65 , Not Applicable , Not Applicable , $631.74 , $613.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , $601.65 , $631.74 , Not Applicable
,66820,HCPCS,Incision secondary cataract,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66821,HCPCS,After cataract laser surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , $601.65 , Not Applicable , Not Applicable , $631.74 , $613.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , $601.65 , $631.74 , Not Applicable
,66825,HCPCS,Reposition intraocular lens,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66830,HCPCS,Removal of lens lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66840,HCPCS,Removal of lens material,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66850,HCPCS,Removal of lens material,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66852,HCPCS,Removal of lens material,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,66920,HCPCS,Extraction of lens,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66930,HCPCS,Extraction of lens,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,66940,HCPCS,Extraction of lens,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66982,HCPCS,Xcapsl ctrc rmvl cplx wo ecp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66983,HCPCS,Cataract surg w/iol 1 stage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66984,HCPCS,Xcapsl ctrc rmvl w/o ecp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66985,HCPCS,Insert lens prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66986,HCPCS,Exchange lens prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,66987,HCPCS,Xcapsl ctrc rmvl cplx w/ecp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,66988,HCPCS,Xcapsl ctrc rmvl w/ecp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,66989,HCPCS,Xcpsl ctrc rmvl cplx insj 1+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,975.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,975.55 "," $4,975.55 ", Not Applicable , Not Applicable ," $5,224.33 "," $5,075.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,975.55 ", Not Applicable , Not Applicable ," $4,975.55 "," $5,224.33 ", Not Applicable
,66991,HCPCS,Xcapsl ctrc rmvl insj 1+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,975.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,975.55 "," $4,975.55 ", Not Applicable , Not Applicable ," $5,224.33 "," $5,075.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,975.55 ", Not Applicable , Not Applicable ," $4,975.55 "," $5,224.33 ", Not Applicable
,66999,HCPCS,Eye surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,67005,HCPCS,Partial removal of eye fluid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,67010,HCPCS,Partial removal of eye fluid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,67015,HCPCS,Release of eye fluid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,67025,HCPCS,Replace eye fluid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,67027,HCPCS,Implant eye drug system,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,964.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,964.21 "," $19,964.21 ", Not Applicable , Not Applicable ," $20,962.42 "," $20,363.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,964.21 ", Not Applicable , Not Applicable ," $19,964.21 "," $20,962.42 ", Not Applicable
,67028,HCPCS,Injection eye drug,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,67030,HCPCS,Incise inner eye strands,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,67031,HCPCS,Laser surgery eye strands,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , $601.65 , Not Applicable , Not Applicable , $631.74 , $613.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , $601.65 , $631.74 , Not Applicable
,67036,HCPCS,Removal of inner eye fluid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,67039,HCPCS,Laser treatment of retina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,67040,HCPCS,Laser treatment of retina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,67041,HCPCS,Vit for macular pucker,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,67042,HCPCS,Vit for macular hole,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,67043,HCPCS,Vit for membrane dissect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,67101,HCPCS,Repair detached retina crtx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,67105,HCPCS,Repair detached retina pc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , $601.65 , Not Applicable , Not Applicable , $631.74 , $613.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , $601.65 , $631.74 , Not Applicable
,67107,HCPCS,Repair detached retina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,67108,HCPCS,Repair detached retina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,67110,HCPCS,Repair detached retina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,67113,HCPCS,Repair retinal detach cplx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,67115,HCPCS,Release encircling material,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 "," $4,681.84 ", Not Applicable , Not Applicable ," $4,915.93 "," $4,775.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,681.84 ", Not Applicable , Not Applicable ," $4,681.84 "," $4,915.93 ", Not Applicable
,67120,HCPCS,Remove eye implant material,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,67121,HCPCS,Remove eye implant material,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,67141,HCPCS,Proph rta dtchmnt crtx dthrm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,67145,HCPCS,Proph rta dtchmnt pc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , $601.65 , Not Applicable , Not Applicable , $631.74 , $613.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , $601.65 , $631.74 , Not Applicable
,67208,HCPCS,Treatment of retinal lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,67210,HCPCS,Treatment of retinal lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , $601.65 , Not Applicable , Not Applicable , $631.74 , $613.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , $601.65 , $631.74 , Not Applicable
,67218,HCPCS,Treatment of retinal lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67220,HCPCS,Treatment of choroid lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , $601.65 , Not Applicable , Not Applicable , $631.74 , $613.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , $601.65 , $631.74 , Not Applicable
,67221,HCPCS,Ocular photodynamic ther,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , $601.65 , Not Applicable , Not Applicable , $631.74 , $613.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , $601.65 , $631.74 , Not Applicable
,67227,HCPCS,Dstrj extensive retinopathy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67228,HCPCS,Treatment x10sv retinopathy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , $601.65 , Not Applicable , Not Applicable , $631.74 , $613.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , $601.65 , $631.74 , Not Applicable
,67229,HCPCS,Tr retinal les preterm inf,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , $601.65 , Not Applicable , Not Applicable , $631.74 , $613.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , $601.65 , $631.74 , Not Applicable
,67250,HCPCS,Reinforce eye wall,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67255,HCPCS,Reinforce/graft eye wall,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,67299,HCPCS,Eye surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,67311,HCPCS,Revise eye muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67312,HCPCS,Revise two eye muscles,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67314,HCPCS,Revise eye muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67316,HCPCS,Revise two eye muscles,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67318,HCPCS,Revise eye muscle(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67343,HCPCS,Release eye tissue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67345,HCPCS,Destroy nerve of eye muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,67346,HCPCS,Biopsy eye muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67399,HCPCS,Unlisted px extraocular musc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,67400,HCPCS,Explore/biopsy eye socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67405,HCPCS,Explore/drain eye socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67412,HCPCS,Explore/treat eye socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67413,HCPCS,Explore/treat eye socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67414,HCPCS,Explr/decompress eye socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67415,HCPCS,Aspiration orbital contents,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67420,HCPCS,Explore/treat eye socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67430,HCPCS,Explore/treat eye socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67440,HCPCS,Explore/drain eye socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67445,HCPCS,Explr/decompress eye socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67450,HCPCS,Explore/biopsy eye socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67500,HCPCS,Inject/treat eye socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,67505,HCPCS,Inject/treat eye socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,67515,HCPCS,Inject/treat eye socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,67550,HCPCS,Insert eye socket implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67560,HCPCS,Revise eye socket implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67570,HCPCS,Decompress optic nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67599,HCPCS,Orbit surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,67700,HCPCS,Drainage of eyelid abscess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,67710,HCPCS,Incision of eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , $968.14 , Not Applicable , Not Applicable ," $1,016.55 ", $987.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , $968.14 ," $1,016.55 ", Not Applicable
,67715,HCPCS,Incision of eyelid fold,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67800,HCPCS,Remove eyelid lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,67801,HCPCS,Remove eyelid lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , $968.14 , Not Applicable , Not Applicable ," $1,016.55 ", $987.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , $968.14 ," $1,016.55 ", Not Applicable
,67805,HCPCS,Remove eyelid lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,67808,HCPCS,Remove eyelid lesion(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67810,HCPCS,Biopsy eyelid & lid margin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,67820,HCPCS,Revise eyelashes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,67825,HCPCS,Revise eyelashes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,67830,HCPCS,Revise eyelashes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , $968.14 , Not Applicable , Not Applicable ," $1,016.55 ", $987.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , $968.14 ," $1,016.55 ", Not Applicable
,67835,HCPCS,Revise eyelashes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67840,HCPCS,Remove eyelid lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , $968.14 , Not Applicable , Not Applicable ," $1,016.55 ", $987.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , $968.14 ," $1,016.55 ", Not Applicable
,67850,HCPCS,Treat eyelid lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , $968.14 , Not Applicable , Not Applicable ," $1,016.55 ", $987.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , $968.14 ," $1,016.55 ", Not Applicable
,67875,HCPCS,Closure of eyelid by suture,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , $968.14 , Not Applicable , Not Applicable ," $1,016.55 ", $987.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , $968.14 ," $1,016.55 ", Not Applicable
,67880,HCPCS,Revision of eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67882,HCPCS,Revision of eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67900,HCPCS,Repair brow defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67901,HCPCS,Repair eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67902,HCPCS,Repair eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67903,HCPCS,Repair eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67904,HCPCS,Repair eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67906,HCPCS,Repair eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67908,HCPCS,Repair eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67909,HCPCS,Revise eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67911,HCPCS,Revise eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67912,HCPCS,Correction eyelid w/implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67914,HCPCS,Repair eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67915,HCPCS,Repair eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67916,HCPCS,Repair eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67917,HCPCS,Repair eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67921,HCPCS,Repair eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67922,HCPCS,Repair eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67923,HCPCS,Repair eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67924,HCPCS,Repair eyelid defect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67930,HCPCS,Repair eyelid wound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67935,HCPCS,Repair eyelid wound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67938,HCPCS,Remove eyelid foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,67950,HCPCS,Revision of eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67961,HCPCS,Revision of eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67966,HCPCS,Revision of eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67971,HCPCS,Reconstruction of eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67973,HCPCS,Reconstruction of eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67974,HCPCS,Reconstruction of eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,67975,HCPCS,Reconstruction of eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,67999,HCPCS,Revision of eyelid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,68020,HCPCS,Incise/drain eyelid lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , $968.14 , Not Applicable , Not Applicable ," $1,016.55 ", $987.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , $968.14 ," $1,016.55 ", Not Applicable
,68040,HCPCS,Treatment of eyelid lesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,68100,HCPCS,Biopsy of eyelid lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68110,HCPCS,Remove eyelid lining lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68115,HCPCS,Remove eyelid lining lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68130,HCPCS,Remove eyelid lining lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68135,HCPCS,Remove eyelid lining lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68200,HCPCS,Treat eyelid by injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,68320,HCPCS,Revise/graft eyelid lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68325,HCPCS,Revise/graft eyelid lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,68326,HCPCS,Revise/graft eyelid lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,68328,HCPCS,Revise/graft eyelid lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68330,HCPCS,Revise eyelid lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 "," $2,482.64 ", Not Applicable , Not Applicable ," $2,606.77 "," $2,532.29 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,482.64 ", Not Applicable , Not Applicable ," $2,482.64 "," $2,606.77 ", Not Applicable
,68335,HCPCS,Revise/graft eyelid lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,68340,HCPCS,Separate eyelid adhesions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68360,HCPCS,Revise eyelid lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,68362,HCPCS,Revise eyelid lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68371,HCPCS,Harvest eye tissue alograft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68399,HCPCS,Eyelid lining surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,68400,HCPCS,Incise/drain tear gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , $968.14 , Not Applicable , Not Applicable ," $1,016.55 ", $987.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $968.14 , Not Applicable , Not Applicable , $968.14 ," $1,016.55 ", Not Applicable
,68420,HCPCS,Incise/drain tear sac,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68440,HCPCS,Incise tear duct opening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,68500,HCPCS,Removal of tear gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,68505,HCPCS,Partial removal tear gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,68510,HCPCS,Biopsy of tear gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68520,HCPCS,Removal of tear sac,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,68525,HCPCS,Biopsy of tear sac,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68530,HCPCS,Clearance of tear duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,68540,HCPCS,Remove tear gland lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68550,HCPCS,Remove tear gland lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,68700,HCPCS,Repair tear ducts,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68705,HCPCS,Revise tear duct opening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,68720,HCPCS,Create tear sac drain,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,68745,HCPCS,Create tear duct drain,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,68750,HCPCS,Create tear duct drain,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 "," $3,952.67 ", Not Applicable , Not Applicable ," $4,150.31 "," $4,031.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,952.67 ", Not Applicable , Not Applicable ," $3,952.67 "," $4,150.31 ", Not Applicable
,68760,HCPCS,Close tear duct opening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,68761,HCPCS,Close tear duct opening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,68770,HCPCS,Close tear system fistula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68801,HCPCS,Dilate tear duct opening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,68810,HCPCS,Probe nasolacrimal duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,68811,HCPCS,Probe nasolacrimal duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68815,HCPCS,Probe nasolacrimal duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68816,HCPCS,Probe nl duct w/balloon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,68840,HCPCS,Explore/irrigate tear ducts,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,68841,HCPCS,Insj rx elut implt lac canal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,68899,HCPCS,Tear duct system surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , $312.73 , Not Applicable , Not Applicable , $328.37 , $318.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.73 , Not Applicable , Not Applicable , $312.73 , $328.37 , Not Applicable
,69000,HCPCS,Drain external ear lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,69005,HCPCS,Drain external ear lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,69020,HCPCS,Drain outer ear canal lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , $743.95 , Not Applicable , Not Applicable , $781.15 , $758.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $743.95 , Not Applicable , Not Applicable , $743.95 , $781.15 , Not Applicable
,69100,HCPCS,Biopsy of external ear,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,69105,HCPCS,Biopsy of external ear canal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,69110,HCPCS,Remove external ear partial,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,69120,HCPCS,Removal of external ear,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69140,HCPCS,Remove ear canal lesion(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69145,HCPCS,Remove ear canal lesion(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 "," $2,834.62 ", Not Applicable , Not Applicable ," $2,976.35 "," $2,891.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,834.62 ", Not Applicable , Not Applicable ," $2,834.62 "," $2,976.35 ", Not Applicable
,69150,HCPCS,Extensive ear canal surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69200,HCPCS,Clear outer ear canal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,69205,HCPCS,Clear outer ear canal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 "," $1,682.11 ", Not Applicable , Not Applicable ," $1,766.22 "," $1,715.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,682.11 ", Not Applicable , Not Applicable ," $1,682.11 "," $1,766.22 ", Not Applicable
,69209,HCPCS,Remove impacted ear wax uni,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,69210,HCPCS,Remove impacted ear wax uni,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,69220,HCPCS,Clean out mastoid cavity,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,69222,HCPCS,Clean out mastoid cavity,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,69300,HCPCS,Revise external ear,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,69310,HCPCS,Rebuild outer ear canal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69320,HCPCS,Rebuild outer ear canal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69399,HCPCS,Outer ear surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,69420,HCPCS,Incision of eardrum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,69421,HCPCS,Incision of eardrum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,69424,HCPCS,Remove ventilating tube,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,69433,HCPCS,Create eardrum opening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,69436,HCPCS,Create eardrum opening,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,69440,HCPCS,Exploration of middle ear,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,69450,HCPCS,Eardrum revision,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,69501,HCPCS,Mastoidectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69502,HCPCS,Mastoidectomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69505,HCPCS,Remove mastoid structures,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69511,HCPCS,Extensive mastoid surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69530,HCPCS,Extensive mastoid surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69540,HCPCS,Remove ear lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,69550,HCPCS,Remove ear lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69552,HCPCS,Remove ear lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69601,HCPCS,Mastoid surgery revision,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69602,HCPCS,Mastoid surgery revision,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69603,HCPCS,Mastoid surgery revision,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69604,HCPCS,Mastoid surgery revision,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69610,HCPCS,Repair of eardrum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,69620,HCPCS,Repair of eardrum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,69631,HCPCS,Repair eardrum structures,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69632,HCPCS,Rebuild eardrum structures,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69633,HCPCS,Rebuild eardrum structures,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69635,HCPCS,Repair eardrum structures,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69636,HCPCS,Rebuild eardrum structures,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69637,HCPCS,Rebuild eardrum structures,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69641,HCPCS,Revise middle ear & mastoid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69642,HCPCS,Revise middle ear & mastoid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69643,HCPCS,Revise middle ear & mastoid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69644,HCPCS,Revise middle ear & mastoid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69645,HCPCS,Revise middle ear & mastoid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69646,HCPCS,Revise middle ear & mastoid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69650,HCPCS,Release middle ear bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,69660,HCPCS,Revise middle ear bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69661,HCPCS,Revise middle ear bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69662,HCPCS,Revise middle ear bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69666,HCPCS,Repair middle ear structures,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,69667,HCPCS,Repair middle ear structures,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,69670,HCPCS,Remove mastoid air cells,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69676,HCPCS,Remove middle ear nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,69700,HCPCS,Close mastoid fistula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,69705,HCPCS,Nps surg dilat eust tube uni,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69706,HCPCS,Nps surg dilat eust tube bi,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69711,HCPCS,Remove/repair hearing aid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,69714,HCPCS,Impltj oi implt skl perq esp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,69716,HCPCS,Impltj oi implt skl tc esp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,69717,HCPCS,Revj/rplcmt oi implt prq esp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,69719,HCPCS,Revj/rplcmt oi implt tc esp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,69720,HCPCS,Release facial nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69725,HCPCS,Release facial nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69726,HCPCS,Rmvl oi implt skl perq esp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,69727,HCPCS,Rmvl oi implt skl tc esp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 "," $3,385.65 ", Not Applicable , Not Applicable ," $3,554.93 "," $3,453.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,385.65 ", Not Applicable , Not Applicable ," $3,385.65 "," $3,554.93 ", Not Applicable
,69740,HCPCS,Repair facial nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69745,HCPCS,Repair facial nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69799,HCPCS,Middle ear surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,69801,HCPCS,Incise inner ear,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,69805,HCPCS,Explore inner ear,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69806,HCPCS,Explore inner ear,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69905,HCPCS,Remove inner ear,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69910,HCPCS,Remove inner ear & mastoid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69915,HCPCS,Incise inner ear nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,69930,HCPCS,Implant cochlear device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $41,207.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,207.47 "," $41,207.47 ", Not Applicable , Not Applicable ," $43,267.84 "," $42,031.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $41,207.47 ", Not Applicable , Not Applicable ," $41,207.47 "," $43,267.84 ", Not Applicable
,69949,HCPCS,Inner ear surgery procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,69955,HCPCS,Release facial nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69960,HCPCS,Release inner ear canal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69970,HCPCS,Remove inner ear lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 "," $6,080.31 ", Not Applicable , Not Applicable ," $6,384.32 "," $6,201.91 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,080.31 ", Not Applicable , Not Applicable ," $6,080.31 "," $6,384.32 ", Not Applicable
,69979,HCPCS,Temporal bone surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , $252.93 , Not Applicable , Not Applicable , $265.57 , $257.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $252.93 , Not Applicable , Not Applicable , $252.93 , $265.57 , Not Applicable
,70010,HCPCS,Contrast x-ray of brain,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,70015,HCPCS,Contrast x-ray of brain,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,70030,HCPCS,X-ray eye for foreign body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70100,HCPCS,X-ray exam of jaw <4views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70110,HCPCS,X-ray exam of jaw 4/> views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,70120,HCPCS,X-ray exam of mastoids,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,70130,HCPCS,X-ray exam of mastoids,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,70134,HCPCS,X-ray exam of middle ear,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,70140,HCPCS,X-ray exam of facial bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70150,HCPCS,X-ray exam of facial bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,70160,HCPCS,X-ray exam of nasal bones,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70170,HCPCS,X-ray exam of tear duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,70190,HCPCS,X-ray exam of eye sockets,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70200,HCPCS,X-ray exam of eye sockets,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,70210,HCPCS,X-ray exam of sinuses,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70220,HCPCS,X-ray exam of sinuses,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70240,HCPCS,X-ray exam pituitary saddle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70250,HCPCS,X-ray exam of skull,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,70260,HCPCS,X-ray exam of skull,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,70300,HCPCS,X-ray exam of teeth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70310,HCPCS,X-ray exam of teeth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,70320,HCPCS,Full mouth x-ray of teeth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,70328,HCPCS,X-ray exam of jaw joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70330,HCPCS,X-ray exam of jaw joints,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70332,HCPCS,X-ray exam of jaw joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,70336,HCPCS,Magnetic image jaw joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,70350,HCPCS,X-ray head for orthodontia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70355,HCPCS,Panoramic x-ray of jaws,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70360,HCPCS,X-ray exam of neck,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70370,HCPCS,Throat x-ray & fluoroscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70371,HCPCS,Speech evaluation complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,70380,HCPCS,X-ray exam of salivary gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,70390,HCPCS,X-ray exam of salivary duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,70450,HCPCS,Ct head/brain w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,70460,HCPCS,Ct head/brain w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,70470,HCPCS,Ct head/brain w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,70480,HCPCS,Ct orbit/ear/fossa w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,70481,HCPCS,Ct orbit/ear/fossa w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,70482,HCPCS,Ct orbit/ear/fossa w/o&w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,70486,HCPCS,Ct maxillofacial w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,70487,HCPCS,Ct maxillofacial w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,70488,HCPCS,Ct maxillofacial w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,70490,HCPCS,Ct soft tissue neck w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,70491,HCPCS,Ct soft tissue neck w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,70492,HCPCS,Ct sft tsue nck w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,70496,HCPCS,Ct angiography head,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,70498,HCPCS,Ct angiography neck,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,70540,HCPCS,Mri orbit/face/neck w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,70542,HCPCS,Mri orbit/face/neck w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,70543,HCPCS,Mri orbt/fac/nck w/o &w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,70544,HCPCS,Mr angiography head w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,70545,HCPCS,Mr angiography head w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,70546,HCPCS,Mr angiograph head w/o&w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,70547,HCPCS,Mr angiography neck w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,70548,HCPCS,Mr angiography neck w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,70549,HCPCS,Mr angiograph neck w/o&w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,70551,HCPCS,Mri brain stem w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,70552,HCPCS,Mri brain stem w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,70553,HCPCS,Mri brain stem w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,70554,HCPCS,Fmri brain by tech,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,70555,HCPCS,Fmri brain by phys/psych,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,70557,HCPCS,Mri brain w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,70558,HCPCS,Mri brain w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,70559,HCPCS,Mri brain w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,71045,HCPCS,X-ray exam chest 1 view,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,71046,HCPCS,X-ray exam chest 2 views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,71047,HCPCS,X-ray exam chest 3 views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,71048,HCPCS,X-ray exam chest 4+ views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,71100,HCPCS,X-ray exam ribs uni 2 views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,71101,HCPCS,X-ray exam unilat ribs/chest,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,71110,HCPCS,X-ray exam ribs bil 3 views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,71111,HCPCS,X-ray exam ribs/chest4/> vws,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,71120,HCPCS,X-ray exam breastbone 2/>vws,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,71130,HCPCS,X-ray strenoclavic jt 3/>vws,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,71250,HCPCS,Ct thorax dx c-,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,71260,HCPCS,Ct thorax dx c+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,71270,HCPCS,Ct thorax dx c-/c+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,71271,HCPCS,Ct thorax lung cancer scr c-,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,71275,HCPCS,Ct angiography chest,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,71550,HCPCS,Mri chest w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,71551,HCPCS,Mri chest w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,71552,HCPCS,Mri chest w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,72020,HCPCS,X-ray exam of spine 1 view,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,72040,HCPCS,X-ray exam neck spine 2-3 vw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,72050,HCPCS,X-ray exam neck spine 4/5vws,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72052,HCPCS,X-ray exam neck spine 6/>vws,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72070,HCPCS,X-ray exam thorac spine 2vws,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72072,HCPCS,X-ray exam thorac spine 3vws,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72074,HCPCS,X-ray exam thorac spine4/>vw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72080,HCPCS,X-ray exam thoracolmb 2/> vw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,72081,HCPCS,X-ray exam entire spi 1 vw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,72082,HCPCS,X-ray exam entire spi 2/3 vw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72083,HCPCS,X-ray exam entire spi 4/5 vw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72084,HCPCS,X-ray exam entire spi 6/> vw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72100,HCPCS,X-ray exam l-s spine 2/3 vws,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72110,HCPCS,X-ray exam l-2 spine 4/>vws,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72114,HCPCS,X-ray exam l-s spine bending,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72120,HCPCS,X-ray bend only l-s spine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72125,HCPCS,Ct neck spine w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72126,HCPCS,Ct neck spine w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,72127,HCPCS,Ct neck spine w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,72128,HCPCS,Ct chest spine w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72129,HCPCS,Ct chest spine w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,72130,HCPCS,Ct chest spine w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,72131,HCPCS,Ct lumbar spine w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72132,HCPCS,Ct lumbar spine w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,72133,HCPCS,Ct lumbar spine w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,72141,HCPCS,Mri neck spine w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,72142,HCPCS,Mri neck spine w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,72146,HCPCS,Mri chest spine w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,72147,HCPCS,Mri chest spine w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,72148,HCPCS,Mri lumbar spine w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,72149,HCPCS,Mri lumbar spine w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,72156,HCPCS,Mri neck spine w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,72157,HCPCS,Mri chest spine w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,72158,HCPCS,Mri lumbar spine w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,72170,HCPCS,X-ray exam of pelvis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72190,HCPCS,X-ray exam of pelvis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72191,HCPCS,Ct angiograph pelv w/o&w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,72192,HCPCS,Ct pelvis w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72193,HCPCS,Ct pelvis w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,72194,HCPCS,Ct pelvis w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,72195,HCPCS,Mri pelvis w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,72196,HCPCS,Mri pelvis w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,72197,HCPCS,Mri pelvis w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,72200,HCPCS,X-ray exam si joints,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72202,HCPCS,X-ray exam si joints 3/> vws,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,72220,HCPCS,X-ray exam sacrum tailbone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,72240,HCPCS,Myelography neck spine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,72255,HCPCS,Myelography thoracic spine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,72265,HCPCS,Myelography l-s spine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,72270,HCPCS,Myelogphy 2/> spine regions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,72285,HCPCS,Discography cerv/thor spine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,72295,HCPCS,X-ray of lower spine disk,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 "," $2,099.21 ", Not Applicable , Not Applicable ," $2,204.17 "," $2,141.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,099.21 ", Not Applicable , Not Applicable ," $2,099.21 "," $2,204.17 ", Not Applicable
,73000,HCPCS,X-ray exam of collar bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73010,HCPCS,X-ray exam of shoulder blade,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,73020,HCPCS,X-ray exam of shoulder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73030,HCPCS,X-ray exam of shoulder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73040,HCPCS,Contrast x-ray of shoulder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,73050,HCPCS,X-ray exam of shoulders,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73060,HCPCS,X-ray exam of humerus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73070,HCPCS,X-ray exam of elbow,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73080,HCPCS,X-ray exam of elbow,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73085,HCPCS,Contrast x-ray of elbow,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,73090,HCPCS,X-ray exam of forearm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73092,HCPCS,X-ray exam of arm infant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,73100,HCPCS,X-ray exam of wrist,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73110,HCPCS,X-ray exam of wrist,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73115,HCPCS,Contrast x-ray of wrist,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,73120,HCPCS,X-ray exam of hand,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,73130,HCPCS,X-ray exam of hand,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73140,HCPCS,X-ray exam of finger(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73200,HCPCS,Ct upper extremity w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,73201,HCPCS,Ct upper extremity w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,73202,HCPCS,Ct uppr extremity w/o&w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,73206,HCPCS,Ct angio upr extrm w/o&w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,73218,HCPCS,Mri upper extremity w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,73219,HCPCS,Mri upper extremity w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,73220,HCPCS,Mri uppr extremity w/o&w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,73221,HCPCS,Mri joint upr extrem w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,73222,HCPCS,Mri joint upr extrem w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,73223,HCPCS,Mri joint upr extr w/o&w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,73501,HCPCS,X-ray exam hip uni 1 view,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73502,HCPCS,X-ray exam hip uni 2-3 views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73503,HCPCS,X-ray exam hip uni 4/> views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,73521,HCPCS,X-ray exam hips bi 2 views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,73522,HCPCS,X-ray exam hips bi 3-4 views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,73523,HCPCS,X-ray exam hips bi 5/> views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,73525,HCPCS,Contrast x-ray of hip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,73551,HCPCS,X-ray exam of femur 1,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73552,HCPCS,X-ray exam of femur 2/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73560,HCPCS,X-ray exam of knee 1 or 2,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73562,HCPCS,X-ray exam of knee 3,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73564,HCPCS,X-ray exam knee 4 or more,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,73565,HCPCS,X-ray exam of knees,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73580,HCPCS,Contrast x-ray of knee joint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,73590,HCPCS,X-ray exam of lower leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73592,HCPCS,X-ray exam of leg infant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73600,HCPCS,X-ray exam of ankle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73610,HCPCS,X-ray exam of ankle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73615,HCPCS,Contrast x-ray of ankle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,73620,HCPCS,X-ray exam of foot,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73630,HCPCS,X-ray exam of foot,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73650,HCPCS,X-ray exam of heel,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73660,HCPCS,X-ray exam of toe(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,73700,HCPCS,Ct lower extremity w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,73701,HCPCS,Ct lower extremity w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,73702,HCPCS,Ct lwr extremity w/o&w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,73706,HCPCS,Ct angio lwr extr w/o&w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,73718,HCPCS,Mri lower extremity w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,73719,HCPCS,Mri lower extremity w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,73720,HCPCS,Mri lwr extremity w/o&w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,73721,HCPCS,Mri jnt of lwr extre w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,73722,HCPCS,Mri joint of lwr extr w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,73723,HCPCS,Mri joint lwr extr w/o&w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,74018,HCPCS,X-ray exam abdomen 1 view,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,74019,HCPCS,X-ray exam abdomen 2 views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,74021,HCPCS,X-ray exam abdomen 3+ views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,74022,HCPCS,X-ray exam complete abdomen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,74150,HCPCS,Ct abdomen w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,74160,HCPCS,Ct abdomen w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74170,HCPCS,Ct abdomen w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74174,HCPCS,Ct angio abd&pelv w/o&w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,74175,HCPCS,Ct angio abdom w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74176,HCPCS,Ct abd & pelvis w/o contrast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,74177,HCPCS,Ct abd & pelv w/contrast,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,74178,HCPCS,Ct abd & pelv 1/> regns,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,74181,HCPCS,Mri abdomen w/o dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,74182,HCPCS,Mri abdomen w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,74183,HCPCS,Mri abdomen w/o & w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,74190,HCPCS,X-ray exam of peritoneum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,74210,HCPCS,X-ray xm phrnx&/crv esoph c+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74220,HCPCS,X-ray xm esophagus 1cntrst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74221,HCPCS,X-ray xm esophagus 2cntrst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74230,HCPCS,X-ray xm swlng funcj c+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74240,HCPCS,X-ray xm upr gi trc 1cntrst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74246,HCPCS,X-ray xm upr gi trc 2cntrst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74250,HCPCS,X-ray xm sm int 1cntrst std,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74251,HCPCS,X-ray xm sm int 2cntrst std,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74261,HCPCS,Ct colonography dx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,74262,HCPCS,Ct colonography dx w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74270,HCPCS,X-ray xm colon 1cntrst std,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74280,HCPCS,X-ray xm colon 2cntrst std,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74283,HCPCS,Ther nma rdctj intus/obstrcj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74290,HCPCS,Contrast x-ray gallbladder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74400,HCPCS,Urography iv +-kub tomog,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74410,HCPCS,Urography nfs drip&/bolus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74415,HCPCS,Urography nfs drip&/bls w/nf,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,74420,HCPCS,Urography rtrgr +-kub,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,74425,HCPCS,Urography antegrade rs&i,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,74430,HCPCS,Contrast x-ray bladder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,74440,HCPCS,X-ray male genital tract,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,74445,HCPCS,X-ray exam of penis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,74450,HCPCS,X-ray urethra/bladder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,74455,HCPCS,X-ray urethra/bladder,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,74470,HCPCS,X-ray exam of kidney lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,74485,HCPCS,Dilation urtr/urt rs&i,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 "," $2,140.58 ", Not Applicable , Not Applicable ," $2,247.61 "," $2,183.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,140.58 ", Not Applicable , Not Applicable ," $2,140.58 "," $2,247.61 ", Not Applicable
,74710,HCPCS,X-ray measurement of pelvis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,74712,HCPCS,Mri fetal sngl/1st gestation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,74740,HCPCS,X-ray female genital tract,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,74775,HCPCS,X-ray exam of perineum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,75557,HCPCS,Cardiac mri for morph,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,75559,HCPCS,Cardiac mri w/stress img,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,75561,HCPCS,Cardiac mri for morph w/dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,75563,HCPCS,Card mri w/stress img & dye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,75571,HCPCS,Ct hrt w/o dye w/ca test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,75572,HCPCS,Ct hrt w/3d image,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,75573,HCPCS,Ct hrt c+ strux cgen hrt ds,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,75574,HCPCS,Ct angio hrt w/3d image,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,75600,HCPCS,Contrast exam thoracic aorta,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75605,HCPCS,Contrast exam thoracic aorta,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,75625,HCPCS,Contrast exam abdominl aorta,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75630,HCPCS,X-ray aorta leg arteries,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75635,HCPCS,Ct angio abdominal arteries,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,75705,HCPCS,Artery x-rays spine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,75710,HCPCS,Artery x-rays arm/leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75716,HCPCS,Artery x-rays arms/legs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75726,HCPCS,Artery x-rays abdomen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,75731,HCPCS,Artery x-rays adrenal gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75733,HCPCS,Artery x-rays adrenals,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75736,HCPCS,Artery x-rays pelvis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,75741,HCPCS,Artery x-rays lung,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75743,HCPCS,Artery x-rays lungs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75746,HCPCS,Artery x-rays lung,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75756,HCPCS,Artery x-rays chest,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75801,HCPCS,Lymph vessel x-ray arm/leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,75803,HCPCS,Lymph vessel x-ray arms/legs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,75805,HCPCS,Lymph vessel x-ray trunk,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75807,HCPCS,Lymph vessel x-ray trunk,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75809,HCPCS,Nonvascular shunt x-ray,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,75810,HCPCS,Vein x-ray spleen/liver,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75820,HCPCS,Vein x-ray arm/leg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,75822,HCPCS,Vein x-ray arms/legs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,75825,HCPCS,Vein x-ray trunk,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75827,HCPCS,Vein x-ray chest,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,75831,HCPCS,Vein x-ray kidney,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75833,HCPCS,Vein x-ray kidneys,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75840,HCPCS,Vein x-ray adrenal gland,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75842,HCPCS,Vein x-ray adrenal glands,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,75860,HCPCS,Vein x-ray neck,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75870,HCPCS,Vein x-ray skull,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75872,HCPCS,Vein x-ray skull epidural,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,75880,HCPCS,Vein x-ray eye socket,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , $646.21 , Not Applicable , Not Applicable , $678.52 , $659.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $646.21 , Not Applicable , Not Applicable , $646.21 , $678.52 , Not Applicable
,75885,HCPCS,Vein x-ray liver w/hemodynam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75887,HCPCS,Vein x-ray liver w/o hemodyn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75889,HCPCS,Vein x-ray liver w/hemodynam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75891,HCPCS,Vein x-ray liver,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,75893,HCPCS,Venous sampling by catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 "," $5,701.02 ", Not Applicable , Not Applicable ," $5,986.07 "," $5,815.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,701.02 ", Not Applicable , Not Applicable ," $5,701.02 "," $5,986.07 ", Not Applicable
,75898,HCPCS,Follow-up angiography,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,76000,HCPCS,Fluoroscopy <1 hr phys/qhp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,76010,HCPCS,X-ray nose to rectum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,76080,HCPCS,X-ray exam of fistula,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,76098,HCPCS,X-ray exam surgical specimen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,76100,HCPCS,X-ray exam of body section,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76120,HCPCS,Cine/video x-rays,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76145,HCPCS,Med physic dos eval rad exps,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , $404.85 , Not Applicable , Not Applicable , $425.09 , $412.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , $404.85 , $425.09 , Not Applicable
,76380,HCPCS,Cat scan follow-up study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,76390,HCPCS,Mr spectroscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,76391,HCPCS,Mr elastography,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,76496,HCPCS,Fluoroscopic procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,76497,HCPCS,Ct procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,76498,HCPCS,Mri procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,76499,HCPCS,Radiographic procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,76506,HCPCS,Echo exam of head,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76510,HCPCS,Oph us dx b-scan&quan a-scan,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,76511,HCPCS,Oph us dx quan a-scan only,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76512,HCPCS,Oph us dx b-scan,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76513,HCPCS,Oph us dx ant sgm us uni/bi,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76514,HCPCS,Echo exam of eye thickness,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,76516,HCPCS,Echo exam of eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76519,HCPCS,Echo exam of eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76529,HCPCS,Echo exam of eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,76536,HCPCS,Us exam of head and neck,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76604,HCPCS,Us exam chest,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76641,HCPCS,Ultrasound breast complete,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76642,HCPCS,Ultrasound breast limited,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,76700,HCPCS,Us exam abdom complete,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76705,HCPCS,Echo exam of abdomen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76706,HCPCS,Us abdl aorta screen aaa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76770,HCPCS,Us exam abdo back wall comp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76775,HCPCS,Us exam abdo back wall lim,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76776,HCPCS,Us exam k transpl w/doppler,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76800,HCPCS,Us exam spinal canal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76801,HCPCS,Ob us < 14 wks single fetus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76805,HCPCS,Ob us >= 14 wks sngl fetus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76811,HCPCS,Ob us detailed sngl fetus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,76813,HCPCS,Ob us nuchal meas 1 gest,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76815,HCPCS,Ob us limited fetus(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76816,HCPCS,Ob us follow-up per fetus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76817,HCPCS,Transvaginal us obstetric,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76818,HCPCS,Fetal biophys profile w/nst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76819,HCPCS,Fetal biophys profil w/o nst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76820,HCPCS,Umbilical artery echo,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76821,HCPCS,Middle cerebral artery echo,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76825,HCPCS,Echo exam of fetal heart,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,76826,HCPCS,Echo exam of fetal heart,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,76827,HCPCS,Echo exam of fetal heart,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76828,HCPCS,Echo exam of fetal heart,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76830,HCPCS,Transvaginal us non-ob,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76831,HCPCS,Echo exam uterus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,76856,HCPCS,Us exam pelvic complete,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76857,HCPCS,Us exam pelvic limited,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76870,HCPCS,Us exam scrotum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76872,HCPCS,Us transrectal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76873,HCPCS,Echograp trans r pros study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76881,HCPCS,Us compl joint r-t w/img,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76882,HCPCS,Us lmtd jt/nonvasc xtr strux,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76885,HCPCS,Us exam infant hips dynamic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,76886,HCPCS,Us exam infant hips static,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,76936,HCPCS,Echo guide for artery repair,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,76975,HCPCS,Gi endoscopic ultrasound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,76977,HCPCS,Us bone density measure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76978,HCPCS,Us trgt dyn mbubb 1st les,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,76981,HCPCS,Use parenchyma,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76982,HCPCS,Use 1st target lesion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,76999,HCPCS,Echo examination procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,77046,HCPCS,Mri breast c- unilateral,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,77047,HCPCS,Mri breast c- bilateral,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,77053,HCPCS,X-ray of mammary duct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,77054,HCPCS,X-ray of mammary ducts,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,77071,HCPCS,X-ray stress view,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,77072,HCPCS,X-rays for bone age,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,77073,HCPCS,X-rays bone length studies,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,77074,HCPCS,X-rays bone survey limited,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,77075,HCPCS,X-rays bone survey complete,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,77076,HCPCS,X-rays bone survey infant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,77077,HCPCS,Joint survey single view,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,77078,HCPCS,Ct bone density axial,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,77080,HCPCS,Dxa bone density axial,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,77081,HCPCS,Dxa bone density/peripheral,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,77084,HCPCS,Magnetic image bone marrow,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,77085,HCPCS,Dxa bone density study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,77086,HCPCS,Fracture assessment via dxa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,77090,HCPCS,Tbs techl prep&transmis data,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,77091,HCPCS,Tbs techl calculation only,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,77280,HCPCS,Set radiation therapy field,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , $151.70 , Not Applicable , Not Applicable , $159.28 , $154.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , $151.70 , $159.28 , Not Applicable
,77285,HCPCS,Set radiation therapy field,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , $404.85 , Not Applicable , Not Applicable , $425.09 , $412.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , $404.85 , $425.09 , Not Applicable
,77290,HCPCS,Set radiation therapy field,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , $404.85 , Not Applicable , Not Applicable , $425.09 , $412.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , $404.85 , $425.09 , Not Applicable
,77295,HCPCS,3-d radiotherapy plan,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,509.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,509.66 "," $1,509.66 ", Not Applicable , Not Applicable ," $1,585.15 "," $1,539.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,509.66 ", Not Applicable , Not Applicable ," $1,509.66 "," $1,585.15 ", Not Applicable
,77299,HCPCS,Radiation therapy planning,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , $151.70 , Not Applicable , Not Applicable , $159.28 , $154.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , $151.70 , $159.28 , Not Applicable
,77300,HCPCS,Radiation therapy dose plan,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , $151.70 , Not Applicable , Not Applicable , $159.28 , $154.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , $151.70 , $159.28 , Not Applicable
,77301,HCPCS,Radiotherapy dose plan imrt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,509.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,509.66 "," $1,509.66 ", Not Applicable , Not Applicable ," $1,585.15 "," $1,539.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,509.66 ", Not Applicable , Not Applicable ," $1,509.66 "," $1,585.15 ", Not Applicable
,77306,HCPCS,Telethx isodose plan simple,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , $404.85 , Not Applicable , Not Applicable , $425.09 , $412.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , $404.85 , $425.09 , Not Applicable
,77307,HCPCS,Telethx isodose plan cplx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , $404.85 , Not Applicable , Not Applicable , $425.09 , $412.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , $404.85 , $425.09 , Not Applicable
,77316,HCPCS,Brachytx isodose plan simple,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , $404.85 , Not Applicable , Not Applicable , $425.09 , $412.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , $404.85 , $425.09 , Not Applicable
,77317,HCPCS,Brachytx isodose intermed,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , $404.85 , Not Applicable , Not Applicable , $425.09 , $412.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , $404.85 , $425.09 , Not Applicable
,77318,HCPCS,Brachytx isodose complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , $404.85 , Not Applicable , Not Applicable , $425.09 , $412.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , $404.85 , $425.09 , Not Applicable
,77321,HCPCS,Special teletx port plan,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , $404.85 , Not Applicable , Not Applicable , $425.09 , $412.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , $404.85 , $425.09 , Not Applicable
,77331,HCPCS,Special radiation dosimetry,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , $151.70 , Not Applicable , Not Applicable , $159.28 , $154.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , $151.70 , $159.28 , Not Applicable
,77332,HCPCS,Radiation treatment aid(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , $151.70 , Not Applicable , Not Applicable , $159.28 , $154.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , $151.70 , $159.28 , Not Applicable
,77333,HCPCS,Radiation treatment aid(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , $151.70 , Not Applicable , Not Applicable , $159.28 , $154.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , $151.70 , $159.28 , Not Applicable
,77334,HCPCS,Radiation treatment aid(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , $404.85 , Not Applicable , Not Applicable , $425.09 , $412.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , $404.85 , $425.09 , Not Applicable
,77336,HCPCS,Radiation physics consult,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , $151.70 , Not Applicable , Not Applicable , $159.28 , $154.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , $151.70 , $159.28 , Not Applicable
,77338,HCPCS,Design mlc device for imrt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , $404.85 , Not Applicable , Not Applicable , $425.09 , $412.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $404.85 , Not Applicable , Not Applicable , $404.85 , $425.09 , Not Applicable
,77370,HCPCS,Radiation physics consult,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , $151.70 , Not Applicable , Not Applicable , $159.28 , $154.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , $151.70 , $159.28 , Not Applicable
,77371,HCPCS,Srs multisource,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,297.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,297.89 "," $9,297.89 ", Not Applicable , Not Applicable ," $9,762.79 "," $9,483.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,297.89 ", Not Applicable , Not Applicable ," $9,297.89 "," $9,762.79 ", Not Applicable
,77372,HCPCS,Srs linear based,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,297.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,297.89 "," $9,297.89 ", Not Applicable , Not Applicable ," $9,762.79 "," $9,483.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,297.89 ", Not Applicable , Not Applicable ," $9,297.89 "," $9,762.79 ", Not Applicable
,77373,HCPCS,Sbrt delivery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,073.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,073.42 "," $2,073.42 ", Not Applicable , Not Applicable ," $2,177.10 "," $2,114.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,073.42 ", Not Applicable , Not Applicable ," $2,073.42 "," $2,177.10 ", Not Applicable
,77385,HCPCS,Ntsty modul rad tx dlvr smpl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , $648.64 , Not Applicable , Not Applicable , $681.07 , $661.61 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , $648.64 , $681.07 , Not Applicable
,77386,HCPCS,Ntsty modul rad tx dlvr cplx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , $648.64 , Not Applicable , Not Applicable , $681.07 , $661.61 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , $648.64 , $681.07 , Not Applicable
,77399,HCPCS,External radiation dosimetry,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , $151.70 , Not Applicable , Not Applicable , $159.28 , $154.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $151.70 , Not Applicable , Not Applicable , $151.70 , $159.28 , Not Applicable
,77401,HCPCS,Radiation treatment delivery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $143.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $143.21 , $143.21 , Not Applicable , Not Applicable , $150.37 , $146.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $143.21 , Not Applicable , Not Applicable , $143.21 , $150.37 , Not Applicable
,77402,HCPCS,Radiation treatment delivery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $143.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $143.21 , $143.21 , Not Applicable , Not Applicable , $150.37 , $146.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $143.21 , Not Applicable , Not Applicable , $143.21 , $150.37 , Not Applicable
,77407,HCPCS,Radiation treatment delivery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.98 , $288.98 , Not Applicable , Not Applicable , $303.43 , $294.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.98 , Not Applicable , Not Applicable , $288.98 , $303.43 , Not Applicable
,77412,HCPCS,Radiation treatment delivery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.98 , $288.98 , Not Applicable , Not Applicable , $303.43 , $294.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.98 , Not Applicable , Not Applicable , $288.98 , $303.43 , Not Applicable
,77423,HCPCS,Neutron beam tx complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , $648.64 , Not Applicable , Not Applicable , $681.07 , $661.61 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , $648.64 , $681.07 , Not Applicable
,77424,HCPCS,Io rad tx delivery by x-ray,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,297.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,297.89 "," $9,297.89 ", Not Applicable , Not Applicable ," $9,762.79 "," $9,483.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,297.89 ", Not Applicable , Not Applicable ," $9,297.89 "," $9,762.79 ", Not Applicable
,77425,HCPCS,Io rad tx deliver by elctrns,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,297.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,297.89 "," $9,297.89 ", Not Applicable , Not Applicable ," $9,762.79 "," $9,483.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,297.89 ", Not Applicable , Not Applicable ," $9,297.89 "," $9,762.79 ", Not Applicable
,77470,HCPCS,Special radiation treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , $648.64 , Not Applicable , Not Applicable , $681.07 , $661.61 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , $648.64 , $681.07 , Not Applicable
,77520,HCPCS,Proton trmt simple w/o comp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , $648.64 , Not Applicable , Not Applicable , $681.07 , $661.61 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , $648.64 , $681.07 , Not Applicable
,77522,HCPCS,Proton trmt simple w/comp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,546.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,546.48 "," $1,546.48 ", Not Applicable , Not Applicable ," $1,623.80 "," $1,577.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,546.48 ", Not Applicable , Not Applicable ," $1,546.48 "," $1,623.80 ", Not Applicable
,77523,HCPCS,Proton trmt intermediate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,546.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,546.48 "," $1,546.48 ", Not Applicable , Not Applicable ," $1,623.80 "," $1,577.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,546.48 ", Not Applicable , Not Applicable ," $1,546.48 "," $1,623.80 ", Not Applicable
,77525,HCPCS,Proton treatment complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,546.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,546.48 "," $1,546.48 ", Not Applicable , Not Applicable ," $1,623.80 "," $1,577.41 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,546.48 ", Not Applicable , Not Applicable ," $1,546.48 "," $1,623.80 ", Not Applicable
,77600,HCPCS,Hyperthermia treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.98 , $288.98 , Not Applicable , Not Applicable , $303.43 , $294.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.98 , Not Applicable , Not Applicable , $288.98 , $303.43 , Not Applicable
,77605,HCPCS,Hyperthermia treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $848.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $848.09 , $848.09 , Not Applicable , Not Applicable , $890.49 , $865.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $848.09 , Not Applicable , Not Applicable , $848.09 , $890.49 , Not Applicable
,77610,HCPCS,Hyperthermia treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , $648.64 , Not Applicable , Not Applicable , $681.07 , $661.61 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , $648.64 , $681.07 , Not Applicable
,77615,HCPCS,Hyperthermia treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , $648.64 , Not Applicable , Not Applicable , $681.07 , $661.61 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , $648.64 , $681.07 , Not Applicable
,77620,HCPCS,Hyperthermia treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , $648.64 , Not Applicable , Not Applicable , $681.07 , $661.61 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , $648.64 , $681.07 , Not Applicable
,77750,HCPCS,Infuse radioactive materials,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.98 , $288.98 , Not Applicable , Not Applicable , $303.43 , $294.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.98 , Not Applicable , Not Applicable , $288.98 , $303.43 , Not Applicable
,77761,HCPCS,Apply intrcav radiat simple,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , $648.64 , Not Applicable , Not Applicable , $681.07 , $661.61 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , $648.64 , $681.07 , Not Applicable
,77762,HCPCS,Apply intrcav radiat interm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , $648.64 , Not Applicable , Not Applicable , $681.07 , $661.61 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $648.64 , Not Applicable , Not Applicable , $648.64 , $681.07 , Not Applicable
,77763,HCPCS,Apply intrcav radiat compl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $848.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $848.09 , $848.09 , Not Applicable , Not Applicable , $890.49 , $865.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $848.09 , Not Applicable , Not Applicable , $848.09 , $890.49 , Not Applicable
,77767,HCPCS,Hdr rdncl skn surf brachytx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.98 , $288.98 , Not Applicable , Not Applicable , $303.43 , $294.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.98 , Not Applicable , Not Applicable , $288.98 , $303.43 , Not Applicable
,77768,HCPCS,Hdr rdncl skn surf brachytx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $288.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.98 , $288.98 , Not Applicable , Not Applicable , $303.43 , $294.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $288.98 , Not Applicable , Not Applicable , $288.98 , $303.43 , Not Applicable
,77770,HCPCS,Hdr rdncl ntrstl/icav brchtx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $848.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $848.09 , $848.09 , Not Applicable , Not Applicable , $890.49 , $865.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $848.09 , Not Applicable , Not Applicable , $848.09 , $890.49 , Not Applicable
,77771,HCPCS,Hdr rdncl ntrstl/icav brchtx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $848.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $848.09 , $848.09 , Not Applicable , Not Applicable , $890.49 , $865.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $848.09 , Not Applicable , Not Applicable , $848.09 , $890.49 , Not Applicable
,77772,HCPCS,Hdr rdncl ntrstl/icav brchtx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $848.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $848.09 , $848.09 , Not Applicable , Not Applicable , $890.49 , $865.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $848.09 , Not Applicable , Not Applicable , $848.09 , $890.49 , Not Applicable
,77778,HCPCS,Apply interstit radiat compl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $848.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $848.09 , $848.09 , Not Applicable , Not Applicable , $890.49 , $865.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $848.09 , Not Applicable , Not Applicable , $848.09 , $890.49 , Not Applicable
,77789,HCPCS,Apply surf ldr radionuclide,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $143.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $143.21 , $143.21 , Not Applicable , Not Applicable , $150.37 , $146.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $143.21 , Not Applicable , Not Applicable , $143.21 , $150.37 , Not Applicable
,77799,HCPCS,Radium/radioisotope therapy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $143.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $143.21 , $143.21 , Not Applicable , Not Applicable , $150.37 , $146.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $143.21 , Not Applicable , Not Applicable , $143.21 , $150.37 , Not Applicable
,78012,HCPCS,Thyroid uptake measurement,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78013,HCPCS,Thyroid imaging w/blood flow,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78014,HCPCS,Thyroid imaging w/blood flow,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78015,HCPCS,Thyroid met imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78016,HCPCS,Thyroid met imaging/studies,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78018,HCPCS,Thyroid met imaging body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78070,HCPCS,Parathyroid planar imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78071,HCPCS,Parathyrd planar w/wo subtrj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78072,HCPCS,Parathyrd planar w/spect&ct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78075,HCPCS,Adrenal cortex & medulla img,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78099,HCPCS,Endocrine nuclear procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78102,HCPCS,Bone marrow imaging ltd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78103,HCPCS,Bone marrow imaging mult,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78104,HCPCS,Bone marrow imaging body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78110,HCPCS,Plasma volume single,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78111,HCPCS,Plasma volume multiple,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78120,HCPCS,Red cell mass single,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78121,HCPCS,Red cell mass multiple,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78122,HCPCS,Blood volume,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78130,HCPCS,Red cell survival study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78140,HCPCS,Red cell sequestration,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78185,HCPCS,Spleen imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78191,HCPCS,Platelet survival,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78195,HCPCS,Lymph system imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78199,HCPCS,Blood/lymph nuclear exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78201,HCPCS,Liver imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78202,HCPCS,Liver imaging with flow,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78215,HCPCS,Liver and spleen imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78216,HCPCS,Liver & spleen image/flow,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78226,HCPCS,Hepatobiliary system imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78227,HCPCS,Hepatobil syst image w/drug,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78230,HCPCS,Salivary gland imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78231,HCPCS,Serial salivary imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78232,HCPCS,Salivary gland function exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78258,HCPCS,Esophageal motility study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78261,HCPCS,Gastric mucosa imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78262,HCPCS,Gastroesophageal reflux exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78264,HCPCS,Gastric emptying imag study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78265,HCPCS,Gastric emptying imag study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78266,HCPCS,Gastric emptying imag study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78278,HCPCS,Acute gi blood loss imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78282,HCPCS,Gi protein loss exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78290,HCPCS,Meckels divert exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78291,HCPCS,Leveen/shunt patency exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78299,HCPCS,Gi nuclear procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78300,HCPCS,Bone imaging limited area,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78305,HCPCS,Bone imaging multiple areas,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78306,HCPCS,Bone imaging whole body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78315,HCPCS,Bone imaging 3 phase,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78399,HCPCS,Musculoskeletal nuclear exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78414,HCPCS,Non-imaging heart function,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78428,HCPCS,Cardiac shunt imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78429,HCPCS,Myocrd img pet 1 std w/ct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 "," $1,769.40 ", Not Applicable , Not Applicable ," $1,857.87 "," $1,804.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable ," $1,769.40 "," $1,857.87 ", Not Applicable
,78430,HCPCS,Myocrd img pet rst/strs w/ct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 "," $1,769.40 ", Not Applicable , Not Applicable ," $1,857.87 "," $1,804.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable ," $1,769.40 "," $1,857.87 ", Not Applicable
,78431,HCPCS,Myocrd img pet rst&strs ct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,634.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,634.39 "," $2,634.39 ", Not Applicable , Not Applicable ," $2,766.11 "," $2,687.08 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,634.39 ", Not Applicable , Not Applicable ," $2,634.39 "," $2,766.11 ", Not Applicable
,78432,HCPCS,Myocrd img pet 2rtracer,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,219.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,219.68 "," $3,219.68 ", Not Applicable , Not Applicable ," $3,380.66 "," $3,284.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,219.68 ", Not Applicable , Not Applicable ," $3,219.68 "," $3,380.66 ", Not Applicable
,78433,HCPCS,Myocrd img pet 2rtracer ct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,219.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,219.68 "," $3,219.68 ", Not Applicable , Not Applicable ," $3,380.66 "," $3,284.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,219.68 ", Not Applicable , Not Applicable ," $3,219.68 "," $3,380.66 ", Not Applicable
,78445,HCPCS,Vascular flow imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78451,HCPCS,Ht muscle image spect sing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78452,HCPCS,Ht muscle image spect mult,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78453,HCPCS,Ht muscle image planar sing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78454,HCPCS,Ht musc image planar mult,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78456,HCPCS,Acute venous thrombus image,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78457,HCPCS,Venous thrombosis imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78458,HCPCS,Ven thrombosis images bilat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78459,HCPCS,Myocrd img pet single study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78466,HCPCS,Heart infarct image,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78468,HCPCS,Heart infarct image (ef),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78469,HCPCS,Heart infarct image (3d),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78472,HCPCS,Gated heart planar single,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78473,HCPCS,Gated heart multiple,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78481,HCPCS,Heart first pass single,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78483,HCPCS,Heart first pass multiple,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78491,HCPCS,Myocrd img pet 1std rst/strs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 "," $1,769.40 ", Not Applicable , Not Applicable ," $1,857.87 "," $1,804.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable ," $1,769.40 "," $1,857.87 ", Not Applicable
,78492,HCPCS,Myocrd img pet mlt rst&strs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 "," $1,769.40 ", Not Applicable , Not Applicable ," $1,857.87 "," $1,804.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable ," $1,769.40 "," $1,857.87 ", Not Applicable
,78494,HCPCS,Heart image spect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78499,HCPCS,Cardiovascular nuclear exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78579,HCPCS,Lung ventilation imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78580,HCPCS,Lung perfusion imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78582,HCPCS,Lung ventilat&perfus imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78597,HCPCS,Lung perfusion differential,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78598,HCPCS,Lung perf&ventilat diferentl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78599,HCPCS,Respiratory nuclear exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78600,HCPCS,Brain image < 4 views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78601,HCPCS,Brain image w/flow < 4 views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78605,HCPCS,Brain image 4+ views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78606,HCPCS,Brain image w/flow 4 + views,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78608,HCPCS,Brain imaging (pet),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 "," $1,769.40 ", Not Applicable , Not Applicable ," $1,857.87 "," $1,804.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable ," $1,769.40 "," $1,857.87 ", Not Applicable
,78610,HCPCS,Brain flow imaging only,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78630,HCPCS,Cerebrospinal fluid scan,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78635,HCPCS,Csf ventriculography,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78645,HCPCS,Csf shunt evaluation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78650,HCPCS,Csf leakage imaging,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78660,HCPCS,Nuclear exam of tear flow,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78699,HCPCS,Nervous system nuclear exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78700,HCPCS,Kidney imaging morphol,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78701,HCPCS,Kidney imaging with flow,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78707,HCPCS,K flow/funct image w/o drug,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78708,HCPCS,K flow/funct image w/drug,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78709,HCPCS,K flow/funct image multiple,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , $585.03 , Not Applicable , Not Applicable , $614.28 , $596.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.03 , Not Applicable , Not Applicable , $585.03 , $614.28 , Not Applicable
,78725,HCPCS,Kidney function study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78740,HCPCS,Ureteral reflux study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78761,HCPCS,Testicular imaging w/flow,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78799,HCPCS,Genitourinary nuclear exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78800,HCPCS,Rp loclzj tum 1 area 1 d img,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78801,HCPCS,Rp loclzj tum 2+area 1+d img,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78802,HCPCS,Rp loclzj tum whbdy 1 d img,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78803,HCPCS,Rp loclzj tum spect 1 area,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78804,HCPCS,Rp loclzj tum whbdy 2+d img,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78808,HCPCS,Iv inj ra drug dx study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,78811,HCPCS,Pet image ltd area,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78812,HCPCS,Pet image skull-thigh,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 "," $1,769.40 ", Not Applicable , Not Applicable ," $1,857.87 "," $1,804.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable ," $1,769.40 "," $1,857.87 ", Not Applicable
,78813,HCPCS,Pet image full body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 "," $1,769.40 ", Not Applicable , Not Applicable ," $1,857.87 "," $1,804.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable ," $1,769.40 "," $1,857.87 ", Not Applicable
,78814,HCPCS,Pet image w/ct lmtd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 "," $1,769.40 ", Not Applicable , Not Applicable ," $1,857.87 "," $1,804.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable ," $1,769.40 "," $1,857.87 ", Not Applicable
,78815,HCPCS,Pet image w/ct skull-thigh,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 "," $1,769.40 ", Not Applicable , Not Applicable ," $1,857.87 "," $1,804.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable ," $1,769.40 "," $1,857.87 ", Not Applicable
,78816,HCPCS,Pet image w/ct full body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 "," $1,769.40 ", Not Applicable , Not Applicable ," $1,857.87 "," $1,804.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable ," $1,769.40 "," $1,857.87 ", Not Applicable
,78830,HCPCS,Rp loclzj tum spect w/ct 1,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78831,HCPCS,Rp loclzj tum spect 2 areas,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 "," $1,562.28 ", Not Applicable , Not Applicable ," $1,640.39 "," $1,593.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,562.28 ", Not Applicable , Not Applicable ," $1,562.28 "," $1,640.39 ", Not Applicable
,78832,HCPCS,Rp loclzj tum spect w/ct 2,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 "," $1,769.40 ", Not Applicable , Not Applicable ," $1,857.87 "," $1,804.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,769.40 ", Not Applicable , Not Applicable ," $1,769.40 "," $1,857.87 ", Not Applicable
,78999,HCPCS,Nuclear diagnostic exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,79005,HCPCS,Nuclear rx oral admin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , $302.50 , Not Applicable , Not Applicable , $317.63 , $308.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , $302.50 , $317.63 , Not Applicable
,79101,HCPCS,Nuclear rx iv admin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , $302.50 , Not Applicable , Not Applicable , $317.63 , $308.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , $302.50 , $317.63 , Not Applicable
,79200,HCPCS,Nuclear rx intracav admin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , $302.50 , Not Applicable , Not Applicable , $317.63 , $308.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , $302.50 , $317.63 , Not Applicable
,79300,HCPCS,Nuclr rx interstit colloid,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , $302.50 , Not Applicable , Not Applicable , $317.63 , $308.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , $302.50 , $317.63 , Not Applicable
,79403,HCPCS,Hematopoietic nuclear tx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , $302.50 , Not Applicable , Not Applicable , $317.63 , $308.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , $302.50 , $317.63 , Not Applicable
,79440,HCPCS,Nuclear rx intra-articular,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , $302.50 , Not Applicable , Not Applicable , $317.63 , $308.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , $302.50 , $317.63 , Not Applicable
,79445,HCPCS,Nuclear rx intra-arterial,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , $302.50 , Not Applicable , Not Applicable , $317.63 , $308.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , $302.50 , $317.63 , Not Applicable
,79999,HCPCS,Nuclear medicine therapy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , $302.50 , Not Applicable , Not Applicable , $317.63 , $308.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $302.50 , Not Applicable , Not Applicable , $302.50 , $317.63 , Not Applicable
,80503,HCPCS,Path clin consltj sf 5-20,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,80504,HCPCS,Path clin consltj mod 21-40,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,80505,HCPCS,Path clin consltj high 41-60,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,85097,HCPCS,Bone marrow interpretation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , $783.46 , Not Applicable , Not Applicable , $822.63 , $799.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , $783.46 , $822.63 , Not Applicable
,86077,HCPCS,Phys blood bank serv xmatch,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,86078,HCPCS,Phys blood bank serv reactj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86079,HCPCS,Phys blood bank serv authrj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,86485,HCPCS,Skin test candida,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,86486,HCPCS,Skin test nos antigen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,86490,HCPCS,Coccidioidomycosis skin test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,86510,HCPCS,Histoplasmosis skin test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,86580,HCPCS,Tb intradermal test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,86850,HCPCS,Rbc antibody screen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,86860,HCPCS,Rbc antibody elution,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86870,HCPCS,Rbc antibody identification,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,86880,HCPCS,Coombs test direct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,86885,HCPCS,Coombs test indirect qual,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86886,HCPCS,Coombs test indirect titer,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86890,HCPCS,Autologous blood process,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86891,HCPCS,Autologous blood op salvage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , $783.46 , Not Applicable , Not Applicable , $822.63 , $799.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , $783.46 , $822.63 , Not Applicable
,86900,HCPCS,Blood typing serologic abo,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,86901,HCPCS,Blood typing serologic rh(d),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,86902,HCPCS,Blood type antigen donor ea,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,86904,HCPCS,Blood typing patient serum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,86905,HCPCS,Blood typing rbc antigens,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,86906,HCPCS,Bld typing serologic rh phnt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,86920,HCPCS,Compatibility test spin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86921,HCPCS,Compatibility test incubate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86922,HCPCS,Compatibility test antiglob,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86923,HCPCS,Compatibility test electric,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86927,HCPCS,Plasma fresh frozen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86930,HCPCS,Frozen blood prep,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,86931,HCPCS,Frozen blood thaw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,86932,HCPCS,Frozen blood freeze/thaw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,86945,HCPCS,Blood product/irradiation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,86950,HCPCS,Leukacyte transfusion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86960,HCPCS,Vol reduction of blood/prod,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86965,HCPCS,Pooling blood platelets,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86970,HCPCS,Rbc pretx incubatj w/chemicl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,86971,HCPCS,Rbc pretx incubatj w/enzymes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,86972,HCPCS,Rbc pretx incubatj w/density,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86975,HCPCS,Rbc serum pretx incubj drugs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,86976,HCPCS,Rbc serum pretx id dilution,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,86977,HCPCS,Rbc serum pretx incubj/inhib,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86978,HCPCS,Rbc pretreatment serum,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,86985,HCPCS,Split blood or products,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,86999,HCPCS,Transfusion procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,88104,HCPCS,Cytopath fl nongyn smears,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,88106,HCPCS,Cytopath fl nongyn filter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,88108,HCPCS,Cytopath concentrate tech,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,88112,HCPCS,Cytopath cell enhance tech,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,88120,HCPCS,Cytp urne 3-5 probes ea spec,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,88121,HCPCS,Cytp urine 3-5 probes cmptr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,88125,HCPCS,Forensic cytopathology,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,88160,HCPCS,Cytopath smear other source,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,88161,HCPCS,Cytopath smear other source,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,88162,HCPCS,Cytopath smear other source,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,88172,HCPCS,Cytp dx eval fna 1st ea site,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,88173,HCPCS,Cytopath eval fna report,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,88182,HCPCS,Cell marker study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,88184,HCPCS,Flowcytometry/ tc 1 marker,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,88199,HCPCS,Cytopathology procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,88299,HCPCS,Cytogenetic study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,88300,HCPCS,Surgical path gross,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,88302,HCPCS,Tissue exam by pathologist,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,88304,HCPCS,Tissue exam by pathologist,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,88305,HCPCS,Tissue exam by pathologist,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,88307,HCPCS,Tissue exam by pathologist,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,88309,HCPCS,Tissue exam by pathologist,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , $783.46 , Not Applicable , Not Applicable , $822.63 , $799.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , $783.46 , $822.63 , Not Applicable
,88312,HCPCS,Special stains group 1,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,88313,HCPCS,Special stains group 2,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,88319,HCPCS,Enzyme histochemistry,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , $783.46 , Not Applicable , Not Applicable , $822.63 , $799.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , $783.46 , $822.63 , Not Applicable
,88321,HCPCS,Microslide consultation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,88323,HCPCS,Microslide consultation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,88325,HCPCS,Comprehensive review of data,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,88329,HCPCS,Path consult introp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,88331,HCPCS,Path consult intraop 1 bloc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,88333,HCPCS,Intraop cyto path consult 1,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , $783.46 , Not Applicable , Not Applicable , $822.63 , $799.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , $783.46 , $822.63 , Not Applicable
,88342,HCPCS,Immunohisto antb 1st stain,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,88344,HCPCS,Immunohisto antibody slide,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,88346,HCPCS,Immunofluor antb 1st stain,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,88348,HCPCS,Electron microscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , $783.46 , Not Applicable , Not Applicable , $822.63 , $799.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , $783.46 , $822.63 , Not Applicable
,88355,HCPCS,Analysis skeletal muscle,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,88356,HCPCS,Analysis nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,88358,HCPCS,Analysis tumor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,88360,HCPCS,Tumor immunohistochem/manual,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,88361,HCPCS,Tumor immunohistochem/comput,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,88362,HCPCS,Nerve teasing preparations,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , $783.46 , Not Applicable , Not Applicable , $822.63 , $799.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , $783.46 , $822.63 , Not Applicable
,88363,HCPCS,Xm archive tissue molec anal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,88365,HCPCS,Insitu hybridization (fish),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,88366,HCPCS,Insitu hybridization (fish),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,88367,HCPCS,Insitu hybridization auto,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,88368,HCPCS,Insitu hybridization manual,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,88374,HCPCS,M/phmtrc alys ishquant/semiq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,88377,HCPCS,M/phmtrc alys ishquant/semiq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,88399,HCPCS,Surgical pathology procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,89049,HCPCS,Chct for mal hyperthermia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89220,HCPCS,Sputum specimen collection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89230,HCPCS,Collect sweat for test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,89240,HCPCS,Pathology lab procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,89250,HCPCS,Cultr oocyte/embryo <4 days,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89251,HCPCS,Cultr oocyte/embryo <4 days,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89253,HCPCS,Embryo hatching,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89254,HCPCS,Oocyte identification,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89255,HCPCS,Prepare embryo for transfer,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,89257,HCPCS,Sperm identification,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,89258,HCPCS,Cryopreservation embryo(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , $783.46 , Not Applicable , Not Applicable , $822.63 , $799.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , $783.46 , $822.63 , Not Applicable
,89259,HCPCS,Cryopreservation sperm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89260,HCPCS,Sperm isolation simple,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,89261,HCPCS,Sperm isolation complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,89264,HCPCS,Identify sperm tissue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,89268,HCPCS,Insemination of oocytes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89272,HCPCS,Extended culture of oocytes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , $783.46 , Not Applicable , Not Applicable , $822.63 , $799.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , $783.46 , $822.63 , Not Applicable
,89280,HCPCS,Assist oocyte fertilization,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , $783.46 , Not Applicable , Not Applicable , $822.63 , $799.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.46 , Not Applicable , Not Applicable , $783.46 , $822.63 , Not Applicable
,89281,HCPCS,Assist oocyte fertilization,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89290,HCPCS,Biopsy oocyte polar body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89291,HCPCS,Biopsy oocyte polar body,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89335,HCPCS,Cryopreserve testicular tiss,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,89337,HCPCS,Cryopreservation oocyte(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89342,HCPCS,Storage/year embryo(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89343,HCPCS,Storage/year sperm/semen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89344,HCPCS,Storage/year reprod tissue,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89346,HCPCS,Storage/year oocyte(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,89352,HCPCS,Thawing cryopresrved embryo,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89353,HCPCS,Thawing cryopresrved sperm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,89354,HCPCS,Thaw cryoprsvrd reprod tiss,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89356,HCPCS,Thawing cryopresrved oocyte,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , $178.30 , Not Applicable , Not Applicable , $187.22 , $181.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $178.30 , Not Applicable , Not Applicable , $178.30 , $187.22 , Not Applicable
,89398,HCPCS,Unlisted reprod med lab proc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , $59.41 , Not Applicable , Not Applicable , $62.38 , $60.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $59.41 , Not Applicable , Not Applicable , $59.41 , $62.38 , Not Applicable
,90371,HCPCS,Hep b ig im,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $152.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $152.54 , $152.54 , Not Applicable , Not Applicable , $160.16 , $155.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $152.54 , Not Applicable , Not Applicable , $152.54 , $160.16 , Not Applicable
,90375,HCPCS,Rabies ig im/sc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.90 , $312.90 , Not Applicable , Not Applicable , $328.54 , $319.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.90 , Not Applicable , Not Applicable , $312.90 , $328.54 , Not Applicable
,90376,HCPCS,Rabies ig heat treated,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $336.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $336.40 , $336.40 , Not Applicable , Not Applicable , $353.22 , $343.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $336.40 , Not Applicable , Not Applicable , $336.40 , $353.22 , Not Applicable
,90378,HCPCS,Rsv mab im 50mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,387.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,387.92 "," $1,387.92 ", Not Applicable , Not Applicable ," $1,457.32 "," $1,415.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,387.92 ", Not Applicable , Not Applicable ," $1,387.92 "," $1,457.32 ", Not Applicable
,90385,HCPCS,Rh ig minidose im,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $177.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $177.24 , $177.24 , Not Applicable , Not Applicable , $186.10 , $180.78 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $177.24 , Not Applicable , Not Applicable , $177.24 , $186.10 , Not Applicable
,90396,HCPCS,Varicella-zoster ig im,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,301.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,301.33 "," $2,301.33 ", Not Applicable , Not Applicable ," $2,416.39 "," $2,347.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,301.33 ", Not Applicable , Not Applicable ," $2,301.33 "," $2,416.39 ", Not Applicable
,90471,HCPCS,Immunization admin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , $74.12 , Not Applicable , Not Applicable , $77.83 , $75.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , $74.12 , $77.83 , Not Applicable
,90473,HCPCS,Immune admin oral/nasal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , $74.12 , Not Applicable , Not Applicable , $77.83 , $75.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , $74.12 , $77.83 , Not Applicable
,90675,HCPCS,Rabies vaccine im,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $383.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $383.40 , $383.40 , Not Applicable , Not Applicable , $402.57 , $391.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $383.40 , Not Applicable , Not Applicable , $383.40 , $402.57 , Not Applicable
,90676,HCPCS,Rabies vaccine id,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $221.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $221.98 , $221.98 , Not Applicable , Not Applicable , $233.08 , $226.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $221.98 , Not Applicable , Not Applicable , $221.98 , $233.08 , Not Applicable
,90791,HCPCS,Psych diagnostic evaluation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , $159.96 , Not Applicable , Not Applicable , $167.96 , $163.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , $159.96 , $167.96 , Not Applicable
,90792,HCPCS,Psych diag eval w/med srvcs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , $159.96 , Not Applicable , Not Applicable , $167.96 , $163.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , $159.96 , $167.96 , Not Applicable
,90832,HCPCS,Psytx w pt 30 minutes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , $159.96 , Not Applicable , Not Applicable , $167.96 , $163.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , $159.96 , $167.96 , Not Applicable
,90834,HCPCS,Psytx w pt 45 minutes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , $159.96 , Not Applicable , Not Applicable , $167.96 , $163.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , $159.96 , $167.96 , Not Applicable
,90837,HCPCS,Psytx w pt 60 minutes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , $159.96 , Not Applicable , Not Applicable , $167.96 , $163.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , $159.96 , $167.96 , Not Applicable
,90839,HCPCS,Psytx crisis initial 60 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , $159.96 , Not Applicable , Not Applicable , $167.96 , $163.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , $159.96 , $167.96 , Not Applicable
,90845,HCPCS,Psychoanalysis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , $159.96 , Not Applicable , Not Applicable , $167.96 , $163.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , $159.96 , $167.96 , Not Applicable
,90846,HCPCS,Family psytx w/o pt 50 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , $159.96 , Not Applicable , Not Applicable , $167.96 , $163.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , $159.96 , $167.96 , Not Applicable
,90847,HCPCS,Family psytx w/pt 50 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , $159.96 , Not Applicable , Not Applicable , $167.96 , $163.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , $159.96 , $167.96 , Not Applicable
,90849,HCPCS,Multiple family group psytx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , $159.96 , Not Applicable , Not Applicable , $167.96 , $163.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , $159.96 , $167.96 , Not Applicable
,90853,HCPCS,Group psychotherapy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,90865,HCPCS,Narcosynthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , $159.96 , Not Applicable , Not Applicable , $167.96 , $163.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , $159.96 , $167.96 , Not Applicable
,90867,HCPCS,Tcranial magn stim tx plan,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,90868,HCPCS,Tcranial magn stim tx deli,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,90869,HCPCS,Tcran magn stim redetemine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,90870,HCPCS,Electroconvulsive therapy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,90880,HCPCS,Hypnotherapy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,90899,HCPCS,Psychiatric service/therapy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,90935,HCPCS,Hemodialysis one evaluation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $783.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.01 , $783.01 , Not Applicable , Not Applicable , $822.16 , $798.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.01 , Not Applicable , Not Applicable , $783.01 , $822.16 , Not Applicable
,90945,HCPCS,Dialysis one evaluation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $434.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $434.89 , $434.89 , Not Applicable , Not Applicable , $456.64 , $443.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $434.89 , Not Applicable , Not Applicable , $434.89 , $456.64 , Not Applicable
,91010,HCPCS,Esophagus motility study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,91020,HCPCS,Gastric motility studies,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,91022,HCPCS,Duodenal motility study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,91030,HCPCS,Acid perfusion of esophagus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,91034,HCPCS,Gastroesophageal reflux test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,91035,HCPCS,G-esoph reflx tst w/electrod,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,91037,HCPCS,Esoph imped function test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,91038,HCPCS,Esoph imped funct test > 1hr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,91040,HCPCS,Esoph balloon distension tst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,91065,HCPCS,Breath hydrogen/methane test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,91110,HCPCS,Gi trc img intral esoph-ile,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,91111,HCPCS,Gi trc img intral esophagus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,91112,HCPCS,Gi wireless capsule measure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,91113,HCPCS,Gi trc img intral colon i&r,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,91117,HCPCS,Colon motility 6 hr study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,91120,HCPCS,Rectal sensation test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,91122,HCPCS,Anal pressure record,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , $318.13 , Not Applicable , Not Applicable , $334.03 , $324.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $318.13 , Not Applicable , Not Applicable , $318.13 , $334.03 , Not Applicable
,91132,HCPCS,Electrogastrography,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,91133,HCPCS,Electrogastrography w/test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,91200,HCPCS,Liver elastography,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,91299,HCPCS,Gastroenterology procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92002,HCPCS,Eye exam new patient,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,92004,HCPCS,Eye exam new patient,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,92012,HCPCS,Eye exam establish patient,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,92014,HCPCS,Eye exam&tx estab pt 1/>vst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,92018,HCPCS,New eye exam & treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,92019,HCPCS,Eye exam & treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 "," $2,392.31 ", Not Applicable , Not Applicable ," $2,511.93 "," $2,440.16 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,392.31 ", Not Applicable , Not Applicable ," $2,392.31 "," $2,511.93 ", Not Applicable
,92020,HCPCS,Special eye evaluation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92025,HCPCS,Corneal topography,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92060,HCPCS,Special eye evaluation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92065,HCPCS,Orthoptic training,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92081,HCPCS,Visual field examination(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92082,HCPCS,Visual field examination(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92083,HCPCS,Visual field examination(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92132,HCPCS,Cmptr ophth dx img ant segmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92133,HCPCS,Cmptr ophth img optic nerve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92134,HCPCS,Cptr ophth dx img post segmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92136,HCPCS,Ophthalmic biometry,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92145,HCPCS,Corneal hysteresis deter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92201,HCPCS,Opscpy extnd rta draw uni/bi,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92202,HCPCS,Opscpy extnd on/mac draw,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92227,HCPCS,Img rta detcj/mntr ds staff,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92228,HCPCS,Img rta detc/mntr ds phy/qhp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92229,HCPCS,Img rta detc/mntr ds poc aly,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92230,HCPCS,Eye exam with photos,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,92235,HCPCS,Fluorescein angrph uni/bi,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,92240,HCPCS,Icg angiography uni/bi,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,92242,HCPCS,Fluorescein icg angiography,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,92250,HCPCS,Eye exam with photos,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92260,HCPCS,Ophthalmoscopy/dynamometry,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92265,HCPCS,Eye muscle evaluation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92270,HCPCS,Electro-oculography,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92273,HCPCS,Full field erg w/i&r,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,92274,HCPCS,Multifocal erg w/i&r,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92283,HCPCS,Color vision examination,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92284,HCPCS,Dark adaptation eye exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,92285,HCPCS,Eye photography,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92286,HCPCS,Internal eye photography,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92287,HCPCS,Internal eye photography,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92311,HCPCS,Contact lens fitting,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,92312,HCPCS,Contact lens fitting,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92313,HCPCS,Contact lens fitting,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92315,HCPCS,Rx cntact lens aphakia 1 eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92316,HCPCS,Rx cntact lens aphakia 2 eye,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92317,HCPCS,Rx corneoscleral cntact lens,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92325,HCPCS,Modification of contact lens,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92326,HCPCS,Replacement of contact lens,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92352,HCPCS,Fit aphakia spectcl monofocl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92353,HCPCS,Fit aphakia spectcl multifoc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92354,HCPCS,Fit spectacles single system,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92355,HCPCS,Fit spectacles compound lens,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92358,HCPCS,Aphakia prosth service temp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92371,HCPCS,Repair & adjust spectacles,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92499,HCPCS,Eye service or procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,92502,HCPCS,Ear and throat examination,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , $540.69 , Not Applicable , Not Applicable , $567.73 , $551.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $540.69 , Not Applicable , Not Applicable , $540.69 , $567.73 , Not Applicable
,92511,HCPCS,Nasopharyngoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $196.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $196.80 , $196.80 , Not Applicable , Not Applicable , $206.64 , $200.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $196.80 , Not Applicable , Not Applicable , $196.80 , $206.64 , Not Applicable
,92512,HCPCS,Nasal function studies,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,92516,HCPCS,Facial nerve function test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,92517,HCPCS,Vemp test i&r cervical,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92518,HCPCS,Vemp test i&r ocular,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92519,HCPCS,Vemp tst i&r cervical&ocular,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,92520,HCPCS,Laryngeal function studies,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92537,HCPCS,Caloric vstblr test w/rec,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92538,HCPCS,Caloric vstblr test w/rec,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92540,HCPCS,Basic vestibular evaluation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92541,HCPCS,Spontaneous nystagmus test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92542,HCPCS,Positional nystagmus test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92544,HCPCS,Optokinetic nystagmus test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92545,HCPCS,Oscillating tracking test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,92546,HCPCS,Sinusoidal rotational test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92548,HCPCS,Cdp-sot 6 cond w/i&r,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92549,HCPCS,Cdp-sot 6 cond w/i&r mct&adt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92550,HCPCS,Tympanometry & reflex thresh,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92552,HCPCS,Pure tone audiometry air,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,92553,HCPCS,Audiometry air & bone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92555,HCPCS,Speech threshold audiometry,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92556,HCPCS,Speech audiometry complete,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92557,HCPCS,Comprehensive hearing test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92562,HCPCS,Loudness balance test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92563,HCPCS,Tone decay hearing test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92565,HCPCS,Stenger test pure tone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92567,HCPCS,Tympanometry,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92568,HCPCS,Acoustic refl threshold tst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92570,HCPCS,Acoustic immitance testing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92571,HCPCS,Filtered speech hearing test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92572,HCPCS,Staggered spondaic word test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92575,HCPCS,Sensorineural acuity test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92576,HCPCS,Synthetic sentence test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92577,HCPCS,Stenger test speech,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,92579,HCPCS,Visual audiometry (vra),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92582,HCPCS,Conditioning play audiometry,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92583,HCPCS,Select picture audiometry,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,92584,HCPCS,Electrocochleography,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92587,HCPCS,Evoked auditory test limited,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,92588,HCPCS,Evoked auditory tst complete,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,92596,HCPCS,Ear protector evaluation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,92601,HCPCS,Cochlear implt f/up exam <7,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92602,HCPCS,Reprogram cochlear implt <7,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92603,HCPCS,Cochlear implt f/up exam 7/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92604,HCPCS,Reprogram cochlear implt 7/>,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92620,HCPCS,Auditory function 60 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92625,HCPCS,Tinnitus assessment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92626,HCPCS,Eval aud funcj 1st hour,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92640,HCPCS,Aud brainstem implt programg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92651,HCPCS,Aep hearing status deter i&r,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,92652,HCPCS,Aep thrshld est mlt freq i&r,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,92653,HCPCS,Aep neurodiagnostic i&r,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,92700,HCPCS,Ent procedure/service,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,92920,HCPCS,Prq cardiac angioplast 1 art,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 "," $5,925.35 ", Not Applicable , Not Applicable ," $6,221.61 "," $6,043.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable ," $5,925.35 "," $6,221.61 ", Not Applicable
,92924,HCPCS,Prq card angio/athrect 1 art,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,92928,HCPCS,Prq card stent w/angio 1 vsl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,92933,HCPCS,Prq card stent/ath/angio,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,92937,HCPCS,Prq revasc byp graft 1 vsl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,92943,HCPCS,Prq card revasc chronic 1vsl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,92950,HCPCS,Heart/lung resuscitation cpr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,92953,HCPCS,Temporary external pacing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $671.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $671.60 , $671.60 , Not Applicable , Not Applicable , $705.18 , $685.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $671.60 , Not Applicable , Not Applicable , $671.60 , $705.18 , Not Applicable
,92960,HCPCS,Cardioversion electric ext,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $671.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $671.60 , $671.60 , Not Applicable , Not Applicable , $705.18 , $685.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $671.60 , Not Applicable , Not Applicable , $671.60 , $705.18 , Not Applicable
,92961,HCPCS,Cardioversion electric int,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $671.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $671.60 , $671.60 , Not Applicable , Not Applicable , $705.18 , $685.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $671.60 , Not Applicable , Not Applicable , $671.60 , $705.18 , Not Applicable
,92977,HCPCS,Dissolve clot heart vessel,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,92986,HCPCS,Revision of aortic valve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 "," $5,925.35 ", Not Applicable , Not Applicable ," $6,221.61 "," $6,043.85 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,925.35 ", Not Applicable , Not Applicable ," $5,925.35 "," $6,221.61 ", Not Applicable
,92987,HCPCS,Revision of mitral valve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,92990,HCPCS,Revision of pulmonary valve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,92997,HCPCS,Pul art balloon repr percut,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,93005,HCPCS,Electrocardiogram tracing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,93017,HCPCS,Cardiovascular stress test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,93024,HCPCS,Cardiac drug stress test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,93025,HCPCS,Microvolt t-wave assess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,93041,HCPCS,Rhythm ecg tracing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,93050,HCPCS,Art pressure waveform analys,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,93225,HCPCS,Ecg monit/reprt up to 48 hrs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,93226,HCPCS,Ecg monit/reprt up to 48 hrs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,93229,HCPCS,Remote 30 day ecg tech supp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,93242,HCPCS,Ext ecg>48hr<7d recording,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,93243,HCPCS,Ext ecg>48hr<7d scan a/r,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,93246,HCPCS,Ext ecg>7d<15d recording,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,93247,HCPCS,Ext ecg>7d<15d scan a/r,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,93260,HCPCS,Prgrmg dev eval impltbl sys,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93261,HCPCS,Interrogate subq defib,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93270,HCPCS,Remote 30 day ecg rev/report,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93271,HCPCS,Ecg/monitoring and analysis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , $120.02 , Not Applicable , Not Applicable , $126.02 , $122.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , $120.02 , $126.02 , Not Applicable
,93278,HCPCS,Ecg/signal-averaged,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,93279,HCPCS,Prgrmg dev eval pm/ldls pm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93280,HCPCS,Pm device progr eval dual,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93281,HCPCS,Pm device progr eval multi,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93282,HCPCS,Prgrmg eval implantable dfb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93283,HCPCS,Prgrmg eval implantable dfb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93284,HCPCS,Prgrmg eval implantable dfb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93285,HCPCS,Prgrmg dev eval scrms ip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93288,HCPCS,Interrog evl pm/ldls pm ip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93289,HCPCS,Interrog device eval heart,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93290,HCPCS,Interrog dev eval icpms ip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93291,HCPCS,Interrog dev eval scrms ip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,93292,HCPCS,Wcd device interrogate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93293,HCPCS,Pm phone r-strip device eval,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93296,HCPCS,Rem interrog evl pm/ids,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,93303,HCPCS,Echo transthoracic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,93304,HCPCS,Echo transthoracic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,93306,HCPCS,Tte w/doppler complete,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,93307,HCPCS,Tte w/o doppler complete,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,93308,HCPCS,Tte f-up or lmtd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,93312,HCPCS,Echo transesophageal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,93313,HCPCS,Echo transesophageal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,93315,HCPCS,Echo transesophageal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,93316,HCPCS,Echo transesophageal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,93318,HCPCS,Echo transesophageal intraop,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,93350,HCPCS,Stress tte only,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,93351,HCPCS,Stress tte complete,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,93451,HCPCS,Right heart cath,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93452,HCPCS,Left hrt cath w/ventrclgrphy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93453,HCPCS,R&l hrt cath w/ventriclgrphy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93454,HCPCS,Coronary artery angio s&i,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93455,HCPCS,Coronary art/grft angio s&i,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93456,HCPCS,R hrt coronary artery angio,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93457,HCPCS,R hrt art/grft angio,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93458,HCPCS,L hrt artery/ventricle angio,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93459,HCPCS,L hrt art/grft angio,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93460,HCPCS,R&l hrt art/ventricle angio,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93461,HCPCS,R&l hrt art/ventricle angio,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93503,HCPCS,Insert/place heart catheter,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 "," $1,681.14 ", Not Applicable , Not Applicable ," $1,765.20 "," $1,714.76 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,681.14 ", Not Applicable , Not Applicable ," $1,681.14 "," $1,765.20 ", Not Applicable
,93505,HCPCS,Biopsy of heart lining,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 "," $3,422.34 ", Not Applicable , Not Applicable ," $3,593.46 "," $3,490.79 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,422.34 ", Not Applicable , Not Applicable ," $3,422.34 "," $3,593.46 ", Not Applicable
,93580,HCPCS,Transcath closure of asd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,93581,HCPCS,Transcath closure of vsd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,93582,HCPCS,Perq transcath closure pda,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,93590,HCPCS,Perq transcath cls mitral,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,93591,HCPCS,Perq transcath cls aortic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,93593,HCPCS,R hrt cath chd nml nt cnj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93594,HCPCS,R hrt cath chd abnl nt cnj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93595,HCPCS,L hrt cath chd nm/abn nt cnj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93596,HCPCS,R&l hrt cath chd nml nt cnj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93597,HCPCS,R&l hrt cath chd abnl nt cnj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 "," $3,466.70 ", Not Applicable , Not Applicable ," $3,640.03 "," $3,536.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,466.70 ", Not Applicable , Not Applicable ," $3,466.70 "," $3,640.03 ", Not Applicable
,93600,HCPCS,Bundle of his recording,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 "," $7,266.77 ", Not Applicable , Not Applicable ," $7,630.11 "," $7,412.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable ," $7,266.77 "," $7,630.11 ", Not Applicable
,93602,HCPCS,Intra-atrial recording,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 "," $7,266.77 ", Not Applicable , Not Applicable ," $7,630.11 "," $7,412.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable ," $7,266.77 "," $7,630.11 ", Not Applicable
,93603,HCPCS,Right ventricular recording,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,331.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,331.56 "," $1,331.56 ", Not Applicable , Not Applicable ," $1,398.14 "," $1,358.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,331.56 ", Not Applicable , Not Applicable ," $1,331.56 "," $1,398.14 ", Not Applicable
,93610,HCPCS,Intra-atrial pacing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 "," $7,266.77 ", Not Applicable , Not Applicable ," $7,630.11 "," $7,412.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable ," $7,266.77 "," $7,630.11 ", Not Applicable
,93612,HCPCS,Intraventricular pacing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 "," $7,266.77 ", Not Applicable , Not Applicable ," $7,630.11 "," $7,412.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable ," $7,266.77 "," $7,630.11 ", Not Applicable
,93615,HCPCS,Esophageal recording,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,331.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,331.56 "," $1,331.56 ", Not Applicable , Not Applicable ," $1,398.14 "," $1,358.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,331.56 ", Not Applicable , Not Applicable ," $1,331.56 "," $1,398.14 ", Not Applicable
,93616,HCPCS,Esophageal recording,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,331.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,331.56 "," $1,331.56 ", Not Applicable , Not Applicable ," $1,398.14 "," $1,358.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,331.56 ", Not Applicable , Not Applicable ," $1,331.56 "," $1,398.14 ", Not Applicable
,93618,HCPCS,Heart rhythm pacing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,331.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,331.56 "," $1,331.56 ", Not Applicable , Not Applicable ," $1,398.14 "," $1,358.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,331.56 ", Not Applicable , Not Applicable ," $1,331.56 "," $1,398.14 ", Not Applicable
,93619,HCPCS,Electrophysiology evaluation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 "," $7,266.77 ", Not Applicable , Not Applicable ," $7,630.11 "," $7,412.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable ," $7,266.77 "," $7,630.11 ", Not Applicable
,93620,HCPCS,Electrophysiology evaluation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 "," $7,266.77 ", Not Applicable , Not Applicable ," $7,630.11 "," $7,412.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable ," $7,266.77 "," $7,630.11 ", Not Applicable
,93624,HCPCS,Electrophysiologic study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 "," $7,266.77 ", Not Applicable , Not Applicable ," $7,630.11 "," $7,412.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable ," $7,266.77 "," $7,630.11 ", Not Applicable
,93642,HCPCS,Electrophysiology evaluation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,331.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,331.56 "," $1,331.56 ", Not Applicable , Not Applicable ," $1,398.14 "," $1,358.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,331.56 ", Not Applicable , Not Applicable ," $1,331.56 "," $1,398.14 ", Not Applicable
,93650,HCPCS,Ablate heart dysrhythm focus,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 "," $7,266.77 ", Not Applicable , Not Applicable ," $7,630.11 "," $7,412.11 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,266.77 ", Not Applicable , Not Applicable ," $7,266.77 "," $7,630.11 ", Not Applicable
,93653,HCPCS,Compre ep eval tx svt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $25,653.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,653.94 "," $25,653.94 ", Not Applicable , Not Applicable ," $26,936.64 "," $26,167.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,653.94 ", Not Applicable , Not Applicable ," $25,653.94 "," $26,936.64 ", Not Applicable
,93654,HCPCS,Compre ep eval tx vt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $25,653.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,653.94 "," $25,653.94 ", Not Applicable , Not Applicable ," $26,936.64 "," $26,167.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,653.94 ", Not Applicable , Not Applicable ," $25,653.94 "," $26,936.64 ", Not Applicable
,93656,HCPCS,Compre ep eval abltj atr fib,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $25,653.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,653.94 "," $25,653.94 ", Not Applicable , Not Applicable ," $26,936.64 "," $26,167.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,653.94 ", Not Applicable , Not Applicable ," $25,653.94 "," $26,936.64 ", Not Applicable
,93660,HCPCS,Tilt table evaluation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,93668,HCPCS,Peripheral vascular rehab,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,93701,HCPCS,Bioimpedance cv analysis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,93702,HCPCS,Bis xtracell fluid analysis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,93724,HCPCS,Analyze pacemaker system,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , $326.43 , Not Applicable , Not Applicable , $342.75 , $332.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , $326.43 , $342.75 , Not Applicable
,93740,HCPCS,Temperature gradient studies,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,93745,HCPCS,Set-up cardiovert-defibrill,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , $326.43 , Not Applicable , Not Applicable , $342.75 , $332.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $326.43 , Not Applicable , Not Applicable , $326.43 , $342.75 , Not Applicable
,93750,HCPCS,Interrogation vad in person,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , $120.02 , Not Applicable , Not Applicable , $126.02 , $122.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , $120.02 , $126.02 , Not Applicable
,93786,HCPCS,Ambl bp mntr w/sw rec only,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,93788,HCPCS,Ambl bp mntr w/sw a/r,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,93797,HCPCS,Cardiac rehab,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $138.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $138.77 , $138.77 , Not Applicable , Not Applicable , $145.71 , $141.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $138.77 , Not Applicable , Not Applicable , $138.77 , $145.71 , Not Applicable
,93798,HCPCS,Cardiac rehab/monitor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $138.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $138.77 , $138.77 , Not Applicable , Not Applicable , $145.71 , $141.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $138.77 , Not Applicable , Not Applicable , $138.77 , $145.71 , Not Applicable
,93799,HCPCS,Cardiovascular procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,93880,HCPCS,Extracranial bilat study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,93882,HCPCS,Extracranial uni/ltd study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,93886,HCPCS,Intracranial complete study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,93888,HCPCS,Intracranial limited study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,93890,HCPCS,Tcd vasoreactivity study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,93892,HCPCS,Tcd emboli detect w/o inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,93893,HCPCS,Tcd emboli detect w/inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,93922,HCPCS,Upr/l xtremity art 2 levels,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,93923,HCPCS,Upr/lxtr art stdy 3+ lvls,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,93924,HCPCS,Lwr xtr vasc stdy bilat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,93925,HCPCS,Lower extremity study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,93926,HCPCS,Lower extremity study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,93930,HCPCS,Upper extremity study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,93931,HCPCS,Upper extremity study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,93970,HCPCS,Extremity study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,93971,HCPCS,Extremity study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,93975,HCPCS,Vascular study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,93976,HCPCS,Vascular study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,93978,HCPCS,Vascular study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,93979,HCPCS,Vascular study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,93980,HCPCS,Penile vascular study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,93981,HCPCS,Penile vascular study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,93985,HCPCS,Dup-scan hemo compl bi std,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,93986,HCPCS,Dup-scan hemo compl uni std,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,93990,HCPCS,Doppler flow testing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,93998,HCPCS,Noninvas vasc dx study proc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,94002,HCPCS,Vent mgmt inpat init day,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $582.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $582.41 , $582.41 , Not Applicable , Not Applicable , $611.53 , $594.06 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $582.41 , Not Applicable , Not Applicable , $582.41 , $611.53 , Not Applicable
,94003,HCPCS,Vent mgmt inpat subq day,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $582.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $582.41 , $582.41 , Not Applicable , Not Applicable , $611.53 , $594.06 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $582.41 , Not Applicable , Not Applicable , $582.41 , $611.53 , Not Applicable
,94010,HCPCS,Breathing capacity test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,94011,HCPCS,Spirometry up to 2 yrs old,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,94012,HCPCS,Spirmtry w/brnchdil inf-2 yr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,94013,HCPCS,Meas lung vol thru 2 yrs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,94014,HCPCS,Patient recorded spirometry,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,94015,HCPCS,Patient recorded spirometry,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,94060,HCPCS,Evaluation of wheezing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,94070,HCPCS,Evaluation of wheezing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,94150,HCPCS,Vital capacity test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,94200,HCPCS,Lung function test (mbc/mvv),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,94375,HCPCS,Respiratory flow volume loop,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,94450,HCPCS,Hypoxia response curve,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,94452,HCPCS,Hast w/report,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,94453,HCPCS,Hast w/oxygen titrate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,94610,HCPCS,Surfactant admin thru tube,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $224.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $224.72 , $224.72 , Not Applicable , Not Applicable , $235.95 , $229.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $224.72 , Not Applicable , Not Applicable , $224.72 , $235.95 , Not Applicable
,94617,HCPCS,Exercise tst brncspsm w/ecg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,94618,HCPCS,Pulmonary stress testing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,94619,HCPCS,Exercise tst brncspsm wo ecg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,94621,HCPCS,Cardiopulm exercise testing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,94625,HCPCS,Phy/qhp op pulm rhb w/o mntr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,94626,HCPCS,Phy/qhp op pulm rhb w/mntr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,94640,HCPCS,Airway inhalation treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $224.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $224.72 , $224.72 , Not Applicable , Not Applicable , $235.95 , $229.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $224.72 , Not Applicable , Not Applicable , $224.72 , $235.95 , Not Applicable
,94642,HCPCS,Aerosol inhalation treatment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $224.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $224.72 , $224.72 , Not Applicable , Not Applicable , $235.95 , $229.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $224.72 , Not Applicable , Not Applicable , $224.72 , $235.95 , Not Applicable
,94644,HCPCS,Cbt 1st hour,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,94660,HCPCS,Pos airway pressure cpap,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $224.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $224.72 , $224.72 , Not Applicable , Not Applicable , $235.95 , $229.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $224.72 , Not Applicable , Not Applicable , $224.72 , $235.95 , Not Applicable
,94662,HCPCS,Neg press ventilation cnp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $582.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $582.41 , $582.41 , Not Applicable , Not Applicable , $611.53 , $594.06 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $582.41 , Not Applicable , Not Applicable , $582.41 , $611.53 , Not Applicable
,94664,HCPCS,Evaluate pt use of inhaler,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $224.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $224.72 , $224.72 , Not Applicable , Not Applicable , $235.95 , $229.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $224.72 , Not Applicable , Not Applicable , $224.72 , $235.95 , Not Applicable
,94667,HCPCS,Chest wall manipulation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,94668,HCPCS,Chest wall manipulation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,94669,HCPCS,Mechanical chest wall oscill,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $224.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $224.72 , $224.72 , Not Applicable , Not Applicable , $235.95 , $229.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $224.72 , Not Applicable , Not Applicable , $224.72 , $235.95 , Not Applicable
,94680,HCPCS,Exhaled air analysis o2,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,94681,HCPCS,Exhaled air analysis o2/co2,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,94690,HCPCS,Exhaled air analysis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,94726,HCPCS,Pulm funct tst plethysmograp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,94727,HCPCS,Pulm function test by gas,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,94728,HCPCS,Airwy resist by oscillometry,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,94762,HCPCS,Measure blood oxygen level,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,94772,HCPCS,Breath recording infant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,94775,HCPCS,Ped home apnea rec hk-up,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,94776,HCPCS,Ped home apnea rec downld,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,94780,HCPCS,Cars/bd tst inft-12mo 60 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,94799,HCPCS,Pulmonary service/procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,95004,HCPCS,Percut allergy skin tests,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,95012,HCPCS,Exhaled nitric oxide meas,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,95017,HCPCS,Perq & icut allg test venoms,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,95018,HCPCS,Perq&ic allg test drugs/biol,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,95024,HCPCS,Icut allergy test drug/bug,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,95027,HCPCS,Icut allergy titrate-airborn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,95028,HCPCS,Icut allergy test-delayed,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,95044,HCPCS,Allergy patch tests,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,95052,HCPCS,Photo patch test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,95056,HCPCS,Photosensitivity tests,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,95060,HCPCS,Eye allergy tests,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,95065,HCPCS,Nose allergy test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,95070,HCPCS,Bronchial allergy tests,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95076,HCPCS,Ingest challenge ini 120 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95115,HCPCS,Immunotherapy one injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,95117,HCPCS,Immunotherapy injections,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,95144,HCPCS,Antigen therapy services,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,95145,HCPCS,Antigen therapy services,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,95146,HCPCS,Antigen therapy services,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,95147,HCPCS,Antigen therapy services,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , $74.12 , Not Applicable , Not Applicable , $77.83 , $75.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , $74.12 , $77.83 , Not Applicable
,95148,HCPCS,Antigen therapy services,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , $74.12 , Not Applicable , Not Applicable , $77.83 , $75.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , $74.12 , $77.83 , Not Applicable
,95149,HCPCS,Antigen therapy services,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , $74.12 , Not Applicable , Not Applicable , $77.83 , $75.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , $74.12 , $77.83 , Not Applicable
,95165,HCPCS,Antigen therapy services,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,95170,HCPCS,Antigen therapy services,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,95180,HCPCS,Rapid desensitization,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,95199,HCPCS,Allergy immunology services,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,95249,HCPCS,Cont gluc mntr pt prov eqp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,95250,HCPCS,Cont gluc mntr phys/qhp eqp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,95700,HCPCS,Eeg cont rec w/vid eeg tech,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95705,HCPCS,Eeg w/o vid 2-12 hr unmntr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95706,HCPCS,Eeg wo vid 2-12hr intmt mntr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95707,HCPCS,Eeg w/o vid 2-12hr cont mntr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95708,HCPCS,Eeg wo vid ea 12-26hr unmntr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95709,HCPCS,Eeg w/o vid ea 12-26hr intmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95710,HCPCS,Eeg w/o vid ea 12-26hr cont,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95711,HCPCS,Veeg 2-12 hr unmonitored,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95712,HCPCS,Veeg 2-12 hr intmt mntr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95713,HCPCS,Veeg 2-12 hr cont mntr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95714,HCPCS,Veeg ea 12-26 hr unmntr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95715,HCPCS,Veeg ea 12-26hr intmt mntr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95716,HCPCS,Veeg ea 12-26hr cont mntr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,95782,HCPCS,Polysom <6 yrs 4/> paramtrs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,95783,HCPCS,Polysom <6 yrs cpap/bilvl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,95800,HCPCS,Slp stdy unattended,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,95801,HCPCS,Slp stdy unatnd w/anal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,95803,HCPCS,Actigraphy testing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,95805,HCPCS,Multiple sleep latency test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95806,HCPCS,Sleep study unatt&resp efft,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,95807,HCPCS,Sleep study attended,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95808,HCPCS,Polysom any age 1-3> param,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,95810,HCPCS,Polysom 6/> yrs 4/> param,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,95811,HCPCS,Polysom 6/>yrs cpap 4/> parm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,95812,HCPCS,Eeg 41-60 minutes,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95813,HCPCS,Eeg extnd mntr 61-119 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95816,HCPCS,Eeg awake and drowsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95819,HCPCS,Eeg awake and asleep,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95822,HCPCS,Eeg coma or sleep only,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95824,HCPCS,Eeg cerebral death only,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95836,HCPCS,Ecog impltd brn npgt <30 d,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,95857,HCPCS,Cholinesterase challenge,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95860,HCPCS,Muscle test one limb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,95861,HCPCS,Muscle test 2 limbs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,95863,HCPCS,Muscle test 3 limbs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,95864,HCPCS,Muscle test 4 limbs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,95865,HCPCS,Muscle test larynx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,95866,HCPCS,Muscle test hemidiaphragm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,95867,HCPCS,Muscle test cran nerv unilat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95868,HCPCS,Muscle test cran nerve bilat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95869,HCPCS,Muscle test thor paraspinal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,95870,HCPCS,Muscle test nonparaspinal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,95872,HCPCS,Muscle test one fiber,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,95875,HCPCS,Limb exercise test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,95905,HCPCS,Motor &/ sens nrve cndj test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,95907,HCPCS,Nvr cndj tst 1-2 studies,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,95908,HCPCS,Nrv cndj tst 3-4 studies,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95909,HCPCS,Nrv cndj tst 5-6 studies,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95910,HCPCS,Nrv cndj test 7-8 studies,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95911,HCPCS,Nrv cndj test 9-10 studies,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95912,HCPCS,Nrv cndj test 11-12 studies,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95913,HCPCS,Nrv cndj test 13/> studies,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95921,HCPCS,Autonomic nrv parasym inervj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,95922,HCPCS,Autonomic nrv adrenrg inervj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,95923,HCPCS,Autonomic nrv syst funj test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,95924,HCPCS,Ans parasymp & symp w/tilt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95925,HCPCS,Somatosensory testing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95926,HCPCS,Somatosensory testing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95927,HCPCS,Somatosensory testing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95928,HCPCS,C motor evoked uppr limbs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,95929,HCPCS,C motor evoked lwr limbs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95930,HCPCS,Visual ep test cns w/i&r,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,95933,HCPCS,Blink reflex test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,95937,HCPCS,Neuromuscular junction test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,95938,HCPCS,Somatosensory testing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95939,HCPCS,C motor evoked upr&lwr limbs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,95954,HCPCS,Eeg monitoring/giving drugs,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,95958,HCPCS,Eeg monitoring/function test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,95961,HCPCS,Electrode stimulation brain,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,95965,HCPCS,Meg spontaneous,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,95966,HCPCS,Meg evoked single,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,95970,HCPCS,Alys npgt w/o prgrmg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,95971,HCPCS,Alys smpl sp/pn npgt w/prgrm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , $120.02 , Not Applicable , Not Applicable , $126.02 , $122.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , $120.02 , $126.02 , Not Applicable
,95972,HCPCS,Alys cplx sp/pn npgt w/prgrm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , $120.02 , Not Applicable , Not Applicable , $126.02 , $122.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , $120.02 , $126.02 , Not Applicable
,95976,HCPCS,Alys smpl cn npgt prgrmg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,95977,HCPCS,Alys cplx cn npgt prgrmg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , $120.02 , Not Applicable , Not Applicable , $126.02 , $122.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , $120.02 , $126.02 , Not Applicable
,95981,HCPCS,Io anal gast n-stim subsq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,95982,HCPCS,Io ga n-stim subsq w/reprog,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,95983,HCPCS,Alys brn npgt prgrmg 15 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , $120.02 , Not Applicable , Not Applicable , $126.02 , $122.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $120.02 , Not Applicable , Not Applicable , $120.02 , $126.02 , Not Applicable
,95990,HCPCS,Spin/brain pump refil & main,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,95991,HCPCS,Spin/brain pump refil & main,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , $312.35 , Not Applicable , Not Applicable , $327.96 , $318.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $312.35 , Not Applicable , Not Applicable , $312.35 , $327.96 , Not Applicable
,95999,HCPCS,Neurological procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,96000,HCPCS,Motion analysis video/3d,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,96001,HCPCS,Motion test w/ft press meas,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 "," $1,099.89 ", Not Applicable , Not Applicable ," $1,154.88 "," $1,121.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,099.89 ", Not Applicable , Not Applicable ," $1,099.89 "," $1,154.88 ", Not Applicable
,96002,HCPCS,Dynamic surface emg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,96003,HCPCS,Dynamic fine wire emg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,96112,HCPCS,Devel tst phys/qhp 1st hr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,96116,HCPCS,Nubhvl xm phys/qhp 1st hr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,96127,HCPCS,Brief emotional/behav assmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,96130,HCPCS,Psycl tst eval phys/qhp 1st,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,96132,HCPCS,Nrpsyc tst eval phys/qhp 1st,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,96136,HCPCS,Psycl/nrpsyc tst phy/qhp 1st,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,96138,HCPCS,Psycl/nrpsyc tech 1st,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,96146,HCPCS,Psycl/nrpsyc tst auto result,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,96156,HCPCS,Hlth bhv assmt/reassessment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,96158,HCPCS,Hlth bhv ivntj indiv 1st 30,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,96160,HCPCS,Pt-focused hlth risk assmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,96161,HCPCS,Caregiver health risk assmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,96164,HCPCS,Hlth bhv ivntj grp 1st 30,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,96167,HCPCS,Hlth bhv ivntj fam 1st 30,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,96360,HCPCS,Hydration iv infusion init,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , $244.57 , Not Applicable , Not Applicable , $256.80 , $249.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , $244.57 , $256.80 , Not Applicable
,96361,HCPCS,Hydrate iv infusion add-on,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,96365,HCPCS,Ther/proph/diag iv inf init,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , $244.57 , Not Applicable , Not Applicable , $256.80 , $249.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , $244.57 , $256.80 , Not Applicable
,96366,HCPCS,Ther/proph/diag iv inf addon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,96367,HCPCS,Tx/proph/dg addl seq iv inf,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , $74.12 , Not Applicable , Not Applicable , $77.83 , $75.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , $74.12 , $77.83 , Not Applicable
,96369,HCPCS,Sc ther infusion up to 1 hr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , $244.57 , Not Applicable , Not Applicable , $256.80 , $249.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , $244.57 , $256.80 , Not Applicable
,96370,HCPCS,Sc ther infusion addl hr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,96371,HCPCS,Sc ther infusion reset pump,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , $74.12 , Not Applicable , Not Applicable , $77.83 , $75.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , $74.12 , $77.83 , Not Applicable
,96372,HCPCS,Ther/proph/diag inj sc/im,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , $74.12 , Not Applicable , Not Applicable , $77.83 , $75.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , $74.12 , $77.83 , Not Applicable
,96373,HCPCS,Ther/proph/diag inj ia,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , $244.57 , Not Applicable , Not Applicable , $256.80 , $249.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , $244.57 , $256.80 , Not Applicable
,96374,HCPCS,Ther/proph/diag inj iv push,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , $244.57 , Not Applicable , Not Applicable , $256.80 , $249.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , $244.57 , $256.80 , Not Applicable
,96375,HCPCS,Tx/pro/dx inj new drug addon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,96377,HCPCS,Applicaton on-body injector,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,96379,HCPCS,Ther/prop/diag inj/inf proc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,96401,HCPCS,Chemo anti-neopl sq/im,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , $74.12 , Not Applicable , Not Applicable , $77.83 , $75.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , $74.12 , $77.83 , Not Applicable
,96402,HCPCS,Chemo hormon antineopl sq/im,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , $74.12 , Not Applicable , Not Applicable , $77.83 , $75.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , $74.12 , $77.83 , Not Applicable
,96405,HCPCS,Chemo intralesional up to 7,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , $74.12 , Not Applicable , Not Applicable , $77.83 , $75.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , $74.12 , $77.83 , Not Applicable
,96406,HCPCS,Chemo intralesional over 7,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , $244.57 , Not Applicable , Not Applicable , $256.80 , $249.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , $244.57 , $256.80 , Not Applicable
,96409,HCPCS,Chemo iv push sngl drug,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , $244.57 , Not Applicable , Not Applicable , $256.80 , $249.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , $244.57 , $256.80 , Not Applicable
,96411,HCPCS,Chemo iv push addl drug,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , $74.12 , Not Applicable , Not Applicable , $77.83 , $75.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , $74.12 , $77.83 , Not Applicable
,96413,HCPCS,Chemo iv infusion 1 hr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,96415,HCPCS,Chemo iv infusion addl hr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , $74.12 , Not Applicable , Not Applicable , $77.83 , $75.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , $74.12 , $77.83 , Not Applicable
,96416,HCPCS,Chemo prolong infuse w/pump,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,96417,HCPCS,Chemo iv infus each addl seq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , $74.12 , Not Applicable , Not Applicable , $77.83 , $75.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.12 , Not Applicable , Not Applicable , $74.12 , $77.83 , Not Applicable
,96420,HCPCS,Chemo ia push tecnique,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,96422,HCPCS,Chemo ia infusion up to 1 hr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , $244.57 , Not Applicable , Not Applicable , $256.80 , $249.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , $244.57 , $256.80 , Not Applicable
,96423,HCPCS,Chemo ia infuse each addl hr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,96425,HCPCS,Chemotherapy infusion method,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,96440,HCPCS,Chemotherapy intracavitary,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,96446,HCPCS,Chemotx admn prtl cavity,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,96450,HCPCS,Chemotherapy into cns,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,96521,HCPCS,Refill/maint portable pump,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , $244.57 , Not Applicable , Not Applicable , $256.80 , $249.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , $244.57 , $256.80 , Not Applicable
,96522,HCPCS,Refill/maint pump/resvr syst,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , $244.57 , Not Applicable , Not Applicable , $256.80 , $249.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , $244.57 , $256.80 , Not Applicable
,96523,HCPCS,Irrig drug delivery device,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,96542,HCPCS,Chemotherapy injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , $244.57 , Not Applicable , Not Applicable , $256.80 , $249.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $244.57 , Not Applicable , Not Applicable , $244.57 , $256.80 , Not Applicable
,96549,HCPCS,Chemotherapy unspecified,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,96567,HCPCS,Pdt dstr prmlg les skn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,96573,HCPCS,Pdt dstr prmlg les phys/qhp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,96574,HCPCS,Dbrdmt prmlg les w/pdt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,96900,HCPCS,Ultraviolet light therapy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,96910,HCPCS,Photochemotherapy with uv-b,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,96912,HCPCS,Photochemotherapy with uv-a,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,96913,HCPCS,Photochemotherapy uv-a or b,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,96920,HCPCS,Laser tx skin < 250 sq cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,96921,HCPCS,Laser tx skin 250-500 sq cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,96922,HCPCS,Laser tx skin >500 sq cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,96999,HCPCS,Dermatological procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,97151,HCPCS,Bhv id assmt by phys/qhp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,97152,HCPCS,Bhv id suprt assmt by 1 tech,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,97153,HCPCS,Adaptive behavior tx by tech,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,97154,HCPCS,Grp adapt bhv tx by tech,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,97155,HCPCS,Adapt behavior tx phys/qhp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,97156,HCPCS,Fam adapt bhv tx gdn phy/qhp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,97157,HCPCS,Mult fam adapt bhv tx gdn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,97158,HCPCS,Grp adapt bhv tx by phy/qhp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,97597,HCPCS,Rmvl devital tis 20 cm/<,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,97602,HCPCS,Wound(s) care non-selective,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,97605,HCPCS,Neg press wound tx <=50 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,97606,HCPCS,Neg press wound tx >50 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,97607,HCPCS,Neg press wnd tx <=50 sq cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,97608,HCPCS,Neg press wound tx >50 cm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , $413.21 , Not Applicable , Not Applicable , $433.88 , $421.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $413.21 , Not Applicable , Not Applicable , $413.21 , $433.88 , Not Applicable
,97610,HCPCS,Low frequency non-thermal us,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,97810,HCPCS,Acupunct w/o stimul 15 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,97813,HCPCS,Acupunct w/stimul 15 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,98925,HCPCS,Osteopath manj 1-2 regions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , $31.89 , Not Applicable , Not Applicable , $33.48 , $32.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , $31.89 , $33.48 , Not Applicable
,98926,HCPCS,Osteopath manj 3-4 regions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , $31.89 , Not Applicable , Not Applicable , $33.48 , $32.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , $31.89 , $33.48 , Not Applicable
,98927,HCPCS,Osteopath manj 5-6 regions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , $31.89 , Not Applicable , Not Applicable , $33.48 , $32.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , $31.89 , $33.48 , Not Applicable
,98928,HCPCS,Osteopath manj 7-8 regions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , $31.89 , Not Applicable , Not Applicable , $33.48 , $32.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , $31.89 , $33.48 , Not Applicable
,98929,HCPCS,Osteopath manj 9-10 regions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , $31.89 , Not Applicable , Not Applicable , $33.48 , $32.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , $31.89 , $33.48 , Not Applicable
,98940,HCPCS,Chiropract manj 1-2 regions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , $31.89 , Not Applicable , Not Applicable , $33.48 , $32.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , $31.89 , $33.48 , Not Applicable
,98941,HCPCS,Chiropract manj 3-4 regions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , $31.89 , Not Applicable , Not Applicable , $33.48 , $32.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , $31.89 , $33.48 , Not Applicable
,98942,HCPCS,Chiropractic manj 5 regions,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , $31.89 , Not Applicable , Not Applicable , $33.48 , $32.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.89 , Not Applicable , Not Applicable , $31.89 , $33.48 , Not Applicable
,98975,HCPCS,Rem ther mntr 1st setup&edu,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,98976,HCPCS,Rem ther mntr dev sply resp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,98977,HCPCS,Rem ther mntr dv sply mscskl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,99170,HCPCS,Anogenital exam child w imag,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , $203.67 , Not Applicable , Not Applicable , $213.85 , $207.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.67 , Not Applicable , Not Applicable , $203.67 , $213.85 , Not Applicable
,99195,HCPCS,Phlebotomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,99281,HCPCS,Emergency dept visit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $86.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $86.72 , $86.72 , Not Applicable , Not Applicable , $91.05 , $88.45 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $86.72 , Not Applicable , Not Applicable , $86.72 , $91.05 , Not Applicable
,99282,HCPCS,Emergency dept visit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $157.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $157.03 , $157.03 , Not Applicable , Not Applicable , $164.88 , $160.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $157.03 , Not Applicable , Not Applicable , $157.03 , $164.88 , Not Applicable
,99283,HCPCS,Emergency dept visit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $276.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $276.67 , $276.67 , Not Applicable , Not Applicable , $290.50 , $282.20 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $276.67 , Not Applicable , Not Applicable , $276.67 , $290.50 , Not Applicable
,99284,HCPCS,Emergency dept visit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $434.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $434.89 , $434.89 , Not Applicable , Not Applicable , $456.64 , $443.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $434.89 , Not Applicable , Not Applicable , $434.89 , $456.64 , Not Applicable
,99285,HCPCS,Emergency dept visit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $624.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $624.24 , $624.24 , Not Applicable , Not Applicable , $655.45 , $636.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $624.24 , Not Applicable , Not Applicable , $624.24 , $655.45 , Not Applicable
,99291,HCPCS,Critical care first hour,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $890.51 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $890.51 , $890.51 , Not Applicable , Not Applicable , $935.03 , $908.32 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $890.51 , Not Applicable , Not Applicable , $890.51 , $935.03 , Not Applicable
,99406,HCPCS,Behav chng smoking 3-10 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,99407,HCPCS,Behav chng smoking > 10 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,99426,HCPCS,Prin care mgmt staff 1st 30,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,99453,HCPCS,Rem mntr physiol param setup,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,99454,HCPCS,Rem mntr physiol param dev,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,99460,HCPCS,Init nb em per day hosp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,99463,HCPCS,Same day nb discharge,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,99465,HCPCS,Nb resuscitation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $671.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $671.60 , $671.60 , Not Applicable , Not Applicable , $705.18 , $685.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $671.60 , Not Applicable , Not Applicable , $671.60 , $705.18 , Not Applicable
,99473,HCPCS,Self-meas bp pt educaj/train,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,99483,HCPCS,Assmt & care pln pt cog imp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,99484,HCPCS,Care mgmt svc bhvl hlth cond,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,99487,HCPCS,Cplx chrnc care 1st 60 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , $159.96 , Not Applicable , Not Applicable , $167.96 , $163.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , $159.96 , $167.96 , Not Applicable
,99490,HCPCS,Chrnc care mgmt staff 1st 20,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,99492,HCPCS,1st psyc collab care mgmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,99493,HCPCS,Sbsq psyc collab care mgmt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,99495,HCPCS,Trans care mgmt 14 day disch,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,99496,HCPCS,Trans care mgmt 7 day disch,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,99497,HCPCS,Advncd care plan 30 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,A9513,HCPCS,Lutetium lu 177 dotatat ther,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $321.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $321.12 , $321.12 , Not Applicable , Not Applicable , $337.18 , $327.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $321.12 , Not Applicable , Not Applicable , $321.12 , $337.18 , Not Applicable
,A9517,HCPCS,"I131 iodide cap, rx",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $23.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $23.55 , $23.55 , Not Applicable , Not Applicable , $24.73 , $24.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $23.55 , Not Applicable , Not Applicable , $23.55 , $24.73 , Not Applicable
,A9527,HCPCS,Iodine i-125 sodium iodide,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.26 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.26 , $47.26 , Not Applicable , Not Applicable , $49.62 , $48.20 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.26 , Not Applicable , Not Applicable , $47.26 , $49.62 , Not Applicable
,A9530,HCPCS,"I131 iodide sol, rx",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $15.62 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $15.62 , $15.62 , Not Applicable , Not Applicable , $16.40 , $15.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $15.62 , Not Applicable , Not Applicable , $15.62 , $16.40 , Not Applicable
,A9543,HCPCS,"Y90 ibritumomab, rx",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $69,993.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $69,993.48 "," $69,993.48 ", Not Applicable , Not Applicable ," $73,493.16 "," $71,393.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $69,993.48 ", Not Applicable , Not Applicable ," $69,993.48 "," $73,493.16 ", Not Applicable
,A9563,HCPCS,P32 na phosphate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $536.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $536.52 , $536.52 , Not Applicable , Not Applicable , $563.35 , $547.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $536.52 , Not Applicable , Not Applicable , $536.52 , $563.35 , Not Applicable
,A9590,HCPCS,Iodine i-131 iobenguane 1mci,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $374.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $374.73 , $374.73 , Not Applicable , Not Applicable , $393.46 , $382.22 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $374.73 , Not Applicable , Not Applicable , $374.73 , $393.46 , Not Applicable
,A9591,HCPCS,Fluoroestradiol f 18,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $754.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $754.83 , $754.83 , Not Applicable , Not Applicable , $792.57 , $769.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $754.83 , Not Applicable , Not Applicable , $754.83 , $792.57 , Not Applicable
,A9592,HCPCS,Copper cu 64 dotatate diag,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,074.83 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,074.83 "," $1,074.83 ", Not Applicable , Not Applicable ," $1,128.57 "," $1,096.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,074.83 ", Not Applicable , Not Applicable ," $1,074.83 "," $1,128.57 ", Not Applicable
,A9593,HCPCS,Gallium ga-68 psma-11 ucsf,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $857.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $857.87 , $857.87 , Not Applicable , Not Applicable , $900.76 , $875.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $857.87 , Not Applicable , Not Applicable , $857.87 , $900.76 , Not Applicable
,A9594,HCPCS,"Gallium ga-68 psma-11, ucla",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $839.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $839.94 , $839.94 , Not Applicable , Not Applicable , $881.94 , $856.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $839.94 , Not Applicable , Not Applicable , $839.94 , $881.94 , Not Applicable
,A9595,HCPCS,"Piflu f-18, dia 1 millicurie",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $616.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $616.24 , $616.24 , Not Applicable , Not Applicable , $647.06 , $628.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $616.24 , Not Applicable , Not Applicable , $616.24 , $647.06 , Not Applicable
,A9600,HCPCS,Sr89 strontium,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,653.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,653.06 "," $4,653.06 ", Not Applicable , Not Applicable ," $4,885.71 "," $4,746.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,653.06 ", Not Applicable , Not Applicable ," $4,653.06 "," $4,885.71 ", Not Applicable
,A9604,HCPCS,Sm 153 lexidronam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $20,204.04 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,204.04 "," $20,204.04 ", Not Applicable , Not Applicable ," $21,214.24 "," $20,608.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,204.04 ", Not Applicable , Not Applicable ," $20,204.04 "," $21,214.24 ", Not Applicable
,A9606,HCPCS,Radium ra223 dichloride ther,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $170.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $170.50 , $170.50 , Not Applicable , Not Applicable , $179.02 , $173.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $170.50 , Not Applicable , Not Applicable , $170.50 , $179.02 , Not Applicable
,C1052,HCPCS,"Hemostatic agent, gi, topic",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable
,C1062,HCPCS,Intravertebral fx aug impl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable
,C1716,HCPCS,"Brachytx, non-str, gold-198",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $721.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $721.79 , $721.79 , Not Applicable , Not Applicable , $757.88 , $736.23 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $721.79 , Not Applicable , Not Applicable , $721.79 , $757.88 , Not Applicable
,C1717,HCPCS,"Brachytx, non-str,hdr ir-192",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $400.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $400.01 , $400.01 , Not Applicable , Not Applicable , $420.01 , $408.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $400.01 , Not Applicable , Not Applicable , $400.01 , $420.01 , Not Applicable
,C1719,HCPCS,"Brachytx, ns, non-hdrir-192",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $240.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $240.93 , $240.93 , Not Applicable , Not Applicable , $252.98 , $245.75 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $240.93 , Not Applicable , Not Applicable , $240.93 , $252.98 , Not Applicable
,C1734,HCPCS,"Orth/devic/drug bn/bn,tis/bn",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable
,C1748,HCPCS,"Endoscope, single, ugi",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable
,C1761,HCPCS,"Cath, trans intra litho/coro",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable
,C1823,HCPCS,"Gen, neuro, trans sen/stim",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable
,C1824,HCPCS,"Generator, ccm, implant",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable
,C1825,HCPCS,"Gen, neuro, carot sinus baro",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable
,C1831,HCPCS,Personalized interbody cage,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable
,C1832,HCPCS,Auto cell process sys,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable
,C1833,HCPCS,Cardiac monitor sys,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable
,C1839,HCPCS,Iris prosthesis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable
,C1982,HCPCS,"Cath, pressure,valve-occlu",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable
,C2596,HCPCS,"Probe, robotic, water-jet",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $- , Not Applicable , Not Applicable , $- , $- , Not Applicable
,C2616,HCPCS,"Brachytx, non-str,yttrium-90",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $20,793.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,793.26 "," $20,793.26 ", Not Applicable , Not Applicable ," $21,832.92 "," $21,209.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,793.26 ", Not Applicable , Not Applicable ," $20,793.26 "," $21,832.92 ", Not Applicable
,C2634,HCPCS,"Brachytx, non-str, ha, i-125",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $176.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $176.99 , $176.99 , Not Applicable , Not Applicable , $185.84 , $180.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $176.99 , Not Applicable , Not Applicable , $176.99 , $185.84 , Not Applicable
,C2635,HCPCS,"Brachytx, non-str, ha, p-103",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $53.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $53.40 , $53.40 , Not Applicable , Not Applicable , $56.07 , $54.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $53.40 , Not Applicable , Not Applicable , $53.40 , $56.07 , Not Applicable
,C2636,HCPCS,"Brachy linear, non-str,p-103",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $61.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $61.54 , $61.54 , Not Applicable , Not Applicable , $64.61 , $62.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $61.54 , Not Applicable , Not Applicable , $61.54 , $64.61 , Not Applicable
,C2638,HCPCS,"Brachytx, stranded, i-125",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.70 , $44.70 , Not Applicable , Not Applicable , $46.94 , $45.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.70 , Not Applicable , Not Applicable , $44.70 , $46.94 , Not Applicable
,C2639,HCPCS,"Brachytx, non-stranded,i-125",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.76 , $40.76 , Not Applicable , Not Applicable , $42.80 , $41.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.76 , Not Applicable , Not Applicable , $40.76 , $42.80 , Not Applicable
,C2640,HCPCS,"Brachytx, stranded, p-103",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $104.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $104.87 , $104.87 , Not Applicable , Not Applicable , $110.12 , $106.97 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $104.87 , Not Applicable , Not Applicable , $104.87 , $110.12 , Not Applicable
,C2641,HCPCS,"Brachytx, non-stranded,p-103",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $83.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $83.05 , $83.05 , Not Applicable , Not Applicable , $87.21 , $84.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $83.05 , Not Applicable , Not Applicable , $83.05 , $87.21 , Not Applicable
,C2642,HCPCS,"Brachytx, stranded, c-131",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $85.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $85.89 , $85.89 , Not Applicable , Not Applicable , $90.18 , $87.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $85.89 , Not Applicable , Not Applicable , $85.89 , $90.18 , Not Applicable
,C2643,HCPCS,"Brachytx, non-stranded,c-131",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.02 , $96.02 , Not Applicable , Not Applicable , $100.82 , $97.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.02 , Not Applicable , Not Applicable , $96.02 , $100.82 , Not Applicable
,C2645,HCPCS,"Brachytx planar, p-103",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $5.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $5.49 , $5.49 , Not Applicable , Not Applicable , $5.76 , $5.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $5.49 , Not Applicable , Not Applicable , $5.49 , $5.76 , Not Applicable
,C2698,HCPCS,"Brachytx, stranded, nos",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.70 , $44.70 , Not Applicable , Not Applicable , $46.94 , $45.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.70 , Not Applicable , Not Applicable , $44.70 , $46.94 , Not Applicable
,C2699,HCPCS,"Brachytx, non-stranded, nos",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.76 , $40.76 , Not Applicable , Not Applicable , $42.80 , $41.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.76 , Not Applicable , Not Applicable , $40.76 , $42.80 , Not Applicable
,C5271,HCPCS,Low cost skin substitute app,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,C5273,HCPCS,Low cost skin substitute app,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,C5275,HCPCS,Low cost skin substitute app,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,C5277,HCPCS,Low cost skin substitute app,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , $626.13 , Not Applicable , Not Applicable , $657.44 , $638.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $626.13 , Not Applicable , Not Applicable , $626.13 , $657.44 , Not Applicable
,C8900,HCPCS,"Mra w/cont, abd",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8901,HCPCS,"Mra w/o cont, abd",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,C8902,HCPCS,"Mra w/o fol w/cont, abd",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8903,HCPCS,"Mri w/cont, breast, uni",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,C8905,HCPCS,"Mri w/o fol w/cont, brst, un",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8906,HCPCS,"Mri w/cont, breast, bi",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8908,HCPCS,"Mri w/o fol w/cont, breast,",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8909,HCPCS,"Mra w/cont, chest",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8910,HCPCS,"Mra w/o cont, chest",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,C8911,HCPCS,"Mra w/o fol w/cont, chest",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8912,HCPCS,"Mra w/cont, lwr ext",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8913,HCPCS,"Mra w/o cont, lwr ext",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,C8914,HCPCS,"Mra w/o fol w/cont, lwr ext",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8918,HCPCS,"Mra w/cont, pelvis",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8919,HCPCS,"Mra w/o cont, pelvis",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,C8920,HCPCS,"Mra w/o fol w/cont, pelvis",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8921,HCPCS,"Tte w or w/o fol w/cont, com",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,C8922,HCPCS,"Tte w or w/o fol w/cont, f/u",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,C8923,HCPCS,"2d tte w or w/o fol w/con,co",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,C8924,HCPCS,"2d tte w or w/o fol w/con,fu",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8925,HCPCS,"2d tee w or w/o fol w/con,in",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,C8926,HCPCS,"Tee w or w/o fol w/cont,cong",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,C8927,HCPCS,"Tee w or w/o fol w/cont, mon",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,C8928,HCPCS,"Tte w or w/o fol w/con,stres",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,C8929,HCPCS,"Tte w or wo fol wcon,doppler",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,C8930,HCPCS,"Tte w or w/o contr, cont ecg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , $855.31 , Not Applicable , Not Applicable , $898.07 , $872.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $855.31 , Not Applicable , Not Applicable , $855.31 , $898.07 , Not Applicable
,C8931,HCPCS,"Mra, w/dye, spinal canal",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8932,HCPCS,"Mra, w/o dye, spinal canal",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,C8933,HCPCS,"Mra, w/o&w/dye, spinal canal",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8934,HCPCS,"Mra, w/dye, upper extremity",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8935,HCPCS,"Mra, w/o dye, upper extr",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , $275.09 , Not Applicable , Not Applicable , $288.84 , $280.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $275.09 , Not Applicable , Not Applicable , $275.09 , $288.84 , Not Applicable
,C8936,HCPCS,"Mra, w/o&w/dye, upper extr",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C8957,HCPCS,"Prolonged iv inf, req pump",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,C9046,HCPCS,Cocaine hcl nasal solution,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.56 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.56 , $1.56 , Not Applicable , Not Applicable , $1.64 , $1.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.56 , Not Applicable , Not Applicable , $1.56 , $1.64 , Not Applicable
,C9047,HCPCS,"Injection, caplacizumab-yhdp",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $809.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $809.21 , $809.21 , Not Applicable , Not Applicable , $849.67 , $825.39 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $809.21 , Not Applicable , Not Applicable , $809.21 , $849.67 , Not Applicable
,C9067,HCPCS,Gallium ga-68 dotatoc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $10.11 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $10.11 , $10.11 , Not Applicable , Not Applicable , $10.62 , $10.32 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $10.11 , Not Applicable , Not Applicable , $10.11 , $10.62 , Not Applicable
,C9084,HCPCS,"loncastuximab-lpyl, 0.1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $283.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $283.34 , $283.34 , Not Applicable , Not Applicable , $297.51 , $289.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $283.34 , Not Applicable , Not Applicable , $283.34 , $297.51 , Not Applicable
,C9085,HCPCS,Inj avalglucosid alfa-ngpt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $82.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $82.71 , $82.71 , Not Applicable , Not Applicable , $86.84 , $84.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $82.71 , Not Applicable , Not Applicable , $82.71 , $86.84 , Not Applicable
,C9086,HCPCS,"Inj, anifrolumab-fnia",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $18.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $18.49 , $18.49 , Not Applicable , Not Applicable , $19.41 , $18.86 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $18.49 , Not Applicable , Not Applicable , $18.49 , $19.41 , Not Applicable
,C9087,HCPCS,Inj cyclophosphamd auromedic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $8.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $8.80 , $8.80 , Not Applicable , Not Applicable , $9.24 , $8.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $8.80 , Not Applicable , Not Applicable , $8.80 , $9.24 , Not Applicable
,C9250,HCPCS,Artiss fibrin sealant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $183.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $183.60 , $183.60 , Not Applicable , Not Applicable , $192.78 , $187.27 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $183.60 , Not Applicable , Not Applicable , $183.60 , $192.78 , Not Applicable
,C9257,HCPCS,Bevacizumab injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.06 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.06 , $2.06 , Not Applicable , Not Applicable , $2.16 , $2.10 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.06 , Not Applicable , Not Applicable , $2.06 , $2.16 , Not Applicable
,C9460,HCPCS,"Injection, cangrelor",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $19.10 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $19.10 , $19.10 , Not Applicable , Not Applicable , $20.06 , $19.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $19.10 , Not Applicable , Not Applicable , $19.10 , $20.06 , Not Applicable
,C9482,HCPCS,Sotalol hydrochloride iv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $20.58 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $20.58 , $20.58 , Not Applicable , Not Applicable , $21.61 , $20.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $20.58 , Not Applicable , Not Applicable , $20.58 , $21.61 , Not Applicable
,C9488,HCPCS,Conivaptan hcl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $51.44 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $51.44 , $51.44 , Not Applicable , Not Applicable , $54.01 , $52.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $51.44 , Not Applicable , Not Applicable , $51.44 , $54.01 , Not Applicable
,C9600,HCPCS,Perc drug-el cor stent sing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,C9602,HCPCS,Perc d-e cor stent ather s,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,C9604,HCPCS,Perc d-e cor revasc t cabg s,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,C9607,HCPCS,Perc d-e cor revasc chro sin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,C9725,HCPCS,Place endorectal app,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,C9727,HCPCS,Insert palate implants,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 "," $1,617.20 ", Not Applicable , Not Applicable ," $1,698.06 "," $1,649.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,617.20 ", Not Applicable , Not Applicable ," $1,617.20 "," $1,698.06 ", Not Applicable
,C9728,HCPCS,"Place device/marker, non pro",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,509.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,509.66 "," $1,509.66 ", Not Applicable , Not Applicable ," $1,585.15 "," $1,539.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,509.66 ", Not Applicable , Not Applicable ," $1,509.66 "," $1,585.15 ", Not Applicable
,C9733,HCPCS,Non-ophthalmic fva,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,C9734,HCPCS,"U/s trtmt, not leiomyomata",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,C9739,HCPCS,Cystoscopy prostatic imp 1-3,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,C9740,HCPCS,Cysto impl 4 or more,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 "," $9,866.61 ", Not Applicable , Not Applicable ," $10,359.94 "," $10,063.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable ," $9,866.61 "," $10,359.94 ", Not Applicable
,C9751,HCPCS,"Microwave bronch, 3d, ebus",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,390.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,390.26 "," $4,390.26 ", Not Applicable , Not Applicable ," $4,609.77 "," $4,478.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,390.26 ", Not Applicable , Not Applicable ," $4,390.26 "," $4,609.77 ", Not Applicable
,C9757,HCPCS,Spine/lumbar disk surgery,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 "," $14,741.45 ", Not Applicable , Not Applicable ," $15,478.53 "," $15,036.28 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $14,741.45 ", Not Applicable , Not Applicable ," $14,741.45 "," $15,478.53 ", Not Applicable
,C9758,HCPCS,Blind interatrial shunt ide,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $20,485.74 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,485.74 "," $20,485.74 ", Not Applicable , Not Applicable ," $21,510.02 "," $20,895.45 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $20,485.74 ", Not Applicable , Not Applicable ," $20,485.74 "," $21,510.02 ", Not Applicable
,C9760,HCPCS,Non-blind interatrial shunt,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $32,191.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,191.54 "," $32,191.54 ", Not Applicable , Not Applicable ," $33,801.11 "," $32,835.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $32,191.54 ", Not Applicable , Not Applicable ," $32,191.54 "," $33,801.11 ", Not Applicable
,C9761,HCPCS,"Cysto, litho, vacuum kidney",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 "," $9,866.61 ", Not Applicable , Not Applicable ," $10,359.94 "," $10,063.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,866.61 ", Not Applicable , Not Applicable ," $9,866.61 "," $10,359.94 ", Not Applicable
,C9762,HCPCS,Cardiac mri seg dys strain,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,C9763,HCPCS,Cardiac mri seg dys stress,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , $577.66 , Not Applicable , Not Applicable , $606.54 , $589.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $577.66 , Not Applicable , Not Applicable , $577.66 , $606.54 , Not Applicable
,C9764,HCPCS,Revasc intravasc lithotripsy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,C9765,HCPCS,Revasc intra lithotrip-stent,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,C9766,HCPCS,Revasc intra lithotrip-ather,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,C9767,HCPCS,Revasc lithotrip-stent-ather,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,C9769,HCPCS,Cysto w/temp pros implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 "," $5,274.50 ", Not Applicable , Not Applicable ," $5,538.23 "," $5,379.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,274.50 ", Not Applicable , Not Applicable ," $5,274.50 "," $5,538.23 ", Not Applicable
,C9770,HCPCS,"Vitrec/mech pars, subret inj",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,804.97 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,804.97 "," $3,804.97 ", Not Applicable , Not Applicable ," $3,995.22 "," $3,881.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,804.97 ", Not Applicable , Not Applicable ," $3,804.97 "," $3,995.22 ", Not Applicable
,C9771,HCPCS,Nsl/sins cryo post nasal tis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 "," $3,270.58 ", Not Applicable , Not Applicable ," $3,434.11 "," $3,335.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,270.58 ", Not Applicable , Not Applicable ," $3,270.58 "," $3,434.11 ", Not Applicable
,C9772,HCPCS,Revasc lithotrip tibi/perone,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 "," $12,008.38 ", Not Applicable , Not Applicable ," $12,608.80 "," $12,248.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $12,008.38 ", Not Applicable , Not Applicable ," $12,008.38 "," $12,608.80 ", Not Applicable
,C9773,HCPCS,Revasc lithotr-stent tib/per,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,C9774,HCPCS,Revasc lithotr-ather tib/per,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,C9775,HCPCS,Revasc lith-sten-ath tib/per,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,C9777,HCPCS,Esophag muc integ w/eso EGD,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 "," $3,670.82 ", Not Applicable , Not Applicable ," $3,854.36 "," $3,744.24 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,670.82 ", Not Applicable , Not Applicable ," $3,670.82 "," $3,854.36 ", Not Applicable
,C9778,HCPCS,"Colpopexy, min/inv, ex-perit",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 "," $5,271.70 ", Not Applicable , Not Applicable ," $5,535.28 "," $5,377.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $5,271.70 ", Not Applicable , Not Applicable ," $5,271.70 "," $5,535.28 ", Not Applicable
,C9779,HCPCS,Esd endoscopy or colonoscopy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 "," $2,920.64 ", Not Applicable , Not Applicable ," $3,066.68 "," $2,979.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,920.64 ", Not Applicable , Not Applicable ," $2,920.64 "," $3,066.68 ", Not Applicable
,C9780,HCPCS,Insert cv cath inf & sup app,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $9,657.87 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,657.87 "," $9,657.87 ", Not Applicable , Not Applicable ," $10,140.76 "," $9,851.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $9,657.87 ", Not Applicable , Not Applicable ," $9,657.87 "," $10,140.76 ", Not Applicable
,C9803,HCPCS,Hopd covid-19 spec collect,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,D0150,HCPCS,Comprehensve oral evaluation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D0240,HCPCS,Intraoral occlusal film,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D0250,HCPCS,Extraoral 2d project image,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D0251,HCPCS,Extraoral posterior image,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , $96.70 , Not Applicable , Not Applicable , $101.54 , $98.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.70 , Not Applicable , Not Applicable , $96.70 , $101.54 , Not Applicable
,D0270,HCPCS,Dental bitewing single image,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D0272,HCPCS,Dental bitewings two images,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D0274,HCPCS,Bitewings four images,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D0277,HCPCS,Vert bitewings 7 to 8 images,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D0460,HCPCS,Pulp vitality test,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D0600,HCPCS,Non-ionizing diag proc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D1510,HCPCS,Space maintainer fxd unilat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D1516,HCPCS,"Fixed bilat space maint, max",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D1517,HCPCS,"Fixed bilat space maint, man",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D1520,HCPCS,Remove unilat space maintain,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D1526,HCPCS,"Remove bilat space main, max",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D1527,HCPCS,"Remove bilat space main, man",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D1551,HCPCS,Recement space maint - max,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D1552,HCPCS,Recement space maint - man,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D1553,HCPCS,Recement unilat space maint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D1575,HCPCS,"Dist space maint, fixed unil",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D2999,HCPCS,Dental unspec restorative pr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D3460,HCPCS,Endodontic endosseous implan,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D3999,HCPCS,Endodontic procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D4260,HCPCS,Osseous surgery 4 or more,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D4263,HCPCS,Bone replce graft first site,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D4264,HCPCS,Bone replce graft each add,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D4268,HCPCS,Surgical revision procedure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D4270,HCPCS,Pedicle soft tissue graft pr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D4273,HCPCS,Auto tissue graft 1st tooth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D4355,HCPCS,Full mouth debridement,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D4381,HCPCS,Localized delivery antimicro,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D5911,HCPCS,Facial moulage sectional,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D5912,HCPCS,Facial moulage complete,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D5983,HCPCS,Radiation applicator,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D5984,HCPCS,Radiation shield,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D5985,HCPCS,Radiation cone locator,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D5987,HCPCS,Commissure splint,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D6920,HCPCS,Dental connector bar,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D7111,HCPCS,Extraction coronal remnants,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D7140,HCPCS,Extraction erupted tooth/exr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D7210,HCPCS,Rem imp tooth w mucoper flp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D7220,HCPCS,Impact tooth remov soft tiss,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D7230,HCPCS,Impact tooth remov part bony,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D7240,HCPCS,Impact tooth remov comp bony,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D7241,HCPCS,Impact tooth rem bony w/comp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D7250,HCPCS,Tooth root removal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D7260,HCPCS,Oral antral fistula closure,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D7261,HCPCS,Primary closure sinus perf,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D7291,HCPCS,Transseptal fiberotomy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D7940,HCPCS,Reshaping bone orthognathic,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D9930,HCPCS,Treatment of complications,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D9944,HCPCS,"Occ guard, hard, full arch",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D9945,HCPCS,"Occ guard, soft, full arch",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D9946,HCPCS,"Occ guard, hard, part arch",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D9950,HCPCS,Occlusion analysis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D9951,HCPCS,Limited occlusal adjustment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,D9952,HCPCS,Complete occlusal adjustment,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 "," $1,658.27 ", Not Applicable , Not Applicable ," $1,741.18 "," $1,691.43 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,658.27 ", Not Applicable , Not Applicable ," $1,658.27 "," $1,741.18 ", Not Applicable
,G0008,HCPCS,Admin influenza virus vac,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,G0009,HCPCS,Admin pneumococcal vaccine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,G0010,HCPCS,Admin hepatitis b vaccine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , $47.84 , Not Applicable , Not Applicable , $50.23 , $48.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.84 , Not Applicable , Not Applicable , $47.84 , $50.23 , Not Applicable
,G0101,HCPCS,Ca screen;pelvic/breast exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,G0104,HCPCS,Ca screen;flexi sigmoidscope,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,G0105,HCPCS,Colorectal scrn; hi risk ind,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,G0106,HCPCS,Colon ca screen;barium enema,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , $213.55 , Not Applicable , Not Applicable , $224.23 , $217.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $213.55 , Not Applicable , Not Applicable , $213.55 , $224.23 , Not Applicable
,G0117,HCPCS,Glaucoma scrn hgh risk direc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,G0118,HCPCS,Glaucoma scrn hgh risk direc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,G0120,HCPCS,Colon ca scrn; barium enema,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , $440.24 , Not Applicable , Not Applicable , $462.26 , $449.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.24 , Not Applicable , Not Applicable , $440.24 , $462.26 , Not Applicable
,G0121,HCPCS,Colon ca scrn not hi rsk ind,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , $948.73 , Not Applicable , Not Applicable , $996.17 , $967.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $948.73 , Not Applicable , Not Applicable , $948.73 , $996.17 , Not Applicable
,G0127,HCPCS,Trim nail(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,G0130,HCPCS,Single energy x-ray study,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , $130.16 , Not Applicable , Not Applicable , $136.66 , $132.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $130.16 , Not Applicable , Not Applicable , $130.16 , $136.66 , Not Applicable
,G0166,HCPCS,"Extrnl counterpulse, per tx",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , $134.80 , Not Applicable , Not Applicable , $141.54 , $137.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $134.80 , Not Applicable , Not Applicable , $134.80 , $141.54 , Not Applicable
,G0175,HCPCS,"Opps service,sched team conf",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $434.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $434.89 , $434.89 , Not Applicable , Not Applicable , $456.64 , $443.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $434.89 , Not Applicable , Not Applicable , $434.89 , $456.64 , Not Applicable
,G0186,HCPCS,"Dstry eye lesn,fdr vssl tech",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , $601.65 , Not Applicable , Not Applicable , $631.74 , $613.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $601.65 , Not Applicable , Not Applicable , $601.65 , $631.74 , Not Applicable
,G0235,HCPCS,Pet not otherwise specified,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , $450.66 , Not Applicable , Not Applicable , $473.19 , $459.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $450.66 , Not Applicable , Not Applicable , $450.66 , $473.19 , Not Applicable
,G0237,HCPCS,Therapeutic procd strg endur,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,G0238,HCPCS,"Oth resp proc, indiv",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,G0239,HCPCS,"Oth resp proc, group",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,G0245,HCPCS,Initial foot exam pt lops,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,G0246,HCPCS,Followup eval of foot pt lop,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,G0247,HCPCS,Routine footcare pt w lops,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , $214.68 , Not Applicable , Not Applicable , $225.42 , $218.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $214.68 , Not Applicable , Not Applicable , $214.68 , $225.42 , Not Applicable
,G0248,HCPCS,Demonstrate use home inr mon,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,G0249,HCPCS,Provide inr test mater/equip,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,G0257,HCPCS,Unsched dialysis esrd pt hos,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $783.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.01 , $783.01 , Not Applicable , Not Applicable , $822.16 , $798.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $783.01 , Not Applicable , Not Applicable , $783.01 , $822.16 , Not Applicable
,G0260,HCPCS,Inj for sacroiliac jt anesth,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , $759.14 , Not Applicable , Not Applicable , $797.10 , $774.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $759.14 , Not Applicable , Not Applicable , $759.14 , $797.10 , Not Applicable
,G0276,HCPCS,Pild/placebo control clin tr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,G0277,HCPCS,"Hbot, full body chamber, 30m",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.58 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.58 , $142.58 , Not Applicable , Not Applicable , $149.71 , $145.43 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.58 , Not Applicable , Not Applicable , $142.58 , $149.71 , Not Applicable
,G0293,HCPCS,"Non-cov surg proc,clin trial",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,G0294,HCPCS,"Non-cov proc, clinical trial",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,G0296,HCPCS,Visit to determ ldct elig,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,G0302,HCPCS,Pre-op service lvrs complete,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,G0303,HCPCS,Pre-op service lvrs 10-15dos,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,G0304,HCPCS,Pre-op service lvrs 1-9 dos,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,G0305,HCPCS,Post op service lvrs min 6,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,G0379,HCPCS,Direct refer hospital observ,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $624.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $624.24 , $624.24 , Not Applicable , Not Applicable , $655.45 , $636.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $624.24 , Not Applicable , Not Applicable , $624.24 , $655.45 , Not Applicable
,G0380,HCPCS,Lev 1 hosp type b ed visit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $84.45 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $84.45 , $84.45 , Not Applicable , Not Applicable , $88.67 , $86.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $84.45 , Not Applicable , Not Applicable , $84.45 , $88.67 , Not Applicable
,G0381,HCPCS,Lev 2 hosp type b ed visit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $114.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $114.42 , $114.42 , Not Applicable , Not Applicable , $120.15 , $116.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $114.42 , Not Applicable , Not Applicable , $114.42 , $120.15 , Not Applicable
,G0382,HCPCS,Lev 3 hosp type b ed visit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $216.39 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $216.39 , $216.39 , Not Applicable , Not Applicable , $227.21 , $220.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $216.39 , Not Applicable , Not Applicable , $216.39 , $227.21 , Not Applicable
,G0383,HCPCS,Lev 4 hosp type b ed visit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $273.39 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $273.39 , $273.39 , Not Applicable , Not Applicable , $287.06 , $278.86 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $273.39 , Not Applicable , Not Applicable , $273.39 , $287.06 , Not Applicable
,G0384,HCPCS,Lev 5 hosp type b ed visit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $380.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $380.99 , $380.99 , Not Applicable , Not Applicable , $400.04 , $388.61 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $380.99 , Not Applicable , Not Applicable , $380.99 , $400.04 , Not Applicable
,G0390,HCPCS,Trauma respons w/hosp criti,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,138.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,138.90 "," $1,138.90 ", Not Applicable , Not Applicable ," $1,195.85 "," $1,161.68 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,138.90 ", Not Applicable , Not Applicable ," $1,138.90 "," $1,195.85 ", Not Applicable
,G0396,HCPCS,Alcohol/subs interv 15-30mn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,G0397,HCPCS,Alcohol/subs interv >30 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , $159.96 , Not Applicable , Not Applicable , $167.96 , $163.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , $159.96 , $167.96 , Not Applicable
,G0398,HCPCS,Home sleep test/type 2 porta,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,G0399,HCPCS,Home sleep test/type 3 porta,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , $166.91 , Not Applicable , Not Applicable , $175.26 , $170.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $166.91 , Not Applicable , Not Applicable , $166.91 , $175.26 , Not Applicable
,G0400,HCPCS,Home sleep test/type 4 porta,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , $316.40 , Not Applicable , Not Applicable , $332.22 , $322.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $316.40 , Not Applicable , Not Applicable , $316.40 , $332.22 , Not Applicable
,G0402,HCPCS,Initial preventive exam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,G0404,HCPCS,Ekg tracing for initial prev,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,G0413,HCPCS,Pelvic ring fracture uni/bil,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 "," $7,488.26 ", Not Applicable , Not Applicable ," $7,862.67 "," $7,638.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $7,488.26 ", Not Applicable , Not Applicable ," $7,488.26 "," $7,862.67 ", Not Applicable
,G0416,HCPCS,"Prostate biopsy, any mthd",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , $348.19 , Not Applicable , Not Applicable , $365.60 , $355.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $348.19 , Not Applicable , Not Applicable , $348.19 , $365.60 , Not Applicable
,G0422,HCPCS,Intens cardiac rehab w/exerc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $138.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $138.77 , $138.77 , Not Applicable , Not Applicable , $145.71 , $141.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $138.77 , Not Applicable , Not Applicable , $138.77 , $145.71 , Not Applicable
,G0423,HCPCS,Intens cardiac rehab no exer,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $138.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $138.77 , $138.77 , Not Applicable , Not Applicable , $145.71 , $141.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $138.77 , Not Applicable , Not Applicable , $138.77 , $145.71 , Not Applicable
,G0429,HCPCS,Dermal filler injection(s),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,G0442,HCPCS,Annual alcohol screen 15 min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,G0443,HCPCS,Brief alcohol misuse counsel,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,G0444,HCPCS,Depression screen annual,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,G0445,HCPCS,High inten beh couns std 30m,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,G0446,HCPCS,Intens behave ther cardio dx,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,G0447,HCPCS,Behavior counsel obesity 15m,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,G0451,HCPCS,Devlopment test interpt&rep,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,G0455,HCPCS,Fecal microbiota prep instil,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , $967.36 , Not Applicable , Not Applicable ," $1,015.72 ", $986.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $967.36 , Not Applicable , Not Applicable , $967.36 ," $1,015.72 ", Not Applicable
,G0460,HCPCS,Autologous prp for non-ulcers,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,G0463,HCPCS,Hospital outpt clinic visit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , $142.05 , Not Applicable , Not Applicable , $149.15 , $144.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $142.05 , Not Applicable , Not Applicable , $142.05 , $149.15 , Not Applicable
,G0465 ,HCPCS,Autolog prp diab wound ulcer,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 "," $2,047.65 ", Not Applicable , Not Applicable ," $2,150.03 "," $2,088.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,047.65 ", Not Applicable , Not Applicable ," $2,047.65 "," $2,150.03 ", Not Applicable
,G0473,HCPCS,Group behave couns 2-10,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , $31.42 , Not Applicable , Not Applicable , $32.99 , $32.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.42 , Not Applicable , Not Applicable , $31.42 , $32.99 , Not Applicable
,G0498,HCPCS,Chemo extend iv infus w/pump,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , $381.19 , Not Applicable , Not Applicable , $400.25 , $388.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $381.19 , Not Applicable , Not Applicable , $381.19 , $400.25 , Not Applicable
,G0516,HCPCS,"Insert drug del implant, >=4",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,G0517,HCPCS,Remove drug implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,G0518,HCPCS,Remove w insert drug implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , $324.46 , Not Applicable , Not Applicable , $340.68 , $330.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $324.46 , Not Applicable , Not Applicable , $324.46 , $340.68 , Not Applicable
,G2000,HCPCS,Blinded conv. tx mdd clin tr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , $583.57 , Not Applicable , Not Applicable , $612.75 , $595.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $583.57 , Not Applicable , Not Applicable , $583.57 , $612.75 , Not Applicable
,G2011,HCPCS,Alcohol/sub misuse assess,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,G2066,HCPCS,Inter devc remote 30d,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , $44.52 , Not Applicable , Not Applicable , $46.74 , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.52 , Not Applicable , Not Applicable , $44.52 , $46.74 , Not Applicable
,G2082,HCPCS,Visit esketamine 56m or less,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $761.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $761.46 , $761.46 , Not Applicable , Not Applicable , $799.54 , $776.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $761.46 , Not Applicable , Not Applicable , $761.46 , $799.54 , Not Applicable
,G2083,HCPCS,"Visit esketamine, > 56m",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,112.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,112.64 "," $1,112.64 ", Not Applicable , Not Applicable ," $1,168.27 "," $1,134.89 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,112.64 ", Not Applicable , Not Applicable ," $1,112.64 "," $1,168.27 ", Not Applicable
,G2086,HCPCS,Off base opioid tx 70min,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , $159.96 , Not Applicable , Not Applicable , $167.96 , $163.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , $159.96 , $167.96 , Not Applicable
,G2087,HCPCS,"Off base opioid tx, 60 m",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , $159.96 , Not Applicable , Not Applicable , $167.96 , $163.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $159.96 , Not Applicable , Not Applicable , $159.96 , $167.96 , Not Applicable
,G2170,HCPCS,Avf by tissue w thermal e,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,G2171,HCPCS,Avf use magnetic/art/ven,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 "," $19,200.22 ", Not Applicable , Not Applicable ," $20,160.23 "," $19,584.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $19,200.22 ", Not Applicable , Not Applicable ," $19,200.22 "," $20,160.23 ", Not Applicable
,G2214,HCPCS,Init/sub psych care m 1st 30,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , $89.46 , Not Applicable , Not Applicable , $93.93 , $91.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.46 , Not Applicable , Not Applicable , $89.46 , $93.93 , Not Applicable
,J0121,HCPCS,"Inj., omadacycline, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $3.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.87 , $3.87 , Not Applicable , Not Applicable , $4.06 , $3.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.87 , Not Applicable , Not Applicable , $3.87 , $4.06 , Not Applicable
,J0129,HCPCS,Abatacept injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $52.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $52.99 , $52.99 , Not Applicable , Not Applicable , $55.64 , $54.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $52.99 , Not Applicable , Not Applicable , $52.99 , $55.64 , Not Applicable
,J0135,HCPCS,Adalimumab injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,851.35 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,851.35 "," $1,851.35 ", Not Applicable , Not Applicable ," $1,943.92 "," $1,888.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,851.35 ", Not Applicable , Not Applicable ," $1,851.35 "," $1,943.92 ", Not Applicable
,J0172,HCPCS,"Inj, aducanumab-avwa, 2 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $13.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $13.50 , $13.50 , Not Applicable , Not Applicable , $14.18 , $13.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $13.50 , Not Applicable , Not Applicable , $13.50 , $14.18 , Not Applicable
,J0178,HCPCS,Aflibercept injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,074.53 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,074.53 "," $1,074.53 ", Not Applicable , Not Applicable ," $1,128.25 "," $1,096.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,074.53 ", Not Applicable , Not Applicable ," $1,074.53 "," $1,128.25 ", Not Applicable
,J0179,HCPCS,"Inj, brolucizumab-dbll, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $365.23 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $365.23 , $365.23 , Not Applicable , Not Applicable , $383.49 , $372.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $365.23 , Not Applicable , Not Applicable , $365.23 , $383.49 , Not Applicable
,J0180,HCPCS,Agalsidase beta injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $231.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $231.94 , $231.94 , Not Applicable , Not Applicable , $243.54 , $236.58 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $231.94 , Not Applicable , Not Applicable , $231.94 , $243.54 , Not Applicable
,J0185,HCPCS,"Inj., aprepitant, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.98 , $1.98 , Not Applicable , Not Applicable , $2.08 , $2.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.98 , Not Applicable , Not Applicable , $1.98 , $2.08 , Not Applicable
,J0202,HCPCS,"Injection, alemtuzumab",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,442.20 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,442.20 "," $2,442.20 ", Not Applicable , Not Applicable ," $2,564.31 "," $2,491.05 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,442.20 ", Not Applicable , Not Applicable ," $2,442.20 "," $2,564.31 ", Not Applicable
,J0207,HCPCS,Amifostine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,329.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,329.42 "," $1,329.42 ", Not Applicable , Not Applicable ," $1,395.89 "," $1,356.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,329.42 ", Not Applicable , Not Applicable ," $1,329.42 "," $1,395.89 ", Not Applicable
,J0220,HCPCS,Alglucosidase alfa injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $137.04 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $137.04 , $137.04 , Not Applicable , Not Applicable , $143.89 , $139.78 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $137.04 , Not Applicable , Not Applicable , $137.04 , $143.89 , Not Applicable
,J0221,HCPCS,Lumizyme injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $211.11 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $211.11 , $211.11 , Not Applicable , Not Applicable , $221.67 , $215.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $211.11 , Not Applicable , Not Applicable , $211.11 , $221.67 , Not Applicable
,J0222,HCPCS,"Inj., patisiran, 0.1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $114.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $114.42 , $114.42 , Not Applicable , Not Applicable , $120.15 , $116.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $114.42 , Not Applicable , Not Applicable , $114.42 , $120.15 , Not Applicable
,J0223,HCPCS,Inj givosiran 0.5 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $124.97 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $124.97 , $124.97 , Not Applicable , Not Applicable , $131.22 , $127.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $124.97 , Not Applicable , Not Applicable , $124.97 , $131.22 , Not Applicable
,J0224,HCPCS,"Inj. lumasiran, 0.5 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $353.86 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $353.86 , $353.86 , Not Applicable , Not Applicable , $371.55 , $360.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $353.86 , Not Applicable , Not Applicable , $353.86 , $371.55 , Not Applicable
,J0256,HCPCS,Alpha 1 proteinase inhibitor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $5.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $5.31 , $5.31 , Not Applicable , Not Applicable , $5.58 , $5.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $5.31 , Not Applicable , Not Applicable , $5.31 , $5.58 , Not Applicable
,J0257,HCPCS,Glassia injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $5.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $5.79 , $5.79 , Not Applicable , Not Applicable , $6.08 , $5.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $5.79 , Not Applicable , Not Applicable , $5.79 , $6.08 , Not Applicable
,J0287,HCPCS,Amphotericin b lipid complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $11.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $11.13 , $11.13 , Not Applicable , Not Applicable , $11.68 , $11.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $11.13 , Not Applicable , Not Applicable , $11.13 , $11.68 , Not Applicable
,J0289,HCPCS,Amphotericin b liposome inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $33.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $33.65 , $33.65 , Not Applicable , Not Applicable , $35.33 , $34.32 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $33.65 , Not Applicable , Not Applicable , $33.65 , $35.33 , Not Applicable
,J0291,HCPCS,"Inj., plazomicin, 5 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $3.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.57 , $3.57 , Not Applicable , Not Applicable , $3.75 , $3.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.57 , Not Applicable , Not Applicable , $3.57 , $3.75 , Not Applicable
,J0300,HCPCS,Amobarbital 125 mg inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $146.58 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $146.58 , $146.58 , Not Applicable , Not Applicable , $153.91 , $149.51 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $146.58 , Not Applicable , Not Applicable , $146.58 , $153.91 , Not Applicable
,J0390,HCPCS,Chloroquine injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $193.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $193.40 , $193.40 , Not Applicable , Not Applicable , $203.07 , $197.27 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $193.40 , Not Applicable , Not Applicable , $193.40 , $203.07 , Not Applicable
,J0401,HCPCS,Inj aripiprazole ext rel 1mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $7.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.03 , $7.03 , Not Applicable , Not Applicable , $7.38 , $7.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.03 , Not Applicable , Not Applicable , $7.03 , $7.38 , Not Applicable
,J0475,HCPCS,Baclofen 10 mg injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $207.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $207.70 , $207.70 , Not Applicable , Not Applicable , $218.09 , $211.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $207.70 , Not Applicable , Not Applicable , $207.70 , $218.09 , Not Applicable
,J0480,HCPCS,Basiliximab,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,697.63 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,697.63 "," $4,697.63 ", Not Applicable , Not Applicable ," $4,932.51 "," $4,791.59 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,697.63 ", Not Applicable , Not Applicable ," $4,697.63 "," $4,932.51 ", Not Applicable
,J0485,HCPCS,Belatacept injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $4.45 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $4.45 , $4.45 , Not Applicable , Not Applicable , $4.68 , $4.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $4.45 , Not Applicable , Not Applicable , $4.45 , $4.68 , Not Applicable
,J0490,HCPCS,Belimumab injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $55.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $55.68 , $55.68 , Not Applicable , Not Applicable , $58.46 , $56.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $55.68 , Not Applicable , Not Applicable , $55.68 , $58.46 , Not Applicable
,J0517,HCPCS,"Inj., benralizumab, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $199.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $199.93 , $199.93 , Not Applicable , Not Applicable , $209.93 , $203.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $199.93 , Not Applicable , Not Applicable , $199.93 , $209.93 , Not Applicable
,J0558,HCPCS,Peng benzathine/procaine inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $13.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $13.80 , $13.80 , Not Applicable , Not Applicable , $14.49 , $14.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $13.80 , Not Applicable , Not Applicable , $13.80 , $14.49 , Not Applicable
,J0561,HCPCS,Penicillin g benzathine inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $17.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $17.50 , $17.50 , Not Applicable , Not Applicable , $18.37 , $17.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $17.50 , Not Applicable , Not Applicable , $17.50 , $18.37 , Not Applicable
,J0565,HCPCS,"Inj, bezlotoxumab, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $46.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.55 , $46.55 , Not Applicable , Not Applicable , $48.88 , $47.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.55 , Not Applicable , Not Applicable , $46.55 , $48.88 , Not Applicable
,J0570,HCPCS,Buprenorphine implant 74.2mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,535.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,535.51 "," $1,535.51 ", Not Applicable , Not Applicable ," $1,612.28 "," $1,566.22 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,535.51 ", Not Applicable , Not Applicable ," $1,535.51 "," $1,612.28 ", Not Applicable
,J0584,HCPCS,"Injection, burosumab-twza 1m",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $432.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $432.07 , $432.07 , Not Applicable , Not Applicable , $453.67 , $440.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $432.07 , Not Applicable , Not Applicable , $432.07 , $453.67 , Not Applicable
,J0585,HCPCS,"Injection,onabotulinumtoxina",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $7.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.12 , $7.12 , Not Applicable , Not Applicable , $7.48 , $7.27 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.12 , Not Applicable , Not Applicable , $7.12 , $7.48 , Not Applicable
,J0586,HCPCS,Abobotulinumtoxina,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $9.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $9.84 , $9.84 , Not Applicable , Not Applicable , $10.33 , $10.04 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $9.84 , Not Applicable , Not Applicable , $9.84 , $10.33 , Not Applicable
,J0587,HCPCS,"Inj, rimabotulinumtoxinb",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $14.11 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $14.11 , $14.11 , Not Applicable , Not Applicable , $14.81 , $14.39 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $14.11 , Not Applicable , Not Applicable , $14.11 , $14.81 , Not Applicable
,J0588,HCPCS,Incobotulinumtoxin a,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $5.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $5.91 , $5.91 , Not Applicable , Not Applicable , $6.20 , $6.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $5.91 , Not Applicable , Not Applicable , $5.91 , $6.20 , Not Applicable
,J0594,HCPCS,Busulfan injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.00 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.00 , $2.00 , Not Applicable , Not Applicable , $2.10 , $2.04 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.00 , Not Applicable , Not Applicable , $2.00 , $2.10 , Not Applicable
,J0596,HCPCS,"Injection, ruconest",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $35.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $35.08 , $35.08 , Not Applicable , Not Applicable , $36.84 , $35.78 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $35.08 , Not Applicable , Not Applicable , $35.08 , $36.84 , Not Applicable
,J0597,HCPCS,"C-1 esterase, berinert",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $67.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $67.18 , $67.18 , Not Applicable , Not Applicable , $70.54 , $68.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $67.18 , Not Applicable , Not Applicable , $67.18 , $70.54 , Not Applicable
,J0598,HCPCS,"C-1 esterase, cinryze",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $68.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $68.98 , $68.98 , Not Applicable , Not Applicable , $72.43 , $70.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $68.98 , Not Applicable , Not Applicable , $68.98 , $72.43 , Not Applicable
,J0600,HCPCS,Edetate calcium disodium inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,682.37 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,682.37 "," $6,682.37 ", Not Applicable , Not Applicable ," $7,016.48 "," $6,816.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,682.37 ", Not Applicable , Not Applicable ," $6,682.37 "," $7,016.48 ", Not Applicable
,J0630,HCPCS,Calcitonin salmon injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,629.73 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,629.73 "," $3,629.73 ", Not Applicable , Not Applicable ," $3,811.21 "," $3,702.32 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,629.73 ", Not Applicable , Not Applicable ," $3,629.73 "," $3,811.21 ", Not Applicable
,J0638,HCPCS,Canakinumab injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $135.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $135.33 , $135.33 , Not Applicable , Not Applicable , $142.09 , $138.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $135.33 , Not Applicable , Not Applicable , $135.33 , $142.09 , Not Applicable
,J0642,HCPCS,"Injection, khapzory, 0.5 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.18 , $2.18 , Not Applicable , Not Applicable , $2.29 , $2.22 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.18 , Not Applicable , Not Applicable , $2.18 , $2.29 , Not Applicable
,J0691,HCPCS,Inj lefamulin 1 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $0.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $0.85 , $0.85 , Not Applicable , Not Applicable , $0.89 , $0.86 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $0.85 , Not Applicable , Not Applicable , $0.85 , $0.89 , Not Applicable
,J0695,HCPCS,Inj ceftolozane tazobactam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $7.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.77 , $7.77 , Not Applicable , Not Applicable , $8.16 , $7.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.77 , Not Applicable , Not Applicable , $7.77 , $8.16 , Not Applicable
,J0699,HCPCS,"Inj, cefiderocol, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.35 , $2.35 , Not Applicable , Not Applicable , $2.47 , $2.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.35 , Not Applicable , Not Applicable , $2.35 , $2.47 , Not Applicable
,J0712,HCPCS,Ceftaroline fosamil inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $4.11 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $4.11 , $4.11 , Not Applicable , Not Applicable , $4.31 , $4.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $4.11 , Not Applicable , Not Applicable , $4.11 , $4.31 , Not Applicable
,J0714,HCPCS,Ceftazidime and avibactam,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $108.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $108.15 , $108.15 , Not Applicable , Not Applicable , $113.56 , $110.32 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $108.15 , Not Applicable , Not Applicable , $108.15 , $113.56 , Not Applicable
,J0716,HCPCS,Centruroides immune f(ab),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,075.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,075.48 "," $6,075.48 ", Not Applicable , Not Applicable ," $6,379.26 "," $6,196.99 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,075.48 ", Not Applicable , Not Applicable ," $6,075.48 "," $6,379.26 ", Not Applicable
,J0717,HCPCS,Certolizumab pegol inj 1mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $7.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.34 , $7.34 , Not Applicable , Not Applicable , $7.71 , $7.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.34 , Not Applicable , Not Applicable , $7.34 , $7.71 , Not Applicable
,J0740,HCPCS,Cidofovir injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $659.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $659.93 , $659.93 , Not Applicable , Not Applicable , $692.92 , $673.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $659.93 , Not Applicable , Not Applicable , $659.93 , $692.92 , Not Applicable
,J0741,HCPCS,"Inj, cabote rilpivir 2mg 3mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $24.06 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $24.06 , $24.06 , Not Applicable , Not Applicable , $25.26 , $24.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $24.06 , Not Applicable , Not Applicable , $24.06 , $25.26 , Not Applicable
,J0742,HCPCS,Inj imip 4 cilas 4 releb 2mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.72 , $2.72 , Not Applicable , Not Applicable , $2.86 , $2.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.72 , Not Applicable , Not Applicable , $2.72 , $2.86 , Not Applicable
,J0745,HCPCS,Inj codeine phosphate /30 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $158.78 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $158.78 , $158.78 , Not Applicable , Not Applicable , $166.72 , $161.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $158.78 , Not Applicable , Not Applicable , $158.78 , $166.72 , Not Applicable
,J0775,HCPCS,"Collagenase, clost hist inj",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.32 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.32 , $66.32 , Not Applicable , Not Applicable , $69.64 , $67.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.32 , Not Applicable , Not Applicable , $66.32 , $69.64 , Not Applicable
,J0791,HCPCS,Inj crizanlizumab-tmca 5mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $144.32 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $144.32 , $144.32 , Not Applicable , Not Applicable , $151.54 , $147.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $144.32 , Not Applicable , Not Applicable , $144.32 , $151.54 , Not Applicable
,J0795,HCPCS,Corticorelin ovine triflutal,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $11.32 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $11.32 , $11.32 , Not Applicable , Not Applicable , $11.89 , $11.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $11.32 , Not Applicable , Not Applicable , $11.32 , $11.89 , Not Applicable
,J0840,HCPCS,Crotalidae poly immune fab,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,211.33 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,211.33 "," $3,211.33 ", Not Applicable , Not Applicable ," $3,371.89 "," $3,275.55 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,211.33 ", Not Applicable , Not Applicable ," $3,211.33 "," $3,371.89 ", Not Applicable
,J0841,HCPCS,Inj crotalidae im f(ab')2 eq,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,392.77 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,392.77 "," $1,392.77 ", Not Applicable , Not Applicable ," $1,462.40 "," $1,420.62 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,392.77 ", Not Applicable , Not Applicable ," $1,392.77 "," $1,462.40 ", Not Applicable
,J0850,HCPCS,Cytomegalovirus imm iv /vial,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,801.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,801.17 "," $1,801.17 ", Not Applicable , Not Applicable ," $1,891.23 "," $1,837.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,801.17 ", Not Applicable , Not Applicable ," $1,801.17 "," $1,891.23 ", Not Applicable
,J0875,HCPCS,"Injection, dalbavancin",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $18.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $18.60 , $18.60 , Not Applicable , Not Applicable , $19.53 , $18.97 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $18.60 , Not Applicable , Not Applicable , $18.60 , $19.53 , Not Applicable
,J0881,HCPCS,"Darbepoetin alfa, non-esrd",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $3.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.69 , $3.69 , Not Applicable , Not Applicable , $3.88 , $3.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.69 , Not Applicable , Not Applicable , $3.69 , $3.88 , Not Applicable
,J0882,HCPCS,"Darbepoetin alfa, esrd use",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $3.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.69 , $3.69 , Not Applicable , Not Applicable , $3.88 , $3.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.69 , Not Applicable , Not Applicable , $3.69 , $3.88 , Not Applicable
,J0883,HCPCS,Argatroban nonesrd use 1mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.41 , $1.41 , Not Applicable , Not Applicable , $1.48 , $1.44 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.41 , Not Applicable , Not Applicable , $1.41 , $1.48 , Not Applicable
,J0884,HCPCS,Argatroban esrd dialysis 1mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.41 , $1.41 , Not Applicable , Not Applicable , $1.48 , $1.44 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.41 , Not Applicable , Not Applicable , $1.41 , $1.48 , Not Applicable
,J0885,HCPCS,"Epoetin alfa, non-esrd",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $9.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $9.54 , $9.54 , Not Applicable , Not Applicable , $10.02 , $9.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $9.54 , Not Applicable , Not Applicable , $9.54 , $10.02 , Not Applicable
,J0888,HCPCS,Epoetin beta non esrd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.77 , $1.77 , Not Applicable , Not Applicable , $1.86 , $1.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.77 , Not Applicable , Not Applicable , $1.77 , $1.86 , Not Applicable
,J0894,HCPCS,Decitabine injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $4.04 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $4.04 , $4.04 , Not Applicable , Not Applicable , $4.24 , $4.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $4.04 , Not Applicable , Not Applicable , $4.04 , $4.24 , Not Applicable
,J0896,HCPCS,Inj luspatercept-aamt 0.25mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $43.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $43.13 , $43.13 , Not Applicable , Not Applicable , $45.29 , $43.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $43.13 , Not Applicable , Not Applicable , $43.13 , $45.29 , Not Applicable
,J0897,HCPCS,Denosumab injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $24.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $24.80 , $24.80 , Not Applicable , Not Applicable , $26.04 , $25.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $24.80 , Not Applicable , Not Applicable , $24.80 , $26.04 , Not Applicable
,J1095,HCPCS,"Injection, dexamethasone 9%",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.21 , $1.21 , Not Applicable , Not Applicable , $1.27 , $1.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.21 , Not Applicable , Not Applicable , $1.21 , $1.27 , Not Applicable
,J1096,HCPCS,Dexametha opth insert 0.1 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $156.04 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $156.04 , $156.04 , Not Applicable , Not Applicable , $163.84 , $159.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $156.04 , Not Applicable , Not Applicable , $156.04 , $163.84 , Not Applicable
,J1162,HCPCS,Digoxin immune fab (ovine),Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,832.38 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,832.38 "," $4,832.38 ", Not Applicable , Not Applicable ," $5,074.00 "," $4,929.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,832.38 ", Not Applicable , Not Applicable ," $4,832.38 "," $5,074.00 ", Not Applicable
,J1190,HCPCS,Dexrazoxane hcl injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $225.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $225.14 , $225.14 , Not Applicable , Not Applicable , $236.39 , $229.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $225.14 , Not Applicable , Not Applicable , $225.14 , $236.39 , Not Applicable
,J1201,HCPCS,Inj. cetirizine hcl 0.5mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $18.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $18.01 , $18.01 , Not Applicable , Not Applicable , $18.91 , $18.37 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $18.01 , Not Applicable , Not Applicable , $18.01 , $18.91 , Not Applicable
,J1212,HCPCS,Dimethyl sulfoxide 50% 50 ml,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $745.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $745.79 , $745.79 , Not Applicable , Not Applicable , $783.08 , $760.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $745.79 , Not Applicable , Not Applicable , $745.79 , $783.08 , Not Applicable
,J1290,HCPCS,Ecallantide injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $589.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $589.83 , $589.83 , Not Applicable , Not Applicable , $619.32 , $601.63 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $589.83 , Not Applicable , Not Applicable , $589.83 , $619.32 , Not Applicable
,J1300,HCPCS,Eculizumab injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $268.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $268.33 , $268.33 , Not Applicable , Not Applicable , $281.75 , $273.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $268.33 , Not Applicable , Not Applicable , $268.33 , $281.75 , Not Applicable
,J1301,HCPCS,"Injection, edaravone, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $24.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $24.01 , $24.01 , Not Applicable , Not Applicable , $25.21 , $24.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $24.01 , Not Applicable , Not Applicable , $24.01 , $25.21 , Not Applicable
,J1303,HCPCS,"Inj., ravulizumab-cwvz 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $263.00 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $263.00 , $263.00 , Not Applicable , Not Applicable , $276.15 , $268.26 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $263.00 , Not Applicable , Not Applicable , $263.00 , $276.15 , Not Applicable
,J1305,HCPCS,"Inj, evinacumab-dgnb, 5mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $193.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $193.88 , $193.88 , Not Applicable , Not Applicable , $203.57 , $197.75 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $193.88 , Not Applicable , Not Applicable , $193.88 , $203.57 , Not Applicable
,J1322,HCPCS,"Elosulfase alfa, injection",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $293.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $293.03 , $293.03 , Not Applicable , Not Applicable , $307.68 , $298.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $293.03 , Not Applicable , Not Applicable , $293.03 , $307.68 , Not Applicable
,J1327,HCPCS,Eptifibatide injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.33 , $2.33 , Not Applicable , Not Applicable , $2.44 , $2.37 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.33 , Not Applicable , Not Applicable , $2.33 , $2.44 , Not Applicable
,J1410,HCPCS,Inj estrogen conjugate 25 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $399.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $399.70 , $399.70 , Not Applicable , Not Applicable , $419.69 , $407.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $399.70 , Not Applicable , Not Applicable , $399.70 , $419.69 , Not Applicable
,J1426,HCPCS,"Injection, casimersen, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $194.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $194.87 , $194.87 , Not Applicable , Not Applicable , $204.61 , $198.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $194.87 , Not Applicable , Not Applicable , $194.87 , $204.61 , Not Applicable
,J1427,HCPCS,Inj. viltolarsen,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $69.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $69.13 , $69.13 , Not Applicable , Not Applicable , $72.58 , $70.51 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $69.13 , Not Applicable , Not Applicable , $69.13 , $72.58 , Not Applicable
,J1429 ,HCPCS,Inj golodirsen 10 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $194.56 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $194.56 , $194.56 , Not Applicable , Not Applicable , $204.29 , $198.45 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $194.56 , Not Applicable , Not Applicable , $194.56 , $204.29 , Not Applicable
,J1430,HCPCS,Ethanolamine oleate 100 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $519.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $519.85 , $519.85 , Not Applicable , Not Applicable , $545.85 , $530.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $519.85 , Not Applicable , Not Applicable , $519.85 , $545.85 , Not Applicable
,J1437,HCPCS,Inj. fe derisomaltose 10 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.11 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.11 , $29.11 , Not Applicable , Not Applicable , $30.57 , $29.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.11 , Not Applicable , Not Applicable , $29.11 , $30.57 , Not Applicable
,J1438,HCPCS,Etanercept injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $925.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $925.67 , $925.67 , Not Applicable , Not Applicable , $971.96 , $944.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $925.67 , Not Applicable , Not Applicable , $925.67 , $971.96 , Not Applicable
,J1439,HCPCS,Inj ferric carboxymaltos 1mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.31 , $1.31 , Not Applicable , Not Applicable , $1.38 , $1.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.31 , Not Applicable , Not Applicable , $1.31 , $1.38 , Not Applicable
,J1442,HCPCS,Inj filgrastim excl biosimil,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.14 , $1.14 , Not Applicable , Not Applicable , $1.19 , $1.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.14 , Not Applicable , Not Applicable , $1.14 , $1.19 , Not Applicable
,J1447,HCPCS,Inj tbo filgrastim 1 microg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $0.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $0.53 , $0.53 , Not Applicable , Not Applicable , $0.56 , $0.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $0.53 , Not Applicable , Not Applicable , $0.53 , $0.56 , Not Applicable
,J1448,HCPCS,"Injection, trilaciclib, 1mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $5.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $5.82 , $5.82 , Not Applicable , Not Applicable , $6.11 , $5.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $5.82 , Not Applicable , Not Applicable , $5.82 , $6.11 , Not Applicable
,J1451,HCPCS,"Fomepizole, 15 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $7.00 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.00 , $7.00 , Not Applicable , Not Applicable , $7.35 , $7.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.00 , Not Applicable , Not Applicable , $7.00 , $7.35 , Not Applicable
,J1454,HCPCS,"Inj fosnetupitant, palonoset",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $668.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $668.66 , $668.66 , Not Applicable , Not Applicable , $702.09 , $682.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $668.66 , Not Applicable , Not Applicable , $668.66 , $702.09 , Not Applicable
,J1455,HCPCS,Foscarnet sodium injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $85.29 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $85.29 , $85.29 , Not Applicable , Not Applicable , $89.56 , $87.00 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $85.29 , Not Applicable , Not Applicable , $85.29 , $89.56 , Not Applicable
,J1458,HCPCS,Galsulfase injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $482.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $482.19 , $482.19 , Not Applicable , Not Applicable , $506.30 , $491.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $482.19 , Not Applicable , Not Applicable , $482.19 , $506.30 , Not Applicable
,J1459,HCPCS,Inj ivig privigen 500 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $52.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $52.07 , $52.07 , Not Applicable , Not Applicable , $54.67 , $53.11 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $52.07 , Not Applicable , Not Applicable , $52.07 , $54.67 , Not Applicable
,J1460,HCPCS,Gamma globulin 1 cc inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $51.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $51.66 , $51.66 , Not Applicable , Not Applicable , $54.24 , $52.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $51.66 , Not Applicable , Not Applicable , $51.66 , $54.24 , Not Applicable
,J1554,HCPCS,Inj. asceniv,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $563.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $563.95 , $563.95 , Not Applicable , Not Applicable , $592.15 , $575.23 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $563.95 , Not Applicable , Not Applicable , $563.95 , $592.15 , Not Applicable
,J1555,HCPCS,"Inj cuvitru, 100 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $16.97 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $16.97 , $16.97 , Not Applicable , Not Applicable , $17.82 , $17.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $16.97 , Not Applicable , Not Applicable , $16.97 , $17.82 , Not Applicable
,J1556,HCPCS,"Inj, imm glob bivigam, 500mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $82.51 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $82.51 , $82.51 , Not Applicable , Not Applicable , $86.64 , $84.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $82.51 , Not Applicable , Not Applicable , $82.51 , $86.64 , Not Applicable
,J1557,HCPCS,Gammaplex injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $56.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $56.81 , $56.81 , Not Applicable , Not Applicable , $59.65 , $57.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $56.81 , Not Applicable , Not Applicable , $56.81 , $59.65 , Not Applicable
,J1558,HCPCS,"Inj. xembify, 100 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $15.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $15.93 , $15.93 , Not Applicable , Not Applicable , $16.72 , $16.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $15.93 , Not Applicable , Not Applicable , $15.93 , $16.72 , Not Applicable
,J1559,HCPCS,Hizentra injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $13.56 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $13.56 , $13.56 , Not Applicable , Not Applicable , $14.24 , $13.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $13.56 , Not Applicable , Not Applicable , $13.56 , $14.24 , Not Applicable
,J1560,HCPCS,Gamma globulin > 10 cc inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $516.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $516.59 , $516.59 , Not Applicable , Not Applicable , $542.41 , $526.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $516.59 , Not Applicable , Not Applicable , $516.59 , $542.41 , Not Applicable
,J1561,HCPCS,Gamunex-c/gammaked,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $56.44 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $56.44 , $56.44 , Not Applicable , Not Applicable , $59.27 , $57.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $56.44 , Not Applicable , Not Applicable , $56.44 , $59.27 , Not Applicable
,J1566,HCPCS,"Immune globulin, powder",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $76.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $76.66 , $76.66 , Not Applicable , Not Applicable , $80.49 , $78.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $76.66 , Not Applicable , Not Applicable , $76.66 , $80.49 , Not Applicable
,J1568,HCPCS,Octagam injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $48.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $48.73 , $48.73 , Not Applicable , Not Applicable , $51.17 , $49.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $48.73 , Not Applicable , Not Applicable , $48.73 , $51.17 , Not Applicable
,J1569,HCPCS,Gammagard liquid injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $52.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $52.08 , $52.08 , Not Applicable , Not Applicable , $54.68 , $53.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $52.08 , Not Applicable , Not Applicable , $52.08 , $54.68 , Not Applicable
,J1571,HCPCS,Hepagam b im injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $83.04 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $83.04 , $83.04 , Not Applicable , Not Applicable , $87.19 , $84.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $83.04 , Not Applicable , Not Applicable , $83.04 , $87.19 , Not Applicable
,J1572,HCPCS,Flebogamma injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $43.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $43.08 , $43.08 , Not Applicable , Not Applicable , $45.24 , $43.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $43.08 , Not Applicable , Not Applicable , $43.08 , $45.24 , Not Applicable
,J1573,HCPCS,"Hepagam b intravenous, inj",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $83.39 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $83.39 , $83.39 , Not Applicable , Not Applicable , $87.56 , $85.06 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $83.39 , Not Applicable , Not Applicable , $83.39 , $87.56 , Not Applicable
,J1575,HCPCS,Hyqvia 100mg immuneglobulin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $17.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $17.74 , $17.74 , Not Applicable , Not Applicable , $18.63 , $18.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $17.74 , Not Applicable , Not Applicable , $17.74 , $18.63 , Not Applicable
,J1595,HCPCS,Injection glatiramer acetate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $165.39 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $165.39 , $165.39 , Not Applicable , Not Applicable , $173.66 , $168.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $165.39 , Not Applicable , Not Applicable , $165.39 , $173.66 , Not Applicable
,J1602,HCPCS,Golimumab for iv use 1mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $19.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $19.69 , $19.69 , Not Applicable , Not Applicable , $20.67 , $20.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $19.69 , Not Applicable , Not Applicable , $19.69 , $20.67 , Not Applicable
,J1610,HCPCS,Glucagon hydrochloride/1 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $201.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $201.03 , $201.03 , Not Applicable , Not Applicable , $211.08 , $205.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $201.03 , Not Applicable , Not Applicable , $201.03 , $211.08 , Not Applicable
,J1627,HCPCS,"Inj, granisetron, xr, 0.1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $8.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $8.12 , $8.12 , Not Applicable , Not Applicable , $8.53 , $8.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $8.12 , Not Applicable , Not Applicable , $8.12 , $8.53 , Not Applicable
,J1628,HCPCS,"Inj., guselkumab, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $96.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.64 , $96.64 , Not Applicable , Not Applicable , $101.48 , $98.58 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $96.64 , Not Applicable , Not Applicable , $96.64 , $101.48 , Not Applicable
,J1632,HCPCS,"Inj., brexanolone, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $87.39 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $87.39 , $87.39 , Not Applicable , Not Applicable , $91.76 , $89.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $87.39 , Not Applicable , Not Applicable , $87.39 , $91.76 , Not Applicable
,J1640,HCPCS,"Hemin, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $31.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.19 , $31.19 , Not Applicable , Not Applicable , $32.75 , $31.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $31.19 , Not Applicable , Not Applicable , $31.19 , $32.75 , Not Applicable
,J1670,HCPCS,Tetanus immune globulin inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $517.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $517.05 , $517.05 , Not Applicable , Not Applicable , $542.90 , $527.39 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $517.05 , Not Applicable , Not Applicable , $517.05 , $542.90 , Not Applicable
,J1726,HCPCS,"Makena, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $19.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $19.68 , $19.68 , Not Applicable , Not Applicable , $20.67 , $20.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $19.68 , Not Applicable , Not Applicable , $19.68 , $20.67 , Not Applicable
,J1729,HCPCS,Inj hydroxyprogst capoat nos,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $25.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $25.21 , $25.21 , Not Applicable , Not Applicable , $26.48 , $25.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $25.21 , Not Applicable , Not Applicable , $25.21 , $26.48 , Not Applicable
,J1738,HCPCS,Inj. meloxicam 1 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $3.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.72 , $3.72 , Not Applicable , Not Applicable , $3.91 , $3.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.72 , Not Applicable , Not Applicable , $3.72 , $3.91 , Not Applicable
,J1742,HCPCS,Ibutilide fumarate injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $240.04 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $240.04 , $240.04 , Not Applicable , Not Applicable , $252.04 , $244.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $240.04 , Not Applicable , Not Applicable , $240.04 , $252.04 , Not Applicable
,J1744,HCPCS,Icatibant injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $239.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $239.93 , $239.93 , Not Applicable , Not Applicable , $251.92 , $244.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $239.93 , Not Applicable , Not Applicable , $239.93 , $251.92 , Not Applicable
,J1745,HCPCS,Infliximab not biosimil 10mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $46.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.28 , $46.28 , Not Applicable , Not Applicable , $48.59 , $47.20 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $46.28 , Not Applicable , Not Applicable , $46.28 , $48.59 , Not Applicable
,J1746,HCPCS,"Inj., ibalizumab-uiyk, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $77.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $77.72 , $77.72 , Not Applicable , Not Applicable , $81.61 , $79.27 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $77.72 , Not Applicable , Not Applicable , $77.72 , $81.61 , Not Applicable
,J1750,HCPCS,Inj iron dextran,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $18.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $18.54 , $18.54 , Not Applicable , Not Applicable , $19.47 , $18.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $18.54 , Not Applicable , Not Applicable , $18.54 , $19.47 , Not Applicable
,J1786,HCPCS,Imuglucerase injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $51.56 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $51.56 , $51.56 , Not Applicable , Not Applicable , $54.14 , $52.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $51.56 , Not Applicable , Not Applicable , $51.56 , $54.14 , Not Applicable
,J1823,HCPCS,"Inj. inebilizumab-cdon, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $536.37 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $536.37 , $536.37 , Not Applicable , Not Applicable , $563.19 , $547.10 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $536.37 , Not Applicable , Not Applicable , $536.37 , $563.19 , Not Applicable
,J1826,HCPCS,Interferon beta-1a inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,685.13 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,685.13 "," $2,685.13 ", Not Applicable , Not Applicable ," $2,819.39 "," $2,738.84 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,685.13 ", Not Applicable , Not Applicable ," $2,685.13 "," $2,819.39 ", Not Applicable
,J1830,HCPCS,Interferon beta-1b / .25 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $475.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $475.53 , $475.53 , Not Applicable , Not Applicable , $499.31 , $485.04 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $475.53 , Not Applicable , Not Applicable , $475.53 , $499.31 , Not Applicable
,J1833,HCPCS,"Injection, isavuconazonium",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $0.97 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $0.97 , $0.97 , Not Applicable , Not Applicable , $1.01 , $0.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $0.97 , Not Applicable , Not Applicable , $0.97 , $1.01 , Not Applicable
,J1930,HCPCS,Lanreotide injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $79.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $79.18 , $79.18 , Not Applicable , Not Applicable , $83.13 , $80.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $79.18 , Not Applicable , Not Applicable , $79.18 , $83.13 , Not Applicable
,J1931,HCPCS,Laronidase injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.67 , $40.67 , Not Applicable , Not Applicable , $42.71 , $41.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.67 , Not Applicable , Not Applicable , $40.67 , $42.71 , Not Applicable
,J1943,HCPCS,"Inj., aristada initio, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $3.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.57 , $3.57 , Not Applicable , Not Applicable , $3.75 , $3.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.57 , Not Applicable , Not Applicable , $3.57 , $3.75 , Not Applicable
,J1944,HCPCS,Aripirazole lauroxil 1 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $3.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.50 , $3.50 , Not Applicable , Not Applicable , $3.68 , $3.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.50 , Not Applicable , Not Applicable , $3.50 , $3.68 , Not Applicable
,J1950,HCPCS,Leuprolide acetate /3.75 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,646.26 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,646.26 "," $1,646.26 ", Not Applicable , Not Applicable ," $1,728.58 "," $1,679.19 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,646.26 ", Not Applicable , Not Applicable ," $1,646.26 "," $1,728.58 ", Not Applicable
,J1951,HCPCS,Inj fensolvi 0.25 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $147.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $147.82 , $147.82 , Not Applicable , Not Applicable , $155.21 , $150.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $147.82 , Not Applicable , Not Applicable , $147.82 , $155.21 , Not Applicable
,J2182,HCPCS,"Injection, mepolizumab, 1mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $33.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $33.12 , $33.12 , Not Applicable , Not Applicable , $34.77 , $33.78 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $33.12 , Not Applicable , Not Applicable , $33.12 , $34.77 , Not Applicable
,J2186,HCPCS,"Inj., meropenem, vaborbactam",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.06 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.06 , $2.06 , Not Applicable , Not Applicable , $2.16 , $2.10 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.06 , Not Applicable , Not Applicable , $2.06 , $2.16 , Not Applicable
,J2265,HCPCS,Minocycline hydrochloride,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.34 , $2.34 , Not Applicable , Not Applicable , $2.46 , $2.39 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.34 , Not Applicable , Not Applicable , $2.34 , $2.46 , Not Applicable
,J2278,HCPCS,Ziconotide injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $10.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $10.17 , $10.17 , Not Applicable , Not Applicable , $10.68 , $10.37 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $10.17 , Not Applicable , Not Applicable , $10.17 , $10.68 , Not Applicable
,J2315,HCPCS,"Naltrexone, depot form",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $4.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $4.13 , $4.13 , Not Applicable , Not Applicable , $4.34 , $4.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $4.13 , Not Applicable , Not Applicable , $4.13 , $4.34 , Not Applicable
,J2323,HCPCS,Natalizumab injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $27.20 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $27.20 , $27.20 , Not Applicable , Not Applicable , $28.56 , $27.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $27.20 , Not Applicable , Not Applicable , $27.20 , $28.56 , Not Applicable
,J2326,HCPCS,"Inj, nusinersen, 0.1mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,313.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,313.54 "," $1,313.54 ", Not Applicable , Not Applicable ," $1,379.21 "," $1,339.81 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,313.54 ", Not Applicable , Not Applicable ," $1,313.54 "," $1,379.21 ", Not Applicable
,J2350,HCPCS,"Injection, ocrelizumab, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $68.23 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $68.23 , $68.23 , Not Applicable , Not Applicable , $71.65 , $69.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $68.23 , Not Applicable , Not Applicable , $68.23 , $71.65 , Not Applicable
,J2353,HCPCS,"Octreotide injection, depot",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $240.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $240.40 , $240.40 , Not Applicable , Not Applicable , $252.42 , $245.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $240.40 , Not Applicable , Not Applicable , $240.40 , $252.42 , Not Applicable
,J2357,HCPCS,Omalizumab injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.09 , $44.09 , Not Applicable , Not Applicable , $46.30 , $44.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.09 , Not Applicable , Not Applicable , $44.09 , $46.30 , Not Applicable
,J2358,HCPCS,Olanzapine long-acting inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $3.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.41 , $3.41 , Not Applicable , Not Applicable , $3.58 , $3.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.41 , Not Applicable , Not Applicable , $3.41 , $3.58 , Not Applicable
,J2406,HCPCS,"Injection, oritavancin 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $49.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $49.07 , $49.07 , Not Applicable , Not Applicable , $51.53 , $50.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $49.07 , Not Applicable , Not Applicable , $49.07 , $51.53 , Not Applicable
,J2407,HCPCS,"Injection, oritavancin",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $27.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $27.66 , $27.66 , Not Applicable , Not Applicable , $29.04 , $28.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $27.66 , Not Applicable , Not Applicable , $27.66 , $29.04 , Not Applicable
,J2425,HCPCS,Palifermin injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $28.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $28.01 , $28.01 , Not Applicable , Not Applicable , $29.41 , $28.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $28.01 , Not Applicable , Not Applicable , $28.01 , $29.41 , Not Applicable
,J2426,HCPCS,Paliperidone palmitate inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $14.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $14.82 , $14.82 , Not Applicable , Not Applicable , $15.56 , $15.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $14.82 , Not Applicable , Not Applicable , $14.82 , $15.56 , Not Applicable
,J2502,HCPCS,"Inj, pasireotide long acting",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $420.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $420.28 , $420.28 , Not Applicable , Not Applicable , $441.29 , $428.68 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $420.28 , Not Applicable , Not Applicable , $420.28 , $441.29 , Not Applicable
,J2506,HCPCS,Inj pegfilgrast ex bio 0.5mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $216.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $216.72 , $216.72 , Not Applicable , Not Applicable , $227.55 , $221.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $216.72 , Not Applicable , Not Applicable , $216.72 , $227.55 , Not Applicable
,J2507,HCPCS,Pegloticase injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,465.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,465.98 "," $3,465.98 ", Not Applicable , Not Applicable ," $3,639.28 "," $3,535.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,465.98 ", Not Applicable , Not Applicable ," $3,465.98 "," $3,639.28 ", Not Applicable
,J2547,HCPCS,"Injection, peramivir",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.96 , $1.96 , Not Applicable , Not Applicable , $2.06 , $2.00 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.96 , Not Applicable , Not Applicable , $1.96 , $2.06 , Not Applicable
,J2560,HCPCS,Phenobarbital sodium inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.08 , $47.08 , Not Applicable , Not Applicable , $49.43 , $48.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.08 , Not Applicable , Not Applicable , $47.08 , $49.43 , Not Applicable
,J2562,HCPCS,Plerixafor injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $448.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $448.16 , $448.16 , Not Applicable , Not Applicable , $470.57 , $457.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $448.16 , Not Applicable , Not Applicable , $448.16 , $470.57 , Not Applicable
,J2597,HCPCS,Inj desmopressin acetate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $11.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $11.01 , $11.01 , Not Applicable , Not Applicable , $11.56 , $11.23 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $11.01 , Not Applicable , Not Applicable , $11.01 , $11.56 , Not Applicable
,J2724,HCPCS,Protein c concentrate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $17.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $17.71 , $17.71 , Not Applicable , Not Applicable , $18.59 , $18.06 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $17.71 , Not Applicable , Not Applicable , $17.71 , $18.59 , Not Applicable
,J2760,HCPCS,Phentolaine mesylate inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $486.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $486.96 , $486.96 , Not Applicable , Not Applicable , $511.31 , $496.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $486.96 , Not Applicable , Not Applicable , $486.96 , $511.31 , Not Applicable
,J2770,HCPCS,Quinupristin/dalfopristin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $520.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $520.52 , $520.52 , Not Applicable , Not Applicable , $546.55 , $530.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $520.52 , Not Applicable , Not Applicable , $520.52 , $546.55 , Not Applicable
,J2778,HCPCS,Ranibizumab injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $372.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $372.80 , $372.80 , Not Applicable , Not Applicable , $391.44 , $380.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $372.80 , Not Applicable , Not Applicable , $372.80 , $391.44 , Not Applicable
,J2783,HCPCS,Rasburicase,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $368.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $368.80 , $368.80 , Not Applicable , Not Applicable , $387.24 , $376.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $368.80 , Not Applicable , Not Applicable , $368.80 , $387.24 , Not Applicable
,J2786,HCPCS,"Injection, reslizumab, 1mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $11.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $11.84 , $11.84 , Not Applicable , Not Applicable , $12.43 , $12.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $11.84 , Not Applicable , Not Applicable , $11.84 , $12.43 , Not Applicable
,J2792,HCPCS,"Rho(d) immune globulin h, sd",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $36.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $36.77 , $36.77 , Not Applicable , Not Applicable , $38.61 , $37.51 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $36.77 , Not Applicable , Not Applicable , $36.77 , $38.61 , Not Applicable
,J2794,HCPCS,"Inj risperdal consta, 0.5 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $12.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $12.93 , $12.93 , Not Applicable , Not Applicable , $13.57 , $13.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $12.93 , Not Applicable , Not Applicable , $12.93 , $13.57 , Not Applicable
,J2796,HCPCS,Romiplostim injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $97.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $97.70 , $97.70 , Not Applicable , Not Applicable , $102.59 , $99.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $97.70 , Not Applicable , Not Applicable , $97.70 , $102.59 , Not Applicable
,J2820,HCPCS,Sargramostim injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $60.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $60.34 , $60.34 , Not Applicable , Not Applicable , $63.36 , $61.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $60.34 , Not Applicable , Not Applicable , $60.34 , $63.36 , Not Applicable
,J2840,HCPCS,Inj sebelipase alfa 1 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $632.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $632.01 , $632.01 , Not Applicable , Not Applicable , $663.61 , $644.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $632.01 , Not Applicable , Not Applicable , $632.01 , $663.61 , Not Applicable
,J2850,HCPCS,Inj secretin synthetic human,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.71 , $40.71 , Not Applicable , Not Applicable , $42.75 , $41.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.71 , Not Applicable , Not Applicable , $40.71 , $42.75 , Not Applicable
,J2860,HCPCS,"Injection, siltuximab",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $145.26 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $145.26 , $145.26 , Not Applicable , Not Applicable , $152.52 , $148.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $145.26 , Not Applicable , Not Applicable , $145.26 , $152.52 , Not Applicable
,J2993,HCPCS,Reteplase injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,934.07 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,934.07 "," $2,934.07 ", Not Applicable , Not Applicable ," $3,080.78 "," $2,992.75 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,934.07 ", Not Applicable , Not Applicable ," $2,934.07 "," $3,080.78 ", Not Applicable
,J2997,HCPCS,Alteplase recombinant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $102.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $102.72 , $102.72 , Not Applicable , Not Applicable , $107.85 , $104.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $102.72 , Not Applicable , Not Applicable , $102.72 , $107.85 , Not Applicable
,J3031,HCPCS,"Inj., fremanezumab-vfrm 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.74 , $2.74 , Not Applicable , Not Applicable , $2.88 , $2.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.74 , Not Applicable , Not Applicable , $2.74 , $2.88 , Not Applicable
,J3032,HCPCS,Inj. eptinezumab-jjmr 1 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $18.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $18.30 , $18.30 , Not Applicable , Not Applicable , $19.22 , $18.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $18.30 , Not Applicable , Not Applicable , $18.30 , $19.22 , Not Applicable
,J3060,HCPCS,"Inj, taliglucerase alfa 10 u",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $48.37 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $48.37 , $48.37 , Not Applicable , Not Applicable , $50.79 , $49.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $48.37 , Not Applicable , Not Applicable , $48.37 , $50.79 , Not Applicable
,J3090,HCPCS,Inj tedizolid phosphate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.87 , $1.87 , Not Applicable , Not Applicable , $1.96 , $1.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.87 , Not Applicable , Not Applicable , $1.87 , $1.96 , Not Applicable
,J3095,HCPCS,Telavancin injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $7.20 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.20 , $7.20 , Not Applicable , Not Applicable , $7.57 , $7.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.20 , Not Applicable , Not Applicable , $7.20 , $7.57 , Not Applicable
,J3101,HCPCS,Tenecteplase injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $157.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $157.72 , $157.72 , Not Applicable , Not Applicable , $165.61 , $160.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $157.72 , Not Applicable , Not Applicable , $157.72 , $165.61 , Not Applicable
,J3111,HCPCS,Inj. romosozumab-aqqg 1 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $10.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $10.94 , $10.94 , Not Applicable , Not Applicable , $11.48 , $11.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $10.94 , Not Applicable , Not Applicable , $10.94 , $11.48 , Not Applicable
,J3145,HCPCS,Testosterone undecanoate 1mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.91 , $1.91 , Not Applicable , Not Applicable , $2.00 , $1.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.91 , Not Applicable , Not Applicable , $1.91 , $2.00 , Not Applicable
,J3240,HCPCS,Thyrotropin injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,150.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,150.64 "," $2,150.64 ", Not Applicable , Not Applicable ," $2,258.18 "," $2,193.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,150.64 ", Not Applicable , Not Applicable ," $2,150.64 "," $2,258.18 ", Not Applicable
,J3241,HCPCS,Inj. teprotumumab-trbw 10 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $369.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $369.76 , $369.76 , Not Applicable , Not Applicable , $388.25 , $377.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $369.76 , Not Applicable , Not Applicable , $369.76 , $388.25 , Not Applicable
,J3245,HCPCS,"Inj., tildrakizumab, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $156.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $156.95 , $156.95 , Not Applicable , Not Applicable , $164.79 , $160.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $156.95 , Not Applicable , Not Applicable , $156.95 , $164.79 , Not Applicable
,J3246,HCPCS,Tirofiban hcl,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $4.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $4.48 , $4.48 , Not Applicable , Not Applicable , $4.71 , $4.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $4.48 , Not Applicable , Not Applicable , $4.48 , $4.71 , Not Applicable
,J3262,HCPCS,Tocilizumab injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $6.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $6.50 , $6.50 , Not Applicable , Not Applicable , $6.83 , $6.63 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $6.50 , Not Applicable , Not Applicable , $6.50 , $6.83 , Not Applicable
,J3285,HCPCS,Treprostinil injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $69.86 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $69.86 , $69.86 , Not Applicable , Not Applicable , $73.35 , $71.26 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $69.86 , Not Applicable , Not Applicable , $69.86 , $73.35 , Not Applicable
,J3304,HCPCS,Inj triamcinolone ace xr 1mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $20.78 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $20.78 , $20.78 , Not Applicable , Not Applicable , $21.81 , $21.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $20.78 , Not Applicable , Not Applicable , $20.78 , $21.81 , Not Applicable
,J3315,HCPCS,Triptorelin pamoate,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $444.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $444.71 , $444.71 , Not Applicable , Not Applicable , $466.94 , $453.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $444.71 , Not Applicable , Not Applicable , $444.71 , $466.94 , Not Applicable
,J3316,HCPCS,"Inj., triptorelin xr 3.75 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,652.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,652.34 "," $3,652.34 ", Not Applicable , Not Applicable ," $3,834.96 "," $3,725.39 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,652.34 ", Not Applicable , Not Applicable ," $3,652.34 "," $3,834.96 ", Not Applicable
,J3357,HCPCS,"Ustekinumab sub cu inj, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $206.78 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $206.78 , $206.78 , Not Applicable , Not Applicable , $217.12 , $210.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $206.78 , Not Applicable , Not Applicable , $206.78 , $217.12 , Not Applicable
,J3358,HCPCS,"Ustekinumab, iv inject, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $13.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $13.67 , $13.67 , Not Applicable , Not Applicable , $14.36 , $13.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $13.67 , Not Applicable , Not Applicable , $13.67 , $14.36 , Not Applicable
,J3380,HCPCS,"Injection, vedolizumab",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $24.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $24.91 , $24.91 , Not Applicable , Not Applicable , $26.15 , $25.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $24.91 , Not Applicable , Not Applicable , $24.91 , $26.15 , Not Applicable
,J3385,HCPCS,Velaglucerase alfa,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $420.58 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $420.58 , $420.58 , Not Applicable , Not Applicable , $441.61 , $428.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $420.58 , Not Applicable , Not Applicable , $420.58 , $441.61 , Not Applicable
,J3396,HCPCS,Verteporfin injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $13.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $13.17 , $13.17 , Not Applicable , Not Applicable , $13.83 , $13.43 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $13.17 , Not Applicable , Not Applicable , $13.17 , $13.83 , Not Applicable
,J3398,HCPCS,Inj luxturna 1 billion vec g,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,457.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,457.56 "," $3,457.56 ", Not Applicable , Not Applicable ," $3,630.44 "," $3,526.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,457.56 ", Not Applicable , Not Applicable ," $3,457.56 "," $3,630.44 ", Not Applicable
,J7168,HCPCS,Prothrombin complex kcentra,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.33 , $2.33 , Not Applicable , Not Applicable , $2.44 , $2.37 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.33 , Not Applicable , Not Applicable , $2.33 , $2.44 , Not Applicable
,J7169,HCPCS,"Inj andexxa, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $339.39 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $339.39 , $339.39 , Not Applicable , Not Applicable , $356.36 , $346.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $339.39 , Not Applicable , Not Applicable , $339.39 , $356.36 , Not Applicable
,J7170,HCPCS,"Inj., emicizumab-kxwh 0.5 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $57.22 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $57.22 , $57.22 , Not Applicable , Not Applicable , $60.08 , $58.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $57.22 , Not Applicable , Not Applicable , $57.22 , $60.08 , Not Applicable
,J7175,HCPCS,"Inj, factor x, (human), 1iu",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $9.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $9.60 , $9.60 , Not Applicable , Not Applicable , $10.08 , $9.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $9.60 , Not Applicable , Not Applicable , $9.60 , $10.08 , Not Applicable
,J7178,HCPCS,Inj human fibrinogen con nos,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.52 , $1.52 , Not Applicable , Not Applicable , $1.59 , $1.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.52 , Not Applicable , Not Applicable , $1.52 , $1.59 , Not Applicable
,J7179,HCPCS,Vonvendi inj 1 iu vwf:rco,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.17 , $2.17 , Not Applicable , Not Applicable , $2.28 , $2.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.17 , Not Applicable , Not Applicable , $2.17 , $2.28 , Not Applicable
,J7180,HCPCS,Factor xiii anti-hem factor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $10.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $10.70 , $10.70 , Not Applicable , Not Applicable , $11.24 , $10.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $10.70 , Not Applicable , Not Applicable , $10.70 , $11.24 , Not Applicable
,J7181,HCPCS,Factor xiii recomb a-subunit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $18.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $18.57 , $18.57 , Not Applicable , Not Applicable , $19.50 , $18.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $18.57 , Not Applicable , Not Applicable , $18.57 , $19.50 , Not Applicable
,J7182,HCPCS,Factor viii recomb novoeight,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.76 , $1.76 , Not Applicable , Not Applicable , $1.85 , $1.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.76 , Not Applicable , Not Applicable , $1.76 , $1.85 , Not Applicable
,J7183,HCPCS,Wilate injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.36 , $1.36 , Not Applicable , Not Applicable , $1.43 , $1.39 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.36 , Not Applicable , Not Applicable , $1.36 , $1.43 , Not Applicable
,J7185,HCPCS,Xyntha inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.55 , $1.55 , Not Applicable , Not Applicable , $1.63 , $1.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.55 , Not Applicable , Not Applicable , $1.55 , $1.63 , Not Applicable
,J7186,HCPCS,Antihemophilic viii/vwf comp,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.33 , $1.33 , Not Applicable , Not Applicable , $1.40 , $1.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.33 , Not Applicable , Not Applicable , $1.33 , $1.40 , Not Applicable
,J7187,HCPCS,"Humate-p, inj",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.48 , $1.48 , Not Applicable , Not Applicable , $1.55 , $1.51 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.48 , Not Applicable , Not Applicable , $1.48 , $1.55 , Not Applicable
,J7188,HCPCS,Factor viii recomb obizur,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $3.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.73 , $3.73 , Not Applicable , Not Applicable , $3.92 , $3.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.73 , Not Applicable , Not Applicable , $3.73 , $3.92 , Not Applicable
,J7189,HCPCS,Factor viia recomb novoseven,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.72 , $2.72 , Not Applicable , Not Applicable , $2.86 , $2.78 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.72 , Not Applicable , Not Applicable , $2.72 , $2.86 , Not Applicable
,J7190,HCPCS,Factor viii,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.31 , $1.31 , Not Applicable , Not Applicable , $1.38 , $1.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.31 , Not Applicable , Not Applicable , $1.31 , $1.38 , Not Applicable
,J7192,HCPCS,Factor viii recombinant nos,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.67 , $1.67 , Not Applicable , Not Applicable , $1.75 , $1.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.67 , Not Applicable , Not Applicable , $1.67 , $1.75 , Not Applicable
,J7193,HCPCS,Factor ix non-recombinant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.36 , $1.36 , Not Applicable , Not Applicable , $1.43 , $1.39 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.36 , Not Applicable , Not Applicable , $1.36 , $1.43 , Not Applicable
,J7194,HCPCS,Factor ix complex,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.80 , $1.80 , Not Applicable , Not Applicable , $1.89 , $1.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.80 , Not Applicable , Not Applicable , $1.80 , $1.89 , Not Applicable
,J7195,HCPCS,Factor ix recombinant nos,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.88 , $1.88 , Not Applicable , Not Applicable , $1.98 , $1.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.88 , Not Applicable , Not Applicable , $1.88 , $1.98 , Not Applicable
,J7197,HCPCS,Antithrombin iii injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $3.75 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.75 , $3.75 , Not Applicable , Not Applicable , $3.94 , $3.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.75 , Not Applicable , Not Applicable , $3.75 , $3.94 , Not Applicable
,J7198,HCPCS,Anti-inhibitor,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.58 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.58 , $2.58 , Not Applicable , Not Applicable , $2.71 , $2.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.58 , Not Applicable , Not Applicable , $2.58 , $2.71 , Not Applicable
,J7200,HCPCS,Factor ix recombinan rixubis,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.80 , $1.80 , Not Applicable , Not Applicable , $1.89 , $1.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.80 , Not Applicable , Not Applicable , $1.80 , $1.89 , Not Applicable
,J7201,HCPCS,Factor ix alprolix recomb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $3.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.84 , $3.84 , Not Applicable , Not Applicable , $4.03 , $3.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.84 , Not Applicable , Not Applicable , $3.84 , $4.03 , Not Applicable
,J7202,HCPCS,Factor ix idelvion inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $5.38 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $5.38 , $5.38 , Not Applicable , Not Applicable , $5.64 , $5.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $5.38 , Not Applicable , Not Applicable , $5.38 , $5.64 , Not Applicable
,J7203,HCPCS,Factor ix recomb gly rebinyn,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $4.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $4.95 , $4.95 , Not Applicable , Not Applicable , $5.19 , $5.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $4.95 , Not Applicable , Not Applicable , $4.95 , $5.19 , Not Applicable
,J7204,HCPCS,Inj recombin esperoct per iu,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.61 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.61 , $2.61 , Not Applicable , Not Applicable , $2.74 , $2.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.61 , Not Applicable , Not Applicable , $2.61 , $2.74 , Not Applicable
,J7205,HCPCS,Factor viii fc fusion recomb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.52 , $2.52 , Not Applicable , Not Applicable , $2.64 , $2.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.52 , Not Applicable , Not Applicable , $2.52 , $2.64 , Not Applicable
,J7207,HCPCS,Factor viii pegylated recomb,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.25 , $2.25 , Not Applicable , Not Applicable , $2.36 , $2.29 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.25 , Not Applicable , Not Applicable , $2.25 , $2.36 , Not Applicable
,J7208,HCPCS,Inj. jivi 1 iu,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.46 , $2.46 , Not Applicable , Not Applicable , $2.58 , $2.51 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.46 , Not Applicable , Not Applicable , $2.46 , $2.58 , Not Applicable
,J7209,HCPCS,Factor viii nuwiq recomb 1iu,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.45 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.45 , $1.45 , Not Applicable , Not Applicable , $1.52 , $1.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.45 , Not Applicable , Not Applicable , $1.45 , $1.52 , Not Applicable
,J7210,HCPCS,"Inj, afstyla, 1 i.u.",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.59 , $1.59 , Not Applicable , Not Applicable , $1.67 , $1.62 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.59 , Not Applicable , Not Applicable , $1.59 , $1.67 , Not Applicable
,J7211,HCPCS,"Inj, kovaltry, 1 i.u.",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.46 , $1.46 , Not Applicable , Not Applicable , $1.53 , $1.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.46 , Not Applicable , Not Applicable , $1.46 , $1.53 , Not Applicable
,J7212,HCPCS,Factor viia recomb sevenfact,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.66 , $2.66 , Not Applicable , Not Applicable , $2.79 , $2.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.66 , Not Applicable , Not Applicable , $2.66 , $2.79 , Not Applicable
,J7308,HCPCS,Aminolevulinic acid hcl top,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $459.43 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $459.43 , $459.43 , Not Applicable , Not Applicable , $482.40 , $468.62 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $459.43 , Not Applicable , Not Applicable , $459.43 , $482.40 , Not Applicable
,J7311,HCPCS,"Inj., retisert, 0.01 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $396.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $396.82 , $396.82 , Not Applicable , Not Applicable , $416.66 , $404.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $396.82 , Not Applicable , Not Applicable , $396.82 , $416.66 , Not Applicable
,J7312,HCPCS,Dexamethasone intra implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $233.75 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $233.75 , $233.75 , Not Applicable , Not Applicable , $245.44 , $238.43 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $233.75 , Not Applicable , Not Applicable , $233.75 , $245.44 , Not Applicable
,J7313,HCPCS,"Inj., iluvien, 0.01 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $574.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $574.69 , $574.69 , Not Applicable , Not Applicable , $603.43 , $586.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $574.69 , Not Applicable , Not Applicable , $574.69 , $603.43 , Not Applicable
,J7314,HCPCS,"Inj., yutiq, 0.01 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $600.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $600.69 , $600.69 , Not Applicable , Not Applicable , $630.73 , $612.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $600.69 , Not Applicable , Not Applicable , $600.69 , $630.73 , Not Applicable
,J7316,HCPCS,"Inj, ocriplasmin, 0.125 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,225.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,225.51 "," $1,225.51 ", Not Applicable , Not Applicable ," $1,286.79 "," $1,250.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,225.51 ", Not Applicable , Not Applicable ," $1,225.51 "," $1,286.79 ", Not Applicable
,J7318,HCPCS,"Inj, durolane 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $20.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $20.16 , $20.16 , Not Applicable , Not Applicable , $21.17 , $20.57 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $20.16 , Not Applicable , Not Applicable , $20.16 , $21.17 , Not Applicable
,J7320,HCPCS,"Genvisc 850, inj, 1mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $19.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $19.80 , $19.80 , Not Applicable , Not Applicable , $20.79 , $20.20 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $19.80 , Not Applicable , Not Applicable , $19.80 , $20.79 , Not Applicable
,J7322,HCPCS,Hymovis injection 1 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $37.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $37.07 , $37.07 , Not Applicable , Not Applicable , $38.92 , $37.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $37.07 , Not Applicable , Not Applicable , $37.07 , $38.92 , Not Applicable
,J7323,HCPCS,Euflexxa inj per dose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $162.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $162.50 , $162.50 , Not Applicable , Not Applicable , $170.62 , $165.75 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $162.50 , Not Applicable , Not Applicable , $162.50 , $170.62 , Not Applicable
,J7324,HCPCS,Orthovisc inj per dose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $174.11 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $174.11 , $174.11 , Not Applicable , Not Applicable , $182.82 , $177.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $174.11 , Not Applicable , Not Applicable , $174.11 , $182.82 , Not Applicable
,J7325,HCPCS,Synvisc or synvisc-one,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $13.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $13.15 , $13.15 , Not Applicable , Not Applicable , $13.81 , $13.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $13.15 , Not Applicable , Not Applicable , $13.15 , $13.81 , Not Applicable
,J7326,HCPCS,Gel-one,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,426.94 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,426.94 "," $1,426.94 ", Not Applicable , Not Applicable ," $1,498.28 "," $1,455.48 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,426.94 ", Not Applicable , Not Applicable ," $1,426.94 "," $1,498.28 ", Not Applicable
,J7327,HCPCS,Monovisc inj per dose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $892.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $892.92 , $892.92 , Not Applicable , Not Applicable , $937.56 , $910.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $892.92 , Not Applicable , Not Applicable , $892.92 , $937.56 , Not Applicable
,J7328,HCPCS,Gelsyn-3 injection 0.1 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.55 , $2.55 , Not Applicable , Not Applicable , $2.68 , $2.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.55 , Not Applicable , Not Applicable , $2.55 , $2.68 , Not Applicable
,J7329,HCPCS,"Inj, trivisc 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $22.38 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $22.38 , $22.38 , Not Applicable , Not Applicable , $23.50 , $22.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $22.38 , Not Applicable , Not Applicable , $22.38 , $23.50 , Not Applicable
,J7331,HCPCS,"Synojoynt, inj., 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $21.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $21.09 , $21.09 , Not Applicable , Not Applicable , $22.14 , $21.51 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $21.09 , Not Applicable , Not Applicable , $21.09 , $22.14 , Not Applicable
,J7336,HCPCS,Capsaicin 8% patch,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $3.78 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.78 , $3.78 , Not Applicable , Not Applicable , $3.97 , $3.86 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.78 , Not Applicable , Not Applicable , $3.78 , $3.97 , Not Applicable
,J7340,HCPCS,Carbidopa levodopa ent 100ml,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $247.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $247.81 , $247.81 , Not Applicable , Not Applicable , $260.20 , $252.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $247.81 , Not Applicable , Not Applicable , $247.81 , $260.20 , Not Applicable
,J7342,HCPCS,Ciprofloxacin otic susp 6 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $35.10 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $35.10 , $35.10 , Not Applicable , Not Applicable , $36.85 , $35.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $35.10 , Not Applicable , Not Applicable , $35.10 , $36.85 , Not Applicable
,J7345,HCPCS,"Aminolevulinic acid, 10% gel",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.86 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.86 , $1.86 , Not Applicable , Not Applicable , $1.95 , $1.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.86 , Not Applicable , Not Applicable , $1.86 , $1.95 , Not Applicable
,J7351,HCPCS,Inj bimatoprost itc imp1mcg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $240.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $240.71 , $240.71 , Not Applicable , Not Applicable , $252.75 , $245.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $240.71 , Not Applicable , Not Applicable , $240.71 , $252.75 , Not Applicable
,J7352,HCPCS,"Afamelanotide implant, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,767.98 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,767.98 "," $3,767.98 ", Not Applicable , Not Applicable ," $3,956.38 "," $3,843.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,767.98 ", Not Applicable , Not Applicable ," $3,767.98 "," $3,956.38 ", Not Applicable
,J7402,HCPCS,Mometasone sinus sinuva,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $12.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $12.36 , $12.36 , Not Applicable , Not Applicable , $12.98 , $12.61 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $12.36 , Not Applicable , Not Applicable , $12.36 , $12.98 , Not Applicable
,J7501,HCPCS,Azathioprine parenteral,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $286.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $286.81 , $286.81 , Not Applicable , Not Applicable , $301.16 , $292.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $286.81 , Not Applicable , Not Applicable , $286.81 , $301.16 , Not Applicable
,J7504,HCPCS,Lymphocyte immune globulin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,757.34 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,757.34 "," $2,757.34 ", Not Applicable , Not Applicable ," $2,895.21 "," $2,812.49 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,757.34 ", Not Applicable , Not Applicable ," $2,757.34 "," $2,895.21 ", Not Applicable
,J7511,HCPCS,Antithymocyte globuln rabbit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $980.27 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $980.27 , $980.27 , Not Applicable , Not Applicable ," $1,029.28 ", $999.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $980.27 , Not Applicable , Not Applicable , $980.27 ," $1,029.28 ", Not Applicable
,J7525,HCPCS,Tacrolimus injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $256.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $256.74 , $256.74 , Not Applicable , Not Applicable , $269.57 , $261.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $256.74 , Not Applicable , Not Applicable , $256.74 , $269.57 , Not Applicable
,J8560,HCPCS,Etoposide oral 50 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $88.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $88.53 , $88.53 , Not Applicable , Not Applicable , $92.95 , $90.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $88.53 , Not Applicable , Not Applicable , $88.53 , $92.95 , Not Applicable
,J8655,HCPCS,"Oral netupitant, palonosetro",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $369.43 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $369.43 , $369.43 , Not Applicable , Not Applicable , $387.90 , $376.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $369.43 , Not Applicable , Not Applicable , $369.43 , $387.90 , Not Applicable
,J8670,HCPCS,"Rolapitant, oral, 1mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.05 , $2.05 , Not Applicable , Not Applicable , $2.15 , $2.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.05 , Not Applicable , Not Applicable , $2.05 , $2.15 , Not Applicable
,J9015,HCPCS,Aldesleukin injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $4,442.66 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,442.66 "," $4,442.66 ", Not Applicable , Not Applicable ," $4,664.79 "," $4,531.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $4,442.66 ", Not Applicable , Not Applicable ," $4,442.66 "," $4,664.79 ", Not Applicable
,J9017,HCPCS,Arsenic trioxide injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $15.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $15.35 , $15.35 , Not Applicable , Not Applicable , $16.12 , $15.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $15.35 , Not Applicable , Not Applicable , $15.35 , $16.12 , Not Applicable
,J9019,HCPCS,Erwinaze injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $500.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $500.15 , $500.15 , Not Applicable , Not Applicable , $525.16 , $510.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $500.15 , Not Applicable , Not Applicable , $500.15 , $525.16 , Not Applicable
,J9021,HCPCS,"Inj, aspara, rylaze, 0.1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $52.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $52.93 , $52.93 , Not Applicable , Not Applicable , $55.58 , $53.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $52.93 , Not Applicable , Not Applicable , $52.93 , $55.58 , Not Applicable
,J9022,HCPCS,"Inj, atezolizumab,10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $93.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $93.35 , $93.35 , Not Applicable , Not Applicable , $98.02 , $95.22 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $93.35 , Not Applicable , Not Applicable , $93.35 , $98.02 , Not Applicable
,J9023,HCPCS,"Injection, avelumab, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $100.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $100.89 , $100.89 , Not Applicable , Not Applicable , $105.94 , $102.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $100.89 , Not Applicable , Not Applicable , $100.89 , $105.94 , Not Applicable
,J9025,HCPCS,Azacitidine injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.09 , $1.09 , Not Applicable , Not Applicable , $1.14 , $1.11 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.09 , Not Applicable , Not Applicable , $1.09 , $1.14 , Not Applicable
,J9027,HCPCS,Clofarabine injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $62.22 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $62.22 , $62.22 , Not Applicable , Not Applicable , $65.33 , $63.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $62.22 , Not Applicable , Not Applicable , $62.22 , $65.33 , Not Applicable
,J9032,HCPCS,"Injection, belinostat, 10mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $50.06 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $50.06 , $50.06 , Not Applicable , Not Applicable , $52.57 , $51.06 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $50.06 , Not Applicable , Not Applicable , $50.06 , $52.57 , Not Applicable
,J9033,HCPCS,"Inj., treanda 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $25.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $25.77 , $25.77 , Not Applicable , Not Applicable , $27.06 , $26.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $25.77 , Not Applicable , Not Applicable , $25.77 , $27.06 , Not Applicable
,J9034,HCPCS,"Inj., bendeka 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $23.00 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $23.00 , $23.00 , Not Applicable , Not Applicable , $24.15 , $23.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $23.00 , Not Applicable , Not Applicable , $23.00 , $24.15 , Not Applicable
,J9035,HCPCS,Bevacizumab injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $82.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $82.42 , $82.42 , Not Applicable , Not Applicable , $86.54 , $84.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $82.42 , Not Applicable , Not Applicable , $82.42 , $86.54 , Not Applicable
,J9036,HCPCS,Inj. belrapzo/bendamustine,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $25.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $25.13 , $25.13 , Not Applicable , Not Applicable , $26.39 , $25.63 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $25.13 , Not Applicable , Not Applicable , $25.13 , $26.39 , Not Applicable
,J9037,HCPCS,Inj belantamab mafodont blmf,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $50.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $50.08 , $50.08 , Not Applicable , Not Applicable , $52.58 , $51.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $50.08 , Not Applicable , Not Applicable , $50.08 , $52.58 , Not Applicable
,J9039,HCPCS,"Injection, blinatumomab",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $145.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $145.01 , $145.01 , Not Applicable , Not Applicable , $152.26 , $147.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $145.01 , Not Applicable , Not Applicable , $145.01 , $152.26 , Not Applicable
,J9041,HCPCS,"Inj., velcade 0.1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $52.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $52.87 , $52.87 , Not Applicable , Not Applicable , $55.51 , $53.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $52.87 , Not Applicable , Not Applicable , $52.87 , $55.51 , Not Applicable
,J9042,HCPCS,Brentuximab vedotin inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $221.63 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $221.63 , $221.63 , Not Applicable , Not Applicable , $232.71 , $226.06 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $221.63 , Not Applicable , Not Applicable , $221.63 , $232.71 , Not Applicable
,J9043,HCPCS,Cabazitaxel injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $221.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $221.24 , $221.24 , Not Applicable , Not Applicable , $232.30 , $225.66 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $221.24 , Not Applicable , Not Applicable , $221.24 , $232.30 , Not Applicable
,J9044,HCPCS,"Inj, bortezomib, nos, 0.1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $21.43 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $21.43 , $21.43 , Not Applicable , Not Applicable , $22.50 , $21.86 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $21.43 , Not Applicable , Not Applicable , $21.43 , $22.50 , Not Applicable
,J9047,HCPCS,"Injection, carfilzomib, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $48.11 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $48.11 , $48.11 , Not Applicable , Not Applicable , $50.52 , $49.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $48.11 , Not Applicable , Not Applicable , $48.11 , $50.52 , Not Applicable
,J9050,HCPCS,Carmustine injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,445.03 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,445.03 "," $1,445.03 ", Not Applicable , Not Applicable ," $1,517.28 "," $1,473.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,445.03 ", Not Applicable , Not Applicable ," $1,445.03 "," $1,517.28 ", Not Applicable
,J9055,HCPCS,Cetuximab injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $78.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $78.08 , $78.08 , Not Applicable , Not Applicable , $81.99 , $79.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $78.08 , Not Applicable , Not Applicable , $78.08 , $81.99 , Not Applicable
,J9057,HCPCS,"Inj., copanlisib, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $94.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $94.77 , $94.77 , Not Applicable , Not Applicable , $99.51 , $96.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $94.77 , Not Applicable , Not Applicable , $94.77 , $99.51 , Not Applicable
,J9061,HCPCS,"Inj, amivantamab-vmjw",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $20.58 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $20.58 , $20.58 , Not Applicable , Not Applicable , $21.60 , $20.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $20.58 , Not Applicable , Not Applicable , $20.58 , $21.60 , Not Applicable
,J9065,HCPCS,Inj cladribine per 1 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $21.10 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $21.10 , $21.10 , Not Applicable , Not Applicable , $22.15 , $21.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $21.10 , Not Applicable , Not Applicable , $21.10 , $22.15 , Not Applicable
,J9070,HCPCS,Cyclophosphamide 100 mg inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $34.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $34.13 , $34.13 , Not Applicable , Not Applicable , $35.83 , $34.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $34.13 , Not Applicable , Not Applicable , $34.13 , $35.83 , Not Applicable
,J9119,HCPCS,"Inj., cemiplimab-rwlc, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $32.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $32.24 , $32.24 , Not Applicable , Not Applicable , $33.85 , $32.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $32.24 , Not Applicable , Not Applicable , $32.24 , $33.85 , Not Applicable
,J9120,HCPCS,Dactinomycin injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,042.57 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,042.57 "," $1,042.57 ", Not Applicable , Not Applicable ," $1,094.70 "," $1,063.42 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,042.57 ", Not Applicable , Not Applicable ," $1,042.57 "," $1,094.70 ", Not Applicable
,J9144,HCPCS,"Daratumumab, hyaluronidase",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $52.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $52.79 , $52.79 , Not Applicable , Not Applicable , $55.43 , $53.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $52.79 , Not Applicable , Not Applicable , $52.79 , $55.43 , Not Applicable
,J9145,HCPCS,"Injection, daratumumab 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $67.37 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $67.37 , $67.37 , Not Applicable , Not Applicable , $70.74 , $68.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $67.37 , Not Applicable , Not Applicable , $67.37 , $70.74 , Not Applicable
,J9150,HCPCS,Daunorubicin injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $47.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.24 , $47.24 , Not Applicable , Not Applicable , $49.60 , $48.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $47.24 , Not Applicable , Not Applicable , $47.24 , $49.60 , Not Applicable
,J9153,HCPCS,"Inj daunorubicin, cytarabine",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $237.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $237.15 , $237.15 , Not Applicable , Not Applicable , $249.01 , $241.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $237.15 , Not Applicable , Not Applicable , $237.15 , $249.01 , Not Applicable
,J9155,HCPCS,Degarelix injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $4.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $4.82 , $4.82 , Not Applicable , Not Applicable , $5.06 , $4.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $4.82 , Not Applicable , Not Applicable , $4.82 , $5.06 , Not Applicable
,J9173,HCPCS,"Inj., durvalumab, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $89.97 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.97 , $89.97 , Not Applicable , Not Applicable , $94.47 , $91.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $89.97 , Not Applicable , Not Applicable , $89.97 , $94.47 , Not Applicable
,J9176,HCPCS,"Injection, elotuzumab, 1mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $7.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.93 , $7.93 , Not Applicable , Not Applicable , $8.32 , $8.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.93 , Not Applicable , Not Applicable , $7.93 , $8.32 , Not Applicable
,J9177,HCPCS,Inj enfort vedo-ejfv 0.25mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $35.32 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $35.32 , $35.32 , Not Applicable , Not Applicable , $37.08 , $36.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $35.32 , Not Applicable , Not Applicable , $35.32 , $37.08 , Not Applicable
,J9179,HCPCS,Eribulin mesylate injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $145.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $145.07 , $145.07 , Not Applicable , Not Applicable , $152.32 , $147.97 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $145.07 , Not Applicable , Not Applicable , $145.07 , $152.32 , Not Applicable
,J9198,HCPCS,"Inj. infugem, 100 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $39.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $39.80 , $39.80 , Not Applicable , Not Applicable , $41.79 , $40.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $39.80 , Not Applicable , Not Applicable , $39.80 , $41.79 , Not Applicable
,J9202,HCPCS,Goserelin acetate implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $614.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $614.80 , $614.80 , Not Applicable , Not Applicable , $645.54 , $627.10 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $614.80 , Not Applicable , Not Applicable , $614.80 , $645.54 , Not Applicable
,J9203,HCPCS,Gemtuzumab ozogamicin 0.1 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $243.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $243.47 , $243.47 , Not Applicable , Not Applicable , $255.64 , $248.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $243.47 , Not Applicable , Not Applicable , $243.47 , $255.64 , Not Applicable
,J9204,HCPCS,"Inj mogamulizumab-kpkc, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $245.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $245.87 , $245.87 , Not Applicable , Not Applicable , $258.17 , $250.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $245.87 , Not Applicable , Not Applicable , $245.87 , $258.17 , Not Applicable
,J9205,HCPCS,Inj irinotecan liposome 1 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.95 , $66.95 , Not Applicable , Not Applicable , $70.30 , $68.29 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.95 , Not Applicable , Not Applicable , $66.95 , $70.30 , Not Applicable
,J9207,HCPCS,Ixabepilone injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $131.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $131.24 , $131.24 , Not Applicable , Not Applicable , $137.80 , $133.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $131.24 , Not Applicable , Not Applicable , $131.24 , $137.80 , Not Applicable
,J9210,HCPCS,"Inj., emapalumab-lzsg, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $440.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.18 , $440.18 , Not Applicable , Not Applicable , $462.19 , $448.98 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $440.18 , Not Applicable , Not Applicable , $440.18 , $462.19 , Not Applicable
,J9214,HCPCS,Interferon alfa-2b inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $38.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $38.91 , $38.91 , Not Applicable , Not Applicable , $40.85 , $39.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $38.91 , Not Applicable , Not Applicable , $38.91 , $40.85 , Not Applicable
,J9217,HCPCS,Leuprolide acetate suspnsion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $162.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $162.82 , $162.82 , Not Applicable , Not Applicable , $170.96 , $166.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $162.82 , Not Applicable , Not Applicable , $162.82 , $170.96 , Not Applicable
,J9223,HCPCS,"Inj. lurbinectedin, 0.1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $203.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.72 , $203.72 , Not Applicable , Not Applicable , $213.91 , $207.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $203.72 , Not Applicable , Not Applicable , $203.72 , $213.91 , Not Applicable
,J9225,HCPCS,Vantas implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $6,047.56 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,047.56 "," $6,047.56 ", Not Applicable , Not Applicable ," $6,349.94 "," $6,168.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $6,047.56 ", Not Applicable , Not Applicable ," $6,047.56 "," $6,349.94 ", Not Applicable
,J9226,HCPCS,Supprelin la implant,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $50,881.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $50,881.64 "," $50,881.64 ", Not Applicable , Not Applicable ," $53,425.72 "," $51,899.27 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $50,881.64 ", Not Applicable , Not Applicable ," $50,881.64 "," $53,425.72 ", Not Applicable
,J9227,HCPCS,Inj. isatuximab-irfc 10 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $79.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $79.13 , $79.13 , Not Applicable , Not Applicable , $83.09 , $80.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $79.13 , Not Applicable , Not Applicable , $79.13 , $83.09 , Not Applicable
,J9228,HCPCS,Ipilimumab injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $185.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $185.71 , $185.71 , Not Applicable , Not Applicable , $195.00 , $189.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $185.71 , Not Applicable , Not Applicable , $185.71 , $195.00 , Not Applicable
,J9229,HCPCS,Inj inotuzumab ozogam 0.1 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,776.17 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,776.17 "," $2,776.17 ", Not Applicable , Not Applicable ," $2,914.98 "," $2,831.70 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,776.17 ", Not Applicable , Not Applicable ," $2,776.17 "," $2,914.98 ", Not Applicable
,J9230,HCPCS,Mechlorethamine hcl inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $13.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $13.74 , $13.74 , Not Applicable , Not Applicable , $14.43 , $14.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $13.74 , Not Applicable , Not Applicable , $13.74 , $14.43 , Not Applicable
,J9245,HCPCS,Inj melpha hydroch nos 50 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $243.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $243.96 , $243.96 , Not Applicable , Not Applicable , $256.16 , $248.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $243.96 , Not Applicable , Not Applicable , $243.96 , $256.16 , Not Applicable
,J9246,HCPCS,"Inj., evomela, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $21.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $21.30 , $21.30 , Not Applicable , Not Applicable , $22.37 , $21.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $21.30 , Not Applicable , Not Applicable , $21.30 , $22.37 , Not Applicable
,J9247,HCPCS,"Inj, melphalan flufenami 1mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $585.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.13 , $585.13 , Not Applicable , Not Applicable , $614.39 , $596.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $585.13 , Not Applicable , Not Applicable , $585.13 , $614.39 , Not Applicable
,J9261,HCPCS,Nelarabine injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $182.49 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $182.49 , $182.49 , Not Applicable , Not Applicable , $191.61 , $186.14 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $182.49 , Not Applicable , Not Applicable , $182.49 , $191.61 , Not Applicable
,J9262,HCPCS,"Inj, omacetaxine mep, 0.01mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $3.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.87 , $3.87 , Not Applicable , Not Applicable , $4.06 , $3.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $3.87 , Not Applicable , Not Applicable , $3.87 , $4.06 , Not Applicable
,J9264,HCPCS,Paclitaxel protein bound,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $16.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $16.48 , $16.48 , Not Applicable , Not Applicable , $17.30 , $16.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $16.48 , Not Applicable , Not Applicable , $16.48 , $17.30 , Not Applicable
,J9266,HCPCS,Pegaspargase injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $25,238.93 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,238.93 "," $25,238.93 ", Not Applicable , Not Applicable ," $26,500.88 "," $25,743.71 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,238.93 ", Not Applicable , Not Applicable ," $25,238.93 "," $26,500.88 ", Not Applicable
,J9268,HCPCS,Pentostatin injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,201.47 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,201.47 "," $2,201.47 ", Not Applicable , Not Applicable ," $2,311.54 "," $2,245.50 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,201.47 ", Not Applicable , Not Applicable ," $2,201.47 "," $2,311.54 ", Not Applicable
,J9269,HCPCS,Inj. tagraxofusp-erzs 10 mcg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $339.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $339.90 , $339.90 , Not Applicable , Not Applicable , $356.89 , $346.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $339.90 , Not Applicable , Not Applicable , $339.90 , $356.89 , Not Applicable
,J9270,HCPCS,Plicamycin (mithramycin) inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $135.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $135.08 , $135.08 , Not Applicable , Not Applicable , $141.84 , $137.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $135.08 , Not Applicable , Not Applicable , $135.08 , $141.84 , Not Applicable
,J9271,HCPCS,Inj pembrolizumab,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $61.75 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $61.75 , $61.75 , Not Applicable , Not Applicable , $64.84 , $62.99 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $61.75 , Not Applicable , Not Applicable , $61.75 , $64.84 , Not Applicable
,J9272,HCPCS,"Inj, dostarlimab-gxly, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $250.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $250.05 , $250.05 , Not Applicable , Not Applicable , $262.55 , $255.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $250.05 , Not Applicable , Not Applicable , $250.05 , $262.55 , Not Applicable
,J9280,HCPCS,Mitomycin injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $45.22 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $45.22 , $45.22 , Not Applicable , Not Applicable , $47.48 , $46.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $45.22 , Not Applicable , Not Applicable , $45.22 , $47.48 , Not Applicable
,J9281,HCPCS,Mitomycin instillation,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $329.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $329.96 , $329.96 , Not Applicable , Not Applicable , $346.46 , $336.56 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $329.96 , Not Applicable , Not Applicable , $329.96 , $346.46 , Not Applicable
,J9285,HCPCS,"Inj, olaratumab, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $60.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $60.95 , $60.95 , Not Applicable , Not Applicable , $64.00 , $62.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $60.95 , Not Applicable , Not Applicable , $60.95 , $64.00 , Not Applicable
,J9293,HCPCS,Mitoxantrone hydrochl / 5 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $30.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $30.77 , $30.77 , Not Applicable , Not Applicable , $32.31 , $31.38 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $30.77 , Not Applicable , Not Applicable , $30.77 , $32.31 , Not Applicable
,J9295,HCPCS,"Injection, necitumumab, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $6.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $6.72 , $6.72 , Not Applicable , Not Applicable , $7.05 , $6.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $6.72 , Not Applicable , Not Applicable , $6.72 , $7.05 , Not Applicable
,J9299,HCPCS,"Injection, nivolumab",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $33.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $33.79 , $33.79 , Not Applicable , Not Applicable , $35.48 , $34.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $33.79 , Not Applicable , Not Applicable , $33.79 , $35.48 , Not Applicable
,J9301,HCPCS,Obinutuzumab inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $75.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $75.54 , $75.54 , Not Applicable , Not Applicable , $79.32 , $77.06 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $75.54 , Not Applicable , Not Applicable , $75.54 , $79.32 , Not Applicable
,J9302,HCPCS,Ofatumumab injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $74.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.87 , $74.87 , Not Applicable , Not Applicable , $78.61 , $76.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $74.87 , Not Applicable , Not Applicable , $74.87 , $78.61 , Not Applicable
,J9303,HCPCS,Panitumumab injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $152.62 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $152.62 , $152.62 , Not Applicable , Not Applicable , $160.25 , $155.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $152.62 , Not Applicable , Not Applicable , $152.62 , $160.25 , Not Applicable
,J9305,HCPCS,Inj. pemetrexed nos 10mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $87.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $87.71 , $87.71 , Not Applicable , Not Applicable , $92.10 , $89.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $87.71 , Not Applicable , Not Applicable , $87.71 , $92.10 , Not Applicable
,J9306,HCPCS,"Injection, pertuzumab, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $15.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $15.87 , $15.87 , Not Applicable , Not Applicable , $16.66 , $16.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $15.87 , Not Applicable , Not Applicable , $15.87 , $16.66 , Not Applicable
,J9307,HCPCS,Pralatrexate injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $368.54 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $368.54 , $368.54 , Not Applicable , Not Applicable , $386.97 , $375.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $368.54 , Not Applicable , Not Applicable , $368.54 , $386.97 , Not Applicable
,J9308,HCPCS,"Injection, ramucirumab",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $73.38 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $73.38 , $73.38 , Not Applicable , Not Applicable , $77.05 , $74.85 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $73.38 , Not Applicable , Not Applicable , $73.38 , $77.05 , Not Applicable
,J9309,HCPCS,"Inj, polatuzumab vedotin 1mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $132.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $132.94 , $132.94 , Not Applicable , Not Applicable , $139.59 , $135.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $132.94 , Not Applicable , Not Applicable , $132.94 , $139.59 , Not Applicable
,J9311,HCPCS,"Inj rituximab, hyaluronidase",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.41 , $44.41 , Not Applicable , Not Applicable , $46.63 , $45.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.41 , Not Applicable , Not Applicable , $44.41 , $46.63 , Not Applicable
,J9312,HCPCS,"Inj., rituximab, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $101.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $101.77 , $101.77 , Not Applicable , Not Applicable , $106.86 , $103.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $101.77 , Not Applicable , Not Applicable , $101.77 , $106.86 , Not Applicable
,J9313,HCPCS,"Inj., lumoxiti, 0.01 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $27.38 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $27.38 , $27.38 , Not Applicable , Not Applicable , $28.75 , $27.93 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $27.38 , Not Applicable , Not Applicable , $27.38 , $28.75 , Not Applicable
,J9316,HCPCS,"Pertuzu, trastuzu, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $84.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $84.46 , $84.46 , Not Applicable , Not Applicable , $88.68 , $86.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $84.46 , Not Applicable , Not Applicable , $84.46 , $88.68 , Not Applicable
,J9317,HCPCS,Sacituzumab govitecan-hziy,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $35.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $35.53 , $35.53 , Not Applicable , Not Applicable , $37.31 , $36.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $35.53 , Not Applicable , Not Applicable , $35.53 , $37.31 , Not Applicable
,J9318,HCPCS,Inj romidepsin non-lyo 0.1mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $39.69 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $39.69 , $39.69 , Not Applicable , Not Applicable , $41.67 , $40.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $39.69 , Not Applicable , Not Applicable , $39.69 , $41.67 , Not Applicable
,J9319,HCPCS,Inj romidepsin lyophil 0.1mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $39.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $39.42 , $39.42 , Not Applicable , Not Applicable , $41.39 , $40.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $39.42 , Not Applicable , Not Applicable , $39.42 , $41.39 , Not Applicable
,J9320,HCPCS,Streptozocin injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $407.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $407.96 , $407.96 , Not Applicable , Not Applicable , $428.36 , $416.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $407.96 , Not Applicable , Not Applicable , $407.96 , $428.36 , Not Applicable
,J9325,HCPCS,Inj talimogene laherparepvec,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $67.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $67.03 , $67.03 , Not Applicable , Not Applicable , $70.38 , $68.37 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $67.03 , Not Applicable , Not Applicable , $67.03 , $70.38 , Not Applicable
,J9328,HCPCS,Temozolomide injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $12.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $12.18 , $12.18 , Not Applicable , Not Applicable , $12.79 , $12.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $12.18 , Not Applicable , Not Applicable , $12.18 , $12.79 , Not Applicable
,J9330,HCPCS,Temsirolimus injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $44.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.77 , $44.77 , Not Applicable , Not Applicable , $47.01 , $45.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $44.77 , Not Applicable , Not Applicable , $44.77 , $47.01 , Not Applicable
,J9340,HCPCS,Thiotepa injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $358.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $358.01 , $358.01 , Not Applicable , Not Applicable , $375.92 , $365.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $358.01 , Not Applicable , Not Applicable , $358.01 , $375.92 , Not Applicable
,J9348,HCPCS,"Inj. naxitamab-gqgk, 1 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $631.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $631.02 , $631.02 , Not Applicable , Not Applicable , $662.57 , $643.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $631.02 , Not Applicable , Not Applicable , $631.02 , $662.57 , Not Applicable
,J9349,HCPCS,"Inj., tafasitamab-cxix",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $14.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $14.77 , $14.77 , Not Applicable , Not Applicable , $15.51 , $15.07 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $14.77 , Not Applicable , Not Applicable , $14.77 , $15.51 , Not Applicable
,J9352,HCPCS,Injection trabectedin 0.1mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $380.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $380.47 , $380.47 , Not Applicable , Not Applicable , $399.50 , $388.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $380.47 , Not Applicable , Not Applicable , $380.47 , $399.50 , Not Applicable
,J9353,HCPCS,"Inj. margetuximab-cmkb, 5 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $50.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $50.33 , $50.33 , Not Applicable , Not Applicable , $52.84 , $51.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $50.33 , Not Applicable , Not Applicable , $50.33 , $52.84 , Not Applicable
,J9354,HCPCS,"Inj, ado-trastuzumab emt 1mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.02 , $40.02 , Not Applicable , Not Applicable , $42.02 , $40.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.02 , Not Applicable , Not Applicable , $40.02 , $42.02 , Not Applicable
,J9355,HCPCS,Inj trastuzumab excl biosimi,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $105.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $105.13 , $105.13 , Not Applicable , Not Applicable , $110.39 , $107.23 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $105.13 , Not Applicable , Not Applicable , $105.13 , $110.39 , Not Applicable
,J9356,HCPCS,"Inj. herceptin hylecta, 10mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $84.11 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $84.11 , $84.11 , Not Applicable , Not Applicable , $88.32 , $85.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $84.11 , Not Applicable , Not Applicable , $84.11 , $88.32 , Not Applicable
,J9357,HCPCS,Valrubicin injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $1,668.51 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,668.51 "," $1,668.51 ", Not Applicable , Not Applicable ," $1,751.93 "," $1,701.88 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $1,668.51 ", Not Applicable , Not Applicable ," $1,668.51 "," $1,751.93 ", Not Applicable
,J9358 ,HCPCS,Inj fam-trastu deru-nxki 1mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $28.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $28.41 , $28.41 , Not Applicable , Not Applicable , $29.83 , $28.97 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $28.41 , Not Applicable , Not Applicable , $28.41 , $29.83 , Not Applicable
,J9371,HCPCS,"Inj, vincristine sul lip 1mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,945.12 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,945.12 "," $3,945.12 ", Not Applicable , Not Applicable ," $4,142.37 "," $4,024.02 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,945.12 ", Not Applicable , Not Applicable ," $3,945.12 "," $4,142.37 ", Not Applicable
,J9395,HCPCS,"Injection, fulvestrant",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $18.70 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $18.70 , $18.70 , Not Applicable , Not Applicable , $19.64 , $19.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $18.70 , Not Applicable , Not Applicable , $18.70 , $19.64 , Not Applicable
,J9400,HCPCS,"Inj, ziv-aflibercept, 1mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $9.86 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $9.86 , $9.86 , Not Applicable , Not Applicable , $10.35 , $10.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $9.86 , Not Applicable , Not Applicable , $9.86 , $10.35 , Not Applicable
,J9600,HCPCS,Porfimer sodium injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $25,584.61 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,584.61 "," $25,584.61 ", Not Applicable , Not Applicable ," $26,863.84 "," $26,096.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $25,584.61 ", Not Applicable , Not Applicable ," $25,584.61 "," $26,863.84 ", Not Applicable
,M0201,HCPCS,Covid-19 vaccine home admin,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $41.56 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $41.56 , $41.56 , Not Applicable , Not Applicable , $43.63 , $42.39 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $41.56 , Not Applicable , Not Applicable , $41.56 , $43.63 , Not Applicable
,M0240,HCPCS,Casiri and imdev repeat,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $527.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $527.35 , $527.35 , Not Applicable , Not Applicable , $553.71 , $537.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $527.35 , Not Applicable , Not Applicable , $527.35 , $553.71 , Not Applicable
,M0241,HCPCS,Casiri and imdev repeat hm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $878.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $878.52 , $878.52 , Not Applicable , Not Applicable , $922.45 , $896.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $878.52 , Not Applicable , Not Applicable , $878.52 , $922.45 , Not Applicable
,M0243,HCPCS,Casirivi and imdevi inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $527.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $527.35 , $527.35 , Not Applicable , Not Applicable , $553.71 , $537.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $527.35 , Not Applicable , Not Applicable , $527.35 , $553.71 , Not Applicable
,M0244,HCPCS,Casirivi and imdevi inj hm,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $878.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $878.52 , $878.52 , Not Applicable , Not Applicable , $922.45 , $896.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $878.52 , Not Applicable , Not Applicable , $878.52 , $922.45 , Not Applicable
,M0245,HCPCS,Bamlan and etesev infusion ,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $527.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $527.35 , $527.35 , Not Applicable , Not Applicable , $553.71 , $537.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $527.35 , Not Applicable , Not Applicable , $527.35 , $553.71 , Not Applicable
,M0246,HCPCS,Bamlan and etesev infus home,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $878.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $878.52 , $878.52 , Not Applicable , Not Applicable , $922.45 , $896.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $878.52 , Not Applicable , Not Applicable , $878.52 , $922.45 , Not Applicable
,M0247,HCPCS,Sotrovimab infusion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $527.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $527.35 , $527.35 , Not Applicable , Not Applicable , $553.71 , $537.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $527.35 , Not Applicable , Not Applicable , $527.35 , $553.71 , Not Applicable
,M0248,HCPCS,"Sotrovimab inf, home admin",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $878.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $878.52 , $878.52 , Not Applicable , Not Applicable , $922.45 , $896.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $878.52 , Not Applicable , Not Applicable , $878.52 , $922.45 , Not Applicable
,M0249,HCPCS,Adm tocilizu covid-19 1st,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $527.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $527.35 , $527.35 , Not Applicable , Not Applicable , $553.71 , $537.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $527.35 , Not Applicable , Not Applicable , $527.35 , $553.71 , Not Applicable
,M0250,HCPCS,Adm tocilizu covid-19 2nd,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $527.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $527.35 , $527.35 , Not Applicable , Not Applicable , $553.71 , $537.89 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $527.35 , Not Applicable , Not Applicable , $527.35 , $553.71 , Not Applicable
,P9010,HCPCS,Whole blood for transfusion,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $179.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $179.30 , $179.30 , Not Applicable , Not Applicable , $188.26 , $182.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $179.30 , Not Applicable , Not Applicable , $179.30 , $188.26 , Not Applicable
,P9011,HCPCS,Blood split unit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $176.39 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $176.39 , $176.39 , Not Applicable , Not Applicable , $185.21 , $179.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $176.39 , Not Applicable , Not Applicable , $176.39 , $185.21 , Not Applicable
,P9012,HCPCS,Cryoprecipitate each unit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $95.44 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $95.44 , $95.44 , Not Applicable , Not Applicable , $100.21 , $97.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $95.44 , Not Applicable , Not Applicable , $95.44 , $100.21 , Not Applicable
,P9016,HCPCS,Rbc leukocytes reduced,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $225.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $225.21 , $225.21 , Not Applicable , Not Applicable , $236.47 , $229.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $225.21 , Not Applicable , Not Applicable , $225.21 , $236.47 , Not Applicable
,P9017,HCPCS,Plasma 1 donor frz w/in 8 hr,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $98.80 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $98.80 , $98.80 , Not Applicable , Not Applicable , $103.74 , $100.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $98.80 , Not Applicable , Not Applicable , $98.80 , $103.74 , Not Applicable
,P9019,HCPCS,"Platelets, each unit",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $85.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $85.21 , $85.21 , Not Applicable , Not Applicable , $89.47 , $86.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $85.21 , Not Applicable , Not Applicable , $85.21 , $89.47 , Not Applicable
,P9020,HCPCS,Plaelet rich plasma unit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $239.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $239.03 , $239.03 , Not Applicable , Not Applicable , $250.98 , $243.81 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $239.03 , Not Applicable , Not Applicable , $239.03 , $250.98 , Not Applicable
,P9021,HCPCS,Red blood cells unit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $164.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $164.50 , $164.50 , Not Applicable , Not Applicable , $172.73 , $167.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $164.50 , Not Applicable , Not Applicable , $164.50 , $172.73 , Not Applicable
,P9022,HCPCS,Washed red blood cells unit,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $454.01 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $454.01 , $454.01 , Not Applicable , Not Applicable , $476.71 , $463.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $454.01 , Not Applicable , Not Applicable , $454.01 , $476.71 , Not Applicable
,P9023,HCPCS,"Frozen plasma, pooled, sd",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $106.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $106.53 , $106.53 , Not Applicable , Not Applicable , $111.86 , $108.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $106.53 , Not Applicable , Not Applicable , $106.53 , $111.86 , Not Applicable
,P9025,HCPCS,Plasma cryo redu path each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $78.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $78.52 , $78.52 , Not Applicable , Not Applicable , $82.45 , $80.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $78.52 , Not Applicable , Not Applicable , $78.52 , $82.45 , Not Applicable
,P9026,HCPCS,Cryo fib comp path redu each,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $95.44 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $95.44 , $95.44 , Not Applicable , Not Applicable , $100.21 , $97.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $95.44 , Not Applicable , Not Applicable , $95.44 , $100.21 , Not Applicable
,P9031,HCPCS,Platelets leukocytes reduced,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $179.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $179.18 , $179.18 , Not Applicable , Not Applicable , $188.14 , $182.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $179.18 , Not Applicable , Not Applicable , $179.18 , $188.14 , Not Applicable
,P9032,HCPCS,"Platelets, irradiated",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $169.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $169.36 , $169.36 , Not Applicable , Not Applicable , $177.83 , $172.75 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $169.36 , Not Applicable , Not Applicable , $169.36 , $177.83 , Not Applicable
,P9033,HCPCS,Platelets leukoreduced irrad,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $254.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $254.79 , $254.79 , Not Applicable , Not Applicable , $267.53 , $259.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $254.79 , Not Applicable , Not Applicable , $254.79 , $267.53 , Not Applicable
,P9034,HCPCS,"Platelets, pheresis",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $387.23 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $387.23 , $387.23 , Not Applicable , Not Applicable , $406.59 , $394.97 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $387.23 , Not Applicable , Not Applicable , $387.23 , $406.59 , Not Applicable
,P9035,HCPCS,Platelet pheres leukoreduced,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $581.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $581.67 , $581.67 , Not Applicable , Not Applicable , $610.76 , $593.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $581.67 , Not Applicable , Not Applicable , $581.67 , $610.76 , Not Applicable
,P9036,HCPCS,Platelet pheresis irradiated,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $722.96 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $722.96 , $722.96 , Not Applicable , Not Applicable , $759.11 , $737.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $722.96 , Not Applicable , Not Applicable , $722.96 , $759.11 , Not Applicable
,P9037,HCPCS,Plate pheres leukoredu irrad,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $737.84 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $737.84 , $737.84 , Not Applicable , Not Applicable , $774.73 , $752.60 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $737.84 , Not Applicable , Not Applicable , $737.84 , $774.73 , Not Applicable
,P9038,HCPCS,Rbc irradiated,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $202.36 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $202.36 , $202.36 , Not Applicable , Not Applicable , $212.48 , $206.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $202.36 , Not Applicable , Not Applicable , $202.36 , $212.48 , Not Applicable
,P9039,HCPCS,Rbc deglycerolized,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $521.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $521.88 , $521.88 , Not Applicable , Not Applicable , $547.97 , $532.32 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $521.88 , Not Applicable , Not Applicable , $521.88 , $547.97 , Not Applicable
,P9040,HCPCS,Rbc leukoreduced irradiated,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $311.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $311.41 , $311.41 , Not Applicable , Not Applicable , $326.98 , $317.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $311.41 , Not Applicable , Not Applicable , $311.41 , $326.98 , Not Applicable
,P9041,HCPCS,"Albumin (human),5%, 50ml",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $12.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $12.28 , $12.28 , Not Applicable , Not Applicable , $12.89 , $12.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $12.28 , Not Applicable , Not Applicable , $12.28 , $12.89 , Not Applicable
,P9043,HCPCS,"Plasma protein fract,5%,50ml",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $9.56 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $9.56 , $9.56 , Not Applicable , Not Applicable , $10.04 , $9.75 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $9.56 , Not Applicable , Not Applicable , $9.56 , $10.04 , Not Applicable
,P9044,HCPCS,Cryoprecipitatereducedplasma,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $78.52 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $78.52 , $78.52 , Not Applicable , Not Applicable , $82.45 , $80.09 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $78.52 , Not Applicable , Not Applicable , $78.52 , $82.45 , Not Applicable
,P9045,HCPCS,"Albumin (human), 5%, 250 ml",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $61.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $61.40 , $61.40 , Not Applicable , Not Applicable , $64.47 , $62.62 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $61.40 , Not Applicable , Not Applicable , $61.40 , $64.47 , Not Applicable
,P9046,HCPCS,"Albumin (human), 25%, 20 ml",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $24.56 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $24.56 , $24.56 , Not Applicable , Not Applicable , $25.79 , $25.05 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $24.56 , Not Applicable , Not Applicable , $24.56 , $25.79 , Not Applicable
,P9047,HCPCS,"Albumin (human), 25%, 50ml",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $61.40 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $61.40 , $61.40 , Not Applicable , Not Applicable , $64.47 , $62.62 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $61.40 , Not Applicable , Not Applicable , $61.40 , $64.47 , Not Applicable
,P9048,HCPCS,"Plasmaprotein fract,5%,250ml",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $191.65 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $191.65 , $191.65 , Not Applicable , Not Applicable , $201.23 , $195.48 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $191.65 , Not Applicable , Not Applicable , $191.65 , $201.23 , Not Applicable
,P9051,HCPCS,"Blood, l/r, cmv-neg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $253.64 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $253.64 , $253.64 , Not Applicable , Not Applicable , $266.32 , $258.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $253.64 , Not Applicable , Not Applicable , $253.64 , $266.32 , Not Applicable
,P9052,HCPCS,"Platelets, hla-m, l/r, unit",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $962.35 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $962.35 , $962.35 , Not Applicable , Not Applicable ," $1,010.46 ", $981.59 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $962.35 , Not Applicable , Not Applicable , $962.35 ," $1,010.46 ", Not Applicable
,P9053,HCPCS,"Plt, pher, l/r cmv-neg, irr",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $534.62 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $534.62 , $534.62 , Not Applicable , Not Applicable , $561.35 , $545.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $534.62 , Not Applicable , Not Applicable , $534.62 , $561.35 , Not Applicable
,P9054,HCPCS,"Blood, l/r, froz/degly/wash",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $371.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $371.33 , $371.33 , Not Applicable , Not Applicable , $389.90 , $378.76 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $371.33 , Not Applicable , Not Applicable , $371.33 , $389.90 , Not Applicable
,P9055,HCPCS,"Plt, aph/pher, l/r, cmv-neg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $573.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $573.74 , $573.74 , Not Applicable , Not Applicable , $602.42 , $585.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $573.74 , Not Applicable , Not Applicable , $573.74 , $602.42 , Not Applicable
,P9056,HCPCS,"Blood, l/r, irradiated",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $184.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $184.24 , $184.24 , Not Applicable , Not Applicable , $193.45 , $187.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $184.24 , Not Applicable , Not Applicable , $184.24 , $193.45 , Not Applicable
,P9057,HCPCS,"Rbc, frz/deg/wsh, l/r, irrad",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $311.44 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $311.44 , $311.44 , Not Applicable , Not Applicable , $327.02 , $317.67 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $311.44 , Not Applicable , Not Applicable , $311.44 , $327.02 , Not Applicable
,P9058,HCPCS,"Rbc, l/r, cmv-neg, irrad",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $291.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $291.46 , $291.46 , Not Applicable , Not Applicable , $306.04 , $297.29 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $291.46 , Not Applicable , Not Applicable , $291.46 , $306.04 , Not Applicable
,P9059,HCPCS,"Plasma, frz between 8-24hour",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $85.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $85.03 , $85.03 , Not Applicable , Not Applicable , $89.28 , $86.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $85.03 , Not Applicable , Not Applicable , $85.03 , $89.28 , Not Applicable
,P9060,HCPCS,Fr frz plasma donor retested,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $77.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $77.79 , $77.79 , Not Applicable , Not Applicable , $81.67 , $79.34 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $77.79 , Not Applicable , Not Applicable , $77.79 , $81.67 , Not Applicable
,P9070,HCPCS,Pathogen reduced plasma pool,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $63.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $63.47 , $63.47 , Not Applicable , Not Applicable , $66.64 , $64.74 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $63.47 , Not Applicable , Not Applicable , $63.47 , $66.64 , Not Applicable
,P9071,HCPCS,Pathogen reduced plasma sing,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $146.79 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $146.79 , $146.79 , Not Applicable , Not Applicable , $154.13 , $149.73 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $146.79 , Not Applicable , Not Applicable , $146.79 , $154.13 , Not Applicable
,P9073,HCPCS,Platelets pheresis path redu,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $697.82 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $697.82 , $697.82 , Not Applicable , Not Applicable , $732.71 , $711.77 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $697.82 , Not Applicable , Not Applicable , $697.82 , $732.71 , Not Applicable
,P9099,HCPCS,Blood component/product noc,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $9.56 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $9.56 , $9.56 , Not Applicable , Not Applicable , $10.04 , $9.75 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $9.56 , Not Applicable , Not Applicable , $9.56 , $10.04 , Not Applicable
,P9100,HCPCS,Pathogen test for platelets,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , $66.55 , Not Applicable , Not Applicable , $69.87 , $67.88 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $66.55 , Not Applicable , Not Applicable , $66.55 , $69.87 , Not Applicable
,Q0035,HCPCS,Cardiokymography,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , $40.47 , Not Applicable , Not Applicable , $42.49 , $41.28 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $40.47 , Not Applicable , Not Applicable , $40.47 , $42.49 , Not Applicable
,Q0091,HCPCS,Obtaining screen pap smear,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , $29.53 , Not Applicable , Not Applicable , $31.01 , $30.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $29.53 , Not Applicable , Not Applicable , $29.53 , $31.01 , Not Applicable
,Q0138,HCPCS,"Ferumoxytol, non-esrd",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.17 , $1.17 , Not Applicable , Not Applicable , $1.23 , $1.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.17 , Not Applicable , Not Applicable , $1.17 , $1.23 , Not Applicable
,Q0139,HCPCS,"Ferumoxytol, esrd use",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $1.17 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.17 , $1.17 , Not Applicable , Not Applicable , $1.23 , $1.19 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $1.17 , Not Applicable , Not Applicable , $1.17 , $1.23 , Not Applicable
,Q2017,HCPCS,"Teniposide, 50 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $3,097.01 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,097.01 "," $3,097.01 ", Not Applicable , Not Applicable ," $3,251.86 "," $3,158.95 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $3,097.01 ", Not Applicable , Not Applicable ," $3,097.01 "," $3,251.86 ", Not Applicable
,Q2026,HCPCS,Radiesse injection,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $301.27 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $301.27 , $301.27 , Not Applicable , Not Applicable , $316.34 , $307.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $301.27 , Not Applicable , Not Applicable , $301.27 , $316.34 , Not Applicable
,Q2028,HCPCS,"Inj, sculptra, 0.5mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $2.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.91 , $2.91 , Not Applicable , Not Applicable , $3.06 , $2.97 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $2.91 , Not Applicable , Not Applicable , $2.91 , $3.06 , Not Applicable
,Q2041,HCPCS,Axicabtagene ciloleucel car+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $462,823.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $462,823.92 "," $462,823.92 ", Not Applicable , Not Applicable ," $485,965.12 "," $472,080.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $462,823.92 ", Not Applicable , Not Applicable ," $462,823.92 "," $485,965.12 ", Not Applicable
,Q2042,HCPCS,Tisagenlecleucel car-pos t,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $508,426.90 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $508,426.90 "," $508,426.90 ", Not Applicable , Not Applicable ," $533,848.25 "," $518,595.44 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $508,426.90 ", Not Applicable , Not Applicable ," $508,426.90 "," $533,848.25 ", Not Applicable
,Q2043,HCPCS,Sipuleucel-t auto cd54+,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $62,061.31 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $62,061.31 "," $62,061.31 ", Not Applicable , Not Applicable ," $65,164.38 "," $63,302.54 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $62,061.31 ", Not Applicable , Not Applicable ," $62,061.31 "," $65,164.38 ", Not Applicable
,Q2049,HCPCS,Imported lipodox inj,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $364.10 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $364.10 , $364.10 , Not Applicable , Not Applicable , $382.30 , $371.38 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $364.10 , Not Applicable , Not Applicable , $364.10 , $382.30 , Not Applicable
,Q2050,HCPCS,Doxorubicin inj 10mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $273.95 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $273.95 , $273.95 , Not Applicable , Not Applicable , $287.65 , $279.43 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $273.95 , Not Applicable , Not Applicable , $273.95 , $287.65 , Not Applicable
,Q2053,HCPCS,Brexucabtagene car pos t,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $462,823.92 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $462,823.92 "," $462,823.92 ", Not Applicable , Not Applicable ," $485,965.12 "," $472,080.40 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $462,823.92 ", Not Applicable , Not Applicable ," $462,823.92 "," $485,965.12 ", Not Applicable
,Q2054,HCPCS,Lisocabtagene mara car pos t,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $494,697.64 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $494,697.64 "," $494,697.64 ", Not Applicable , Not Applicable ," $519,432.53 "," $504,591.60 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $494,697.64 ", Not Applicable , Not Applicable ," $494,697.64 "," $519,432.53 ", Not Applicable
,Q2055,HCPCS,Idecabtagene vicleucel car,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $505,790.06 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $505,790.06 "," $505,790.06 ", Not Applicable , Not Applicable ," $531,079.56 "," $515,905.86 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $505,790.06 ", Not Applicable , Not Applicable ," $505,790.06 "," $531,079.56 ", Not Applicable
,Q3027,HCPCS,Inj beta interferon im 1 mcg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $64.72 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $64.72 , $64.72 , Not Applicable , Not Applicable , $67.96 , $66.02 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $64.72 , Not Applicable , Not Applicable , $64.72 , $67.96 , Not Applicable
,Q5101,HCPCS,"Injection, zarxio",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $0.37 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $0.37 , $0.37 , Not Applicable , Not Applicable , $0.39 , $0.38 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $0.37 , Not Applicable , Not Applicable , $0.37 , $0.39 , Not Applicable
,Q5103,HCPCS,"Injection, inflectra",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $48.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $48.21 , $48.21 , Not Applicable , Not Applicable , $50.62 , $49.18 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $48.21 , Not Applicable , Not Applicable , $48.21 , $50.62 , Not Applicable
,Q5104,HCPCS,"Injection, renflexis",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $45.41 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $45.41 , $45.41 , Not Applicable , Not Applicable , $47.68 , $46.32 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $45.41 , Not Applicable , Not Applicable , $45.41 , $47.68 , Not Applicable
,Q5106,HCPCS,Inj retacrit non-esrd use,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $10.13 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $10.13 , $10.13 , Not Applicable , Not Applicable , $10.64 , $10.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $10.13 , Not Applicable , Not Applicable , $10.13 , $10.64 , Not Applicable
,Q5107,HCPCS,Inj mvasi 10 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $52.16 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $52.16 , $52.16 , Not Applicable , Not Applicable , $54.77 , $53.20 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $52.16 , Not Applicable , Not Applicable , $52.16 , $54.77 , Not Applicable
,Q5108,HCPCS,"Injection, fulphila",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $247.21 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $247.21 , $247.21 , Not Applicable , Not Applicable , $259.57 , $252.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $247.21 , Not Applicable , Not Applicable , $247.21 , $259.57 , Not Applicable
,Q5110,HCPCS,Nivestym,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $0.38 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $0.38 , $0.38 , Not Applicable , Not Applicable , $0.40 , $0.39 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $0.38 , Not Applicable , Not Applicable , $0.38 , $0.40 , Not Applicable
,Q5111,HCPCS,"Injection, udenyca 0.5 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $260.31 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $260.31 , $260.31 , Not Applicable , Not Applicable , $273.32 , $265.51 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $260.31 , Not Applicable , Not Applicable , $260.31 , $273.32 , Not Applicable
,Q5112,HCPCS,Inj ontruzant 10 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $77.90 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $77.90 , $77.90 , Not Applicable , Not Applicable , $81.80 , $79.46 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $77.90 , Not Applicable , Not Applicable , $77.90 , $81.80 , Not Applicable
,Q5113,HCPCS,Inj herzuma 10 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $67.08 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $67.08 , $67.08 , Not Applicable , Not Applicable , $70.43 , $68.42 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $67.08 , Not Applicable , Not Applicable , $67.08 , $70.43 , Not Applicable
,Q5114,HCPCS,Inj ogivri 10 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $70.12 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $70.12 , $70.12 , Not Applicable , Not Applicable , $73.63 , $71.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $70.12 , Not Applicable , Not Applicable , $70.12 , $73.63 , Not Applicable
,Q5115,HCPCS,Inj truxima 10 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $70.91 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $70.91 , $70.91 , Not Applicable , Not Applicable , $74.46 , $72.33 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $70.91 , Not Applicable , Not Applicable , $70.91 , $74.46 , Not Applicable
,Q5116,HCPCS,"Inj., trazimera, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $70.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $70.15 , $70.15 , Not Applicable , Not Applicable , $73.66 , $71.56 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $70.15 , Not Applicable , Not Applicable , $70.15 , $73.66 , Not Applicable
,Q5117,HCPCS,"Inj., kanjinti, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $62.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $62.25 , $62.25 , Not Applicable , Not Applicable , $65.37 , $63.50 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $62.25 , Not Applicable , Not Applicable , $62.25 , $65.37 , Not Applicable
,Q5118,HCPCS,"Inj., zirabev, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $61.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $61.30 , $61.30 , Not Applicable , Not Applicable , $64.37 , $62.53 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $61.30 , Not Applicable , Not Applicable , $61.30 , $64.37 , Not Applicable
,Q5119,HCPCS,"Inj ruxience, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $68.83 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $68.83 , $68.83 , Not Applicable , Not Applicable , $72.27 , $70.20 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $68.83 , Not Applicable , Not Applicable , $68.83 , $72.27 , Not Applicable
,Q5120,HCPCS,Inj pegfilgrastim-bmez 0.5mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $287.30 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $287.30 , $287.30 , Not Applicable , Not Applicable , $301.66 , $293.04 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $287.30 , Not Applicable , Not Applicable , $287.30 , $301.66 , Not Applicable
,Q5121,HCPCS,"Inj. avsola, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $55.15 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $55.15 , $55.15 , Not Applicable , Not Applicable , $57.91 , $56.26 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $55.15 , Not Applicable , Not Applicable , $55.15 , $57.91 , Not Applicable
,Q5122,HCPCS,"Inj, nyvepria",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $333.25 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $333.25 , $333.25 , Not Applicable , Not Applicable , $349.92 , $339.92 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $333.25 , Not Applicable , Not Applicable , $333.25 , $349.92 , Not Applicable
,Q5123,HCPCS,"Inj. riabni, 10 mg",Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $84.55 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $84.55 , $84.55 , Not Applicable , Not Applicable , $88.77 , $86.24 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $84.55 , Not Applicable , Not Applicable , $84.55 , $88.77 , Not Applicable
,Q9968,HCPCS,Visualization adjunct,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $7.87 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.87 , $7.87 , Not Applicable , Not Applicable , $8.27 , $8.03 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $7.87 , Not Applicable , Not Applicable , $7.87 , $8.27 , Not Applicable
,Q9969,HCPCS,Non-heu tc-99m add-on/dose,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable , $11.71 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $11.71 , $11.71 , Not Applicable , Not Applicable , $12.29 , $11.94 , Not Applicable , Not Applicable , Not Applicable , Not Applicable , $11.71 , Not Applicable , Not Applicable , $11.71 , $12.29 , Not Applicable
,Q9991,HCPCS,Buprenorph xr 100 mg or less,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,103.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,103.30 "," $2,103.30 ", Not Applicable , Not Applicable ," $2,208.46 "," $2,145.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,103.30 ", Not Applicable , Not Applicable ," $2,103.30 "," $2,208.46 ", Not Applicable
,Q9992,HCPCS,Buprenorphine xr over 100 mg,Outpatient,Ambulatory Payment Classification (APC),, Not Applicable , Not Applicable , Not Applicable ," $2,103.30 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,103.30 "," $2,103.30 ", Not Applicable , Not Applicable ," $2,208.46 "," $2,145.36 ", Not Applicable , Not Applicable , Not Applicable , Not Applicable ," $2,103.30 ", Not Applicable , Not Applicable ," $2,103.30 "," $2,208.46 ", Not Applicable